Tempus Fugit

Good morning, good afternoon, and good evening to all of you.

Some of you may remember my old Pet Peeve posts from a previous blogging life. I haven’t done one in some time, but here we go.

Fair warning. This is my peeve and my rant, not yours. You may disagree. That’s okay. I welcome your comments as always.

Patients are often very disrespectful of my time.

In the mental health center setting, I have taken to scheduling a thirty minute time slot for follow-up patient visits, and a full  hour for new patients, especially children. The reasons for this are probably obvious to you.

A new patient requires more time to do more extensive history, exploring more details about presenting symptoms, past history, substance abuse, family dynamics, medical problems and review of the overall goals and treatment plan as set forth for each patient. A follow-up may involve seeing someone back after starting a new medication, to review pertinent lab work that has been ordered since the last visit with me, or to deal with a new problem that has popped up. These follow-ups may also be routine six month visits with patients I have known and seen for twenty years or more.

Now, I try to make ready for each visit by looking back at the last note or two that I documented myself, looking at recorded histories that other clinicians have placed in the medical record, reviewing labs, looking at prescription data, and printing out the info that I would like to be holding in my hand as I talk to the person coming to see me. This takes me several minutes for each upcoming visit. I do this before the appointed time so that I may walk up to the lobby as close as possible to the top or bottom of the hour to call the patient’s name and start their appointment.

All this being said, remember that the mental health center I work in schedules patient visits for a specific time. There is no first come first serve thing, no OB office scheduling in massive waves that results in three hour waits, no “morning clinic” or “afternoon clinic”. If your appointment is for ten AM, I expect to see you at ten AM. Usually not before, and definitely not after if I can avoid it at all.

Now, of course, if the transportation company gets you there an hour early and I have nothing to do at that time, I will see you early. If an emergency preempts you, which happens rarely in my clinic setting, I will certainly do my best to see you as soon as the crisis is over and dealt with. If that is not possible, I will reschedule your appointment for as soon as possible on an upcoming day.

What’s the problem with all this?

People show up late.

If they have a thirty minute appointment, they show up fifteen or sometimes twenty minutes into it and expect to be seen for a full appointment time. I may have thirteen appointments scheduled that day, and the next person may already be there, so I am not going to penalize them by pushing them back to accommodate someone who is late. If there is a legitimate reason, then we deal with that. Sometimes, though, folks just show up when they want to show up. That’s not my problem, and that’s not cool. Rudeness and disrespect are no reason for accommodation.

People don’t plan.

Now, please understand that I know if you have schizophrenia, it is difficult for you to plan your normal day and execute normal tasks. That is part of the illness. I’m not talking about that. I’m talking about not planning to leave home on time, arrange the proper transportation for an appointment that you’ve know about for six months, and allowing for things that might make you late.

People don’t respect themselves.

Yes, sometimes they feel that they are not good enough to warrant setting aside time just for them. Again, this may come from several things that I won’t go into  here, but the fact is that time set aside for you is your time. No one else’s. It is time for you to see the doctor, talk, ask questions, and get the help you need.  I am an experienced clinician, but I will not compromise your care by cramming a one hour initial assessment into fifteen minutes because you couldn’t find a ride. Sorry. Reschedule, please, so that we can take our time and do it right.

My fear is that as healthcare is changing and patients are not as responsible for owning their own care and paying for it, that it is cheapened and means less to them sometimes. If you are paying two dollars out of pocket for a thirty minute appointment in a state mental health center as opposed to two hundred dollars in a private outpatient setting, is the time worth the same to you? Is the treatment you receive worth the same to you, in your own mind?

I wonder.

Rant over.

Thanks for listening. I welcome your comments, as always.

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12 thoughts on “Tempus Fugit

  1. Greg,

    Rant away! You deserve it. You only state the very obvious in today’s healthcare world we live in. As I have stated numerous times…I admire you & the work you do.

    Thank you!

    M

  2. I don’t agree with the part about valueing time on a monetary scale. Belonging to a country where, at least until most recent times, everybody could benefit from good care independently of his state of wealth, I cannot agree with that. When my eldest daughter was still a toddler, we moved to an area where there was no pediatrician. We were supposed to follow a schedule of regular visits to get free care for our baby. We therefore went to a government-owned community clinic where the pediatrician was fantastic and we had not to pay for the consultation.
    There were about 2-3 mothers with children waiting every time I went, all from every possible social and ethnic origins. The physician never had more than 10 to 15 minutes late.
    Now, we recently had to change Claire’s glasses (the four of us wear glasses). We go to a private ophtalmology clinic and the consultation is expensive. We usually arrive 10 minutes in advance. We usually wait at least one hour. Many people have their turn before us, although they arrived after us. It’s really frustrating.

    That said, I’m sure that after one of two refusals from your side to see these late, gross patients, they will pay ( :D ) careful attention to your time.

  3. My doctors and clinics send Email reminders to be 15 minutes early. They also make a reminder phone call. The other day, i had my eye exam. No construction, car wrecks, found parking quickly, etc. and I was way early. I apologised for that. To my surprise they quickly called me. My grandson-the designated driver-said people came in. Were told they were late and had to wait. They were rather childish about this. They were told that if they showed up on time, the doctor would have seen them on time. This isn’t the first time that I’ve been put in early. I certainly don’t even hint at that.

    About the money aspect—so true, but it’s combined with human nature-lack of discipline as a child-thinking that the world revolves around you-lack of responsibility.

  4. I was seeing follow up patients in 20 minute slots and new ones in 40. I couldn’t do an adequate job in that time frame but I was told that the number of no-shows made it necessary. Unfortunately this caused many backlogs and patients often had to wait for me.
    Sometimes they would show up late because they figured they were going to have to wait anyway. I don’t think there is a good solution for this, but I am glad you seem to have some control over your schedule. At least I learned to show up ahead of time and be more patient when I visit my own physicians….

  5. Nothing unfair about any of this, Doc. I’ve often thought patients should receive this sort of information (perhaps written, as here) on their first visit, so they’re absolutely clear about their doc’s requirements. Then when they say, “The dog ate my homework”– maybe a brief, but firm reminder. It couldn’t hoit, right?
    It’s an aside, but I’m curious to learn what you might say/think about patients who show up on time–precisely one week early. Yeah, I think I know what you’re thinking right now–“No extra credit!” Over the past twenty years I’ve done it more often than I care to admit, and always at the dentist. Is it because I’m anxious to get the treatment over with, have a crush on my hygienist, or do I simply need a new calendar? Perhaps there are others who suffer from this affliction. The gals at the dental office just laugh at me, but I’m sure they’re snarking behind my back. Would EMDR help?

  6. Rob,

    I think your Tardis needs to be taken in for service, the sooner the better. Else you may end up a year early for your next colonoscopy, and how could that possibly be fun?

    Greg

  7. You’re right Doc–and that could hoit! I’ll get on it as soon as I figure out what a Tardis is (part of the pineal gland?) and whether or not my health insurance covers a re-set. Thanks and all. R.

  8. Time is a precious resource. I have been on both sides of the waiting room on this one. For medical oncology appointments, I wait for up to 2 hours, usually not that much but one of the reasons I work part time is to accommodate that kind of delay. I know that your services do not work that way, nor do mine. And the one or two times every year or so when a patient waits too long or I accidentally double book, I send them a check equivalent to my no show fee ($50, which I rarely charge) with an apology note that says, “My time is no more valuable than yours.”

    I am sorry that this happens. Many people do not have a good sense of time and/or do not really think through the consequences of their tardiness. If people are more than 15 minutes late, I make them reschedule. But I understand that this is much harder in your situation. I also see fewer patients so it is easier to reschedule. Even then, I have a very hard time rescheduling people. And when I get sick, oh boy, does that get difficult.

    I don’t know about the whole money thing. I know that in graduate school they taught us that people should pay something or they won’t value the services. I don’t know if it is a perfectly linear relationship. I do know that I can pick and choose who I work with and although I work with a population who tends to have a lot of difficulty with time due to my specialty, I am pretty darned lucky. Up until my illness, I had only about one late cancellation a year for testing and people were rarely more than 10 minutes late. When I decided to disclose my health status and my surgery schedule extended wait times to 4-5 months for an initial visit, I got more cancellations but not really that many. With psychotherapy, I often get no-shows after holidays, the start of school, etc, anything that throws people’s schedules off.

    At I.U., we charged a $50 deposit for families seeking parent training. It was a minimum 8 session treatment. If they completed it, they got the deposit back. It was a pretty good idea, I think.

    Finally, this is a secret so don’t tell anybody, but in my experience, some of the most disrespectful families are very wealthy ones. Not all, but a subset, and that subset is awful. It’s not the main reason but does factor into my decision to accept insurance even though I don’t need to in order to have a successful business and most psychologists with my specialty don’t. I don’t want to work with families who pay totally out of pocket. They too often think that they are buying particular conclusions.

    Again, I am sorry. This is a particularly frustrating problem, especially for someone like you who is so heavily scheduled. And if it is any consolation, I for one, very much appreciate and value your time.

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