"As long as I'm here..."

[Aristus]

Ask any medical provider what phrase they dislike the most in clinical practice, chances are good the answer will be "Oh! One more thing!..." as the provider is walking out the door to move on to his next patient. It almost always throws off the day's time management, not to mention cutting into the visit-time of the next patient.

Number two on the list is likely to be "As long as I'm here...", which the patient is usually canny enough to ask at the beginning of the visit, and not when the provider is done with the chief complaint and is walking out the exam room door.

Although I'm grateful to any patient considerate enough to ask at the start of the visit, "As long as I'm here..." doesn't necessarily make for more efficient medical management on the part of the patient.

For example, if a patient is visiting for, say, a diabetes assessment, which involves lab testing, review of medication and nutritional compliance, and often a physical exam to check for neuropathy, asking "As long as I'm here, can I get an STD check?" does not mean more gets done in the same span of time. An STD check (just an example) is pretty-much its own fifteen-minute visit, requiring a history of present illness, review of symptoms, a genitourinary exam, and a lab order.

The clock is ticking the whole time, and often the patient in the next room is checking his watch and wondering what the holdup is. I dislike living by the tyranny of the clock, but if I disrespect the needs of the next patient on the schedule, then no one goes home happy.

It's always good to ask these questions when setting the appointment with the scheduler. He or she can usually tell you what can be accomplished in the time span allotted.

[chia]

1. While I understand and appreciate the doctor's POV in this delicate balance between need and time,

I think perhaps the "as long as I'm here" can be a major clue to the real reason the patient is there. They couldn't bring themselves to describe the personal or embarrassing reason to the scheduler, and can barely bring it up to the doctor except in the way you've described. Not at all surprising to me that your example scenario was of an STD. Just a thought.

[Aristus]

4. Yeah. It happens all the time.

Erectile dysfunction is another one. I can't count how many macho manly-men types I've had come in to the clinic for an unrelated complaint, and then tell me the real reason is they're having erectile issues.

First thing I do is thank them for trusting me enough to tell me, then I reassure them that it's nothing to be ashamed of, nothing I or my team are going to blab to others about, or laugh about over the water cooler. A medical complaint is a medical complaint.

My goal is to let them know they can trust me with their sensitive issues, and save them the trouble and embarrassment of hemming and hawing over broaching the subject. If there's any place to be open and frank about issues like this, it's a medical clinic.

[mopinko]

2. a patient's eye view.

some of my fave docs over the years always ran late.
they always take the time not only for that 'while i'm here', but also for the news about your mom, or whatever.
i've also had some of the worst care from docs who ran line the trains.

i expect those good docs to run late. when i'm sitting in the waiting room, i'm not mad. i know i will get all the time i need when it's my turn. if i rly cant wait, i'll reschedule if it isnt urgent.

you should do your best to keep your schedule, but if patients get antsy when you are a little late, maybe say something like- the last patient was more complicated than we thought. or needed a little support today. it'll remind them why they picked you.

[Aristus]

5. I used to be part of a fantastic medical team including a former supervising physician.

My supervising physician was the one who would take an hour with each patient, listen to every complaint, chat with the patient, etc, etc. Some patients loved it, others would walk out of the clinic if their wait ran too long. Medical Assistants didn't always like working with him, because they were routinely going home an hour or two after the clinic had closed.

My style is 'get in, fix the problem, get out'. And our patients would schedule accordingly. Those wanting long, leisurely visits would schedule with my supervising physician; patients needing a regular fifteen minute appointment so they could go on to another engagement, go back to work, run an errand, or take care of family, would book with me.

It was a pretty good system, as long as one wasn't on the MD's staff. Going home late every night got old quickly.

[mopinko]

14. yeah, that part sucks.

i'd be cranky if it was an every day thing.

[Aristus]

15. There were compensations.

My supervising physician was from India. We all adored him. On the rare occasion when we both had no-shows or cancellations at the same time, we'd sit and drink Indian tea (British Blend, hot milk, and brown sugar), and watch Foghorn Leghorn cartoons (his favorite) on YouTube.

[Duncanpup]

3. Our doctor is very thorough

A ten minute appointment can turn into a thirty minute appointment.

[multigraincracker]

6. I've had many Orthopedic Doctors that tell me

only one joint per visit.

[Aristus]

7. HA!

The truth is, they actually have to follow their referral to the letter. If the primary care provider mentions the right knee, the orthopaedist can only focus on the right knee. If the patient is having left shoulder pain, they need another referral.

More inefficiency in clinical medicine, but the intent is the same. If the referral says "Right knee", the orthopaedist prepares for the visit accordingly. If the patient hits him with "Can you look at my shoulder, too? And while I'm here, my ribs are sore, and my left little toe is kinda stiff, and..." that throws the game into extra innings.

[multigraincracker]

8. Hope I don't offend anyone, but I've found

Internists are not so good for me. The last couple I've had never saw me with shirt off or looked down my throat or up my nose. What ever I complained about they sent me to a specialist.
On the other hand D.Os treat most everything in the office and spend more time with me.
Is it just me and my luck or what?

[Aristus]

16. Try your luck with a Physician Assistant.

I can't count how many of my patients have expressed satisfaction with my style of practice, and tell me they'll never visit with an MD again.

Now, I respect MD's, their training, commitment, and experience.

But my "roll up my sleeves and get to it" style of practice does seem to appeal to a lot of my patients.

[multigraincracker]

20. I had one really bad PA and

the rest were great. Rolled up sleeves sounds great.

[multigraincracker]

21. That Pa worked for

Spectrum Health. At the time I didn’t know they were connected to the DeVoss family.

[tblue37]

25. Nurse practitioners are usually good, too.

[Aristus]

26. I've worked with a number of nurse practitioners.

I respected them all immensely.

[csziggy]

10. The orthopedic clinic I go to fixed that - they have specialist for each joint

Shoulder, knees (one doctor just does ligaments, a couple do joint replacements, the elder knee doctor just does clean up - as in removing torn meniscus), hands, feet, spine, and so on. I've seen all of those listed here - except for the knee/leg ligament guy.

The hand doctor will look at more than one hand per visit, but the rest are all one joint per visit. They are all very good at what they do and are one of the best orthopedic clinics in the Southeast US. If it weren't for the doctors in that practice, I would be more of a wreck than I am.

[Xoan]

9. If only patients could time their ailments ...

to coincide with medical providers availability.

[csziggy]

11. I make a list for my annual checkup of questions to ask the doctor about things I am concerned about

We go through the list quickly - if something needs more attention, he either refers me to a specialist or has me make an appointment for a later visit for that particular ailment. I figure an annual checkup is the best time to ask about things that have worried me, but not been troublesome enough to make an appointment just for that. These days my primary care physician doesn't do most of the annual checkups, one of his PAs does them. I trust his PAs - one saved my life a few years ago when she heard the heart murmur no one else had notice.

[Aristus]

12. For an annual physical exam, I usually alot half an hour.

And schedule it for last appointment of the morning or last appointment of the day, in order to free up time for all of the patient's questions. Without having to worry about other patients waiting for their visit.

I usually take about forty-five minutes for a physical. And a patient I had the other day told me it was the most thorough exam he ever had.

[csziggy]

13. My last couple opf annual physicals have been short

Only because they were shortly after major operations so my doctor knew everything had been checked out just before. But normally they are about 45 minutes and very thorough. Now I am overdue for one - with Covid and all, I have not tried to push for one. The practice did make sure that their eligible patients that wanted vaccinations got them. Right now, I am almost a month after my second Pfizer shot so I haven't worried about making an appointment, but I should do it soon.

[SWBTATTReg]

17. My doc had to post flyers on the walls to keep things down to one item that they were in there

for originally, and for patients to pls. schedule another appt. for other items. A good strategy, since wait times were getting insanely long. I've always kept my appts. to one item, and religiously set up another appt. for other issue(s) / item(s). I wish a lot more people would be as considerate too.

It's not the doctor's fault that these wait times are so long. Perhaps the receptionist could be do more of an upfront decision process in order to more appropriately tailor the appointments? Also, if a doctor's appointment on my part wasn't needed (a RN or phy. assistant) could do the appointment, that was fine w/ me.

[Aristus]

18. I've begged the administrators to institute nurse triage both for clinic visits,

and for after-hours calls.

Nada. They refuse to do nurse triage. They want the revenue that comes with full-on clinic visits.

[SWBTATTReg]

19. SMH. Greed over acceptable medical practices...not surprised in a way, more disgusted if

anything, for this would free up actually more 'real' time for all medical staff.

[Skittles]

22. I write down what I need to tell the doc

because I usually remember......when I go back home

[Mr.Bill]

23. I bet doctors also hate to hear

"I read on the internet..."

[Aristus]

24. Heard it twice today.

You get used to it.