Cancer and conference calls

Thursday was a big day in my ongoing quest to ask the question, “Why do people act that way?”

Paul Bradbury/Getty Images

You notice I said, “Ask the question.” I can always ask. I just can’t always answer.

Harriet listed her Chief Complaint as “psoriasis on the scalp.”

“My hairdresser says I have psoriasis,” she said.

I took a look. “You do,” I said. “Just one spot, though. Should be easy to control.”

I then ran through the list of what generally bothers people about scalp psoriasis. “It may come back now and then,” I said, “but you don’t have much of it and you haven’t had it long, so it shouldn’t take much effort to keep it under control. Psoriasis doesn’t cause permanent hair loss,” I added. “And you can color and condition your hair any way you want.”

Harriet smiled. That was what she wanted to hear. But it wasn’t all she wanted to hear.

“Why don’t I look you over completely?” I suggested. Harriet agreed. I found only lentigines and seborrheic keratoses all over, and I told her so.

“That’s wonderful,” said Harriet. “Just one more thing.”

“Sure.”

“That psoriasis on my head. It wouldn’t be cancer, would it?”

I opened my mouth to respond, but nothing came out. Sure, patients worry that anything they don’t understand might be cancer. But that’s to start with, not after a whole conversation about psoriasis. Right?

Maybe not.

“Not cancer,” I said. “Just some local inflammation.” Harriet was happy. I was perplexed. There’s always something new about patients to puzzle over.

Which I did for about 2 hours, until that puzzle was muscled out by another. I walked in to meet a very cheery Rory, who was punching his smartphone screen. “Wouldn’t you know it?” he said with a smile. “The same thing happened last time I came here. You walked in just as I was about to start a conference call.”

I thought of several responses, none of them appropriate.

“Last time you cauterized some of these milia thingies on my face,” said Rory. “I was hoping you could do that again.”

I peered at his face. “Sure,” I said, “if you want me to.”

“Just a sec,” said Rory, peering down at his phone. I assumed he was logging off the conference call.

“OK,” he said. “Go ahead.”

I revved up my Hyfrecator, which started to buzz.

“Wait, can they hear that?” Rory asked.

“Can who hear ... ?”

“This is Rory Stiefel,” he spoke into his phone. “Glad we could meet today. I wanted to talk to all of you about our plans to expand our network services into your Upper Midwestern territory.”

“Hold on,” I said (to myself), “You want me to desiccate your face while you’re expanding your network into the Upper Midwest??!!”

Rory motioned for me to continue. “Sure,” he said to his phone, “We can be up and running by the first of next month, no problem.” Apparently, the hum of the Hyfrecator wasn’t interrupting negotiations.

So I buzzed away, while Rory’s interlocutors responded with apparent enthusiasm. By the time he turned his other cheek, I figured he had occupied Minnesota.

“Did you get all the thingies?” Rory stage-whispered.

I nodded.

“Great!” he said, then turned back to his phone. “Well, this was a great meeting,” he said. “I’m glad we’re ready to go live. Talk to you guys next week to firm up logistics.” He punched the screen to sever the connection.

“Thanks for being so efficient,” he said, this time to me.

“No problem,” I said, now-silent Hyfrecator in hand.

“You’re sure you got them all?”
 

“I handed him a mirror. “Yes,” I said. “I got them all.”

“Well that’s terrific,” he said, jumping off the exam table and heading for the door. “Always a pleasure. See you next time!”

I don’t know exactly what he does, but Rory is one awesome multitasker.

As for me, I just have to consult the CPT code book to find the right designation for “Cautery of benign lesions during a corporate conference call, second episode.”

Any help, dear colleagues, with people or coding, will be appreciated.

I can always ask ...
 

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at [email protected].

Thursday was a big day in my ongoing quest to ask the question, “Why do people act that way?”

Paul Bradbury/Getty Images

You notice I said, “Ask the question.” I can always ask. I just can’t always answer.

Harriet listed her Chief Complaint as “psoriasis on the scalp.”

“My hairdresser says I have psoriasis,” she said.

I took a look. “You do,” I said. “Just one spot, though. Should be easy to control.”

I then ran through the list of what generally bothers people about scalp psoriasis. “It may come back now and then,” I said, “but you don’t have much of it and you haven’t had it long, so it shouldn’t take much effort to keep it under control. Psoriasis doesn’t cause permanent hair loss,” I added. “And you can color and condition your hair any way you want.”

Harriet smiled. That was what she wanted to hear. But it wasn’t all she wanted to hear.

“Why don’t I look you over completely?” I suggested. Harriet agreed. I found only lentigines and seborrheic keratoses all over, and I told her so.

“That’s wonderful,” said Harriet. “Just one more thing.”

“Sure.”

“That psoriasis on my head. It wouldn’t be cancer, would it?”

I opened my mouth to respond, but nothing came out. Sure, patients worry that anything they don’t understand might be cancer. But that’s to start with, not after a whole conversation about psoriasis. Right?

Maybe not.

“Not cancer,” I said. “Just some local inflammation.” Harriet was happy. I was perplexed. There’s always something new about patients to puzzle over.

Which I did for about 2 hours, until that puzzle was muscled out by another. I walked in to meet a very cheery Rory, who was punching his smartphone screen. “Wouldn’t you know it?” he said with a smile. “The same thing happened last time I came here. You walked in just as I was about to start a conference call.”

I thought of several responses, none of them appropriate.

“Last time you cauterized some of these milia thingies on my face,” said Rory. “I was hoping you could do that again.”

I peered at his face. “Sure,” I said, “if you want me to.”

“Just a sec,” said Rory, peering down at his phone. I assumed he was logging off the conference call.

“OK,” he said. “Go ahead.”

I revved up my Hyfrecator, which started to buzz.

“Wait, can they hear that?” Rory asked.

“Can who hear ... ?”

“This is Rory Stiefel,” he spoke into his phone. “Glad we could meet today. I wanted to talk to all of you about our plans to expand our network services into your Upper Midwestern territory.”

“Hold on,” I said (to myself), “You want me to desiccate your face while you’re expanding your network into the Upper Midwest??!!”

Rory motioned for me to continue. “Sure,” he said to his phone, “We can be up and running by the first of next month, no problem.” Apparently, the hum of the Hyfrecator wasn’t interrupting negotiations.

So I buzzed away, while Rory’s interlocutors responded with apparent enthusiasm. By the time he turned his other cheek, I figured he had occupied Minnesota.

“Did you get all the thingies?” Rory stage-whispered.

I nodded.

“Great!” he said, then turned back to his phone. “Well, this was a great meeting,” he said. “I’m glad we’re ready to go live. Talk to you guys next week to firm up logistics.” He punched the screen to sever the connection.

“Thanks for being so efficient,” he said, this time to me.

“No problem,” I said, now-silent Hyfrecator in hand.

“You’re sure you got them all?”
 

“I handed him a mirror. “Yes,” I said. “I got them all.”

“Well that’s terrific,” he said, jumping off the exam table and heading for the door. “Always a pleasure. See you next time!”

I don’t know exactly what he does, but Rory is one awesome multitasker.

As for me, I just have to consult the CPT code book to find the right designation for “Cautery of benign lesions during a corporate conference call, second episode.”

Any help, dear colleagues, with people or coding, will be appreciated.

I can always ask ...
 

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at [email protected].

Thursday was a big day in my ongoing quest to ask the question, “Why do people act that way?”

Paul Bradbury/Getty Images

You notice I said, “Ask the question.” I can always ask. I just can’t always answer.

Harriet listed her Chief Complaint as “psoriasis on the scalp.”

“My hairdresser says I have psoriasis,” she said.

I took a look. “You do,” I said. “Just one spot, though. Should be easy to control.”

I then ran through the list of what generally bothers people about scalp psoriasis. “It may come back now and then,” I said, “but you don’t have much of it and you haven’t had it long, so it shouldn’t take much effort to keep it under control. Psoriasis doesn’t cause permanent hair loss,” I added. “And you can color and condition your hair any way you want.”

Harriet smiled. That was what she wanted to hear. But it wasn’t all she wanted to hear.

“Why don’t I look you over completely?” I suggested. Harriet agreed. I found only lentigines and seborrheic keratoses all over, and I told her so.

“That’s wonderful,” said Harriet. “Just one more thing.”

“Sure.”

“That psoriasis on my head. It wouldn’t be cancer, would it?”

I opened my mouth to respond, but nothing came out. Sure, patients worry that anything they don’t understand might be cancer. But that’s to start with, not after a whole conversation about psoriasis. Right?

Maybe not.

“Not cancer,” I said. “Just some local inflammation.” Harriet was happy. I was perplexed. There’s always something new about patients to puzzle over.

Which I did for about 2 hours, until that puzzle was muscled out by another. I walked in to meet a very cheery Rory, who was punching his smartphone screen. “Wouldn’t you know it?” he said with a smile. “The same thing happened last time I came here. You walked in just as I was about to start a conference call.”

I thought of several responses, none of them appropriate.

“Last time you cauterized some of these milia thingies on my face,” said Rory. “I was hoping you could do that again.”

I peered at his face. “Sure,” I said, “if you want me to.”

“Just a sec,” said Rory, peering down at his phone. I assumed he was logging off the conference call.

“OK,” he said. “Go ahead.”

I revved up my Hyfrecator, which started to buzz.

“Wait, can they hear that?” Rory asked.

“Can who hear ... ?”

“This is Rory Stiefel,” he spoke into his phone. “Glad we could meet today. I wanted to talk to all of you about our plans to expand our network services into your Upper Midwestern territory.”

“Hold on,” I said (to myself), “You want me to desiccate your face while you’re expanding your network into the Upper Midwest??!!”

Rory motioned for me to continue. “Sure,” he said to his phone, “We can be up and running by the first of next month, no problem.” Apparently, the hum of the Hyfrecator wasn’t interrupting negotiations.

So I buzzed away, while Rory’s interlocutors responded with apparent enthusiasm. By the time he turned his other cheek, I figured he had occupied Minnesota.

“Did you get all the thingies?” Rory stage-whispered.

I nodded.

“Great!” he said, then turned back to his phone. “Well, this was a great meeting,” he said. “I’m glad we’re ready to go live. Talk to you guys next week to firm up logistics.” He punched the screen to sever the connection.

“Thanks for being so efficient,” he said, this time to me.

“No problem,” I said, now-silent Hyfrecator in hand.

“You’re sure you got them all?”
 

“I handed him a mirror. “Yes,” I said. “I got them all.”

“Well that’s terrific,” he said, jumping off the exam table and heading for the door. “Always a pleasure. See you next time!”

I don’t know exactly what he does, but Rory is one awesome multitasker.

As for me, I just have to consult the CPT code book to find the right designation for “Cautery of benign lesions during a corporate conference call, second episode.”

Any help, dear colleagues, with people or coding, will be appreciated.

I can always ask ...
 

Dr. Rockoff practices dermatology in Brookline, Mass., and is a longtime contributor to Dermatology News. He serves on the clinical faculty at Tufts University, Boston, and has taught senior medical students and other trainees for 30 years. His second book, “Act Like a Doctor, Think Like a Patient,” is available at amazon.com and barnesandnoble.com. Write to him at [email protected].