Wednesday, October 08, 2008

Things that frustrate me

As an endocrinologist, there are some things that frustrate me. Yes, yes, I know, you have your reasons, and perhaps I'm just being unsympathetic, but allow me to vent:
  1. Patients with diabetes on complex insulin programs, who come for their visits not bringing their meter, logbook and have no foggiest idea how their numbers usually run. I know, to forget is human nature, but really, if you're coming with no numbers for us to go over, then you're just going to be wasting your time. I'm going to be billing you anyway, but you're likely not going to get much out of our meeting simply because I would not be able to give you any firm advice on insulin adjustments
  2. Patients with a list of symptoms and another list of normal blood tests, who come to be because they're obsessed that despite the normal values, "their hormones must be imbalanced to cause all their symptoms". And those symptoms range from weight gain to fatigue to knee pain to an annular rash on their right shin. I wish it was that simple, but often, it isn't. And while I'm not downplaying anyone's symptoms and I know it's bothersome, I'm sorry, if your TSH and T4 are normal then it's not your thyroid. I don't care what Oprah says, but until research proves that earlobe itchiness is a hormonal disorder, don't expect me to have all the answers to your problems. I'm a good listener, yes, but I'm not going to have all the answers.
  3. Patients who don't show up for their appointments. My time is just as important as yours. If you're not planning to show up, don't make the appointment and keep other patients waiting. I'm due to see Mr. T tomorrow who has no-showed 3 previous times. I'm fully expecting him to not show up again tomorrow, and if that's the case I'm going to refuse to ever see him again.
  4. Patients who come late. Our appointment cards tell them to come 15 mins early. And so if they're 15 mins late to see me, really, they're 30 mins late for their appointment. I'm going to contradict myself, I know, but I do sometimes run late myself. I try not to, but sometimes patients are more complex than expected and you end up starting on the next one 5 minutes late. But, on the flipside, if each of my 12 patients were to come 15 mins late, then the last patient of the day's going to have to bring a sleeping bag for his visit. And it pisses me off that you make my other patients suffer and wait just because you decided to pick up a lattĕ on your way here.
  5. Patients who lie. Yes, lie. Not about simple stuff like eating a Big Mac last week. We all do that sometimes. But like the patient I saw yesterday who is trying to file a lawsuit against someone else, who suggested I 'tweak' my notes and make the other party seem more guilty. You know, the very manipulative kind of person. In a nice way, I basically told him to go to hell. And dutifully documented the request he made of me. I'm suspecting his lawyers won't be asking me to be his expert witness.

Thankfully, the majority of patients I see aren't like that. And most of those who sometimes break the above rules often are not malicious about it, and are no repetitive.


Blogger pavlova said...

totally understand about the late bit. and also totally understand about the no show bit.

my practice policy is if you don't show up for 2 apptmts, we dont see you in the practice EVER again. and we tell you about it.

so are the late ones. if you keep wasting our time, we won't see you EVER again.

i even had one lady who screamed and yelled at me and my staff, and she was late, yet demanding me to see her instantly despite my other patient turned up already.
i basically told her to leave yet she did not want to and cried and created a scene. had to call in the cops, but thankfully she left before they arrive.

part and parcel of private practice, really... you get all sorts of people but most of the time they're quite good :P

2:59 AM  
Anonymous Anonymous said...

Wow, this is rich!

You say, "My time is just as important as yours".

In the same breath, you say, "Our appointment cards tell them to come 15 mins early".

Don't you really mean to say your time is more important than theirs? It works both ways, no?

Frankly, I am disgusted when my doctor is late for his appointment. I think it is unprofessional. My accountant is never late, my lawyer is never late. What makes doctors think they are any different? Why can't they space out their appointments more to cater for unforeseen delays?

3:34 AM  
Blogger vagus said...

yes, i know i was going to contradict myself :)
and i suppose human nature dictates that people think their time is more important than other people's.
however there are reasons for the 15 min early policy (one that is practised by every other medical clinic I'm aware off). for one, the snowball effect; if every patient is even a bit late, the later patients pay for it.
but on the more practical and legal side, the patients are asked to come early because the nurse has to take their vital signs, go oer their medication list, and they have a extensive past history form to fill. these take 10-12 mins alone.
i agree, i'm all for spacing time out between patients, but the harsh reality that i'm just learning, coming out from the naive world of training into private practice, is the clinic has to cover its overhead expenses and still make money to pay staff- and with the decreasing medicare reimbursements you may be surprised to learn that this is the only way clinics can stay afloat. a couple of the docs i know was actually LOSING money for their clinic because of the long patient times they were taking. also in my area there is already a 4-6 week waiting period to see me; more time with each patient would mean that patient with the adrenal tumor or overactive thyroid gets to see me only after 3 months.
so, it's not an ideal system, and I wish i had the answers. for i'd love to have double the time for each patient to explain things.
but your feedback is certainly appreciated; thanks for stopping by

6:44 AM  
Blogger Hani Izhar said...

Message for anonymous:

Obviously, you have absolutely NO idea what it's like working as a doctor.

Some facts you should know:

1) We would love to be punctual all the time (yeah, but who would handle the medical emergencies then? These things are unexpected)

2) We try see all patients within the allocated time (unfortunately, patients sometimes come with 1001 problems, the worst being the ones who just don't comply to treatment, to convince them in 15 minutes is almost impossible)

3) Finishing clinics early each time is any doctor's dream. Do you really think we're late on purpose? Please realize that if clinic time runs out, we can't just drop everything and ask the remaining patients to come another day. Clinic stays open until everyone is seen. And yeah, we just ADORE to run the clinic 5 hours after it's supposed to end.

4) Space out appointments? How about asking people not to get sick? Maybe then we'll have more time to spend on everyone. We're trying to do as much as we can in one consultation, and it's not easy

5) Your lawyer is never late, your accountant is never late. What makes us different? We're dealing with LIVES, not just yours. If we take an extra 5 minutes to convince an old lady to take her insulin, please excuse us. It may save her life in the long run. We'd do the same for you. Sorry to sound very pompous, I'm not saying that what accountants and lawyers do aren't important, it's just that our nature of job is different. Please be a bit understanding.

6) Please also take note that what you see on TV about the medical profession is absolute rubbish. You don't get answers on the spot, investigation results don't come back instantly, patients are not cured within 5 minutes. Not everything can be done STAT. Some things take time. There is a WHOLE LOAD of paperwork to do, you never see doctors on tv filling out forms or writing letters, do you? Well, it just doesn't happen in real life.

sorry for the rant on your site Vagus..that person's comment made me see red. Didn't even have the balls not to be anonymous. I must say you're taking the comment very graciously. That makes you the bigger person I guess :)

10:58 AM  
Anonymous Anonymous said...

Vagus, yeah, I can see where you're coming from :) The way I see it, the problem may be a lack of drs in your specialty.

Hani izar, if you were doing a Palin, you sure give Tina Fey a run for her money :)

7:03 AM  
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