The Loss of Letters

The Optimized Doctor

Jeffrey Benabio, MD, MBA


February 03, 2023

My desk looks nothing like my grandfather’s. It stands about mid-abdomen high and has a small surface, perhaps just enough for the monitor and a mug. Yes, I can move it up and down (thank you 21st century), but it has no drawers. It is lean and immaculate, but it has no soul.

Jeffrey Benabio, MD, MBA

My grandfather sat at a large oak desk with three drawers on each side. Each was so heavy you had to be at least 6 years old to pull one open for exploring the contents inside. The desk surface was vast and although immobile, it had a greenish leather blotter for writing. Alongside his pile of correspondences was a treasure for those of us tall enough to get it: A heavy brass letter opener. It came, I believe, with a secretary who would open his letters and stack them neatly before placing this sometimes-pirate’s-sword far enough away from the edge for us to not reach it.

Upon my skinny, adaptable desk the other day sat a white envelope that was hand addressed to me. It was postmarked more than 2 weeks before as it had been waylaid in Endocrinology before being couriered to the rightful recipient. It had not been opened. Nor did I have any way to do so gracefully. I tore it apart with a fat finger while clicking through path reports that just arrived in my inbox.

Dear Dr. Benabio,
Thank you for saving my life. I had been suffering like Job with this maddening itch for months and it was you who finally gave me relief. Please forgive my questioning your diagnosis at first. I had not wanted to believe that this could be scabies and hadn’t realized it was possible to catch it from my father, who has since passed. It has been a difficult time and made much worse by the intense itching and lack of sleep. Thanks to you, I can finally get some rest. I feel like a normal human once again. I’ve now had my house cleaned, which needed it dearly anyway, and I’ve returned to gardening. I’m grateful for your care and expertise. Also, would you please refill my triamcinolone acetonide 0.1% cream? I’m nearly out.

Kind Regards,


I sat down, my desk nearly at eye level now, and felt the paper in my hand. It was white, college ruled paper and a blue ink pen. She carefully looped her “y’s” and crossed her “t’s.” Not one cross out. She thought about each sentence before transcribing it. The paper once sat on her desk, touched her fingers and the envelope sealed with her saliva. It was not filled with trifling requests or complaints. It was not efficient, but it was more than just communication. She took the time to choose the words to capture her emotion and express her gratitude. It was respectful, dignified, decidedly nondigital. For a brief moment I thought I might write back, but quickly realized that was impractical. I knew I wouldn’t make the time to do so. I wish I had.

Having no drawers to save it, I held it up with just a corner of the page resting on my desk and scribbled in black ink “Reviewed. Please scan to media file. 12/8/22. JAB”

Dr. Benabio is director of Healthcare Transformation and chief of dermatology at Kaiser Permanente San Diego. The opinions expressed in this column are his own and do not represent those of Kaiser Permanente. Dr. Benabio is @Dermdoc on Twitter. Write to him at

This article originally appeared on, part of the Medscape Professional Network.

The opinions expressed in this column are Dr Benabio's own and do not represent those of Kaiser Permanente. Dr Benabio is @Dermdoc on Twitter.

Follow Medscape on Facebook, Twitter, Instagram, and YouTube


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.