Bryson City Tales — Wet Behind The Ears (Part 2)

This is from the thirteenth chapter from my best-selling book, Bryson City Tales. I hope that you’ll enjoy going back to Bryson City with me each week, and that if you do, you’ll be sure to invite your friends to join us.

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WET BEHIND THE EARS (PART 2)

The next week, I saw Jimmy’s name on my schedule and greeted him as Helen and I entered the room.

“How you doing, Jimmy?”

“Just fine, Doc, just fine. I’ll be glad to get this thing out. The black drainage has messed up the collar of a shirt or two— at least until I figured out how to stick a cotton ball over it.”

“Sounds like a good idea. Let me have a look at that thing.”

The cyst had indeed shrunk to at least fifty percent of its previous size and looked like a dark black stone just under the skin. “Want me to show you how Dr. Mitchell does it?” asked Helen.

“You bet.” I took a couple of steps back.

Helen washed her hands and put on a pair of gloves. She placed a pointer finger on each side of the lump.

“Jimmy, hold on now. Shouldn’t hurt much.”

Then she pressed her fingertips toward each other and the iodizing remnant of the cyst popped out with the help of the compression on each side of the wound.

I smiled. “Wow, that looked easy. Jimmy, did that hurt?” “Not a bit, Doc. Not even a little bit.”
Helen smiled as she placed a dab of Neosporin and a Band-

Aid over the wound. “Piece of cake, Jimmy. Just put a dab of antibiotic ointment on this four times a day. It should be healed in just a few days.”

As Jimmy was leaving, Helen commented, “Usually I just teach a family member to do this at home. Saves the patient some time, some money, and, for many of them, a trip to town.”

I figured this was only one of many old tricks this new dog was going to need to learn in rural private practice.

At the end of each day in the office, Mitch, Ray, and I would usually sit for a few minutes and chat about the day. A topic of recurring concern to me was Drs. Mathieson and Nordling. Both seemed constantly irritated by my presence. Whenever I’d enter a nurses’ station, they would leave. Mitch and Ray tried to reassure me, and they encouraged me to just give them some time. We also talked about problem patients and practice management issues. Having had training in practice management while in residency, I assumed I had some expertise, albeit no experience.

Because my schedule as a new doctor in town was less crowded that Mitch’s or Ray’s, I offered to help them develop and improve some of their office procedures and policies. One of the most noticeable deficiencies was the billing and collection system. Mitch had some unpaid bills that were decades old. He would send out a bill four times a year—and would keep doing it, sometimes for many years.

We had been taught in our practice management classes that this way of billing was fairly useless. If within the span of about four months the average person had either not paid their bill or made arrangements to pay it off, our teachers said, there was vir- tually no chance that it would ever be paid. So we were taught that if the patient didn’t respond to the fourth or fifth monthly bill, then he or she should be sent a stern letter—return receipt requested—telling them to either pay the bill within thirty days or call the office to arrange to make payments on the bill within thirty days. If they didn’t do so, they would be dismissed from the practice within thirty days and their bill would be sent to a collection agency.

When I suggested this mode of operation to Mitch and Ray one evening, Mitch’s response was swift and stern. “You stupid, son? That won’t work here. First of all, folks pay when they can—and not before. Very few folks ’round these parts leave a bill unpaid unless they’re in tight straits. Second of all, if I throw them out of the practice, they’ll tell everyone they know. That’s no good for them, for me, or for you boys. Might work in the big city. But not here, not with our folks.”

I looked at Ray. He shrugged. I felt I shouldn’t push.

Mitch left to do evening rounds at the hospital. Ray looked at me. “You were wise not to press the issue. I’ve only been here two years, but I’m still learning a lot. Mitch knows his medicine and he knows this community. I’m learning to trust his gut. Let’s just see what happens.”

“Sounds good to me, Ray.”

“But, Walt, don’t stop making suggestions. You’ve made some great ones. Glad you’re here.”

(TO BE CONTINUED NEXT FRIDAY)

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© Copyright Walter L. Larimore, M.D. 2016. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.