He has a mellow, deliberate affect that is calming and would normally put me quickly at ease. As it is, my heart is beating so fast that I imagine my neck must be visibly pulsing.

“It’s for work actually. New plan, entirely new set of providers …. My most recent primary isn’t in network so I had to make a quick change. Which requires a physical. So, here I am.”

“I see.”

Hearing the word “physical” come out of my mouth sends a dreadful shiver through me. My anxiety rises at the mere suggestion of a physical at the hands of anyone. I’ll probably have an anxiety attack before he even touches me. I am so nervous, and pray that it’s not patently obvious.

He nods, grabbing legal pad and pen, then pushes back a bit from the table and leans back in his seat.

“Well, I’m sorry you had to make a change, particularly if you had a good relationship with your former provider …. Alright.”

He pauses for a moment before continuing. I can feel his eyes on me.

“Can you give me a sense of what you’re looking for in a provider?”

His question catches me off guard and my brain freezes for a moment. But as it thaws out, I realize that no other doctor has ever bothered to ask me that. It’s a good question. I shift again in my seat, crossing my legs.

“You know, I see a lot of doctors, and not one has ever asked me that before.”

I look up to find him studying my face, waiting to hear my response. His overall vibe is calm and polite, but something in his affect is hard for me to read and I find it unsettling. It’s nerves I’m sure.

“I actually appreciate the question. It’s simple really. I’m looking for someone who listens well and wants to work with me instead of …”

I choose my words carefully. I don’t know him well enough to be fully transparent with him. So I keep it simple.

“… not.”

I see what could be a flicker of amusement in his eyes. A smile plays on his lips and his features soften slightly.

“I’m pretty sure I know what that means, but why don’t you tell me more?”

His interest throws me oddly off balance. It’s apparent from his tone and body language that he’s genuinely curious, waiting for a reply, and I’m surprised to find it somewhat intimidating.

“Like I said, I see a lot of doctors. Some are more collaborative and well-attuned than others. I prefer the collaborative approach.”

He is taking careful notes while I talk, looking up now and again to nod or encourage me to continue. He’s writing when he asks the question, “And what does that look like for you?” When I don’t reply right away, he looks up from his notes.

“Can you tell me about an experience you’ve had that didn’t feel collaborative to you? Maybe that’s a better way to ask the question.”

“Ah … yeah. I can.” I want to ask him how much time he has.

“A few years back I had some really strange, unsettling symptoms with low blood sugar. They felt entirely psychological without any accompanying physical symptoms, and it was really disorienting. I knew it was a blood sugar issue because the symptoms disappeared as soon as my numbers were back to normal. But I was reluctant to bring it up with my endocrinologist because I wasn’t sure how she would respond …”

I watch him carefully as I recount this experience. It remains one of the most upsetting, disappointing experiences I’ve had with a doctor I thought I could trust, and I’m nervous about sharing it. What if he doesn’t get it? What if he agrees with her?

His demeanor is engaged but dispassionate. I suppose that’s the sign of a good clinician, to be able to maintain a neutral affect no matter what someone tells you, but it puts me at a disadvantage because I can’t get a read on him. It turns out that his eyes are easier for me to read, and I’m encouraged by what I think I see there.

“… and, as it turns out, my reluctance was justified. Long story short, I decided it was something I needed to discuss with her, and when I did, her response – her only response – was to recommend that I consult a psychiatrist because it sounded ‘like schizophrenia or something.’”

Did his eyebrows just rise almost imperceptibly, or did I imagine it? He jots some notes on his legal pad and sits in thoughtful silence for a moment.

“Experiencing those symptoms must have been pretty scary for you.”

I nod quietly and clear my throat nervously.

“I’m sure it wasn’t easy for you to initiate that conversation.”

Thinking about it always made my blood boil. “I found a new doctor after that.” He nods in understanding.

“I’m sorry you had that experience. If we go ahead with an intake today, I’d like to hear more about it. For now, it gives me a little insight into your expectations.”

It’s very important to me that I know his reaction to what I’ve just told him. His reaction as a physician. I need to hear him validate in some way that my expectations weren’t unrealistic.

“May I ask how you might have approached that conversation?”

He straightens and pulls closer to the table, brows furrowed slightly. Then he takes a slow, deep breath, caps his pen, and looks at me.

“What’s clear to me is that your symptoms were upsetting and scary for you – I’m not sure when this hypoglycemic episode occurred – and that it continues to concern you. As I said, I’d like to know more both about your symptoms and your discussion with the endocrinologist, to get some further information. But I can pretty much guarantee that I would have asked more questions, for starters.”

After a beat, he adds, “Have I answered your question?”

I think he has. While he wasn’t explicit about anything, it’s clear to me that he would have done more probing, and more listening. That’s enough for me.

“I believe so. Thank you.”

“Tell me, when was your diabetes diagnosed?”

“Twenty-one years ago.”

“I see several patients with T1D. Tough condition to manage if you don’t have a partner in your physician. How’s that been for you more recently?”

“Luckily, my current endocrinologist is sensitive and practical and collaborative. She’s great.”

I hesitate for a second as I consider how transparent I want to be with him. I’ve seen enough to know that this guy is a good doctor – better attuned and interpersonally engaged than any of my current doctors – atypically good, I suspect.

In a moment of clarity, I decide that I’m done dancing around mediocre doctors to try and get my needs met. If I’m right and he’s as atypically good as I suspect, then my candor shouldn’t put him off. I take a deep breath before I continue.

“I’m going to be honest with you here.”

“Please.”

“Most doctors I’ve encountered, whether in general practice or urgent care settings, are alarmingly ignorant about Type 1 diabetes.”

He nods, raising his eyebrows to prompt me to keep talking.

“It’s exhausting. I’m not looking for someone to manage my diabetes. I’ve been doing it for over twenty years, under the direction of an endocrinologist. But T1D is a complex, demanding condition and I have lots of doctors and they don’t talk to one another. Nothing feels coordinated. It drives me nuts. I’d expect that level of scrutiny to make my life easier, not harder.”

The doctor has been listening intently, taking notes here and there, and I’m curious to know what he’s thinking given my less than flattering comments about doctors. Then again, he’s not a GP. That’s one of the reasons he made the shortlist.

“I just want a primary I can depend on to oversee and coordinate all of the moving parts. Help me with …”

I find myself at an unusual loss for words, and ultimately shake my head slowly in frustration as I close my eyes. Then his voice breaks in.

“Everything else?”

When I open my eyes I find him finishing a quick note, after which he looks up and raises his eyebrows.

“I get it. One of the reasons I start consultations this way is to get a feel for what it might be like to work with you, to manage your care. It’s as much about me learning about you as it is you sizing me up.”

Ah. So this is an interview of sorts. It hadn’t occurred to me that he might decline to take me on. I smile ruefully. “Well, then you’ve learned quite a bit.”

“I appreciate your candor. Truly. You know exactly what you’re looking for. That’s very important. And unusual.”

Of all the doctors in the world, why would God lead me here, into the hands – and they are great hands – of this one in particular? Is it His cosmic sense of humor at play? I’m not sure whether to offer a prayer of thanksgiving or deliverance.

“I try to be as transparent as I can when it comes to my clinical approach, and advise patients that they really need to have a clear sense of what they want and expect from a doctor-patient relationship. Typically they haven’t given this a great deal of thought. But if we’re not synced up in that way, we’re really working at cross purposes.”

He hesitates, studying my face. Perhaps trying to get a read on what I’m thinking. I’m not sure.

“So, what questions do you have for me?”

I have many, some of them wildly inappropriate. But I table those in favor of the ones I’ve prepared in advance.

“I know that you’re an internist. That’s one of the main reasons I wanted to meet with you. But in what areas are your board certifications?”

“That’s right. I’m an internist, board certified in cardiology and emergency medicine.”

“So, do you also treat patients as a specialist?”

“I could, but I choose not to. Cardiology is a big part of my day-to-day practice, but no, I don’t see patients as a cardiac specialist. I split my time between IM patients here in the clinic and work in the ED. I enjoy practicing trauma medicine, and I appreciate the change of pace. Two very different clinical approaches. Keeps me sharp.” He smiles in a low-key, modest kind of way.

“I see.”

Everything about this guy lines up with what I want in a doctor. He’s bright, articulate, personable, and inquisitive. He knows how to communicate. Even better, he appears to know how to listen. Yet, as I sit facing him across this table, I’m honestly not sure I can actually do this. I’ve seen women practitioners for years because the thought of seeing a male physician terrifies me.

“What else?”

My eyes shift. And land unwittingly on the black tubing of his stethoscope peeking out the top of one of his lab coat pockets. The sight of it makes my stomach clench and my mouth dry up. If I dwell on any of it too much my anxiety will get the better of me.

“Ah … well, now that you know what I’m looking for in a doctor, maybe you can tell me what you look for in a patient.”

I can tell by his expression that he wasn’t expecting this question. Still, protracted silence doesn’t seem to bother him, and I watch as he considers how to respond, head tilted slightly to the right.

“That’s a great question … that I want to answer carefully. Because as a physician I don’t generally get to choose who I treat. Certainly not in emergency medicine, anyway.”

He has a habit of stroking his chin between thumb and index finger when he’s thinking something over, drawing my attention to his hands. I imagine them exploring every inch of my body, his long fingers probing with gentle, practiced confidence.

“But we were also just talking about the importance of good alignment. Some people might call it rapport. That’s what I look for – or feel for. That’s probably a better way of putting it. In my experience, it doesn’t take very long to get a feel for that. But to answer your question more directly, I like working with patients who engage, ask questions, push back.”

Is this guy for real? Maybe I just imagined that.

“Really?”

“Absolutely. It keeps me humble, and I believe it yields better clinical outcomes.”

“I can’t tell you how refreshing that is to hear.”

He nods his head in acknowledgement.

“I’m glad. Other questions?”

“Yes. Do you and your colleagues share patients?”

I want to know whether or not I can actually count on seeing him when I need something, as opposed to just once a year at an annual physical. I don’t want to get stuck seeing an NP more than I see him.

“I need a little more information to answer that. The short answer is yes, sometimes. Can you be more specific?”

“I want to know how available you are for appointments outside of the regular annual check-ups? If other needs arise, will I be able to get in to see you, or will I have to accept whoever happens to be available?”

“Ah, I understand. I can tell you that if there’s any way for me to see you in these situations, I will. Our team takes continuity of care very seriously and views it as an essential part of building strong working relationships with patients. Will there be times when I can’t see you? Yes. I need to be up front about that. But we do our very best to try and accommodate our patients. And given your diabetes, I’ll already be seeing you more than once a year for an annual physical. More likely 2-3 times a year. I hope that answers your question.”

“It does, thank you.”

“Other questions for me?”

“I don’t think so, other than … what happens now? Are we a match?”

The words spill out of my mouth before I can stop them, and an amused expression flashes across his face as he pulls up to the table to address me.

“Ms. Mills, based on our discussion I’d be happy to take you on as a patient. But the decision is ultimately yours. ”

Before my hyperactive brain has time to fill me with doubt, I respond.

“Yes, I’d like to proceed. So … what happens now?”

“If you’re ready, we’ll get started with the intake, which usually lasts around two hours. History and physical comes next.”

In an instant, reality bears down on me like a ton of bricks. My brain slowly processes the word “physical,” as my fight or flight response teeters on the edge of activation.

“We’ll spend twenty or thirty minutes discussing your medical history, family history, and any long-term goals you have concerning your health, and then transfer to an exam room.”

I am going to have to undress. Obviously.

“We’ll debrief afterwards, decide what’s next. That’s generally how it works.”

I’m not sure I can do this.