Secret #2 One late patient or one complicated patient is enough to fuck up your doctor’s entire schedule.
From 11 Secrets of the Healthcare System Exposed
Compound this by multiple times a day. Appointments are back-to-back with no room for forgiveness, unless someone happens to no-show. (Every doc with a crazy schedule loves a no-show; nothing personal.) The reality is; not every patient is timely and really sick people require extra attention. But also…
Sometimes patients cry because life (and that’s totally okay!). Only a complete sociopathic dick would say “Times up. Turn off the tears.”
Sometimes patients are suicidal, requiring escalation of care.
Sometimes you have to break bad news to a patient and hold space for them.
Sometimes you need to circle back to a patient who’s getting an in-office treatment.
And unfortunately, it’s not uncommon that people come in with serious shit and you’ve gotta call the ambulance and coordinate with the ED.
You can’t always predict what’s coming in the door.
Speaking of not being able to predict things… the most common phenomena, in my experience, are what I call the “red herrings” hiding in the schedule. Many people, understandably, don’t feel comfortable telling the call-center the real reason(s) they need to see the doctor, so they cite some minor or vague issue. I can’t tell you the number of times I’ve been blind-sided in the exam room.
A couple of real examples:
New patient, 30’s. Reason for visit: “Rash”
I talk to the patient and look at the rash, which happens to be just a bruise.
Then, it comes out.
“I get these severe, debilitating headaches and I’ve tried everything. The only thing that works is (X narcotic). They’re a life-saver and I would love a refill.”
So… long story short, an innocuous “rash” evolved into the uncovering of a long history of opioid addiction and a pattern of “doctor-shopping” for early refills.
I’m pretty sure this otherwise lovely person didn’t ask to be addicted to opioids in order to function or to mask underlying problems. The system has failed them.
Another example:
New patient, 60’s. Reason for Visit: “Fatigue”
I’m ready to evaluate for all the possible causes of fatigue.
Then, I enter the door.
“Hi Dr. I’m really here because my hip pain is so bad that I’m feeling suicidal. I can’t take it anymore.”
Well that escalated quickly.
Try managing cases like this in 10 minutes. You’re waiting because we’re dealing with the results of systemic failures every day.