What my mechanic taught me about being a doctor

About a year ago, I began to hear an annoying rattling sound coming from under the hood of my car. I couldn't determine its origin, so I called the foreign car dealership that had sold me the vehicle and scheduled an appointment. I told them that I also wanted the oil changed.

As often happens in such cases, the noise disappeared as mysteriously as it arose. Nevertheless, I decided to keep the appointment for the oil change.

The day of the appointment, the service manager presented me with a computer printout of my entire service record at the dealership.

"I recently changed the spark plugs and air filter myself," I told him. "And the last time I was here, I had all the fluids drained and replaced."

"Well, you should at least have the valves inspected and adjusted," he responded.

The reason, he explained, was that valves in older foreign cars are mechanical and need to be adjusted manually, while valves in newer cars are, as a rule, hydraulic and can adjust themselves. And why was all this important? Because if something he called "valve clearance" wasn't correct, it could lead to an expensive breakdown in the future.

I nodded as he ran through the explanation, but the valves in a car weren't something I knew a lot about.

"About how much will that cost?" I asked.

"About $90, parts and labor," he replied.

I hesitated, but fear of a major breakdown overcame my initial reluctance. An hour later, my car was ready to be driven home. For the valve adjustment and oil change, I'd forked over $120.

An epiphany, post valve adjustment

Back home, I told my wife about the service that had been done. She seemed puzzled.

"Every time you go to the dealership for an oil change, it seems, the car ends up needing some other service as well."

I couldn't disagree with her-and neither could I assure her that the work that was done had been appropriate, this day or during previous visits. After all, automobiles weren't within my realm of expertise. Certainly, I could've asked the mechanic more questions than I had. But not only had I been embarrassed to reveal my ignorance; I was fearful that doing so would've made me an easy mark, especially if the mechanic was really out to take advantage of me.

Later that evening, I was stopped cold by a thought: What if some of the patients who visit my office feel the same way that I did at the car dealership today? The parallels were striking.

Suddenly, I could envision a scene in which the roles were reversed. A 50-year-old mechanic comes to see his family physician. Active and apparently fit, this patient rarely visits the office, but, on this day, he'd like an antibiotic for a "terrible head cold."

After doing a history and physical, the FP diagnoses the patient with a viral upper respiratory infection and prescribes a conservative therapy. But it's been years since the patient has had a complete routine health-maintenance exam, so the FP instructs him to make an appointment for one. He also hands his patient a lab slip to check routine fasting labs a week prior to the visit, along with instructions to obtain ambulatory BP measurements-to confirm an initial diagnosis of hypertension.