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I was always truthful with my patients, and I always assumed that they were, too, in return. One family gave me an early, shocking lesson about telling the truth.

Family connections are icing on the cake of family medicine; they often provide insights that primary care providers could never gain from  seeing one patient in isolation. My patient, Karen, represented a sandwich generation between her adult twin daughters and her elderly parents. Hers represented one of my earliest three-generation families in practice. I felt close to them; I had hospitalized one of the daughters for a serious illness, thankfully with a good outcome.

As part of Karen’s annual preventive care and my routine practice, I had dutifully given her a hemoccult packet for colon cancer screening. Smearing of stool samples onto the paper card is one of the “yuch” factors in preventive care, but nevertheless important. 
I was chagrined when she returned for a follow-up visit.

“I didn’t receive your hemoccult packet, Karen. Did you have a chance to collect the specimens?”

“Yes,” she exclaimed, “I sent it back to you last month!”

My nine-doctor office was a busy one and sometimes disorganized. “We must have lost it!” I assumed. Apologetically I said I would search for her returned specimen packet, but never found it. I wondered: “Did it get lost in the mail?” 
I apologized again when later that week I mailed out a new packet for testing. “Would she be willing to repeat the testing again?” I wondered.

Several weeks later, I was seeing one of Karen’s twin daughters for a visit.

“I felt so bad about losing your Mom’s stool testing kit. I looked all over our office but couldn’t find it. I hated to ask her to collect a specimen again.”

The daughter smiled, then chuckled: “Yes, as if my Mom would ever do that test!”

Mitchell Kaminski
Philadelphia, Pennsylvania



# Jeff Millstein 2019-03-05 13:14
great piece - really highlights a communication challenge with patients who will "yes" you with no intention of following through. Do you find motivational interviewing helpful?
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# Mitch Kaminski 2020-02-14 15:12
Hi Jeff-
yes-developing treatment plans with motivational interviewing makes the plan the patient's and not the doctor's- better chance for success!
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