A Spot-On Analogy

The young woman was only slightly overweight, with a BMI of 28, but she seemed really wound up about her need for me to continue the phentermine her previous doctor out of state had started her on. She volunteered that her BMI was only 29 when she started.

She was a walk-in patient, not a regular, and we didn’t have any records on her, except I was able to verify her prescriptions on the multi-state Prescription Monitoring Program website. I told her it was incredibly easy to lose weight if you really want to, “just don’t eat any refined carbs”, and cited my own example as a recovering vegetarian.

She almost broke into tears.

“With your weight, you don’t even have to be all that radical to get your BMI down under 25”, I tried to reassure her. She did not seem reassured.

I decided to try some analogies.

“Taking diet pills with a BMI of 28 or 29 is like asking for ADHD medication just so you can stay up all night and study for a final exam; it’s not a case of a lifelong, debilitating problem.”

She burst into tears.

“They do help me keep track of my life, I’m so disorganized and so distracted. I flunked out of college, I can’t keep a job…”

“So you think you have ADHD?”

“Yes, and PTSD and anxiety.”

“Well, then, let’s deal with that! I’ve got Behavioral Health Staff right here. On Saturdays, too.”

She stopped crying. I looked at the clinic schedule. My psychologist had a no-show.

“I can introduce you to my psychologist, who can help figure out your diagnosis. Would you like to meet him?

“Sure”, she said and straightened up in her chair.

“You wait right here and I’ll be back in a few minutes.”

I made the introduction, mentioned that I have collaborated with Dr. Brandt for 25 years, and said:

“I’ll refill the phentermine for one month only, and you guys figure out what’s the real problem with your attention. Then, when you see your new primary care provider, you’ll be able to go over what you and Dr. Brandt have found out and go from there. Deal?”

“Deal”, she said, and added “Thank you. I was almost ready to walk out.”

“Just be straight with us. We’ll work with you”, I said and excused myself.

There were three more walk-ins waiting to be seen.

I love my job. And I love working in an integrated practice.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.

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