Wednesday, December 14, 2011

A Doctor Cannot Be on Time and Take Care of Your Needs

By Stewart B Segal, MD, FAAP 
Dr. Segal is a board certified family physician, founder of Lake Zurich Family Treatment Center in Illinois, and author of the book Diets and Other Unnatural Acts. He blogs at www.LiveWellthy.org.

The following article addresses a common complaint about physicians:

“Freewheel” responded to a previous article by writing the following, “you will not make me wait more than 10 minutes. My time is important, too.” One of the most common complaints I hear is “I waited over an hour to see you!” Waiting for an appointment, particularly when you are sick, is frustrating. Once you have that appointment, waiting for a doc who is running 1 hour behind provokes anger.

Meeting patients’ expectations for timely appointments during which their needs are fulfilled is almost impossible. I have to admit, my approach for the last 28 years is brilliant. When my doors open in the morning, we will see you on a first come first serve basis. You don’t have to call to be seen. And, when I come into your exam room, I am on time. (I do make a few appointments for wellness care).

As a patient, it is critical for you to understand why your doc is never on time. Here’s my typical day. I get up at 5:30am to get to the hospital at 6:30am. If all goes well and my patients don’t have any medical crisis, I get to the office on time. On a bad day, Mr. “MI” decides to drop his blood pressure, stop breathing and “code”. I can’t tell Mr. “MI” that he’s not scheduled for a “code” situation; I have to do what I have to do.

I’m lucky, Mr. MI recovers quickly and I get to the office only 15 minutes late. However, I’m behind schedule. For the sake of this article, assume I make appointments like most docs. I walk into Mrs. Ulcer’s room 15 minutes late. I apologize. Mrs. Ulcer is scheduled for a 15 minute appointment for stomach pain. She is 42 years old and has been having intermittent stomach pain for 3 months. When she scheduled the appointment, she told my staff she thinks she has an ulcer. At 2 am, she developed a fever (103 degrees) and severe pain.

Mrs. Ulcer does not have an ulcer. She has an infected gallbladder. Mrs. Ulcer needs surgery. She is alone in the office and can’t drive to the hospital. I call the paramedics, the ER, and the surgeon. I’m now an hour behind.

I apologize to the next 4 patients for being late. They are relatively easy and I’m now 1 hour and 15 minutes late. I walk into Mr. Aged’s room. He has a 15 minute appointment to follow up on his diabetes. Mr. Aged is sitting with Mrs. Aged; she appears concerned. There is a faint smell of urine in the room. Mrs. Aged says, “His blood sugars have been high over the last 2 weeks. He’s more forgetful than usual, stumbling a lot and dropping things.” Mr. Aged’s 15 minute appointment takes 45 minutes. Mr. Aged is on his way to the hospital. He’s had a stroke.

I’m 2 1/2 hours behind, I have to go to the bathroom, my patients are mad, and they are taking it out on my staff. I value their time, but I value their health more.

Your doc cannot be on time and take care of your needs. Your doc cannot tell Mr. MI to schedule his “code.” He cannot tell Mrs. Ulcer to come back in the morning as her appointment time had expired. Mr. Aged needs lots of attention, now!

Deciding how much time to allot for an appointment is like divining what the weather is going to be like next Monday. Either your doc gives you the time you need and is perpetually late, or your doc cuts your appointment short and moves on. If timeliness is of essence, then chose a doc who is in and out on time; and don’t expect him/her to meet your medical needs. If your medical needs are important, then don’t expect an on-time appointment.

You can help your doc improve his timeliness by reading the articles at LiveWellthy.org. Many are designed to help you formulate the answers to your doc’s questions before he/she asks them. The more proactive you are in caring for yourself, the easier formulating a differential diagnosis and treatment plan will be.

Always remember, the life you save may be your own.


1 comment :

  1. While I truly empathize the typical untypical day of a physician, it would be helpful for them to learn some courtesy and realize that a simple apology goes a long way to helping a patient calm down.
    Your comment on being proactive brings to mind my own situation: I always make a list, in order of priority, the issues/problems/concerns I want to discuss. I also like prescription refills I need, specific questions, and finally, if not already included, suggestions or alternatives. Most of the physicians I have had have been more than pleased (not to mention their nurse or PA who may do a review and computer input prior to my time with the physician); however, I have also had doctors be highly insulted and/or irritated, and blatantly have ignored my notes.
    One look at my notes, and the physician may see an association or correlation between symptoms, meds, reactions, etc. The notes usually save a great deal of time and frustration for both of us.

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