(4) ------------The Nurse Ritual -----------------

A visit to a Kaiser 'primary care physician' always follows a predictable course: first, a nurse introduces herself to you; then she takes you to the preliminary exam area where she records your weight, your temperature, and your blood oxygenation level. Except for the weight, which is obvious to you as you stand on the scale, she calls out the values as she encounters them. This nurse did not bother to do that. Also, she did not take a blood oxygen reading. I became somewhat uneasy at her failure to take BO and her failure to communicate temperature information. As the patient I have a right to this information and I should not have to ask for it.

In the exam room I asked her why she had not taken my blood oxygen. (Blood Oxygen, by the way, is read by a device she attaches to one of your fingertips. It somewhat resembles a plastic clothespin, and probably measures the color of your blood spectroscopically. The measurment takes about 5 seconds, and mine is always in the mid-90s.)

She replied that 'somebody must have borrowed the device.' I noted that that information, in this particular case, was important. She agreed. Soon after leaving the exam room she returned with a BO device and took my BO measurment. She did not tell me what it was. I asked her what it was and she replied that it was 89. Close. She did not tell me what my blood pressure reading was but I could read it on her exam sheet. I became more and more uncomfortable.

She went through most of the remaining ritual, then left the room. I amused myself for several minutes by reading some of the stuff fixed to the wall of the exam room as I waited for the physician to appear. I also turned on my voice recorder at this point, and slipped it into my shirt pocket. It is standard practice for me to record all verbal transactions with Kaiser Permanente physicians, and I will explain why, later.