The week after a holiday is always busy in our office, and last week was no exception. It was during a particular bad stretch that I was reminded of a few of my pet peeves regarding patients.

The first is the person who comes in unannounced. Now if someone is really sick or there is an urgent need to see their doctor, of course we don't mind fitting them in. But some people just want a routine check-up or something that can be scheduled ahead of time, and they just don't have the courtesy to do so.

Last Friday, a gentleman came in for a check-up, but he hadn't even phoned us ahead of time. He apparently had the week off and some social arrangement fell through, so he had a window of time to come in. We arranged for him to be seen, but it wasn't an easy fit and he had to wait about an hour, which was regrettable. He stomped around our waiting room and kept sticking his head through the reception window, asking how long he'd have to wait.

This was extremely disruptive, and I felt bad for the other patients who had scheduled appointments and were waiting without complaint. After he was seen, this man exhibited my second pet peeve: he claimed his wallet was in his other pants.

It has been my experience that medical bills are often the last thing a person will pay. Like many in our profession, I resent being forced to act as a bill collector. This man will undoubtedly pay what he owes, but the fact is he should have been prepared to pay following his treatment.

He also should have made an appointment first. A co-worker joked that his rudeness made him the human equivalent of the "perfect storm." Luckily for him, we were professional and courteous. He had no idea how much frustration he had caused. In truth, that is something which makes me proud. When it comes to patients that exaggerate their symptoms however, the scenario is not necessarily as clear as it seems.

I was reading an article in the New York Times about the syndrome of when a patient cries wolf. The doctor who wrote it discussed a patient who wound up nearly dying from a serious complication related to diabetes.

We all know the chronic complainers who make appointments for every ache and pain. More often than not, their symptoms are minor and their concern inflated. As medical professionals, we can't dismiss them, of course, but it's a fact that such patients do wind up relegated to the category of hypochondria.

What piqued my recent interest in this topic was a patient who came in to our office with the regularity of a clock. She was a fairly unpleasant person, and although she suffered from arthritis, she seemed otherwise healthy. It became a chore to see her, and although everyone from the staff to our doctors treated her with courtesy, it was hard not to just want to deal with her quickly and be done with it.

That, of course, is the danger. Last week she was diagnosed with cancer, and while it is in the early stages and her chances for recovery are good, I'd be lying if I didn't say all of us were a bit shaken by the experience.

Yes, we caught it. We did our jobs. But in a sense, that is all we did. It's scary to think about what the practice of medicine becomes when the element of caring is reduced or eliminated. Without some measure of sympathy, are we prone to malpractice by default?