Confessions From The Exam Room
You arrive to your doctor’s office on time – maybe even five minutes early – insurance card and co-payment in hand. Yet despite your penchant for punctuality, you’re left languishing for what seems to be an eternity in the waiting room. Then, when you finally win the equivalent of the lottery because the nurse calls your name, indication it’s your turn to slip into a drafty paper gown, you realize you’ve got to wait another 20 minutes in the exam room before the doctor will finally “see you now.” If you wonder, white your feet dangle over the side of the cold exam table, why in the world your doctor is always running late, you’re not alone. “Patients who arrive late constantly back up a doctor’s day. One late patient can throw off an entire day’s appointment schedule,” says Saundra Dalton-Smith, M.D., an internist in Anniston, Ala., and author of “Set Free to Live Free: Breaking Through the 7 Lies Women Tell Themselves.” But patients’ punctuality – or lack of – isn’t the only reason your doctor never seems to be on time. These confessions from the exam room offer interesting perspectives on why doctors are always late.
They’re Given A List
Bob Linden, M.D., a recently retired board-certified internist and geriatrician, and author of “The Rise & Fall of the American Medical Empire: A Trench Doctor’s View of the Past, Present, and Future of the U.S. Healthcare System,” says “the list” was what often detained him. “I knew disaster was imminent if, as the medical visit was coming to an end, the patient was fumbling for a paper in their purse or trouser pocket,” he says. That’s because that paper was often filled with scores of additional questions or concerns. “The list often came out after reviewing numerous medical illnesses a patient had. That’s when a patient would say, “By the way, Doc, can I just ask a few more question?” I would simply smile and say, “Sure, what are they?” with the full realization that this meant falling behind another 10 minutes. But I never had the heart to turn the person down.” And Linden says if this happened even just two or three times a day, which was not uncommon, patients could be left waiting as much as half an hour or more.
They Like To Chat
“I often get lost in patients’ lives, stories, families, as well as their hearts and heartaches,” says Elizabeth VanderVeer, M.D., an internist in Portland, Ore. She says it’s quite common to see a patient for a routine or non-surgical appointment, like giving a Botox injection, and notice the patient is unusually quite or “off.” So VanderVeer says she stops the exam or procedure to sit down and inquire about what is going on. “I am often speechless, or brought to tears, by how my patients answer my question ‘What’s going on? I notice you’re not yourself today.’ I have hears answers such as ‘my husband died last night.’ Or ‘today is the one-year anniversary of when my son passed away from cancer.’ The list goes on and on, but no matter what, they get my full attention even if it means running late.” Doctors also get caught up in good news, too. So they’ll swap stories about kids graduating from college, upcoming grandkids or job promotions. “You can teach a monkey to inject Botox, but you cannot replace human compassion and being there for your patient in good times and bad,” VanderVeer says. So when it comes to being compassionate, she will risk being late.
They’re Mired In Red Tape
“Occasionally, committee meetings run longer than planned and make me late,” says David Gelber, M.D., a general vascular surgeon in Houston and author of “Behind the Mask: The Mystique of Surgery and the Surgeons Who Perform Them.” “Sometimes insurance companies require physician-to-physician discussions on why a certain treatment is preferred before approving it. His can take up valuable clinic time,” says Ringland S. Murray, M.D., a reproductive endocrinologist in Chattanooga, Tenn. And Linden says practice guidelines also slow things down. “There are bundles of recommendations suggested to doctors by experts in a specific field on how to practice medicine when dealing with an individual disease.” In fact, in 2005 researchers in the Duke University medical school’s Department of Community and Family Medicine calculated it would take a physician 3.5 hours per day to administer care for just 10 chronic medical conditions that the research group reviewed. If the illnesses were uncontrolled, the requirement increased to 10.6 hours per day. The researchers found it would take an additional 7.4 hours per day to explain and discuss the illnesses based on preventive-care recommendations set forth by the U.S Preventive Services Task Force. “As you can imagine, discussions relating to the pros and cons of screenings for prostate and colon cancer can be very time-consuming and put a physician significantly behind, because these guideline grown every year,” says Linden.
They Had A Family Emergency
Yep, that’s right, doctors are people, too. So their kids get sick, their baby sitter bails and, sadly their dog dies. Jennifer Shine Dyer, M.D., a pediatrician and pediatric endocrinologist, says the latter once caused her day to run out of control. “I was running late because I couldn’t stop crying after my husband told me over the phone that my dog was deathly ill from cancer,” she says. The time she needed to process the news and collect her thoughts meant Dryer’s patients had to wait longer than expected. “My patients and their families were extremely kind as I spoke to them with swollen eyes and tears the rest of the day.”
They’re Giving Bad News
Telling patients that they’re sicker than they expected, or that their test results weren’t as good as hoped, isn’t something that can be rushed. “Giving bad news, or news that will be tough to hear, can take longer than the time allotted for the appointment,” says Murray. “It’s essential to devote extra time to these patients, even if it means the rest of the day will get backed up.”
They Hear The Call Of Nature
Austin says she’s also run late because she had to squeeze in a trip to the loo. And sometimes that trip takes longer than planned, or comes at an inopportune time. “I’ll put off a trip to the bathroom for a whole hour sometimes, just so I don’t have to stop and get behind. But sometimes nature just calls!” Dalton-Smith agrees, noting, “Sometimes doctors run late because they have to eat and take care of regular bodily needs like using the bathroom. Patients have to remember their doctors are human, some have medical issues like diabetes and may need to stop for a second to grab a snack before their own blood sugar drops too low.”