Journal of Dermatology for Physician Assistants

The official journal of the Society of Dermatology Physician Assistants

One Dollar and Forty-Two Cents

By Alan Rockoff, MD

The following is an excerpt from Dr. Rockoff’s third and most recent book titled Doctoring from the Outside In: Dermatology Under the Skin.

No good deed goes unpunished.

We froze Myrna’s keratosis off her forehead. Gratis, of course.

This was followed by repeated calls from Myrna: the spot was red, it was painful, it wasn’t healing right.

So, we mailed her an envelope filled with cream to help heal the skin. Although we used our regular postage meter, somehow Myrna got the package with $1.42 postage due.

Not going to work.

Myrna called to complain. Then she drove over and walked into the office, but we weren’t there. Then she called again and left a message. “I’m coming in this afternoon,” she said. “I expect to pick up my $1.42.”


Later that morning, Stephanie came by for a skin check. Because Stephanie is Catering Manager at a downtown ultra-upscale hotel, I knew she would both appreciate the tale of $1.42 and be able to top it. Everyone in her field can fill several books of client encounters no one could make up.

When I asked her to share some stories, Stephanie did not disappoint.

“Sure,” she said. “People plan lavish weddings, no expense spared. But when they send gift baskets, we have to charge $3.50 each to pay the livery people who deliver them. That they object to.”

“But what’s even worse,” she went on, “is when it comes to feeding the band. We discount the meals for musicians 60-70% below the per-plate rate for guests.”

“That’s not low enough for some people, though. We explain to them that the band members do have to eat. ‘Yes,’ say some of the brides, ‘but do we have to give them a whole meal? Can’t we just give them a sandwich or something?’ This is from people who are spending six figures on food alone.”

“Sounds like Marie Antoinette,” I said. “What do you tell them?”

“We say, OK, we’ll see if we can discount the band meals even more,” Stephanie said.

Not an hour later, Ken came in. Ken manages an art-house movie theater in a close-in, affluent suburb. As I knew he would, Ken had stories too.

“People are always angling for some kind of special privilege,” he said. ‘I’ve been a patron for years,” they say. ‘Can’t you do something for me?’

“What do they want?” I ask. “Free tickets?”

“Yes, or preferential seating,” said Ken, “but we tell them that if we do that for them, we’d have to do it for everybody.”

“Or else it’s a cold, winter night and the theater is a little chilly. Some of the patrons want us to give them free popcorn.” Ken sighed.

Anybody in the service business is going to meet up with behavior like this. We probably should be grateful that most patients have enough respect for our profession to dissuade them from:

• Demanding to be seen for free or have us waive the co-pay since “the treatment didn’t work.”
• Refusing to hand over the co-pay for a follow-up, because, “It was just a quick check, didn’t take any time.”
• Insist on having us treat the wart or skin tag again at no charge, because “you missed a spot.”

And so on. At least even our demanding patients don’t ask for popcorn.

Myrna did show up that afternoon, by the way. I don’t know how much she spent on gas to come in.

My Office Manager Amina took care of things. She gave Myrna her buck-42:

Three quarters. Two dimes. Five nickels. And 22 pennies.

Amina is really good at keeping a straight face.

Alan Rockoff, MD, practices dermatology in Boston, Massachusetts. He graduated with his medical degree in 1972 from the Albert Einstein College of Medicine in Bronx, New York and then completed a pediatric internship and residency at Bronx Municipal Hospital Center in Bronx, New York. Continuing his education, Dr. Rockoff completed a dermatology residency program at the combined program at Boston University and Tufts University in Boston, Massachusetts.

Dr. Rockoff is a Clinical Assistant Professor of Dermatology at Tufts University School of Medicine. He has taught senior medical students and other trainees for more than 35 years. Dr. Rockoff has been named one of Boston’s Top Doctors by Boston Magazine for five years. Dr. Rockoff is board certified by the American Board of Pediatrics and the American Board of Dermatology. Dr. Rockoff is a Fellow of the American Academy of Dermatology and a member of the Massachusetts Medical Society and the Massachusetts Academy of Dermatology. Dr. Rockoff’s publications have appeared in numerous journals. He writes a monthly column for his dermatologic colleagues in Dermatology News as well as a blog for the magazine Psychology Today.

His first book, “Under My Skin: A Dermatologist Looks at His Profession and His Patients” is available on Amazon and is his second book, “Act Like a Doctor, Think Like a Patient: Teaching Patient-focused Medicine” is available on Amazon and at Barnes and Noble. His third and most recent book, “Doctoring from the Outside in: Dermatology under the Skin” is available on Amazon in paperback and Kindle format.

Like this article?

Share on Facebook
Share on Twitter
Share on Linkdin