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[Odler]

It was a Monday when Maxine (not her real name) called me the first time. A friend of hers recommended me, and she had the urge to make me her doctor. She would not speak to my secretary. She wanted me, personally, to give her an appointment.

At random, I proposed that she comes on Thursday at 4:00 p.m. She would be in class, she replied, so she would have to make it later than that. We concluded that she would be in the office at 6:00 p.m. on Thursday.

It was a tad after the September 11 attacks; my nurse-secretary of the time would miss days at work, since a daily trip from Manhattan to New Jersey was not a sure thing in those troubled days. She happened to be absent that Thursday. Therefore, I had one of these awful days, of now a distant, almost forgotten, past, when I had to answer my own phone at the Institute.

Maxine came in at 6:00 p.m. She was my last patient. I was exhausted. It was cold.

In a different setting, outside of a medical office, I would have found Maxine attractive and enticing. But in a doctor?s waiting room, the sleeveless and low-cut T-shirt she exhibited, after she removed her red pullover, seemed over the top. And she had the tight low-cut jeans to match!

Maxine was a 22-year old college student. She wanted to see me because she had not seen a doctor in a long time. She also claimed that she wanted a younger doctor, since younger physicians are invariably smarter than the older ones. I explained to her that her premises were highly inaccurate, but that I would see her anyway.

She had no complaint. She was a little tired, but she acknowledged she studied too much on weekdays, and partied too much over the weekends.

After a brief history-taking session, I invited Maxine to move to the privacy of the examination area. I gave her a gown that she would wear (?the slit goes on the back?), after she would disrobe, to the exception of her underwear.

Maxine looked at me with a zany smile and informed: ?Doctor, I wear no underwear.? It sounded like trouble in the air. I called my secretary and obtained a telephone consent from Maxine attesting that she agreed to the examination in the absence of a female observer.

A female observer is recommended only in cases that involve a gynecological examination. Though such exam was not intended, I wanted to get that consent anyway? Everything went fine this Thursday. Maxine went home happy, giggly.

At a follow-up appointment, Maxine complained of a groin pain and supra pubic pressure. Before I invited her, she pulled her pants down, and of course she wore no underwear. She was adamant at having me palpate her area of great discomfort. I called my assistant into the room and did the exam, to no avail.

The week after, and the week after, and the week after, Maxine would call the office almost every day. Every time, she would refuse to speak to any staff member. She always wanted to speak to the doctor.

I refused to take her calls in private. I documented all conversations, all intonations, all allusions in her chart.

Eventually, Maxine, who had no reason to see a doctor anyway, got tired of calling, of walking-in without an appointment, of inviting a level privacy that she would not obtain. She gave up, and was lost to follow-up.

Maxine?s behavior is one example of the many hurdles on the road of younger physicians. This case is typical, though rarely that obvious.

Succumbing to a patient?s flirting is an unethical demeanor, sanctioned with disciplinary actions, and subjected to malpractice litigation. Notwithstanding that 22-year old Maxine with no underwear maybe for some a temptation from hell?

(OdlerRobert Jeanlouie, Friday, May 17, 2002)