Doc Season

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It may not be rabbit season or duck season but it definitely seems to be doc season, especially as the next version of the American Health Care Act is unveiled today. This (and the Affordable Care Act which preceded it) is not about patients — it is about how to keep doctors and the health care industry under reasonable cost control and maintain some semblance of quality service.

Physicians are lined up squarely in the gun sights of the media, government agencies and legislators, as well as our employers and coworkers, not to mention our own professional organizations, our Board Certifying bodies, and our dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim. It’s not enough any more to wear a bullet proof white coat. It’s driving doctors to hang up their stethoscope much earlier than they expected just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too over-committed, uncaring, egotistical, close-minded, inflexible, and especially, and most annoyingly – perpetually late.

One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule. Doctors do run late and patients wait. And wait. And wait some more. Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character as well as their salary compensation.  It is considered basic Customer Service 101.

I admit I’m one of those late doctors. I don’t share the reasons why I’m late with my patients as I enter the exam room apologizing for my tardiness. Taking time to explain takes time away from the task at hand: taking care of the person sitting or lying in front of me. At that moment, they are the most important person in the world to me. More important than the six waiting to see me, more important than the several dozen emails and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message from my daughter from school or the worry I carry about my dying mother.

I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources. I don’t earn more by seeing more patients. There is a work load that I’m expected to carry and my day doesn’t end until that work is done. Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch. I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.

The patient who is angry about waiting for me to arrive in the exam room can’t know that I’m late because the previous patient just found out that her upset stomach was caused by an unplanned and unwanted pregnancy. Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair. Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection is showing signs of a pulmonary embolism caused by oral contraceptives. Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men, or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to a suspicion of undiagnosed chronic hepatitis.

Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs. Quite the opposite. We strive to make our patients feel respected, listened to and cared for. Most days it is a challenge to do that well and stay on time. For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time. The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.”

Patients need to bring a book or catch up on correspondence,  bring knitting, schedule for the first appointment of the day. They also need to bring along a dose of charitable grace when they see how crowded the waiting room is. It might help to know you are not alone in your worry and misery.

But your doctor and health care team is very alone, scrambling to do the very best healing they can in the time available.

I’m not hanging my stethoscope up anytime soon though some days I’m so weary by the end, I’m not sure my brain between the ear tips is still functioning. I don’t wear a bullet proof white coat since I refuse to be defensive. If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed to the needs of the “most important person in the whole world.”

And that human being deserves every minute I can give them.

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chelanshadows

10 thoughts on “Doc Season

  1. Wonderful post! So needed. You are truly the exceptional doctor. Unfortunately many run Very late and it’s not because of deep caring and personalization with each patient.

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  2. Love this post. Dr Season. It really makes me consider your perspective. Heartfelt thanks for all you do. I feel my doctor really does think I’m the most important person in her world when she comes in the room — or more importantly my kids are. Extending grace to her helps me feel more like I can help her in some small way when she always takes such good care of us. Thank you for your posts & giving us a glimpse into your world.

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  3. Emily,
    The best allergist I had retired at 92. I was so thankful for his diligence. After he died the practice forced me out saying I did not have any allergies. In this day I take care of myself according to all that I learned from him and his nurse. I am so thankful…My environmental allergies are challenging and were worse this year affecting my digestive system again, but the Lord is good and provides for me in new ways that I never expected. I am rue to go through the allergy testing yet again so have not sought out another allergist. The Lord bless you in your work….there are few and far between General Practitioners nowadays who have the ‘pursuit of excellence.’

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  4. Yes, my father got a letter this week from his doctor telling us he is retiring the end of the year.
    My frustration is with Big Pharma. I sometimes think they are running the medical decisions today.
    After receiving the letter, I called our local health physician network to ask them to try and bring in more doctors interested in integrative medicine or functional medicine doctors.
    I just feel like we have a sickcare instead of a healthcare system in our country.
    I wish as a country we would focus more on prevention and nutrition…
    Let food be your medicine…
    I’ve read this several times in the last several years as I have tried
    to become more focused on exercise and good nutrition for my own well being.
    Blessings to you and your patients as you continue to serve them.
    Linda

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  5. I’m so appreciative of you and others like you, Emily. I feel blessed by the doctors my husband and I have. I understand how very busy they are, because a non-critical appointment with them is usually a month out. But If we really need to see one of them right away, they will work us in. We may end up being the last appointment of the day, finding our doctor exhausted but patient and caring, even though he/she still has so many reports to write and other responsibilities that we patients are unaware of, before they can go home to their family and dinner. I see no sense in getting angry with them. The waiting room is a good place to strike up interesting conversations and to discover that other waiting patients have life stories that add to the color and flavor of human living.

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  6. Thank you for putting this into perspective – and thank you for what you do.

    My internist is a gem – and always running late. On my first visit to her, the nurse introduced herself, which was very nice. She said that Dr. P almost always runs late, so I should expect this, and she said Dr. P spends a lot of time with patients and is thorough. This was good to know. Dr. P was late – and she was very attentive and thorough, and ended up running a specific test on me that revealed a deficiency, easily remedied but never checked by any other doctor. I have sent several her way, tell them the same thing I was told, and each recommendation has stayed with her. All that to say, sometimes knowing what the expectations are help – and I always bring a book! 🙂

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  7. Thanks for expanding my knowledge and understanding by sharing your story. We need to enter into each others stories and only then will we be able to truly extend empathy. Thank You!

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  8. It seems we are all on the same hamster wheel, chasing (or being chased by) “productivity” and almost without exception it has seriously diminished quality of life in the contemporary workplace. To those who remember the good old days of 45-minute lunch hours, fifteen minutes and a burp is something we might sooner skip altogether. And that’s just for starters. I think it all began when “Personnel”
    became “Human Resources.” An ominous term, in retrospect.

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