This holds special meaning for those of us in emergency medicine. I think often of patients and their families with whom I had a fleeting encounter during one of the worst moments of their lives. I wonder what happened and how they are today. Even as I know they don't remember me or probably even want to ever see me again.
All doctors should realize how much of an impact the front office staff makes. You can be the best doctor in the world...if you have nasty tempered (usually) female staff guarding the gates, your patients won't return. As I was leaving my cardiologist, I thanked the front staff. They are the most capable, friendly, and proactive staff. I told the cardiologist that the ladies out front is the gem of the practice. And said the same to the ladies.
Here's another doctor inaccessibility anecdote: My husband is looking to switch GI docs or at least consult a second one because his issue has not been helped by the one he has seen for years. He was just told that the doctor he wanted to see "does not do second opinions, and if you have seen another GI doc --any GI doc--within the past year, he will not see you." Is this common?
Personally, I find that outrageous. Not sure what his motivation would be as this is a perfect opportunity to be the kind of doctor who addresses the reasons patients ask for a second opinion.
Thank you for this article. As a nurse, I have patients that distinctly stand out in my mind, and wonder what happened after they left the hospital. Your article resonated with me.
As for feedback, my mother told me a story many years ago that has stayed with me, and influenced me to give feedback. Shortly after graduating nursing school, she found out that one of the favorite instructors was leaving. She told that instructor then how much she meant to the students. The instructor's response was that if she had known, she wouldn't have left.
I have given both positive and constructive feedback to colleagues and my doctors, as well as to teachers, and others who had a big influence in my life. Positive feedback is always welcome and appreciated. Constructive feedback may or may not be taken well, but it makes me feel better and closes the loop for me.
At times I treat my doctors as service providers. I have noticed their reaction.
I had one ask me once "do I have anything to say about your treatment?"
I said "of course, what would you suggest?"
He said, "Nothing different, you have it right."
I admit it's a little unsettling for an MD when the patient takes command of their own healthcare choices even tho that's what they want us to do.
Once this same doc tried to get me to do a cancer workup because my WBC was high. I told him my WBC had always been about that level and the normal threshold must have changed. He agreed it had.
I don't doubt your compassion or your abilities, however, there are legitimate reasons for "ghosting" a doctor. I left my specialist after a visit that included: An arrogant response when I asked for the risk associated with a procedure (that he had just performed); he entered false "boiler plate" into my portal (incorrectly stating that he had thoroughly discussed the pros and cons of the procedure); he claimed that I had aFib (but I did not); and he became testy when I ask for the primary studies used to approve the drug that I was taking. There was nothing to be gained by even telling him goodbye. Result: I did my homework and found someone far better.
Really enjoyed this, thanks for sharing!! And I think the feedback part applies to so many professions — especially in teaching. Sometimes the nature of work is that we don’t know the impact it has, though it would be nice to know…
I love this. It resonates. I often desire my patients were more able to express their dissatifaction with my care. In my practice such an expectaion is unreasonable. People would almost never shame thier dcotor. Cutural boundaries make that unforgiveable.
Thank you for revisiting this essay. It stays with the reader because it gives language to something many people sense but rarely name:
the quiet way relationships in medicine can end without anyone quite noticing.
The idea of a “ghost patient panel” is both moving and unsettling. It captures how modern healthcare, for all its data and documentation, often fails to mark endings.
A patient’s name still appears in a record, yet the relationship itself has vanished. That moment - when a familiar name surfaces and you realize you no longer know what became of that person - carries real emotional weight.
What comes through clearly is how little feedback doctors often receive.
Patients leave for many reasons: insurance changes, moves, dissatisfaction, or death. Most of the time, no explanation is given.
The silence creates a distorted picture. Doctors mainly hear from people who stay, which can make it easy to assume things are going well when, in reality, important information is missing.
Your honesty about this blind spot is refreshing and generous.
The story of RP illustrates something deeper than medical care alone. The relationship you describe was not just about managing illnesses, but about shared time, loss, and human connection. When such a relationship ends without acknowledgment, it can feel less like a routine transition and more like an unresolved goodbye. That feeling is understandable, and likely familiar to many readers, whether they are patients or professionals.
I also smiled at the diesel Jetta aside. There is something fitting about a car known for longevity, efficiency, and quietly doing its job for hundreds of thousands of miles becoming the trigger for memory. Like good primary care, a diesel Jetta is rarely flashy, occasionally misunderstood, and deeply appreciated by those who know what it’s built for.
Your reflection also touches on how hard it is to speak up in medical settings. The example of your own surgical experience shows how even small moments can matter, and how power dynamics often keep people silent. Most patients do not complain; they simply move on. The result is a system where absence speaks louder than words, but is much harder to interpret.
What makes this essay resonate is that it does not try to fix the problem. Instead, it invites us to sit with the uncertainty.
The ghost patient panel becomes a mirror - not only of how healthcare systems work, but of how human relationships can fade without closure.
In naming that experience so plainly, you offer readers a chance to reflect on care, loss, and connection in a more honest and humane way.
In my experiences in health care I think communication which includes good listening skills and respect create the best relationships. Doctors often lose patients not bc they make mistakes or are bad (although we do see those) but because they didn't really meet the emotional or communication needs of the patient. they didnt "hear" them. Medicine is an art and it's not just the science of chemistry but the art and science of human relationships.
Oh I forgot one more inaccessible doctor story to add to my long comment below. A few years back my husband had an episode for which he was sent to get a brain MRI. He was told the results showed that he might have had a mini-stroke, but to discuss that he would have to consult a new neurologist who specialized in strokes. And for that there would be a 6-month wait. It's gotten to be really crazy. I'm not sure if it's totally due to the pandemic.
As a PT I understand this piece well. It's funny how I can think of a patient and usually within 24 hours I hear from them. I wish I could do that with the winning lottery numbers. And I have removed patients from my practice who were abusive to myself or the staff. That took a lot of growth. And when we lose a patient I am aware of, I do reach out and ask them for the brutal truth. I would say 50-75% of the time the patient responds. I learn a lot and my practice is better for it. The hard truth is just that sometimes, hard. And only positive feedback isn't reality based doctoring. Here is to 2026 and being open to it all, the good, the bad and the ugly. Heck, the wonderful and glorious too!
There is a certain quality of nostalgia to this piece. Oh, the days when patients had an abundant choice of doctors, when we might have changed only because of an insurance switch or a move. I live in NYC where there is a huge number of doctors and hospitals, but lately, post-pandemic, getting an appointment with a new one or even an established one is increasingly difficult.
In the past few years, the internist my husband and I had been seeing for a decade and were devoted to left the practice to join an "elite" concierge outfit--one with a membership fee only the very wealthy could pay. We were assigned different doctors in that hospital-affiliated practice, and when I called to ask if I could be switched to someone different than the doctor I was assigned to--partly because the one I was assigned to said "I'm not taking Dr. XXX's patients!" the first time I saw her on a same-day emergency basis-- the reply was "All our doctors at all our locations are not taking new patients. Either you go with Dr. XXXX or you can see the residents who staff our clinic."
When I wanted to switch to a new endocrinologist, having disliked the one I had seen via telehealth during the pandemic, I could not find any who accepted new (traditional) Medicare patients and did not entail a year-long wait for an appointment. At any health system in NYC! I gave up looking. And when my husband got tested for signs of Alzheimer's via a spinal tap, he was told he had to wait 6 months for an in-person visit to receive the results! True story. Luckily a nurse practitioner he reached by phone took pity on him and tipped him off that the test was negative.
Also--someone here mentioned being offended when doctors write "patient denied" or "patient refused" in the medical record. I once was fired/fired an internist when I noticed she wrote "patient refused XXX vaccination" when in fact she and I had agreed that I would wait for that one since I was having another on that day. I assumed it was "cover your butt" language, but it still annoyed me because it was inaccurate. When I asked her about it, she told me to find another doctor. So I did. That was in the olden times, when it was easier to do!
Physicians can knowingly or inadvertently impact the care you receive from others by writing their opinions about you or framing that you declines something in a way that "spooks" another physician. Over time care can be degraded. I had this happen once and I had to tell the new physician directly that the previous one was not a good fit and I did not appreciate the way he wrote his notes. I told him how a patients health is negatively impacted by these types of notes and that I hoped he would be more open and kind in his notes if we had a disagreement. He was- mostly because his notes were the most brief I have ever seen! I loved that.
It seems a big miss not to tell the GP that the patient has passed. In theory it would allow you to add someone to your list that needs a doctor. It might be managed differently in different places but I imagine you might have a certain number of patient on the list that is manageable. I have heard stories of doctors dropping patients off their list if they don't see them for a long enough time leaving that person to look for a doctor whenever they do finally decide they need one. Even when I wasn't wanting to see a doctor I made sure to get an annual not for my orthotics so he knew I existed.
My clinic gets paid some amount for having me on the list even if I never go in. In this case I'd always assumed they would be informed someway.
I did fire on doctor once. Instead of telling her I didn't think she would ever help me with anything I politely as I could suggested we weren't a good match and I'd prefer a male doctor and asked if one in the clinic was taking patients. Two polite emails later and I had a new doctor. Being polite saved me figuring out how to navigate the government bureaucracy to officially remove my name from the clinic and get to the bottom of a wait list elsewhere. I don't think her gender was the underlying problem but it seemed nicer than telling her that I didn't trust her to ever help me. I don't think my actual feedback would have actually helped either of us. I try to be as friendly as I can with doctors as I found it may not change the outcome but I feel better being friendly, especially if I have pain to manage.
This holds special meaning for those of us in emergency medicine. I think often of patients and their families with whom I had a fleeting encounter during one of the worst moments of their lives. I wonder what happened and how they are today. Even as I know they don't remember me or probably even want to ever see me again.
All doctors should realize how much of an impact the front office staff makes. You can be the best doctor in the world...if you have nasty tempered (usually) female staff guarding the gates, your patients won't return. As I was leaving my cardiologist, I thanked the front staff. They are the most capable, friendly, and proactive staff. I told the cardiologist that the ladies out front is the gem of the practice. And said the same to the ladies.
Here's another doctor inaccessibility anecdote: My husband is looking to switch GI docs or at least consult a second one because his issue has not been helped by the one he has seen for years. He was just told that the doctor he wanted to see "does not do second opinions, and if you have seen another GI doc --any GI doc--within the past year, he will not see you." Is this common?
Personally, I find that outrageous. Not sure what his motivation would be as this is a perfect opportunity to be the kind of doctor who addresses the reasons patients ask for a second opinion.
Thank you for this article. As a nurse, I have patients that distinctly stand out in my mind, and wonder what happened after they left the hospital. Your article resonated with me.
As for feedback, my mother told me a story many years ago that has stayed with me, and influenced me to give feedback. Shortly after graduating nursing school, she found out that one of the favorite instructors was leaving. She told that instructor then how much she meant to the students. The instructor's response was that if she had known, she wouldn't have left.
I have given both positive and constructive feedback to colleagues and my doctors, as well as to teachers, and others who had a big influence in my life. Positive feedback is always welcome and appreciated. Constructive feedback may or may not be taken well, but it makes me feel better and closes the loop for me.
At times I treat my doctors as service providers. I have noticed their reaction.
I had one ask me once "do I have anything to say about your treatment?"
I said "of course, what would you suggest?"
He said, "Nothing different, you have it right."
I admit it's a little unsettling for an MD when the patient takes command of their own healthcare choices even tho that's what they want us to do.
Once this same doc tried to get me to do a cancer workup because my WBC was high. I told him my WBC had always been about that level and the normal threshold must have changed. He agreed it had.
Our relationship has improved since then.
I don't doubt your compassion or your abilities, however, there are legitimate reasons for "ghosting" a doctor. I left my specialist after a visit that included: An arrogant response when I asked for the risk associated with a procedure (that he had just performed); he entered false "boiler plate" into my portal (incorrectly stating that he had thoroughly discussed the pros and cons of the procedure); he claimed that I had aFib (but I did not); and he became testy when I ask for the primary studies used to approve the drug that I was taking. There was nothing to be gained by even telling him goodbye. Result: I did my homework and found someone far better.
Not enough doctors like you!
Really enjoyed this, thanks for sharing!! And I think the feedback part applies to so many professions — especially in teaching. Sometimes the nature of work is that we don’t know the impact it has, though it would be nice to know…
I love this. It resonates. I often desire my patients were more able to express their dissatifaction with my care. In my practice such an expectaion is unreasonable. People would almost never shame thier dcotor. Cutural boundaries make that unforgiveable.
Thank you for revisiting this essay. It stays with the reader because it gives language to something many people sense but rarely name:
the quiet way relationships in medicine can end without anyone quite noticing.
The idea of a “ghost patient panel” is both moving and unsettling. It captures how modern healthcare, for all its data and documentation, often fails to mark endings.
A patient’s name still appears in a record, yet the relationship itself has vanished. That moment - when a familiar name surfaces and you realize you no longer know what became of that person - carries real emotional weight.
What comes through clearly is how little feedback doctors often receive.
Patients leave for many reasons: insurance changes, moves, dissatisfaction, or death. Most of the time, no explanation is given.
The silence creates a distorted picture. Doctors mainly hear from people who stay, which can make it easy to assume things are going well when, in reality, important information is missing.
Your honesty about this blind spot is refreshing and generous.
The story of RP illustrates something deeper than medical care alone. The relationship you describe was not just about managing illnesses, but about shared time, loss, and human connection. When such a relationship ends without acknowledgment, it can feel less like a routine transition and more like an unresolved goodbye. That feeling is understandable, and likely familiar to many readers, whether they are patients or professionals.
I also smiled at the diesel Jetta aside. There is something fitting about a car known for longevity, efficiency, and quietly doing its job for hundreds of thousands of miles becoming the trigger for memory. Like good primary care, a diesel Jetta is rarely flashy, occasionally misunderstood, and deeply appreciated by those who know what it’s built for.
Your reflection also touches on how hard it is to speak up in medical settings. The example of your own surgical experience shows how even small moments can matter, and how power dynamics often keep people silent. Most patients do not complain; they simply move on. The result is a system where absence speaks louder than words, but is much harder to interpret.
What makes this essay resonate is that it does not try to fix the problem. Instead, it invites us to sit with the uncertainty.
The ghost patient panel becomes a mirror - not only of how healthcare systems work, but of how human relationships can fade without closure.
In naming that experience so plainly, you offer readers a chance to reflect on care, loss, and connection in a more honest and humane way.
Thank you.
Wow, thanks for that thoughtful comment.
I lost 2 patients, husband and wife, devout Christians, when they heard I was leading a meditation class.
Similar has happened to me.
In my experiences in health care I think communication which includes good listening skills and respect create the best relationships. Doctors often lose patients not bc they make mistakes or are bad (although we do see those) but because they didn't really meet the emotional or communication needs of the patient. they didnt "hear" them. Medicine is an art and it's not just the science of chemistry but the art and science of human relationships.
Oh I forgot one more inaccessible doctor story to add to my long comment below. A few years back my husband had an episode for which he was sent to get a brain MRI. He was told the results showed that he might have had a mini-stroke, but to discuss that he would have to consult a new neurologist who specialized in strokes. And for that there would be a 6-month wait. It's gotten to be really crazy. I'm not sure if it's totally due to the pandemic.
Appalling.
As a PT I understand this piece well. It's funny how I can think of a patient and usually within 24 hours I hear from them. I wish I could do that with the winning lottery numbers. And I have removed patients from my practice who were abusive to myself or the staff. That took a lot of growth. And when we lose a patient I am aware of, I do reach out and ask them for the brutal truth. I would say 50-75% of the time the patient responds. I learn a lot and my practice is better for it. The hard truth is just that sometimes, hard. And only positive feedback isn't reality based doctoring. Here is to 2026 and being open to it all, the good, the bad and the ugly. Heck, the wonderful and glorious too!
There is a certain quality of nostalgia to this piece. Oh, the days when patients had an abundant choice of doctors, when we might have changed only because of an insurance switch or a move. I live in NYC where there is a huge number of doctors and hospitals, but lately, post-pandemic, getting an appointment with a new one or even an established one is increasingly difficult.
In the past few years, the internist my husband and I had been seeing for a decade and were devoted to left the practice to join an "elite" concierge outfit--one with a membership fee only the very wealthy could pay. We were assigned different doctors in that hospital-affiliated practice, and when I called to ask if I could be switched to someone different than the doctor I was assigned to--partly because the one I was assigned to said "I'm not taking Dr. XXX's patients!" the first time I saw her on a same-day emergency basis-- the reply was "All our doctors at all our locations are not taking new patients. Either you go with Dr. XXXX or you can see the residents who staff our clinic."
When I wanted to switch to a new endocrinologist, having disliked the one I had seen via telehealth during the pandemic, I could not find any who accepted new (traditional) Medicare patients and did not entail a year-long wait for an appointment. At any health system in NYC! I gave up looking. And when my husband got tested for signs of Alzheimer's via a spinal tap, he was told he had to wait 6 months for an in-person visit to receive the results! True story. Luckily a nurse practitioner he reached by phone took pity on him and tipped him off that the test was negative.
Also--someone here mentioned being offended when doctors write "patient denied" or "patient refused" in the medical record. I once was fired/fired an internist when I noticed she wrote "patient refused XXX vaccination" when in fact she and I had agreed that I would wait for that one since I was having another on that day. I assumed it was "cover your butt" language, but it still annoyed me because it was inaccurate. When I asked her about it, she told me to find another doctor. So I did. That was in the olden times, when it was easier to do!
Physicians can knowingly or inadvertently impact the care you receive from others by writing their opinions about you or framing that you declines something in a way that "spooks" another physician. Over time care can be degraded. I had this happen once and I had to tell the new physician directly that the previous one was not a good fit and I did not appreciate the way he wrote his notes. I told him how a patients health is negatively impacted by these types of notes and that I hoped he would be more open and kind in his notes if we had a disagreement. He was- mostly because his notes were the most brief I have ever seen! I loved that.
Makes one think of the classic Seinfeld issue with Elaine's chart as a "difficult patient."
https://www.youtube.com/watch?v=ZJ2msARQsKU
Thanks for posting--love it!
It seems a big miss not to tell the GP that the patient has passed. In theory it would allow you to add someone to your list that needs a doctor. It might be managed differently in different places but I imagine you might have a certain number of patient on the list that is manageable. I have heard stories of doctors dropping patients off their list if they don't see them for a long enough time leaving that person to look for a doctor whenever they do finally decide they need one. Even when I wasn't wanting to see a doctor I made sure to get an annual not for my orthotics so he knew I existed.
My clinic gets paid some amount for having me on the list even if I never go in. In this case I'd always assumed they would be informed someway.
I did fire on doctor once. Instead of telling her I didn't think she would ever help me with anything I politely as I could suggested we weren't a good match and I'd prefer a male doctor and asked if one in the clinic was taking patients. Two polite emails later and I had a new doctor. Being polite saved me figuring out how to navigate the government bureaucracy to officially remove my name from the clinic and get to the bottom of a wait list elsewhere. I don't think her gender was the underlying problem but it seemed nicer than telling her that I didn't trust her to ever help me. I don't think my actual feedback would have actually helped either of us. I try to be as friendly as I can with doctors as I found it may not change the outcome but I feel better being friendly, especially if I have pain to manage.