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"You never know," said the petite, attractive woman standing in front of me, an optimistic note in her voice. "You could always get cancer and die. Maybe the next receptionist will be more understanding. You wouldn't believe the number of young people I know who die of cancer."

These comments marked the end of a lengthy exchange between me - a gatekeeper, heartbreaker, everyday administrator for a family physician - and the fortysomething woman who was a friend of a current patient. She desperately wanted to become a new patient in our practice.

Working in health care over the past six years has been fascinating as I learn about medical conditions and examine the system from the inside out. While much of my day is filled with administrative tasks, I am in constant contact with the public. Patients, family members, pharmacists and hospital staff all contribute to my enjoyment of my work, but no one is as interesting as the potential patient-to-be.

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By all accounts, I am the office softie. Some may even describe me as a bit of a sucker. I hear dozens of stories a week - sometimes in a single day - from people and families in need of a physician. They tug at my heartstrings and I wish I could help them all.

No matter their story, I feel compelled to listen for a minute or two. I know how difficult it is to find a great family doctor and spent years without one myself. So it's a miserable, thankless job to turn away all these potential patients, and not everyone responds nicely to my polite refusals.

We get cold calls, drop-ins, friends of friends, family members, people who have languished in walk-in clinics, seniors who never expected to outlive their GP, people who are new to town, people who dislike their current GP, people who want more convenience, people who live just around the corner.

They come from all walks of life, all ages, races and professions. There are those who quickly hang up, dejected, when I explain that we are not only full, but also operate on reduced hours. Some sadly ask if I know who might be accepting, while others rant and rave when I say I can't help.

Some ask if I can squeeze in "just one more," like jamming one more shirt into a swollen suitcase. Others smoothly suggest that they could be a replacement if a current patient were to die. I just as smoothly respond that our patients never pass away, and surely they must know that as they have heard such wonderful things about the practice.

My favourite are a group I call the "bait-and-switchers," who account for about a quarter of the cold calls. Their pitch begins with a number of advantages as to why they should be accepted - they are in excellent health and only need a family doctor for a mere checkup, they have never been sick a day in their life and promise to be no trouble at all.

When I gently, respectfully explain that it is just not possible to accept them, they explode. Who is going to renew their cholesterol/blood pressure/high-risk narcotic medications? They need to be seen in a day/week/month to remove their stitches/deliver their baby/follow up on their heart attack.

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If I suggest an alternative elsewhere, they are aghast. How are they supposed to get "all the way" to a practice that's a 15-minute drive away?

Yet if they only need to be seen once a year, surely they could arrange one bus ride every 12 months? I've never actually said that, and my tongue is sore from the proverbial biting.

Believe it or not, we care deeply about the lack of family physicians, and many doctors and staff wish they could accept more patients and do more to help. But practices are bulging at the seams, patients complain bitterly about the time it takes to get in for a checkup and many GPs are trying to scale back their hours with a future eye on retirement.

We know just how many people are in a vulnerable position and it feels horrible to turn them away, even those who are less than polite. When I have a quiet moment and the caller is friendly, I often make a suggestion or two - excellent walk-in clinics, practices that may be accepting or provincial programs designed to connect patients with a doctor. Some people are exceedingly grateful and I wish I could help them even more. Others blame me for everything from walk-in clinic wait times to their own blistering bunions and hang up in disgust.

The woman who sincerely hoped I would die so she could get a new gatekeeper was truly one of a kind. When I think about that encounter, I feel a combination of incredulous hilarity and chilling disbelief. She would not take no for an answer and persisted to the point of cheerfully wishing me an early death from cancer.

"I hope for my sake that you're wrong," I replied and firmly suggested she leave.

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She tossed me a withering look and haughtily stalked away, but not before accosting my co-worker and asking one more time if the practice was accepting. "No, sorry."

"Well," she said as she walked out the door, "at least you treated me humanely, unlike the other one there."

I caught my co-worker's eye for a second and we shared a knowing look. I had just a minute to take a deep breath before the phone started to ring.



Vanessa Chiasson lives in Ottawa.

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