He said “thank you for listening to me” before he left for the Emergency Room. I’m still mulling over his appreciation. He did not want to come to the Urgent Care, but he named a few complaints to his nurse daughter and she asked him to please be seen. His symptoms were vague. He had fatigue and noticed his blood pressure and pulse were higher than usual, especially after climbing stairs. He said “my appetite is gone” as he patted his obese stomach to show that was not a normal symptom. He was a man of numbers and had blood pressure and pulse rates on a sheet of paper that went back for years. He blamed the fatigue on a high stress week at work. He apologized for wasting my time as he had made an appointment with his primary doctor that was only one week away. But you could tell that he could not quite convince himself, even as he tried to convince me, that he was only there to assuage his adult daughter. “My cardiologist gave me a clean bill of health just last month; otherwise I would have come in yesterday. I did take an aspirin last night and this morning, just in case” he admitted. What is it that is bothering you the most? “Every time I climbed stairs yesterday, it just felt difficult and my pulse rate would jump.” Do you always take your pulse after climbing stairs? No, but I just didn’t feel right. Okay, well I know you are not having chest pain, but let’s get an EKG to make your daughter happy, I offered with a smile. When I went in to let him know the EKG was abnormal and showed a probable recent cardiac event, he seemed almost relieved. I explained what would happen upon arrival at the hospital. I answered a few questions and shook his hand and told him to keep listening to both his daughter and his body. That’s when he said “thank you for listening to me”. For some reason his appreciation made me both happy and sad. Not all MDs would take the time to listen to the story. Some would’ve told him to follow-up with his primary care as his main complaints were fatigue and elevated blood pressure. Some would have made him feel guilty for being there. We docs have been dealt our share of abuse recently and the scars are hard to hide from our patients. But connection is the name of the game in primary care. Most docs would’ve gotten the EKG and sent him to the ER. We are often the first entry into the messed up, confusing system. So, we have to find a way to hear our patients. I know that his experience will be better simply because I listened. I heard his unspoken fear. He did not thank me for making the diagnosis. He thanked me for listening.