It may not be rabbit season or duck season, but it definitely seems to be doctor season. Physicians are lined up squarely in the shooting range of the media, government agencies, and our health care industry employers and coworkers, not to mention our own dissatisfied patients — all of whom are happily acquiring hunting licenses in order to take aim.
Depending on who is opining, doctors are overcompensated, demanding, whiny, too uncommitted, too overcommitted, uncaring, egotistical, close-minded, inflexible, and especially: perpetually late.
It’s not enough anymore to wear a bulletproof white coat, and the pressure from all sides is driving doctors to hang up their stethoscope just to get out of the line of fire.
One of the most frequent complaints about doctors is their lack of sensitivity to the demands of their patients’ schedule. Doctors do run late, and patients wait. And wait. And wait some more. Patients’ anger at waiting is reflected in patient (dis)satisfaction surveys, which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character.
I admit I’m one of those late doctors, perpetually 20–30 minutes behind.
I don’t share the reasons why I’m late with my patients as we sit down together in the exam room, but I do apologize for my tardiness. Taking time to explain why takes time away from the task at hand: taking care of the person sitting or lying in front of me. At that moment, that is the most important person in the world to me. More important than the six waiting to see me, more important than the dozens of emails, electronic portal messages and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the concerning text message from my daughter or the worry I have about an ill relative.
I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources. I don’t earn more by seeing more patients. There is a work load that I’m expected to carry, and my day doesn’t end until that work is done.
Some days are typically a four-patient-an-hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners. Since there are only so many minutes that can be squeezed out of an hour, patients end up feeling the pinch.
I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Any time that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.
The patient who is angry about waiting for me to arrive in the exam room can’t know that, three patients before them, I saw a woman who found out her upset stomach was caused by an unplanned and unwanted pregnancy.
Perhaps patients might be more understanding if they knew of the earlier patient who came in with self-injury so deep it required repair. Or the woman with a week of cough and new rib pain that could be a simple viral infection but is showing signs of a pulmonary embolism caused by oral contraceptives. Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men. Or the woman with bloating whose examination reveals an ominous ovarian mass, or the patient found with incidental needle tracks on their arms during an evaluation for itchiness, which points to undiagnosed chronic hepatitis.
Doctors running late are not being inconsiderate, selfish, or insensitive to their patients’ needs. Quite the opposite. We strive to make our patients feel respected, listened to and cared for. Most days it is a challenge to do that well and stay on time.
For those who say we are being greedy, so we need to see fewer patients, I respond that healthcare reform and salaried employment demands we see more patients in less time, not fewer patients in more time. The waits will only get longer as more doctors hang up their stethoscopes rather than become targets of anger and resentment as every day becomes “doctor season.” Patients need to bring a book or knitting, or schedule for the first appointment of the day. They also need to bring along a dose of charitable grace when they see how crowded the waiting room is. It might help to know you are not alone in your worry and misery.
But your doctor is very alone, scrambling to do the very best healing he or she can in the time available.
I’m not yet hanging my stethoscope up, though some days I’m so weary by the end, I’m not sure my brain is still functioning. I don’t wear a bulletproof white coat since I refuse to be defensive. If it is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed, for that moment, on the needs of the “most important person in the whole world.”
And that human being deserves every minute I can give them.
Emily Gibson, MD, is a board-certified family physician and the director of the Student Health Center at Western Washington University. She is a 2018–19 Doximity Author.
