Lost to Follow-Up

Rosalie hadn't been by in 3 years. Her chief concern was a growth on her forearm. Then she pointed to a cholesterol deposit above her right eye. “I thought it might have been from crying,” she said. “My daughter died 14 months ago. She was 26.”

I expressed sympathy, and asked if her daughter had been ill. “It's a long story,” she said, “but the short of it is that she had a boyfriend who was not a good person. He stored a gun in her closet, and she didn't even know it was there. One night she came home after going out drinking with her girlfriends, other nurses from the hospital. She tripped in the closet, and the gun went off.

“She used to be your patient,” Rosalie said. “Maybe you remember—she got those crazy warts when she was in middle school.” I checked my records. Her daughter's last visit was in 1996, when she was 13.

In our offices, as elsewhere in our lives, people pass across our line of vision and disappear. We may find out what becomes of them, medically or otherwise, but more often we don't. Sometimes a chance encounter brings their image back into focus, but for the most part, once out of sight they stay out of mind.

This is true not just of patients like Rosalie's daughter who come a time or two for a minor complaint, but for those we get to know over a sustained period. All at once you realize that you haven't seen them lately, and perhaps never will.

Terry is so familiar that I was surprised to see she hadn't come for over a year. Now past 80, she looked a bit frailer but still reasonably hale. I recalled that Tim, her husband and inseparable companion, hadn't come along for her last couple of visits. He wasn't up to it, she'd explained. His mind was getting a little fuzzy. He sent his regards.

This time I asked Terry about him with some hesitation. Dementia, after all, goes in just one direction. “He's doing fairly well,” she said. “Lately when Tim sees women on the TV, he thinks they can see him, so he won't undress in the bedroom because he's embarrassed. I tell him, 'Timmy, why aren't you worried that the men in the TV can see me?' But he still won't get into his pajamas until I turn off the TV.

“During the day he's pretty content,” she went on. “He just sits there by his radio, all day long. He loves to listen to it and look out the window. He can sit there for hours.”

Terry's report jogged my memory of the way Tim looked when I saw him last, an affable gent with a wiry build and thinning brown hair. He always had a smile on his face, ready to help me reassure his wife, the worrier of the pair. At the end of each visit I would wish them good health and say I was looking forward to seeing them next year. Now that I won't be seeing him anymore, I'll have to picture the Tim in Terry's description, listening to his murmuring radio and gazing out the window as he subsides into his own deepening twilight.

Of course, it's not only patients who are lost to follow-up. People come to the office and tell me they had a physical or biopsy as recently as 2 or 3 years ago but cannot for the life of them remember which doctor they saw. It's not even unusual for someone to come back to me after an absence of a decade or two and express disbelief that they'd ever been here, since neither the office nor its proprietor rang a bell.

When I was starting out in practice, an older colleague told me that once he announced his retirement, his mailbox filled and his phone rang off the hook with messages from anguished patients declaring that they simply would not be able to get along without him. “They did manage, though,” he said. “In most cases it took only a couple of weeks.”

Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at [email protected]

Rosalie hadn't been by in 3 years. Her chief concern was a growth on her forearm. Then she pointed to a cholesterol deposit above her right eye. “I thought it might have been from crying,” she said. “My daughter died 14 months ago. She was 26.”

I expressed sympathy, and asked if her daughter had been ill. “It's a long story,” she said, “but the short of it is that she had a boyfriend who was not a good person. He stored a gun in her closet, and she didn't even know it was there. One night she came home after going out drinking with her girlfriends, other nurses from the hospital. She tripped in the closet, and the gun went off.

“She used to be your patient,” Rosalie said. “Maybe you remember—she got those crazy warts when she was in middle school.” I checked my records. Her daughter's last visit was in 1996, when she was 13.

In our offices, as elsewhere in our lives, people pass across our line of vision and disappear. We may find out what becomes of them, medically or otherwise, but more often we don't. Sometimes a chance encounter brings their image back into focus, but for the most part, once out of sight they stay out of mind.

This is true not just of patients like Rosalie's daughter who come a time or two for a minor complaint, but for those we get to know over a sustained period. All at once you realize that you haven't seen them lately, and perhaps never will.

Terry is so familiar that I was surprised to see she hadn't come for over a year. Now past 80, she looked a bit frailer but still reasonably hale. I recalled that Tim, her husband and inseparable companion, hadn't come along for her last couple of visits. He wasn't up to it, she'd explained. His mind was getting a little fuzzy. He sent his regards.

This time I asked Terry about him with some hesitation. Dementia, after all, goes in just one direction. “He's doing fairly well,” she said. “Lately when Tim sees women on the TV, he thinks they can see him, so he won't undress in the bedroom because he's embarrassed. I tell him, 'Timmy, why aren't you worried that the men in the TV can see me?' But he still won't get into his pajamas until I turn off the TV.

“During the day he's pretty content,” she went on. “He just sits there by his radio, all day long. He loves to listen to it and look out the window. He can sit there for hours.”

Terry's report jogged my memory of the way Tim looked when I saw him last, an affable gent with a wiry build and thinning brown hair. He always had a smile on his face, ready to help me reassure his wife, the worrier of the pair. At the end of each visit I would wish them good health and say I was looking forward to seeing them next year. Now that I won't be seeing him anymore, I'll have to picture the Tim in Terry's description, listening to his murmuring radio and gazing out the window as he subsides into his own deepening twilight.

Of course, it's not only patients who are lost to follow-up. People come to the office and tell me they had a physical or biopsy as recently as 2 or 3 years ago but cannot for the life of them remember which doctor they saw. It's not even unusual for someone to come back to me after an absence of a decade or two and express disbelief that they'd ever been here, since neither the office nor its proprietor rang a bell.

When I was starting out in practice, an older colleague told me that once he announced his retirement, his mailbox filled and his phone rang off the hook with messages from anguished patients declaring that they simply would not be able to get along without him. “They did manage, though,” he said. “In most cases it took only a couple of weeks.”

Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at [email protected]

Rosalie hadn't been by in 3 years. Her chief concern was a growth on her forearm. Then she pointed to a cholesterol deposit above her right eye. “I thought it might have been from crying,” she said. “My daughter died 14 months ago. She was 26.”

I expressed sympathy, and asked if her daughter had been ill. “It's a long story,” she said, “but the short of it is that she had a boyfriend who was not a good person. He stored a gun in her closet, and she didn't even know it was there. One night she came home after going out drinking with her girlfriends, other nurses from the hospital. She tripped in the closet, and the gun went off.

“She used to be your patient,” Rosalie said. “Maybe you remember—she got those crazy warts when she was in middle school.” I checked my records. Her daughter's last visit was in 1996, when she was 13.

In our offices, as elsewhere in our lives, people pass across our line of vision and disappear. We may find out what becomes of them, medically or otherwise, but more often we don't. Sometimes a chance encounter brings their image back into focus, but for the most part, once out of sight they stay out of mind.

This is true not just of patients like Rosalie's daughter who come a time or two for a minor complaint, but for those we get to know over a sustained period. All at once you realize that you haven't seen them lately, and perhaps never will.

Terry is so familiar that I was surprised to see she hadn't come for over a year. Now past 80, she looked a bit frailer but still reasonably hale. I recalled that Tim, her husband and inseparable companion, hadn't come along for her last couple of visits. He wasn't up to it, she'd explained. His mind was getting a little fuzzy. He sent his regards.

This time I asked Terry about him with some hesitation. Dementia, after all, goes in just one direction. “He's doing fairly well,” she said. “Lately when Tim sees women on the TV, he thinks they can see him, so he won't undress in the bedroom because he's embarrassed. I tell him, 'Timmy, why aren't you worried that the men in the TV can see me?' But he still won't get into his pajamas until I turn off the TV.

“During the day he's pretty content,” she went on. “He just sits there by his radio, all day long. He loves to listen to it and look out the window. He can sit there for hours.”

Terry's report jogged my memory of the way Tim looked when I saw him last, an affable gent with a wiry build and thinning brown hair. He always had a smile on his face, ready to help me reassure his wife, the worrier of the pair. At the end of each visit I would wish them good health and say I was looking forward to seeing them next year. Now that I won't be seeing him anymore, I'll have to picture the Tim in Terry's description, listening to his murmuring radio and gazing out the window as he subsides into his own deepening twilight.

Of course, it's not only patients who are lost to follow-up. People come to the office and tell me they had a physical or biopsy as recently as 2 or 3 years ago but cannot for the life of them remember which doctor they saw. It's not even unusual for someone to come back to me after an absence of a decade or two and express disbelief that they'd ever been here, since neither the office nor its proprietor rang a bell.

When I was starting out in practice, an older colleague told me that once he announced his retirement, his mailbox filled and his phone rang off the hook with messages from anguished patients declaring that they simply would not be able to get along without him. “They did manage, though,” he said. “In most cases it took only a couple of weeks.”

Dr. Rockoff practices dermatology in Brookline, Mass. To respond to this column, e-mail Dr. Rockoff at [email protected]