Do you hate arriving 15 minutes early for your doctor's appointment only to find the doctor running an hour behind? House Call Doctor tackles this complex issue. Plus - check out a day in the life of a typical primary care doctor.
Next Patient: Ms. Diabetes
Dr. Tardy’s next patient is a 58-year-old woman with diabetes. She comes to Dr. Tardy for her 3-month follow up and to discuss how she can quit smoking because she knows that it, along with diabetes, is a risk factor for heart disease.
Dr. Tardy wants to make certain that the patient has all the resources and tips she needs to succeed, so she takes her time addressing this issue, along with discussing the management of diabetes – both conditions are time-consuming and vital. After all, she doesn’t want Ms. Diabetes to end up with a stroke like her previous patient.
At the end of the 20-minutes, just as Dr. Tardy is about to close the visit, Ms. Diabetes discloses something that cannot be ignored.
“Wait, Doctor, there is one more thing…” She admits that she’s been experiencing chest pain for the last 3 weeks, and this is the reason she finally decided to quit smoking.
Dr. Tardy needs to evaluate this chest pain very thoroughly and cannot tell Ms. Diabetes that she needs to return to discuss this at a future visit. It must be done now. She takes a more detailed history, performs an EKG, and discusses the next steps and management with the patient. This takes her another 20 minutes to complete, and places her 55 minutes behind.
The next patient is 15 minutes late – he is brand new and got lost attempting to locate the clinic. The practice, like many others, has a policy to accept patients up to 15 minutes after their scheduled appointment time.
Ans since Dr. Tardy is late herself, it’s not an issue this time. But what if next time she is actually on time? Then she’d be running late due to a GPS snafu.
Dr. Tardy's next patient was scheduled to discuss tingling in the hands and feet. But during the visit she reveals multiple other complaints that don't seem to be connected: abdominal pain, shortness of breath, feelings of anxiety.
Dr. Tardy, having a great sense of intuition, suspects that there may be something deeper going on and works hard to get the patient to open up.
After some extensive detective work, Ms. Sadness starts to cry uncontrollably. She reveals that not only has she been battling depression for a few years, but that she now "Wishes she were dead." Dr. Tardy finds this comment disturbing and spends a great deal of time trying to understand the level of depresssion and to determine if the patient is seriously suicidal.
Ms. Sadness reveals that she has thought about killing herself by swallowing a bottle of pills belonging to her husband. She has never quite gone through with it, but thinks about it each and every day. Dr. Tardy realizes that Ms. Sadness needs help right away. After all, Dr. Tardy has taken an oath to "Do no harm" and she cannot allow Ms. Sadness to simply walk out of this exam room after revealing these disturbing plans.
Is this a 20-minute visit? No. But how is the person scheduling the appointments supposed to know that this visit would requore much more time? The patient simply made this appointment for "tingling in the hands and feet." This visit took 40 minutes to complete and Dr. Tardy is now running over an hour late.
Last Patients of the Morning
Thankfully, the last patients scheduled for the morning are understanding and wait for Dr. Tardy. She sincerely apologizes to each one, as she does to every single appointment she is late for.
By the time Dr. Tardy ends her morning, she is scheduled to see her first patient of the afternoon. It’s a relief to reset the schedule once again, but this means that not only does she not have a break in the day (which doesn’t really bother Dr. Tardy), but she also has no time for returning patient messages, reviewing lab results, or refilling prescriptions. This means tacking on about 2 hours at the end of her day to complete these tasks after her jam-packed afternoon schedule.
And this is a typical morning for a primary care physician in the United States. Are you tired yet?
Who Is to Blame?
Who is at fault here? Is it Dr. Tardy? Is she too accommodating? Could she have ignored that “By the way, I have chest pain” comment at the end of the visit with Ms. Diabetes? Could she have ignored that financial hardship plea? Should she have ignored the urgent patient lab values or that abnormal EKG reading that could have potentially placed those patient lives in jeopardy?
Should she have allowed the suicidal patient to simply walk out of the clinic?
If not, then do we fault the current health care system model in the United States which underpays primary care doctors for each visit so that they are required to see more and more patients in a shorter amount of time? Do we blame the medical practice that requires 20-minute appointment slots for each patient in order to survive? Should they stop allowing patients to be 15 minutes late in order to maintain good business practices?
I’d like to hear your thoughts on this complex issue. Please post your ideas in Comments below or on the House Call Doctor's Facebook page.
Be sure to tune in next week when I will do my best to provide a solution to this great dilemma. If doctors and patients can work together, we can resolve this challenge and create a better health care system for everyone.
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Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.