On Running Late in General Practice

No one likes to be kept waiting. I hate keeping people waiting, but good medical care takes as long as it takes. If someone’s appointment takes 40 minutes instead of 15, it is sometimes because they have an urgent or complex problem requiring sorting, referral, in-consult treatment or transfer to hospital. Not always. Sometimes it’s because they love to chat. When I’m running late due to providing vital medical care I don’t feel as bad, though I still apologise to the people I have kept waiting and explain it was due to an emergency.

What I really hate is keeping someone waiting because the person booked before them was disorganised and didn’t arrive on time. I don’t know if patients realise at my practice that their allotted time is 15 minutes with the doctor. If you arrive 12 minutes late, despite assuring me that ‘It’s just one quick question’ it NEVER is and by the time we have finished, I am running at least twenty minutes late for the next person and not even for a good reason. I am now having a trial period of getting people to reschedule if they arrive over ten minutes late. This may seem harsh, but if I run behind I become anxious and rushed, which interferes with my goal of providing thorough and unhurried (seeming) care, plus the patients who are kept waiting get annoyed.

There are those who would look askance at my no-late-patients policy, saying this is injustice! Why won’t a doctor wait for her patients but make her patients wait for her!

Well, I am happy for my patients to come late if they were rescuing someone from a burning building, and when they wait for me I want them to know that only a burning building is keeping me from seeing them at the arranged time. They are not sitting in amongst hacking coughs, flicking through out of date magazines simply because Mrs Hernia, who booked before them, couldn’t decide what shoes to wear.

Of course, if a latecomer needs urgent attention I will fit them in the same day, if not the same session. We have a cancellation list for this reason and if I see any of my patients’ names on it I look at my appointment book to see where I can squeeze them in. Just so y’all don’t think I’m heartless.

Most people are very good-natured when I apologise for keeping them waiting. Some will say ‘oh, that was nothing, it’s only been half an hour!’ Others are not as understanding. Once, a colleague of mine went to bring a patient in from the waiting room, fifteen minutes behind schedule.

‘Sorry, I’m running a little late today,’ said Dr Friend.

‘A little late? I wouldn’t call this a LITTLE late!!!’ retorted the irate woman.

There is a doctor in my practice who is always on time. I mean always. I gleaned some of the following wisdom from a brief (they are always brief) chat with him, and the rest from observation.

 

TIPS FOR RUNNING TO TIME from Dr Sherlock (who is always ‘out the drive by half past five’).

 

*Arrive at work early. Ten or fifteen minutes early would be ideal. Try to clear some paperwork before starting.

*Start the session exactly on time, if not early.

*Delegate wherever possible. Do you really need to figure out the fax machine yourself or could Bessie send that referral?

 *Don’t hang around in the tearoom, unless you really do have time to spare. And for heavens sake try not to sit down in there, or open riveting reading material such as Medical Observer (blatant product placement- please publish me!), or before you know it, you’ll be behind.

*Keep a stern eye on your in-tray and when something gets put there, try to clear it between appointments, so there isn’t an end-of-day stack. View a piece of paper sitting in your tray as a mortal enemy that must be shredded, scanned, forwarded, recycled or disembowelled.

*Interruptions should not be met with good cheer, or more will come. Accept calls only from other medical professionals, but interrogate even these people with ruthlessly efficient questions barked like a drill sergeant.

*If it becomes clear the patient will require further time and it’s not urgent, arrange a follow up visit for them. For example, if the patient says at the end of their allotted time ‘oh, by the way doctor, I’ve been getting terrible heartburn…’ respond with something like this: ‘I’m sorry to hear that Mrs Nexium, we should discuss that in detail. How about Friday at 2? I look forward to it!’

 

I don’t know how he does it. My ‘by the ways’ seem to revolve around chest pain, suicidality and bleeding from various orifices, necessitating then-and-there care. What I don’t say to such a patient except in the privacy of my own head is ‘it would have been nice if you’d mentioned this 25 minutes ago, instead of going on and on about your fungal nail infection, your grandson’s teething rash and your latest trip to Bali!’

Patients need a tiny triage nurse in their frontal lobes. I’ve lost count of the ‘urgent’ fit-ins I have arranged for what turns out to be something that could have been done next week. Likewise the ‘urgent’ requests to phone a patient back for ‘a quick question’ about a mole on their husband’s back. Unfortunately, I do not yet possess a phone-dermatoscope.

Many of you will not believe Dr Sherlock can run on time every day, leave on time every day and still have happy, well cared for patients. He seems to be a rarity. Also scarce are the doctors like my beloved Dr Plane, who runs about two hours late every day, but seems resigned to it, never seems rushed or in a hurry and walks around perpetually whistling. The most common breed is like me, or rather, like the OLD me: desperately trying to keep to time but also giving every patient everything they need, including copious hours of listening space- something has to give, and it’s usually lunch, relieving one’s bladder, or the baby’s bath time. If you don’t want to give up any of those things, then you are left with the option of booking in less people for the day and taking home a smaller pay.

I am trying to find that impossible happy medium. I want to give great medical care, without time pressure. I want to get home at a reasonable hour. I need to make a decent wage. Ha! Wish me luck!

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