I hate being late. I’m the one at the airport two hours before the flight (more time to stretch my legs before taking off!). I’m the first person to come to the party (and if I’m way too early, I’ll wait in the car until I’m just a little early).
Same goes when I am in clinic. I want to be on time to see you. I want to address your concerns in a thorough and timely manner. I respect your time. So when I show up in the exam room after your appointment time, what just happened there?
I thought a lot about this today. I was pretty late for my last patient—almost by a half an hour, sorry to say. Where did the time go? The minutes and hours were filled with urgent phone calls with other providers and patients; visits that needed more time than we had; concerns that needed attention sooner rather than later– on top of an already full schedule. Here’s a snippet:
7:40 am: Get to work after dropping the kiddo off at preschool. My first patient is not until 8:20, and I like to start early and set myself up for success– organize my desk, listen to my voicemail, clean my stethoscope, look at my schedule, turn on KEXP. (John in the Morning is the perfect soundtrack for a good day.)
8:05 am: Just started to look at the chart of a complicated patient scheduled later today when I get a call– it’s a psychiatrist I have been playing phone tag with for the past 2 weeks. I have to answer this. I put my chart review on hold.
8:40 am: Still on the phone with the psychiatrist when my medical assistant knocks on the office door. My 8:20 patient just arrived. She’s already 20 minutes late, and with the additional 10 minutes it’ll take to get her vitals, I’ll be 30 minutes late (and my day hasn’t even started!). I agree to see her– she took 2 buses to get to clinic and doesn’t have any other free time to bring her kiddo to the office.
9:05 am: Finishing up with my first patient– thankfully the visit was relatively uncomplicated, giving me some time to catch up and see my 8:40 patient, not too late.
9:10 am: While I am in the exam room, my pager goes off. I glance at the message while pulling up the growth chart for the little one here for her well visit. Looks like an urgent lab result for a patient I saw in the nursery over the weekend. The babe was still working on feeding, and her bilirubin level was just on the cusp of being too high. Should I answer the page right now or finish up with my visit? I decide to finish up with my current visit first—hopefully the lab tech will stay close to the phone for the next few minutes.
9:17 am: Out of the exam room, placing orders for vaccines for one patient while calling back the lab about another patient. The baby from the weekend has jaundice and needs to be hospitalized. The family is primarily Spanish speaking, so I’ll need to call a phone translator first in order to explain the lab results and the need for hospitalization to the family. My 9 am patient is already roomed and ready to go. It’s one of my patients with chronic complex medical needs. I really need our time together to be uninterrupted, so I ask the nurse to complete all of the routine screenings before I am in the room—this will be more efficient for the visit, and also buy me some time so I can admit the baby to the hospital.
9:32 am: On a phone call with the Spanish interpreter, the baby’s mom, hospital admitting, the hospitalist team, and myself. Mom has a great understanding of what is going on with the baby and agrees with the need for admission. The RN pops into my office– all of the screenings are done for my patient here in the clinic, and the vaccines have been consented to and done as well. I give my nurse a thumbs up and quickly glance at the clock. It’s more than 30 minutes past my patient’s appointment time, and still I have to finish the admission, and then see my clinic patient who is here. On top of that, the 2 cups of coffee I had this morning are coming back to haunt me—I have to pee. Really badly. We don’t have a staff bathroom in the clinic (it’s for patients only), which means I have to go to the other side of the building to empty my bladder. Time wise, this translates to 5 minutes of walking, 5 minutes of pee-ing, and another 5 minutes of walking. That’s 15 minutes that I don’t have right now. I guess my urinary needs have to wait—maybe I should schedule voiding time at the end of the day??
So what does all of this mean, for you as a patient? First of all, I hope my little schedule expose helps you realize that there is probably good intention behind why your provider is late. We are trying our darndest to address everyone’s needs. Secondly, I hope this glimpse into a busy day helps you find ways to get your medical needs addressed in an efficient yet thorough manner. Here are a few of my thoughts:
–Schedule medical appointments at the start of the day or right after lunch: Unless an emergency crops up, you are likely to be seen right away.
–Come to your appointment on time: Or better yet, come early. In a busy practice, every step of the process takes time, and every bit of time counts. We ask our patients to come 10-15 minutes early- that way, all the necessary registration, paperwork, and rooming (which usually includes taking vitals, growth measurements, and answering historical questions) is done before the actual scheduled time.
–Find ways other than an appointment to get your medical needs met: In the era of internet connectivity, many providers have the capability of communicating with their patients via email or electronic messaging. Ask your provider about it. Oftentimes I find that this a great way to communicate about non-urgent needs. I can also let my patients know if I think an appointment is needed.
–Come to your appointment organized: I love lists. When patients make lists of questions, then I feel confident that we are addressing the most pressing issues.
–Talk to your provider: Let him or her know your concerns. We care about you, and we want to make things better.