Illness by Proxy
By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.
One of the more challenging and amusing aspects of family practice involves illness by proxy. It is something rarely witnessed in the emergency department or walk-in clinic. I suppose that it is an off-shoot of our busy society and reflects the time stress that we can find ourselves under. Much of illness by proxy involves husbands and boyfriends. During such encounters, the “proxy” patient books into the office and usually arrives late. An illness by proxy encounter is one of the most difficult to book. It requires suave skills of persuation to convince the receptionist that the emergency squeeze-in spot is deserving of such honour.
The illness by proxy encounter is sure to take place later in the day when the office is backed up. It begins with a well rehearsed but familiar proclamation of how the patient is really not there for themselves. Instead they have been sent on behalf of someone to test my skills of diagnosis of the random and never seen. It may involve a husband whom I may have met a decade earlier, another patient whose symptoms they feel I should know about, or the ultimate challenge being a complete stranger whom I have never seen, examined or have the faintest of what they look like.
The newbie to proxy-illness usually tests my skills of rashes or foot ailments. “His feet hurt because he stands on them and he needs orthotics, support stockings and a lumbar support.” as they cleverly pull out a form kept hidden from the receptionist. The form is usually completely blank, and the person usually has not even glanced at it to see what it involves. I am politely told that they have it on good authority by a nameless third party that all I have to do is sign it. There are binding characteristics in this group of proxy-illness seekers. They all seem to have authoritative coffee-break knowledge of previously unknown health benefit clauses. Most admit that they would not buy any of these devices if they had to ante-up the bill themselves. These forms are all the same, and I actually sat down and read one. Amazing what I discovered. The forms usually start off by stating that non of the process is OHIP covered. They ask the patient to sign and date a clause that allows their physician to examine them, and allows this information to be passed on their insurer. They all ask for the results of the examination and any abnormal conditions found. This is followed by the recommendations. I suppose the pety details, like not having the slightest idea of what the proxy patient looks like or having a clinical record to detail my findings in should matter, but my malpractice advisor just loves to spoil everyone’s day. Once upon a time, the insurer would pay for this information. They have downloaded it down to the patients, but it makes it even a better bargain. Most doctors are sympathetic to the pains and concerns of their patients and few will actually not fill out the form, if things are done properly.
Another form of proxy-illness involves rashes and minor ailments in absent patients. “My boyfriend is all itchy and red. What do you think it is doc?” Some even reach for their cell phones and insist that I converse with the phantom patient. Experience quickly tells me to decline such traps. Past calls had people informing me how they have never met me, deplore wasting health care dollars by visiting doctors and go on to relay to me a useless description of their groin or some such. I try to be as professional and helpful as I can in formulating my reply. “ Tell you what, give it a day or two and have your friend come and see me for another emergency appointment.” At this point, the friend has gotten the point and will start to pull their own list of complaints out, and tell me “the real reason” they squeezed themselves in.
Other types of proxy-illness involve second opinions on hospitalized distant relatives, assumptions that my “computer” is all-knowing about opinions received in other clinics, countries and universes. It was recently pointed out to me that soap-opera doctors who only see one patient a week, freely comment on all types of subjects. They also have rapid diagnostics with no line-ups, amazing readily available cures and dashing colleagues in armani suits sipping cappaccinos whilst intellectually conversing about unknown medical break-throughs and offering second opinions on fashion and marital distress. The longest part of these visits is trying to explain why OHIP will not cover these requests.