On The Clock

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I felt as if I had been kicked in the chest. My face flushed. We were in the midst of a staff meeting, going over the patient satisfaction surveys as mandated by corporate. I was fresh out of residency, trying to make a good impression…

“She didn’t spend enough time with me and didn’t answer any of my questions.”

The truth was, I knew who wrote it. The surveys are not anonymous…. Not really.

Over the previous month I had spent about 45 minutes with her. Twice. I was only supposed to spend fifteen. Each time, after we had worked our way through her list of 7-8 items, I summarized the plan and asked if there were any questions.

No, she said, she didn’t have any.

After the initial embarrassment wore off, I felt defensive. Angry. I tried to explain the circumstances to everyone in the room. I wanted them all to know it was not my fault…. All of the other docs in the room just nodded their heads in supportive understanding.

This was my introduction into one of the many laws of medicine:

It is always the patients that I spend the most time with who are the ones who feel I have not spent enough time.

A wise friend said recently, “With certain patients I have found that the visit will end the same whether I spend five minutes or an hour so I try to keep it closer to five minutes for those kinds of patients.”

I will admit that I, myself, am terrible at cutting people off. 

When patients are upset about how long I spend with them, generally speaking, it is not at all about time. Not really. There is something else going on. A personality conflict perhaps. They don’t want a collaborative relationship with their physician, instead they want to be told what to do. Or maybe they want to tell me what to do. They want a solemn, quiet physician and not someone who laughs and smiles and uses their hands when they talk. Maybe they have unrealistic expectations or a past history of bad experiences with other physicians that has left them with trust issues that I cannot break through.

For many years I struggled with this. I wanted everyone to like me. I am competitive. I wanted perfect scores on everything. In the end, though, I finally realized that I cannot be all things to all people. I pick what I am good at, try to help as many people as I can, accepting that sometimes I won’t be that patient’s favorite person. 

All I can do is my best and make sure that patients understand that I care even if I am ultimately not the right doctor for them.

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76 thoughts on “On The Clock

  1. People want doctors to fix everything, even that which is not medical. A lot of peple, especially older ones, wait until everything in their life is falling apart to see a doctor then want the doctor to fix everything in their life. Doctors are not miracle workers like people seem to think, nor are they mind readers.

    Liked by 3 people

  2. I have been blessed to have been cared for by three physicians in my life whom I knew beyond a shadow of a doubt were caring and empathetic. They never spent a lot of time with me but were concise in their statements as to what illness I had and the course of treatment. they answered any and all questions I had and I was cognizant that their time was limited. I always have a list of questions with me. Some doctors I have seen seemed to be disturbed that my list was in my hand and ready to be asked. These three though were appreciative and that made all the difference. I have heard other patients leaving these doctors offices complaining. And i think to myself, “what a shame they don’t listen”. I hope to never be that complaining patient that ultimately has their doctor feeling upset, angry or hurt. And I am heartily sorry that all patients do not take into consideration the lack of time that most doctors experience and change their attitudes.

    Liked by 2 people

  3. I used to be angry at physicians who seemed to rush in to see you and then rush out again. I call it assembly line healthcare. But over time and with some experience, I have learned that often times, physicians behave that way because of the healthcare company they work for; wanting more and more patients seen in a shorter amount of time. And more to the point, which this article express, sometimes patients cannot be pleased. Placing the universe in their hands would never be enough.

    Liked by 1 person

  4. You are only human, and will never satisfy or please everyone all the time. The fact that you spend time with your patients is to your credit…. so many times in the past I had gone into the GP’s surgery to find a prescription or sick note already written out before I’d uttered a single word, and I always felt hurried and an inconvenience. Thankfully my recent appointment was far from it.
    You can only do your best, projecting concern and care, which in turn with be received with confidence.

    Liked by 1 person

  5. Ahh, I am sorry.

    My job often revolves around spending time, companionship really, listening to what ails people. I’ve come to realize it’s not so much medical care people need, but a sounding board, a hello kitty band aid, and some love for their souls. It’s tough on doctors, they’re trained to identify and solve problems rather quickly and yet so many people actually go to doctors looking for something else, something they can’t even really put their finger on.

    We have a tough time on this end of things too, people often want a “real doctor,” a professional opinion…..one they won’t be satisfied with anyway and will likely completely ignore. πŸ™‚

    Liked by 3 people

  6. Do you get the Sunday New York Times? There is a beautiful letter from a young husband who lost his wife after a week in ICU. His letter was a letter of thanks for the caring Doctors and nurses who helped deal with his tragic loss. I hope you can find it. I know it made me feel better about the demands that people place upon my husband.

    Liked by 2 people

  7. This reminded me of when I was nursing. The ward some days, or nights were crazy busy. As I was rushing around an elderly patient, a young mother, a newly diagnosed cancer patient would engage me in conversation. I knew it was a really important conversation for that person and there was nothing I wanted more than to sit, listen, advise or reassure. But sometimes I felt I didn’t give them enough.
    Some of those I still remember today, many years later.
    Yes we can only do our best but sometimes that doesn’t feel good enough.

    Liked by 3 people

  8. This is true no matter what field you are in. As a HVAC specialist I run into it a bit and the reality is that some people are going to complain no matter what you do. I have learnt to have a bit of a thick skin and just ‘smile and wave’ πŸ˜‰ You can’t please all the people all the time. Mind you I have the luxury of putting up my pricing for the annoyance factor πŸ˜€

    Liked by 2 people

  9. I thought of you this weekend as I sat in Emerg with my sick husband.

    There was a doctor working this particular section of the ER who matched my mental image of you. She was tall, dark-haired, with a quiet efficiency in her manner. She was clearly respected by the support staff and other doctors in the ER, and her manner towards them reflected that the feelings were mutual.
    Her face would transform magically from intense concentration as she was preparing notes, to a warm smile whenever she addressed someone.

    I watched for 3 hours as each of the 3 doctors in this VERY busy ER treated every patient they interacted with as though they were the most important issue they had to deal with – all of this in a madhouse of activity.
    I was absolutely fascinated by this complex dance they were performing.

    I know this comment doesn’t really address this particular post, but I wanted you to know I’ve learned SO MUCH from reading your blog. Of all the dozens of people I saw flow through that ER this weekend, only one was belligerent and rude to the staff. It only goes to prove what you already know – you can’t please everyone.

    Liked by 2 people

  10. You are so right, only certain patients even answer the customer surveys and they do so because they have a gripe. Unfortunately, the bean counters don’t care. This issue is when some one tries to pin point something on someone. I think the purpose of these surveys are to get a general idea of how “we are doing” compared to other providers….
    But we too are starting to hold the individual clinician accountable for poor scores based on an nasty survey. It is totally unfair and unrealistic.
    WE should do the same thing to the government…. can you imagine, Poor scores and you do not get my tax dollars…. think of it!

    Liked by 1 person

  11. Some people are just more needy. I certainly don’t think you should feel badly about someone getting 45 minutes when they’re scheduled for 15.

    Cutting people off, on the other hand, well…no one likes that. Best to go with the “I need to submit your ___ and I’ve got more patients waiting” schpiel.

    Liked by 2 people

  12. I can only imagine all the trials you have in your job. Heck, people are the hardest things to please! Now dogs, just throw them a bone and pet them and they are your friend for life πŸ™‚ Whether you spend 5 minutes or 45.
    As for me and Drs. I know that Dr.s can have a lot of difficulty solving my problems, so the smiling and laughing while using their hands when they talk is the one for me πŸ™‚ Just show me you care and will do your best and that’s all I ask! And really we were meant to use our hands when we talk, weren’t we ?

    Liked by 1 person

  13. “When patients are upset about how long I spend with them, generally speaking, it is not at all about time. Not really. There is something else going on.”

    I suspect that some patients aren’t sure what they’re seeking at the doctor’s office. When they leave and find they feel dissatisfied, they try to put a reason to it: “she didn’t spend enough time with me.” It’s possible some of this might just be the need for more continuity and trust that’s built over the course of years, something that doesn’t seem to happen much these days, at least not in the United States. Between job shifts, relocations, changes in insurance plans, and doctors changing their practices to meet their own career and life needs, it’s often difficult to see the same doctor for more than two years in a row, much less build a longer-term relationship. You just can’t build the same kind of trust in one long visit as you would in years of visits. Or at least that’s one of my hypotheses.

    Liked by 1 person

    • I agree. Continuity has a ton to do with it. I have patients who have a new insurance plan each year and when they have complicated medical issues with multiple specialists and have to get new specialists each year…. I feel for them. Urgent care and nurse practitioner models further undermine the physician patient relationship. I am willing to bet that in a couple of years, the physician patient relationship will be whittled away completely.

      Like

  14. And that’s it, isn’t it? The humility to accept that you may not be the right doctor for that patient.

    Thanks for being vulnerable and sharing. We’re not all doctors, but we have customers we aim to please, so this helps.

    Liked by 1 person

  15. Your perspective truly highlights the truth. It’s even more ludicrous to tie ones “scores” to their reimbursements. It would be great if the rest of the world operated like this. Don’t like the color of the shirts of the guys at the car wash? Only pay him half the price.
    Good example of good intentions horribly executed,,,with little repercussions for the ones that implemented the idea.

    Liked by 1 person

  16. What an incredibly challenging profession you have, to have only a short moment to deal with both a medical situation (sometimes complex), a personal situation (worries or frustration), and a personality (or more, if patients come together with someone). Some years ago, my husband needed a series of treatments by different specialists, so I know about sitting opposite of a doctor, waiting to hear about results or next steps. Sounds like you have found a good approach in your work. After all, whatever side of the table we’re at, we’re all just humans!

    Liked by 1 person

  17. This might be the beginning of wisdom? I may have told you that when I was a young (market) researcher, I felt frustrated when clients did not apply my carefully supported strategic recommendations. Then I realized that my job ended when I gave the recs at the end of my presentation. And I felt much much better. When clients did not apply my recommendaions, it gave me the opportunity to repeat them the following time. And when they did, it was… just nice.
    (You cannot succeed with all patients. Their choice. Not yours)
    Be good, V.

    Liked by 1 person

    • I apply that to giving, too. I used worry how the money would be used. Alcohol or drugs vs. food or clothes. Then I realized that it was not my concern. I give as much for myself as for others. The act of the giving is the important part. The problem with it in the professional realm is that we are taught that it IS our fault when someone doesn’t like us. We are beat down by it. How can we be everything to everyone? Impossible! Doesn’t make me less of a physician. πŸ™‚

      Liked by 1 person

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