Op-Med is a collection of original articles contributed by Doximity members.
“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.
Still, 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 that waiting for a good doctor is like waiting to be seated at a good restaurant — it is worth the wait. He never worried about time. I admired how thorough he was with his patients — I don’t think any of his patients felt rushed or unheard, and they came to expect waiting for his care.
Come join me for a day and you’ll see 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 patients’ needs that can be unpredictable.
Monday, 7:50am. 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. 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. Some patients I know will be fairly quick, a straight forward annual exam, and some take a little longer, like those with a complicated infertility issue. Hopefully, they will balance out each other out so I can run on time.
8:20am. I still have not seen a patient yet — my first one is late. 8:30am — now my 8am, 8:15am and 8:30 am 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 8 weeks pregnant and bleeding. What should I do?” “Tell the patient to come in,” as I look at my schedule, “at, um…hmm…at 10am.” 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 3.” 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 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 ready to go after a quick review. Next, I see the patient who thinks she is in labor. Her contractions are every 5 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 am and I have seen 9 patients, written 5 prescriptions, answered 2 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 in my office is a new patient. My medical assistant gives me a quick briefing on why she is here and ends with “she has a stack of medical records.” The patient has a long history of issues with her periods, possible fibroids, heavy bleeding. It takes me a while 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 examine her.
I walk out with her and show her the exam room and 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.
Before I know it, it’s noon. Instead of taking my 30-minute lunch break, I use the 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 5 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, as 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 then “Oh, while I’m here, can’t you just also do…”
Sometimes people have emergencies and need to be seen right away 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 timeframe.
Believe me: I want to run on time as much as you want to be seen 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 that means I may see you a little later than your appointment time.
Sorry, I’m running late.
Andrea Eisenberg, MD, has been an obstetrician/gynecologist in the Metro Detroit area for nearly 25 years. Through her years in women’s health, she’s shared in countless intimate moments of her patients, their joys, heartaches, losses and victories. On her blog, www.secretlifeofobgyn.com, she captures the human side of medicine and what doctors think and feel in caring for patients. She has contributed to Intima, A Journal of Narrative Medicine and Pulse, Voices From the Heart of Medicine. Andrea is a 2018–19 Doximity Author.