Hanging Off The Precipice 

 Man standing on a rock at the beach in Hawaii 

“No worries, Doc. We have her info. We will make sure we get her in ASAP. I promise.”

I had met the patient twice. In less than a week I had diagnosed her with cancer that had metastasized throughout her body and told her that the prognosis was not good.

My next job was getting her into the oncologist STAT. She was hanging over the edge by a thread. Understandable, given the circumstances.

The pleasant voice on the other line, the woman’s helpfulness threw me off. I had been prepared to do battle to get the patient in. Instead there was no resistance. Instead, there was compassion and understanding.

“Ok, but please call me after you get her set up so I can know it got done and when her appointment will be.” So I can raise holy hell when you schedule it for three weeks out…

I was called back within an hour and told that not only had they received the information but they had already called the patient and scheduled her for the next day.

Why do I feel so emotional, like I need to have a good cry? When did I become so jaded that this simple thing feels like a miracle?

THIS is how it should go. It should be that easy to get patients in with specialists. Instead I have to pay a full time employee to fight to get patients seen. 

THIS is how my office should function, too, but it does not. Years of trying to get it there. I feel like a failure.


100 thoughts on “Hanging Off The Precipice 

  1. You feel like that because everybody screws up from time to time — and you have to make sure that time isn’t when somebody needs attention immediately. It really is life or death.

    Liked by 3 people

  2. It is sadly easy to get in defense mode before we even know the outcome! I did that for years at work, always getting ready to defend and expect the worst! When the few things did go smoothly, it did feel emotional! After reading your blog every day I KNOW you are an exceptional physician with nothing but the patients’ best interests!

    Liked by 2 people

  3. Five weeks ago my doctor ordered tests. Two weeks ago we got the results and he referred me to a specialist. It will be up to six weeks before I get the letter with the appointment, and probably several more weeks before I am seen.
    I wish you were my doctor…. or that the system didn’t tie the hands of excellent physicians like my own. It must drive them up the wall in frustration.

    Liked by 2 people

    • Your doctor may not know that the wait is that long. This is why I have a coordinator who tracks it to make sure patients are getting seen in a timely fashion. Otherwise patients fall through the cracks. Granted I am in a different system than yours and do not know the nuances of your issues, there may be nothing that can be done to speed it up.


  4. You are doing an exemplary job Victo. Please stop for a minute and feel good about yourself – you deserve it for your compassion, professionalism, dogged follow ups, fighting for your patients, and general kindness and caring. You are the best..

    As far as getting someone into a specialist – I would expect them to triage, and cancel another less urgent patient based on the file and urgency of the patient that you are sending them. You see they have the luxury of triage because they have info from you to make decisions on. You, on the other hand are a “first res ponder” of sorts and have no idea of the urgency of any particular appointment. Like EMS or fire or police, you have to treat everyone as urgent until you find other wise – you can’t triage. .My GP here in Ottawa got tired of the long wait for appointments for his patients and found that many were no-shows or cancels because of the long wait too get in – some problems go away some have to get addressed by Emerg, some don’t seem so important once the patient gets used to them.- and so on. So he decided that patients could only make same day appointments and he started his admin an hour earlier making appointments for the day only. It worked good for me but I would imagine there would be those for whom it wouldn’t work and they would have to change doctors.

    Anyway, don’t beat yourself up, remember you are a first responder and cannot triage , so here is no way for you to slide appointments into a day,.There is little you can do about that.

    Great post Vito. Keep up the good work!

    Liked by 2 people

      • Bwahaha! it isn’t possible to be anything but who you are. Keep in mind that not everyone will have your dedication.. Or as Jack Welch (the man who built GE into an international conglomerate) once observed of employees: 10% will be your top performers who do he bulk of the work and motivate others – whatever you have to do to keep them, do it. 80% simply do the assigned tasks and not always with efficiency or to the best of their ability. They constitute the bulk of the employees and should be motivated but do not expect great things from them. The lower 10%are useless and often sabotage the good intentions of others.They should be fired.

        So, my point Ms. Alpha is that you should accept others for their limitations and know that you can’t do without those middle 80%. Sometimes it is easier on your head to recognize that things may not ever be to your expectations- as long as the clients are getting the service they require, sometimes you have to settle for “good enough”. While continuously trying to improve of course. 😀 .

        Liked by 1 person

      • Standing here, making pancakes, I have been pondering this further. One if the issues is our complex system. I cannot fix that. It is a corporate issue that will hopefully improve with the new EHR. The second variable is my current office manager. I am not sure that she is training and supervising correctly. It cannot possibly be that I have all of the sub par people in the world, concentrated in my office. I talked to my office manager on Friday about this. I don’t want to have to be the enforcer. That is her job so I can concentrate on patients. Only it isn’t working.

        Liked by 1 person

      • Ahh, therein lies the ambiguity- is there room for doubt? No the ambiguity has taken up all the space.Ha! Yeah, your manager is at least part of the problem if she won’t train, correct or discipline. Perhaps no one has shown her or possibly she is not management material. Many untrained people make the mistake of trying to be friends with their employees. ( I know that ain’t you -oh, you do have to be friendly but not friends) Good Luck.

        Liked by 1 person

  5. When the “little things” simply work I am simply grateful that they work out. If not solutions have to be found. Failure is the one thing that makes people learn and understand.

    If I had not failed at previous undertakings I might not have been the blogger I am today. Through blogging I have found your blog.

    I am grateful to read your work. Thank you.

    Liked by 1 person

  6. WHAT? You’re AMAZING! Don’t let those damn bureaucrats have the power to make you feel as if you did something wrong. They are the toads that make things impossible for patients AND doctors to get anything done. You have a beautiful, caring soul, and you should hold your head high. ❤ xo

    Liked by 2 people

  7. Thank you for following my blog, I am looking forward to reading yours, I get exactly what you mean. I, too am in the medical field, though I don’t openly share that on my blog. Thank you again, have a lovely weekend. xx Paris

    Liked by 1 person

  8. Let’s see. Within a week you not only saw your patient twice but also managed to get her diagnosed. Then you personally arranged for her to see an oncologist asap. What, exactly, do you think you’re doing wrong? A lot of primaries would have waited months to send the patient for the proper tests to reach a diagnosis, and then would have merely given her a slip of paper with the specialist’s name and number, and expected her to make her own initial appointment. I think you are a very good, caring doctor who is a blessing to your patients.

    Liked by 2 people

    • This is what patient centered medical home should be! Not just a buzz word and a bunch of busy work to get some meaningless certification. I want patients to have better access to me. I want to make sure they get the care they need and deserve. I want staff that is cordial all of the time even when they are not feeling it, people who work to be the hero for patients and not just sitting around collecting a paycheck, putting up roadblocks.


  9. Dearest Doc,
    I am so sorry you are beating yourself up for doing the best job anyone can. It is not you but the system. Make sure you give grateful thanks to the person who did their job. It is what the world has come to. We accept substandard as a way of life.
    BUT…you are extraordinary.
    Look in the mirror and repeat this: You are amazing…..you touch so many people in so many ways. You, (insert your real name) are doing the best you can and your light touches many hearts.

    and hear many voices behind you agreeing that all that is true!

    Liked by 2 people

  10. Doctor, the failure is not yours, or the other good doctors out there. It’s the “system” that has grown and multiplied and taken over heath care. Heath care is not about a physician and patient, or health, or well being. It’s the conglomerate that has snowballed into a business model/insurance hell. Please don’t stop. There’s an awful lot of people who need their doctors to be this passionate.

    Liked by 2 people

  11. You are so far from a failure. I still don’t see what you did wrong. I see that much of the time, your vision is not met. But it is possible. You have a clear and important vision. If your hands were not tied, you could create a model program/practice. That’s why I liked your, “hmmmmm.” to Cordelia’s Mom. There is a better way.

    Liked by 2 people

    • I don’t know that it is wrong except that I feel that I have very little control over my staff. Naively I believed that I could do it, create my vision and that everyone else would buy into it. My hands are tied by what corporate allows. I think I am going to do a series on staffing woes soon…

      Liked by 1 person

  12. Good idea. Writing will help you clarify, vent, and explore options. Maybe weekly meetings with staff, or incentives will help. We can influence some people, but we can’t control them. Take care and don’t let it make you crazy. You’re still doing a great job.

    Liked by 1 person

  13. Just breathe, Victo. If you were one of those big charity thermometers measuring donations, we would have seen the red rising quickly these last few posts.

    Breathe. It won’t all be solved quickly, or by one woman. You can only do what you can do. Just keep doing it, not forgetting to breathe, and it will be all right, and you will be all right, and, importantly, your family will be all right, too, because you will be all right.

    X X X

    Liked by 1 person

  14. I wish I had the time to read all of your comments today–most of them are as good as the post. I love the fact that you care and because of you I’ve come to believe that there are other doctor’s who care. Perhaps this experience is the result of a shift in the way medical systems interact with each other.
    Perhaps the staff at the clinic know better than to put you off. What matters is that you care.

    Liked by 1 person

    • I had actually never used this group before, so the experience came as a bit of a shock. It was so atypical. I have to pay a full time person to handle referrals because I kid you not, sometimes it takes weeks of badgering and repeatedly facing the referral info to get someone in. It should not have to be like that. I have taken to calling the offices of the worst offenders, starting with their office manager and if that does not work, I involve the physician. Most of the time the docs have no idea what is going on with their staff.

      Liked by 1 person

  15. So, I am recalling a conversation with a GI doctor and anesthesiologist during a short procedure. This is what they said ( and I am not making this up): I was asking questions about board certification.
    ” General practitioners and Internal medicine doctors need to know more than all of us. They have the real hard job.”

    The sincerity of your writing reflects your passion to do good work. Best wishes for successful pow-wows to come!

    Liked by 1 person

  16. I hope you can also take a short moment or two to appreciate what can happen when the second half of the equation also works as hard to advocate for patients as you do, Doc. And may that happen more often in your, mine, and everybody’s future.

    Liked by 1 person

  17. Pingback: My Article Read (5-30-2015) | My Daily Musing

  18. You are only a failure when you stop trying. Kudos to you for continuing to fight to change a medical system that is sadly in need of repair. I also think it is heart breaking when people need specialists for urgent healthcare and they have weeks of waiting.

    Liked by 1 person

    • That kind of waiting is just unacceptable, I agree. Part of taking care of patients is making and maintaining relationships with other physicians so I can pick up the phone and twist someone’s arm to get my patient in before someone else…

      Liked by 1 person

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