Inspired by a recent post on MedPage’s KevinMD, I found the courage to write.
Confession: I am one of those doctors who rarely runs “on time.” No matter how hard I try, my patient’s needs get in the way. Today was a prime example. You be the judge.
Patient #1. ”Sleep apnea, needs a tonsillectomy and adenoidectomy.” Straightforward. Take a history, examine the child and read a sleep study. Describe the options and if desired, offer surgery. Explain the surgery and its risks and potential benefits.
Then I met the family. His tonsils and adenoids were not the only problem, and maybe not the primary problem. An 11 year old bedwetter (can be caused by sleep disturbances) with asthma, suspected environmental allergies and a nasty cough for years. Had reflux, too. After numbing the nose, I slipped a scope into his airway. Clearly, he needed a lot more time and discussion than was initially thought. Where did that 45 minutes go?
Patient #2. “Ear tube check, hearing test.” Five minutes tops. Look in ear, review hearing test. Give 4 month follow up.
Mom starts telling me that she is having surgery next week to remove a life threatening tumor from her spine. She could be paralyzed or worse. While she was getting a hearing test I ventured to see how Mom was holding up. The story was overwhelming; I started to get teary eyed. And we cried, wiping away the tears quickly when the kid came back. A five minute visit turned into 20 and drained more emotion than was scheduled. Time was flying. I was not.
Patient #3. “Infant with noisy breathing since birth, possible reflux.” Talk to family, look at the airway with a scope, adjust medications, and recommend lifestyle and diet changes (for the breast feeding mom).
They whipped out a hand held video camera. The film showed him making this rather odd noise. This wasn’t going to go as planned, I thought. We scoped him and found both vocal cords were paralyzed. Questions tumbled out. What could this mean? What tests does he need? Why? How do we fix this? Answering questions and trying to allay understandable fears about their little guy. I didn’t want to know the time, but when we had to sign, date and time the surgical consent, I realized I was falling further behind.
Patient #4. “Hearing test for a child not talking–self referred.” Probably some ear fluid. Check his ears, do a hearing test, and refer for early intervention and speech therapy.
Two minutes into the interview my heart grew heavy. I suspected his speech/language delay was classic for Autistic Spectrum Disorders. He had a few words which were now gone. His behavior deteriorated; he was self abusive. Hearing test was normal. We talked about the possibilities, and her eyes had a panicked look. I knew she knew. I suggested a developmental pediatric examination. She wanted to know why. I explained why. I was lost in time and in her fears.
I was only half-way through the morning’s list. I was actually happy when two patients just didn’t show.
This discussion is very important. Most doctors cannot predict what will come in the door. I had to take the time needed to care for them and their families properly. I cannot predict the unpredictable.
I could have taken short cuts. I could have spent less time explaining complex issues. I could have punted giving bad news. I could have avoided “holding hands.” I could have just said let’s get some testing, and left them worrying or maybe not.
I could have, but I didn’t. And I won’t because I can’t. And most doctors can’t. So I (and they) will routinely be late because patients are complex and their needs are unpredictable. And if I am doing a good job, I won’t walk out because it’s time.
Next time I am sitting in my doctor’s office waiting, I hope I can remember this post.
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7 Comments
When you make an hourly wage and the doctor running an hour late, not only do you miss being back to work at the expected time, you run the risk of getting an “occurrence” which is like a demerit. If you’ve missed work because you or your kid has been ill, you get one for each day you are out without pre-planning. If you’re late coming back from a scheduled medical appointment no matter what the reason, you get an occurrence. Enough occurrences and you get a warning. After that, you get fired.
Not everyone has the luxury of a salaried position. Hourly workers lose every time the clinic runs late. They lose money, they lose status, and sometimes they can lose their job. If they lose their job, they lose their health insurance.
This is not fantasyland. Ask anyone who works for an hourly wage where a clock is punched. There is no flexibility. What price are you asking your patient patients to pay?
Perhaps doctors should think of that before they over-schedule themselves.
IMHO
Thank You Dr. Brodsky. It’s powerful to hear your thoughts and experiences. I couldn’t agree more. Our patients and families need our time. It’s the extra explanation, option and/or hand held that can make ALL the difference, no matter what the outcome. Your passion is inspiring - most of all necessary. Your patients are blessed.
What a wonderful post! I’m embarrassed to say that I am usually the one in the waiting room tapping my feet and watching the clock… Thanks for sharing what’s going on “behind the curtain”. I will definitely remind myself of this the next time a doctor runs behind.
Excellent care is worth the wait. Long waits are only annoying when poor care awaits at the end.
As for the comment regarding the hourly employees, I would suggest flexibility (a big theme on this blog, too). Those folks could schedule appointments at the beginning or at the end of their shifts, ask someone to hold over or come in early for them and/or plan an extra cushion for the appointment. I don’t see this as an over scheduling issue in this case, or in many other cases; I see it as a willingness to spend time to listen, to be compassionate and to give excellent care.
I never gripe when I have to wait for excellent care; it’s worth every second. I have been in the unfortunate position of being the one who has the unexpectedly long appointment and I have been fortunate to have had the quick appointment. When I wait and wait and have the quick appointment, I consider myself lucky. And I am mindful that someone who isn’t as lucky is likely responsible for the backlog. Having been in both positions certainly gives that perspective. You can bet the mom in this post who was hoping for a speedy fluid-in-the-ears visit would have give anything to have been a quick visit. Quality care is worth the wait. Any amount of it.
DR. Brodsky
I feel we are parents to raise our kids. I schedule my and did schedule my kids appointments at the end of the day or the biginning usually. I make sure that i can take the time to see my kids and myself through appts. People need to realize that if it was our child that needed extra time, we would be grateful to the doctors that take the time for all us. Better management of our time is essential to raising our families. In my job unexpected barriars come up and i always take the time to address them knowing someone is waiting for me . This is life……I appreciate everything you have done for myself and my family ..Look forward to seeing you again…
With havin so much content and articles do you ever
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your RSS feed to my Google account. I look forward to new updates and will talk about this site with my Facebook group.
Chat soon!