family practice issues and general life events

Posts tagged ‘quality care’

Why your doctor is running late.

I know it is a stereotype that seems to take effect over and over in real life.  You go to the doctor, and he/she is running late.  It is a standard joke, and I have even heard of others attempting to bill the doctor for the time they waited because the patient’s time is also valuable.  Which it is, but are we talking billable hours, quality hours, life saving time.  What kind of time are we talking about?

First of all, let me say, that if you doctor gives the impression that your time is not also important, there is something wrong.  However, there are legitimate reasons why your doctor is running behind.  And rarely even though based on popular opinion is it due to talking overly much to the drug rep who comes into the office bearing gifts, golf outings and fabulous trips.  I wish that is the easy reason why I often run late.  A paid vacation would be wonderful, but those days are long gone, and were before I was ever licensed.  And if I spend time talking to a rep in my office it is so that I can get samples of a medication that might help my patient.  End of story.  I don’t collect money from them, occasionally they buy me a pizza at lunch so that they might detail me on their product and why it is better than their competitor, but if I am going to write for a medication, I will do it based on efficacy.  First in clinical trials, and then based on my patients.  So no, I am not running behind because of the pharmaceutical rep.  And if they come in, and I am running behind, often the time spent is merely to give a signature between patients.

I do meet with reps, and I am not ashamed.  I think that they help with treating my patients.  It is not that I believe their entire spiel, I am not that dumb, but they help a lot by providing samples, which allows my patients to try products before they have to pay copays or even pay for the full prescription.  And it is necessary, because despite what the people at Wal-mart tell you, not all medications have a $4 equivalent, and in the case of COPD, there is not a medication that follows the gold standards for treatment that is generic.  There might be a couple of different brands, but there are no generics.  However, they actually take up little of my day individually.

Most of the time, I am not running behind because I slept in late, or just was moving slow.  While it has happened, it is a rare day for that to happen.  Most of the doctors in my town, start their day by rounding on patients in the hospital.  My husband sees anywhere from one patient a day to 16 yesterday.  Since he usually sits around two or three on the inpatient, the 16 took considerably longer to see than normal, so he got to work about 45 minutes late.  In our clinic, most of our schedules are made 6 months to a year before, so there would have been no way to account for that amount of patients on Monday when it looked like a possibility

Much of the time, running behind schedule has to do with the patient complaint.  They take longer than the front schedules for.  This is not to say that patients are doing something wrong, but more than once I have seen someone worked in for a sore throat, only to have them say as I am walking out the door- “Oh and by the way, I have been having these chest pains.”  Well, I cannot tell you what my malpractice carrier would say, if I answered that “oh by the way” with “well stop at the front desk to schedule an appointment to find out what might be causing that.”  I guess with that complaint, I could send them to the ER, but well I have already done the exam, and gotten vitals, and most of my patients would be very angry if I sent them to the ER.  (This is not to say that if someone calls to tell me that they are having chest pain and shortness of breath, my front office has not been instructed to advice them of heading to the ER to make sure they are not having a heart attack, it is a little different after the exam)  And I would estimate that at least 10% of my exams a day have an “Oh by the way.”  Not always are they so bad as chest pain, but usually they do tend to increase the amount of time of the visit.

I might also be running behind because a patient has come in for one reason and they tell me that they have not been able to sleep since their husband died last week.  I cannot see how as a physician or a human, I can just stop them and say, “Well that is nice, but why are you here?”  Or “well that is too bad, but the patient in the next room has a sore throat, and well your 15 minutes are up.”  That is not what I do.  I am a family practice doctor, and in my mind, giving them a sympathetic ear, and any other comfort I can provide comes with my job description.  I would hope that all citizens of the human race would do the same.

I might be running late, because frankly I over-booked.  As terrible as that might be to say, but I do it frequently.  Why?  Well first of all, I have patients that have chronic conditions that need to be see frequently.  Those appointments are set up at intervals between a month to three months in advance.  So they have been there.  Next there is a group of appointments that are following up from an illness, ER visit or hospital stay.  These are set at intervals between one to two weeks.  Now while we try to cap those visits at a certain number, there are also appointments made available that day for work ins/sick visits.  And truthfully, I would rather fit as many in that day for a sick visit that I can, than have my patients wait, or visit the ER or the urgent care.  I am possessive about my patients.  They are mine.  I know their allergies, I know their history, and I know them better than any other doctor.  So I want them to see me whenever possible.  And truthfully it is easier, if I take care of their sick visit, because then I don’t have to figure out what someone else did.

And that leads me to another delay.  The other patient went and say a specialist, went to the ER, discharged from the hospital, etc.  In the future when interfaces are seamless and electronic records are readily available, I will not have to figure out what happened where.  It is very common for an ER follow up, that the patient tells me that the ER gave them some white medication that didn’t seem to help.  If it is the Emergency Room here in town, I can get access to the records, otherwise I have to stumble through and figure out what treatment they received and whether they need to see another specialist, and whether there are any medications that need to be changed.

Then there is the various exams that are required for work, medical equipment, school, and/or various other agencies which all take time and have requirements that have to be met.  And often these are brought up during the routine medication refill.  Seriously there is no winning in these instances, because few patients are happy if you make them come back for the paperwork and rarely is the paperwork merely one or two pages.

Additionally, there is a seemingly endless requests for medication refills, lab results, and radiology results which all must be reviewed and determined what needs to be done.  This includes consults from specialists (some of which are not legible) and management of more referrals.

All of these reasons contribute to why, I often run between 30 minutes and an hour behind.  I am not crazy about running behind, and I do apologize.  Because I am sorry, and I don’t want to keep you waiting, but I have between 30-35 patients on an average day, that I want to give personal time and attention.  I want to give them the care that they deserve.  I would like your visit to be as personal and comfortable as possible as it is to go to the doctor, but at the same time, I want to give the consideration to everyone.  One of the biggest complaints you see about doctors is that they don’t listen.  Well maybe I don’t want to be that doctor, and maybe I listen for too long.  So maybe your doctor is running late because in an attempt to make sure that your problem can be addressed, they take the extra time to listen and address concerns.  Maybe they are trying to teach better nutrition, making sure that you are receiving quality care.

So the next time you are annoyed that your doctor is running late, ask yourself do they take the necessary time with you?  Do they spend time listening to your problems and concerns?  And if the answer is yes, realize that maybe they are trying to do it for all of their patients

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