My neighbors use me as an information center or mini-emergency room. Cut fingers, fractured clavicles, scraped knees all come to my doorstep. I wish I could still use my well-equipped former office: there I could neatly bandage and splint an avulsed nail and be proud of the job. In my home I have only makeshift equipment. Sometimes my neighbors consult me, asking whether a trip to the emergency room is indicated. They come to me, hoping to avoid a long wait and expense. I can help with this, but, again, I must be conservative with my advice, since I no longer carry malpractice insurance.
There are times when I will say a definite No to a request for help. Not long ago I received an emergency call to the goat shed and found the owner of the goats in tears. Two huskies had jumped across the fence and severely bitten the nanny goat but only scratched the kids. The goat lover wanted me to suture the wounds to avoid the expense of consulting a veterinarian. When I inspected the wound, however, it seemed foolhardy to do anything other than transport the bleating animal to the veterinarian hospital. I was able to persuade my neighbor to do this and was gratified to learn that after several days’ stay, the goat recovered.
One of my former patients called a week ago to talk to me about her mother’s decision not to have an angiogram. She felt her mother’s stance might be an expression of depression. She was, however, determined not to pressure her mother into having the angiogram if depression was absent and the refusal represented a rational decision to limit treatment.
I have known and treated this family for many years. I thought I might be able to help clarify the situation without interfering with the cardiologist and his recommendation. I suggested a meeting in a downtown coffee shop to weigh the pros and cons of alternative pathways. An informal consultation, I thought, might help the family members to sort out their feelings. As a retired family physician and friend, I would bring to the table my long-time acquaintance with these people and knowledge of their family dynamics. Perhaps our talk would help not only the family but also assist the cardiologist in managing his patient with less conflict. The daughter was relieved and grateful for my willingness to talk with the family. She wanted to talk to her brother, who lives out of town, and include him in the conversation, which has yet to take place.
The art of medicine is not lost on retirement. I still have a duty to be responsive and compassionate whenever my former patients, my friends, or my neighbors call upon me. However, I must remember that as time passes, my knowledge of recent medical developments decreases. I must stay within the boundaries of a nonpracticing physician and give cautious, tactful, and conservative answers to pressing questions.