Why I’m Running Late

wildbunny3

 

duckchelan2

 

It may not be rabbit season or duck season but it definitely seems to be doctor season.  Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own 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 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 overcommitted, uncaring, egotistical, close minded,  inflexible, and especially– 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.

I admit I’m one of those late doctors.  Perpetually 20-30 minutes behind.

I don’t share the reasons why I’m late with my patients as we sit down together in the exam room but I do apologize for my tardiness.  Taking time to explain why takes time away from the task at hand: taking care of the person sitting or lying in front of me.   At that moment, that is the most important person in the world to me.  More important than the six waiting to see me, more important than the dozens of emails, electronic portal messages 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 of concern from my daughter or the worry I have about a ill relative.

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 three patients before them I saw a woman who 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, but is showing potential 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 suspected 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, 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 is very alone, scrambling to do the very best healing he or she can in the time available.

I’m not yet hanging my stethoscope up though some days I’m so weary by the end, I’m not sure my brain between the ear buds 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 for that moment to the needs of the “most important person in the whole world.”

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

 

chelanducklings5

 

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The Doctor’s Waiting Room Vladimir Makovsky 1870

9 thoughts on “Why I’m Running Late

  1. An excellent read. We have an excellent doctor as well who is patient and understanding and very caring. We don’t look forward to his ultimate retirement. Perhaps for some of us who worked in high stress jobs with juggling many balls at once we understand the demands and are patient. I wish others would be more tolerant of many things and not be in such a constant state of “rushing” from task to task.

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  2. Sounds similar to what has happened / is happening to professionally prepared educators. I am now retired as an educator. But the deceptive criticisms, hounding, and fault-finding were/are incessant, despite our dedication. I prospered (and, therefore, my students did also) because I was blessed with a wonderful administrator.

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  3. Thank you for explaining all these reasons. Here in Canada it is much the same. The climate of criticism is very undermining. Encouragement, patience and appreciation should be showered on you for your caring.

    Liked by 1 person

  4. We are fortunate to have good insurance and the clinic we go to is well staffed and wait times are short, every time. We are very grateful. Thank you for what you do!!! Your kind heart transfers to your patients i’m sure, they are blessed.♥

    Liked by 1 person

  5. I have sat in chemo (I always have a book to read) while listening to the man across the hall (a first-timer) yelling, “I’m waiting! I’m waiting!” The nurses are very much overworked and understaffed and had to laugh when I said I so wanted to jump from seat and tell him he could wait till the cows some home, but his labs must not be ready yet! Oh, Emily–I have no patience with rude patients! Doctors like you are a true blessing.

    Liked by 1 person

  6. My husband recently had an unusual situation at his doctor appointment. He was there for a physical and had some serious concerns to discuss with the doctor. I was in the waiting room – my husband had already been taken to a patient room. Another patient without an appointment came into the waiting room carrying a little puppy. The front office staff immediately took the puppy from her and took it in to the doctor – to the room where he was seeing my husband. They did not knock – just walked in. The doctor took the puppy and got all excited and put it in his white coat pocket and walked out of the room while my husband waited. The doctor proceeded out to the waiting room to talk to this other patient. Finally he went back into the exam room. He forgot to send in the prescription that he discussed and we have yet to have anyone call us about scheduling some other important testing that was suggested – 2 weeks ago. I have personally worked in 3 physician offices and I know that this behavior is unnecessary and unacceptable professionally. Rant over. I know most physicians are dealing with all that you described. And I can’t imagine what you all go through dealing with the insurance nightmare these days. But some physicians bring on a lot of their own problems by acting like my husband’s physician did – more interested in the puppy and also in how they were all going to go to the opening night of our local baseball team’s season opening that night.

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  7. I appreciated this entry so much. As a retired pastor I see great similarities between caring for a congregation and caring for patients. Some days are harder than others, all the days seem long, and only you are the person that sees the big picture of what you do. Pastoral care at times is only measured in what you do for a particular person and not seen by others as a whole. Being a caregiver is hard and strangely enough being a pastor is, according to Eugene Peterson, an easy thing to fake. No one knows or necessarily sees what we do. God knows and sees though. God knows and sees what you as a doctor do too. We serve and live before an audience of one. Praying for you.

    Liked by 1 person

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