When I opened the exam room door, Lindsey smiled at me.  Gone were the tired appearing eyes, and the troublesome perioral rash. She sparkled with enthusiasm, and said "I want you to meet my husband, daughter, and son.  They are here to see you."  

Lindsey was a Scout Patient.

Scout patient's are a phenomenon I have observed in my allergy practice for nearly 3 decades.  They are the challenging patients--the ones who have sought help from multiple practitioners before they reach my exam room.  And before they "commit" to having other family members seen at our clinic, they want to "scout the territory".  See if I can help.

In short, "see if its worth it".  And with the challenging economic times we all live in, I seem to be seeing more of them.  

Scout patients typically are, in a word, tough patients.  Why should we even  put out the considerable effort in helping them...why not have the attitude one of my professional friends who shrugs his shoulders, and  says, "if I can't help them, someone else can". Not surprisingly, many of these Scout Patients have seen 1, 2 or even 3 allergists before coming to our clinic.  Simple measures (non-sedating antihistamines, rudimentary environmental control) have not helped, and many of them either have never been given the option of immunotherapy, or had reactions to the injections.  To editorialize, the ineffectiveness in the allergy community in dealing with the Scout (Difficult) Patient is one of the biggest crises we have today in our profession...As I've said before, Allergists like their immunology lectures to be complex, but their patients to be simple.  Unfortunately, simple patients don't need to see the allergist.  Scout Patients do.     

I believe there are 3 reasons to help Scout Patients--moralistic, economic, and philosophilic:

1.  Compassion.  The patient with the greatest degree of suffering deserves our greatest effort. Always

2. Referrals:  The difficult "Scout Patient" will be our biggest referral of the "bread and butter" allergy cases of simple Allergic Rhinitis, Eczema, Asthma that we all know we can help with SLIT quickly.  To a large extent, our clinic practice has been built through Scout Patients.  

3.  The "Thrill of the Hunt":  As I get older, the one thing that "keeps me young" and always thrilled with my profession is making the correct diagnosis in a difficult allergy patient.  Sitting in the room with my patient, and gradually "putting all the pieces together" is as enjoyable now as it was back in 1981 when I started my practice.  

As I looked at Lindsey, I could also see she enjoyed bringing her family to see me.  True to form, they had much more easily diagnosable conditions that would respond well to basic allergy management, including SLIT.  

Scout Patients.  Something to think about the next time you see a challenging patient in your office.

Later, 

Dude