RSS

Behind

09 Aug

I spent the week in subspecialty clinics, which was awesome. Except for one thing: the schedulers.

Patients are usually scheduled for follow-up appointments, in 30 minute slots. Occasionally there is an initial visit, which gets an hour. So today, I got to work at 7, spent an hour reading about the 6 follow-ups on my schedule, because even though they are well known to the clinic, they are not well known to me.

My first patient was scheduled for 8, but of course did not show up until 8:15. So by the time I’d seen her, staffed her with the attending, and written her refills, it was nearly 9. (And she was the easiest on my list.) And so it went for the rest of the day, as I slipped further and further behind. I had 2 extremely complicated patients, each of whom took over an hour even before I talked to the attending. Both of them actually need psychiatric care, which I am not qualified to provide — one does not think he needs a “shrink” and the other has limited resources. But when someone tells me they are actively suicidal with access to weapons, I’m not gonna be like “Well that’s not my problem, see ya later!”

Meanwhile, some lady showed up on the wrong day (her appointment is actually later this month) and the schedulers tried to guilt me into seeing her. “Look,” I said, “I’m nearly 1.5 hours behind as it is. She can wait if she wants, but I’m going to see the people who have appointments today first, since they’ve already been waiting.” (She didn’t wait, thank god).

I deferred all my notes, which I hate doing because I worry that patients and plans will blend together. As soon as a patient walked out my door, I went to the waiting room to get another. I felt like a revolving door, and I was rushing slightly toward the end, because I had to get to the Main Hospital, 2 miles away, for a conference.

I saw my last patient, scheduled at 10:30, at almost noon. Skipped grand rounds, disappointingly, because it was on prion disease, and who doesn’t like prion disease? Drove back to the Main Hospital for conference, then had an observed H&P scheduled for 2, then holed up in an empty room for 2.5 hours to write all those notes. Luckily I had no afternoon patients.

It was like this on Wednesday afternoon, too, when they scheduled me for 5 patients between 1:30 and 4, except between a late start and a rather ponderous attending, I didn’t finish seeing people until 6. I was teaching a class that night, so I couldn’t stay to write notes; instead I came back to work at 6:30 in the morning to write them all before Thursday clinic started.

This issue doesn’t happen in the Resident only clinic, I think because the schedulers take staffing-with-attending into account; it nearly doubles the visit time because you have to catch the attending (They are usually staffing 3 or 4 residents at a time), present, and have the attending at least eyeball the patient. But I suspect this is what clinic is like in the Real World of private practice — this revolving door mentality, never feeling caught up, which is frustrating to doctor and patient alike.

(The other frustrating thing: when I left clinic at a little after 5, the support staff, including the schedulers who pushed me into this, were all long gone. As a matter of fact, when I was waiting for the attending on Wednesday, I asked one of the staff if I could bring my next patient back and then staff two together — she said no because “I’ve already cleaned all the empty rooms.” It was 3:45 and she was ready to go home.)

So folks, next time you are pissed that your doctor is running late, remember that she is just as mad as you at a totally broken system that serves no one but the administrators.

About these ads
 
1 Comment

Posted by on August 9, 2013 in health policy, neuro, PGY-2, residency

 

One response to “Behind

  1. WarmSocks

    August 11, 2013 at 12:22 am

    That sounds horrible and exhausting!
    I can’t speak for all private practice, but my family physician’s office doesn’t seem to be run that way. My doctor writes part of his notes right there in the room with me/my kids. When he leaves the exam room, he has a desk where he goes (actually he usually stands at the counter rather than sit at a desk) to finish writing notes. Sometimes he has his MA act as a scribe, which means he just dictates to her while doing the exam. That seems like a good use of his staff, since she’d otherwise just be standing there watching.

    Showing up 15 minutes typically means the person would have to be re-scheduled rather than throw off the entire day.

    As for the scheduler cleaning rooms before all the patients had been seen… sounds like she’s forgotten the whole point of being there. Hope it never happens again, but if it does, well… sometimes its easier to get forgiveness than permission ;)

     

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
Follow

Get every new post delivered to your Inbox.

Join 48 other followers

%d bloggers like this: