Me: So it has been 2 weeks since we made the medication changes. How do you feel?
Patient: I feel better, but still getting chest pain. I am hoping it is acid reflux. Do you guys still want me to be on medical leave?
Me: I am afraid that we cannot send you back to work in your condition. Have you put any thought to any of the procedures I mentioned last visit? What about the smoking situation? Are you still on the smoking cessation medications?
Patient: I do not want to go through another procedure. Yes, I still smoke. I stopped the meds because it made me sick.
Me: You are not giving us many options.
Patient: If you write a letter to HR stating I cannot perform certain things at work that cause chest pain, they said I could possibly return to work with accomodations.
Me: What causes the chest pain?
Patient: Standing and walking
Me: Remind me, what do you do for work again?
Patient: Night shift security guard
Me: If you cannot stand or walk you really would not be making any area secure.
Patient: Good point