Math

15 minutes. This is the typical amount of time allotted for any single follow-up or acute type appointment in Primary Care. 30 minute spots are reserved for new or complicated appointments. Now, I just want that to sink in for a minute. I want everyone to sit down and think real hard for a moment, about how much they can get done in 15 minutes.


How long does it take you to unload and load the dishwasher? How organized, nearby and accessible are your cabinets? If your house is like mine, half the cabinet doors have locks on them, so there's that obstacle as well. Are all the dishes already rinsed off and in the sink? Or do you need to walk about the house gathering them? Do some need to soak? Some need scraping? Does it always take the same amount of time? Is every unload and loading of the dishwasher the same? Or are some meals harder to clean up after, requiring a bit more time and effort?


Tonight, when I asked the 26th patient I'd seen today, a patient I have never met, mind you, if they had any allergies to antibiotics, they crassly replied, "It's in my chart."  This comment doesn't shock me, as I hear it near daily in some shape or form, but it does piss me off. Every. Single. Time. Now, let me preface this to say that I have very consciously chosen not to bring a computer in with me when I see patients. I cannot focus on the patient when I have that thing in front of me. Period. So, I am unable to reference patient charts while in the room. This sort of response to my simple and straight forward question, that every patient should reflexively be able to respond to in an instant, absolutely encompasses ALL that is lacking in patient education and awareness of how a doctor and the office where in they work, functions.


Oh. It's in your chart!? Silly me. How did I miss that? It's only one column of a chart with no less than 15 columns. And having met you for the first time, to discuss your one urgent problem, in less than 15 minutes, how on earth, have I not managed to memorize your ENTIRE chart? I must be a completely negligent and idiotic doctor. I must be incompetent. How rude and irresponsible of me to not know your entire life, inside and out. To not know every med you've ever taken, every surgery you've had. What you've tried previously for your high blood pressure. That you've had an xray of this same knee before.


If you have guests and they offer to help you clean up after dinner, when they ask, "Where does this spatula belong?" Do you reply, "In the kitchen." If you do, you're an asshole. Unless, of course, your kitchen literally has one drawer. Otherwise, they need to open every cabinet door and every drawer until they find where each item belongs, when you could have simply guided them.


Somewhere along the way, people have gotten the impression that doctors have super powers. That we can read and interpret hundreds of pages of "past medical records" in minutes. How far into a novel do you get in 15 minutes? That's just reading it. That's not discussing it, giving it a grade, then writing a review about it. Which is what seems to be expected of us at nearly every visit. We get nasty messages and reviews when disability paperwork doesn't get faxed in a timely manner. When their calls aren't returned same day.


We are supposed to see patients. Document about it. Send in medications. Order labs. Interpret labs. Call patients. Fill out their work physical forms. They're sports release forms. Send in their proof of vaccinations. Refer them to specialists. Talk to pharmacists. Re-explain problems to loved ones. Schedule them. And people wonder why they feel like "they only see their doctor for 2 minutes." Because they do!! That's all there is time for. Literally. It's math. There are only so many minutes in the day. There is no time left to talk to the patient, get to know them, actually listen and enjoy patient interactions. There is simply no way to live up to patient expectations in the current climate.


I'll be the first to admit, I love the people side of patient care. I spend way too much time in the room. I like to problem-solve with the patient and include them in the decisions about their health. I like to educate them. I force them to tell me names of meds and allergies, because I think it's important they know these things. But, you know what? All of this takes time. A lot of it. So, if I am in the room talking to you, that means that something else is getting pushed down the totem pole. For me, it's paperwork. Anything paperwork. Your short-term disability papers, your letter to your employer, it's going to take a while, because I am inside a patient's room, talking to them. Connecting. If your labs are normal, you likely won't hear about it for a couple days. To trade off, if you're scan comes back showing cancer, I have personally called the oncologist already, I've set up your appointment, I've made all the plans for you and I am on the phone calling you immediately.


Trust me, I know everything is important to each patient. Even normal labs. If it could be any different way, I would do it. But it can't. We all have priorities and we all have the same number of minutes in a day. So, quit making snide remarks to your doctor. Quit having super-human expectations of your physician. Take charge of your health, and if you haven't gotten the call back that you wanted, keep calling. But don't be mad that you've called us 3 times to ask if the MRI has been scheduled, and we've already told you once that insurance hasn't responded yet.


Just stop for a moment, and really think about 15 minutes. You might start to appreciate all that we get done, and perhaps even be amazed. Maybe you will be more prepared and thankful during those minutes you have face-to-face with your doctor. Maybe you will forgive those moments where they ask redundant questions about allergies or previous medications. Maybe you will take ownership of your own health and drop forms off earlier than the day they're due. Request refills a week in advance. Schedule follow-ups more regularly. Maybe you will make, what is currently a very rushed and somewhat stressful interaction, a completely functional and enjoyable one.


I mean, a doctor can only hope.