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