" Sorry, I’m running late … sorry, to keep you waiting.” How many times a day do I say that? Sometimes it is every time I walk into a patient’s room as if it is a normal greeting. Sometimes patients respond with: “Oh, you aren’t late” or “I haven’t been waiting long.” I can be so obsessed with not being late that I don’t realize I’m actually running on time! But I know it is a common complaint that patients “always” have to wait to be seen by their doctor. One of my senior partners at work used to say “waiting for a good doctor is like waiting to be seated at a good restaurant, it is worth the wait,” and never worried about time. I admired how thorough he was with his patients — I don’t think any of his patients felt rushed or not heard and came to expect waiting for his care. Come join me for a day and see for yourself why medicine rarely runs on time. It’s not because we don’t try or we sadistically want our patients to suffer waiting naked in an exam room. It’s because, well, stuff happens and as the day rolls on, the stuff gets bigger, like a snowball rolling down a hill. That snowball is filled with the inconsistencies of life and patient needs that can be unpredictable. Let’s start our day — Monday at 7:50 a.m. I arrive at my office, turn on the computer to see my patient list for the day and put on my white coat. While walking down the hallway, my medical assistant greets me as she goes in and out of each exam room, making sure they are stocked. I go back to my station to take a closer look at my schedule. I usually have patients scheduled every 15 minutes, but sometimes the slots are double booked if patients need to be worked in for an urgent issue or emergency. As I look at my list, there is the usual variety of annual exams, OB patients, IUD insertions, and colposcopies. There are also new patients — some with specific issues, some for just a check up — post-op checks, ultrasounds, and consultations about getting pregnant or how not to get pregnant. Some patients I know will be fairly quick, not having any issues and some take a little longer. Hopefully, they will balance out each other out so I can run on time. 8:20 a.m. I still have not seen a patient yet; my first one is late. 8:30am —now my 8 a.m., 8:15 a.m. and 8:30 a.m. patients have arrived within minutes of each other. It’s like the bus arrived and in one fell swoop, I’m already running late. Next thing I know, one of my receptionists is coming towards me quickly, “Dr. Eisenberg, I have a patient on the phone that is eight-weeks pregnant and bleeding. What should I do?” “Tell the patient to come in,” as I look at my schedule, “at, um … hmm … at 10 a.m.” I know she needs to be seen — I hope I don’t have bad news for her. I’m starting to get in my groove — I just finished with a patient, another is ready for me, and another is getting undressed. I need to send in a prescription for birth control pills for the last patient and I know I will forget if I don’t do it right away. So I get on the computer, but the wrong pharmacy is showing on the screen. I have to get out of that window and search for the right pharmacy. As I’m doing this, I hear overhead “Dr. Eisenberg, Dr. Smith is on line three.” The receptionist is now coming down the hallway to give me the chart for the phone call. “The doctor wants to talk to you about a mammogram report,” she says. I get into my multitask mode and answer the phone while electronically sending in the prescription. Now, back to the patients in exam rooms. I walk into the next exam room where the patient is scheduled for an annual exam. She is a young college student and is excited to tell me she is dating someone. After we talk a little about how they met and what he is like, I ask “Are you using condoms?” “Ah, no,” she answers. So I take some time to talk about birth control options and STI prevention. She also was recently diagnosed with a seizure disorder, so I have to take that into account in counseling her about birth control. She decides she wants an IUD and we finally get to the exam. I walk out of her room, ask my medical assistant to give her a pamphlet on IUDs, and start opening the chart for the next patient. As I’m about to open the door, my receptionist is waving me down. “There is a patient in the waiting room that just walked in. She thinks she is in labor and she looks like it.” “OK, bring her back now.” I quickly go into the exam room I’m standing in front of, thinking I can see her before the laboring patient comes back. Luckily, this is a post-op check, and the patient is feeling fine, and after I review the surgery and pathology with her, she is ready to go. Next, I see the patient who thinks she is in labor. Her contractions are every five minutes, and she looks uncomfortable. I check her, and she is 4 cm dilated. “Time to go to the hospital,” I tell her. She is relieved that the pain is really labor. I leave the room, call the hospital to alert them as well as the on-call doctor who will likely deliver her baby. By this time, I have completely lost track of time. I look at my watch. It is 10:30 a.m. and I have seen nine patients, written five prescriptions, answered two phone calls. My coffee’s cold, and now, I have a stack of lab results to go through in between seeing patients. I am running about 15 minutes behind — not bad. My 10:15 patient appears to be a no-show which helps me catch up a little. The early pregnancy bleeding patient hasn’t arrived yet. Next up is a new patient. She is sitting in my office so we can talk. My medical assistant gives me a quick heads up as to why she is here and ends with “she has a stack of medical records.” She has a long history of issues with her periods, possible fibroids, heavy bleeding. It takes me awhile to sift through her story and her records. She ends with “I’m done. I just want my uterus out.” Once we are done talking, I tell her I need to examine her. I walk out with her, show her where her exam room is and the bathroom. My medical assistant says, “You need to go into the ultrasound room next. The bleeder is in there.” When I enter the ultrasound room, the teary-eyed patient says, “Last night I had some spotting. I’ve never had this happen before when I’ve been pregnant.” I ask a few more questions, examine her and do an ultrasound. Fortunately, everything looks okay with the pregnancy, and the patient is relieved. “Thank you for seeing me today,” she said as I walked out of the room. I continue on, and before I know it, it’s noon. Instead of taking my 30-minute lunch break, I use that time to catch up on charting patient visits and phone calls. I realize I haven’t even stopped to go to the bathroom, so I take a moment to do so and then pull out some snacks I have hidden under the counter. I have now seen 18 patients, answered five phone calls and electronically sent several prescriptions. I still need to call some patients about their lab results. That will have to wait for the moment, I have more patients to see and surgery after leaving the office. I think you get the idea of how a doctor’s office flows, well, at least, at my office. We try to accommodate our patients’ needs and sometimes it takes a little longer than anticipated or a patient is scheduled for one thing and “oh, while I’m here, can’t you just also do …” Sometimes people have emergencies or urgent issues and need to be seen right away, even without an appointment. Sometimes people are late for appointments because of traffic or their babysitter came late, and then all patients after that get delayed. Sometimes patients call and need to talk to me at that moment instead of the end of the day. And sometimes, it is my doing — my cat throws up, my child is sick, I get a phone call walking out the door about my elderly parent, and I get to the office late. In the end, life gets messy and doesn’t run on time. Sometimes it helps me to I think of my schedule as more of a guide rather than a concrete time frame. Believe me: As much as you want to be seen on time, I want to run on time. I like my day to flow smoothly, go home on time to see my family, make dinner, maybe even go for a run. But a doctor’s schedule is never nine-to five-because life doesn’t just happen between nine and five. More importantly though, I want you to know that if you need extra time at an appointment, I will do my best to give it to you. And in return, I hope you understand if a patient before you needs that time, I will give it to her too and may see you a little later than your appointment time. As I sit in my doctor’s waiting room for my check up, I too have to remind myself to take a breath, read a book, or play a game on my phone and be patient. I remember when I had an emergency, my doctor took the time to fit me into her busy schedule and address my urgent needs despite making her run late. Andrea Eisenberg is a obstetrician-gynecologist who blogs at Secret Life of an OB/GYN. Source
