Perfectly Reasonable by Linda O'Connor Page A

He grinned with his mouth full.
    “All part of your strategy?”
    “You bet.” He scooped another mouthful. “Okay, ready. Hit me.”
    Margo smiled and split a muffin in two. “A couple comes into your office together for the results of the husband’s physical exam and tests. They’re told that the husband has a neuromuscular disorder and the outlook isn’t good. A week later the wife calls and asks you to write a letter outlining the disabilities so they can get the ball rolling for some insurance money to renovate their home.” She paused. “Do you write the letter?”
    Trace swallowed. “Yes. Poor bloke. I want to do whatever I can to help,” he said confidently.
    Margo nodded. “Turns out the wife wants to divorce the husband and uses the letter in court to prove he is incapable of looking after their children. She wins sole custody.”
    “Holy shit. What?”
    “True case. The doctor was sued for providing a letter without the patient’s written consent.”
    “Even though the wife was at the visit and knew it all anyway.”
    “Even though. Confidentiality is a big deal. You can’t let on what you know, or even say if a person is a patient, without their permission.” She popped a piece of muffin in her mouth. “And no discussing details in an elevator or at the coffee shop. Eavesdroppers are everywhere.”
    “It’s a mine field. How do you figure it all out?”
    Margo finished the muffin and brushed the crumbs to the center of the plate. “Some of it’s common sense. Being humble helps. And respectful. Once you’ve had patients who trust you with their stories, you appreciate what a gift it is to be able to help them.” She gave a crooked smile. “That probably sounds a bit hokey.”
    He smiled at her. “I’m using feng shui. Get in the hokey pokey line behind me.”
    She laughed and wondered what it would be like to wake up beside those twinkling blue eyes. “I better get back to work.” She stood up.
    “This is really helpful. Is this what you were asked when you applied?”
    She shook her head. “This is stuff I saw during my clerkship. Sixteen months of seeing patients.”
    “Wow, a lot of shit goes down. Got any more?”
    “Unfortunately, yes.” She picked up the paintbrush and stepped on the step stool to touch up the edge by the ceiling. “A twenty-two-year-old male comes in asking for a renewal of his asthma medication. He states that he’s been asthmatic since he was little, but the vague history is out of keeping for someone living with asthma for years. You know that the inhaler device has a street value. It can be sold and used to inhale street drugs. You wonder if that’s how this prescription is going to be used.” She stepped down and picked up the roller. “Do you write the prescription?”
    “What if he truly is asthmatic?”
    “He could have an acute asthma attack and die without the medication.”
    Trace frowned. “Damned if you do, damned if you don’t.”
    Margo smiled and nodded.
    “I think I’d go with trusting what he says. His dying seems a bigger risk. And it wouldn’t look too good on my CV.”
    “It’s frowned upon,” she agreed. “That’s what I did, too. I suppose I could have called his pharmacy, but he was visiting from out of town, and I didn’t get a gut sense that he was lying. I could’ve been wrong, but the doctor-patient relationship is built on trust, and at some point you have to trust that the patient isn’t lying to you.”
    Trace nodded as he finished the cereal.
    “How about this,” Margo continued. “What would you do if you saw a resident using cocaine at a party?”
    “A resident is a student?”
    “They have their medical degree and are working toward a full license to practice. Often they see patients on their own, but technically they’re still supervised.”
    “So snorting cocaine would be frowned upon, as you say.”
    “Yes.”
    “And it’s pretty unlikely that they would only snort once, so something