A friend of mine (who I really do adore), posted this on his FB page, which made me go off on a rant. I know you are surprised by this. Vickie says I need a soapbox to stand on in front of my podium at work. I really want to share it with you because I feel like sometimes one of these patients comes in my office and just needs to hear this. (None of the names listed below are real and have been changed to protect the innocent and keep the privacy of those who trust me with their health.)
FB Post: Why in the..keeping it clean-sorry...does a doctor schedule an appointment for 2:40 and keep my ass in the waiting room at least 30 minutes?
Friend response: If you get a decent answer to this, share with the class please.. I told the doctor one time that my blood pressure was high because I was, um, fricking waiting for a half hour...
#2 Friend response: Usually it's because they have added on extra patients at the last minute and it makes everyone suffer. OR because he/she just bought a bigger McMansion...
I am SO glad you asked and also VERY glad you have other people in line who don't know the answer. I am happy to offer you the right one...
While in a perfect world each patient would come in with a simple problem, (i.e., I stubbed my toe, I have poison ivy), they don't. More commonly a day goes like this...
Mrs. Jones is 76 and has smoked nearly her entire life. She made an appointment for a lump that she has noticed come up on her arm. A quick visit...today. I think they might be nothing but since I'm not sure I send her to a surgeon who also thinks they might be nothing but takes one off anyway. Remember Mrs. Jones because she will come up in a moment.
A few days later I am seeing Mr. Green who is 78 and following up on his thyroid medication. Should be simple enough except that Mr. Green's wife of 56 years has just passed away. She, too, was my patient. He is crying, unable to sleep, full of anxiety and depressed. I, too, start to cry and console and pray for him right there in the room. Only after we have that discussion are we able to move on to his "medical" care.
One reason we are late: we console.
Right after him I go in to see a chronically uncontrolled diabetic. It would be easy to think that she is simply non-compliant, but the fact is that she cannot afford her medications and so she only takes them every few days. I am aware that there patient assistance programs available online but she does not have Internet access so I take the time to help her fill out the appropriate paperwork for this.
One reason we are late: we care.
Remember Mrs. Jones? The surgeon is now on the phone and wants to talk to me. Turns out those lumps she had are stage IV lung cancer and he has sent for for a CT scan which he is sending the results of to my office. She is at my front desk asking for these results...she has no idea she has cancer. So, yes, I work her in, "adding on extra patients at the last minute and it makes everyone suffer." Not only do I get the joy of explaining to her that she has cancer that came up as suddenly as a Spring rain, I get to call her husband on the phone and explain it to him while she cries in my office. I call the oncologist to set up her appointment for the very next day. I get to be the one who tells her that she doesn't have very long to live.
One reason we are late: we take time.
Yes, this was a real day. And, yes, often I am AT LEAST 30 minutes behind, at the very least. That particular day I was 90 minutes behind. But I can guarantee you that not another person that day was upset with me because each of them has learned that I am the type of doctor who would do the exact same thing for each of them.
So the next time your doctor is 30 minutes late, instead of playing Candy Crush or FB on your phone and constantly looking at your clock, look around the office or the waiting room. Say a silent pray for those there with you because you have no idea why they are there, just like they have no clue about what you suffer. But I do. I carry it home with me every night. I work my nurses too hard for too little pay because I demand that my patients are taken care of. They do more than just bring patients back to rooms. They call in your refills, fill out your paperwork, write notes for school or work, find samples and coupons, play with your kids, look up your immunization records, talk to your spouse on the phone who is worried about your recent visit to the ER. Sometimes they spend more than two hours on the phone with an insurance company for Mrs. Little, trying to figure out why they will no longer cover her medication for her multiple sclerosis that has been the only thing that has allowed her to function for the past 5 years. And sometimes I even have to argue about it with somebody on the other line.
One reason we are late: we are advocates.
And, sometimes even the doctor has issues like the day I learned (in the middle of my morning) that my mother had breast cancer. I'm sure you were in the waiting room complaining about my being behind while I was in the bathroom crying and trying to freshen up because I still had patients to take care of.
One reason we are late: we are human.
Yes, in a perfect world, we would never be behind, but we would also ONLY see healthy young people whose biggest complaint is how far behind we are in our schedule. And, while it would nice to think that your $20 copay is paying for my "bigger McMansion," the truth is that I work 60 hours a week running my own clinic (actually IN the clinic) and another 4 hours every night (after my kids go to bed) and another 12-24 hours in an ER 2 hours away on the weekends in order to pay my staff less than what they deserve and try to chunk away at the $270,000 in student loans that I willingly took on so I could hear people complain about themselves (or me and my office) all day long.
Take time to think about that the next time you're waiting 30 minutes and maybe you'll realize that 30 minutes really isn't as long as you think.
I could be wrong. What do I know? I'm just a doctor here to piss you off.
Added July 21, 2015: While I wrote this post for my patients, friends and family 2 years ago, it has recently gone "viral" to the point where people from all over are commenting on it. So, yes, there have been nearly 100 comments in the past couple of days. I have read each and every one of them. At least 95% of them have been supportive, suggestive, and have sparked thoughtful regard while the other 5% have been plain mean or derogatory, even cursing at me. I'm glad that this has led people to think, or discuss, this problem more. I know that many physicians are frustrated with the current state of how this works and I would recommend you take the time to discuss it further with your physician if you have your own thoughts or concerns. Doing so, of course, will take more time and may cause the next patient to run a little behind; but, a good physician will certainly want to hear your thoughts, good or bad, and ways to improve your relationship. Thank you for your support, those who have offered it; but I have chosen to not allow the comments to be viewed so that it does not cause argumentative debate or negative banter. I will continue to read each of them, however, and ask that you continue the discussion beyond this.
Saturday, June 25: With over 3.5 million views and 5000 comments, I have to admit that I am humbled by the readers who have responded in multiple ways. I am touched by your stories and comments and have decided to implement some of your positive suggestions. While I have been unable to read all of the comments entirely yet, I will work at them methodically until I have completed the task. So far that have been a few suggestions to which I would like to respond.
1) Schedule less patients: unfortunately this is not an easy answer. I'm not one to say no when somebody needs to be worked in, because, usually, it is a necessary reason. I hope that's forgivable.
2) Many people have recommended that they wish their doctor's staff could inform them and they wouldn't be so upset. While calling everybody on the schedule is not feasible, and only leads to more complaints about the phones not being answered on the incoming lines, I definitely am going to work with my own staff on being sure they are communicating with the patients who are there. And, before any more of you accuse me of turning away late patients. I rarely do that, simply because I know patients have to take time off to get there. So, I usually work them in, which does put me at risk for making me behind, but I know there are circumstances beyond your control.
3) One person literally asked me to "schedule time for compassion." Admittedly, I still laugh at this suggestion because it is absolutely ludicrous to think that I could even know how to do that, but then I became sad that this person perhaps doesn't experience it in his own life. As a physician, your personal life is just as important and directly related to your medical life. When my patient came in just this past week with a cough, I could tell he was concerned about much more. So, while he was in the appropriate time slot for a cough, my staff could not have known that he would relate to me that his sister had just passed a few days earlier. You can not schedule time for this, or prepare for this, and I wasn't about to rush him out after this news.
4) Have a backup plan: I wish I knew what this one meant. It's not like working at a restaurant and you run out of chicken. The assistant manager can just run down to the store and by more. I don't know what it means to have a back-up plan. Of course, the idea to leave open spots in your schedule falls into this category, which we do...but these are often taken by same-day call-ins.
5) One that I am truly going to try is to have a pre-visit form for each patient to fill out that gives expectations about your visit. I'm very excited to implement this concept and am working on something that I can use as of this week.
I seriously will listen to any reasonable offer of suggestion or advice, but I don't think there is room for cursing at me. I understand this struck some people wrong, though that was not my intention. I will continue to read the comments with a prayerful heart and thoughtful consideration. Thank you again, for your time.