After all, who was I really here to see? The patient, who hadn't even spoken yet? Or Mom, who demanded that all of the racket in her house -- the coughing, sneezing and sniffling -- stop because she hasn't been sleeping? (She told me her daughter actually had been sleeping, despite her cough.) If it's sleeping pills Mom needed, then she ought to drive her luxury SUV over to her psychiatrist's office.
I moved on, turning my attention to my patient, still sitting there looking annoyed. (I didn't know whether it was with me or her mother.) I asked her a few cursory questions: Do you have any nasal congestion? Runny nose? Fever? Then I listened to her lungs with my stethoscope -- crystal clear.
I said that the girl's lungs sounded fine right now, but that the dry persistent cough could be caused by viral bronchitis. The best way to treat it wasn't with cough medicine, but with a couple of inhaled medicines that reduce inflammation and open the airways. "I think you'll see improvement in five to seven days," I said.
"But why did my husband get cough medicine, then? I'm just saying, he's sleeping better at night. Sure, he's still coughing, but he's starting to heal."
She went on. "And what's she supposed to do while we're waiting for the medicine to work? Is she just supposed to cough? That'll be another three to five days?"
I wasn't going to back down. "Look, based on what I've heard and my exam, this is the best way to go. But if you're not sure, we can do an X-ray, or you can get a second opinion with your regular doctor. But if you want to get to the root of her problem, this is probably the best way to go. What would you like to do?"
I expected her to walk out right there -- and complain to someone on the way out about her visit. (I probably deserved it.) That's when I heard the first complete sentence out of my patient, the girl sitting on the table whom I'd almost forgotten because the mother was so overbearing. "Mom, let's just try it."
Grudgingly, Mom took the prescription for inhalers. It would take a few days for her to see the earliest signs that her daughter was getting better. I was pretty confident she didn't have that kind of patience.
It wasn't my best moment as a physician. I was stubborn, blunt and dismissive. Doctors should work to serve patients whether we like them or not. It's best for both sides when that pact takes the form of a partnership, in which both work together to figure out what's best by combining science, instincts and heart.
That was not me. And I think it's because that partnership was lacking from the very beginning.
We all agree that patients don't like to be treated like children, talked down to or told to just "take two of these and call me later." But doctors don't like to be treated like waiters -- taking orders from a menu prepared by the patient.
In that sense, maybe we both deserved better from the encounter. She deserved more professionalism, empathy and reassurance from me, as well as a clear, calm explanation as to why there were better ways to handle her daughter's illness than with cough syrup. I deserved the chance to actually consult with my patient, this teenage girl, and have the time to take a better history, without having this mom bear down on me with her demands and expectations.