The office visit is repeated in the clinics of millions of professionals every day throughout the United States. Some offices allot 15 minutes, others 20. Physicians who see fifty people a day should schedule about 8 minutes. If something slows down the process, an elderly person, a talkative person, someone who needs translation or just needs to go to the bathroom, the delicate mechanism breaks like the fist of a storm giant. Somehow it must catch up; there are people in the waiting room who get angry and if something is not done, the doctor will face a whole day of angry patients forced to wait too long. No matter how he looks, a little voice in his head whispers “Hurry up, hurry up.” Last month he did not meet his goal of RVU and faces a great salary cut.
In the first part of the visit, the caregiver stands outside the door and tries to confirm where they are on the computer schedule to make sure they click on the correct patient. In theory, she knows about it, as this is not a “new patient visit”, but if the wrong computer history is entered, it can have catastrophic results. The dreaded “What are you talking about? I didn’t get a mammogram” or “Do you get my prescription for Flexeril? The only medication I take is Synthroid” will send a chill down your spine. Once she is satisfied, the door opens and she immediately tries to manage the interaction.
When the door opens, the patient scan her face and the first impressions are formed. He already has fixed beliefs about her from previous sessions. Strangely, he may have already decided that she is “useless” and that he will ignore anything she says. He may be seething with anger at the medical profession in general. He may have deep-seated fears about anything that violates her personal space. He may be ashamed of her alcoholism or her sexual preferences or her obesity. He last time promised to take her blood pressure medicine, but he hasn’t. He last time she said she would exercise and get a colonoscopy, but no way he’s going to do it. She reminds him of his very annoying sister who is the one who made him cum in the first place. Today she only looks at the computer cradled in her arms, not at him. He looks angry, she thinks.
She sits and laughs at her recipes. She has been off her existing diabetes medication for months and there is no way she has run out. He insists that she is taking it. The Cultural Tradition is for the cabin to accept this and move on. If she tries to argue with him, she will waste time advancing inexorably like a fine stream of sand cascading down her back. He wants that percocet from the refined ER, but she kind of refuses because “it’s not what’s best for him.” When she receives this news, his sensory system may shut down, as if he lowered one of those metal screens in a downtown store front at night. She will signal it by growling all subsequent Answers.
She theoretically does a “Systems Check” for him to open up about any new symptoms or problems. Actually, if there is a new problem, time compels her to ask you to schedule another visit to discuss it. She would rather wrestle her mother-in-law in a sewer during a storm than pay an extra visit for volunteering nothing. She then performs an exam that probably doesn’t involve undressing or putting on a gown. In her Heart She Knows that this is not ideal but time is running out. Shethe launches into her evaluation and orders tests including labs and x-rays. She prints AN AFTER-VISIT SUMMARY WHICH USUALLY LOOKS LIKE A SMALL BOOK AND READS LIKE “MOBY DICK”.
At this point the door tilts. He never mentioned that she wanted some Viagra or that she had gotten up to pee six times a night. Unless his sister forces him is no way to do that radiography.
A study concluded that 55% of patients, including trusting or having faith in their doctor. This group follows medical advice about 15 percent of the time. The sad fact is that you have chosen a great doctor. She is well trained and very compassionate by nature. She became a doctor to make real change in the fucking American healthcare system. But her visit to her office has entangled her like a spider’s web. As the years go by, it is the most dedicated and compassionate doctors who “burn out” and leave the office for “Quality Management” or an insurance or pharmacy job. Unfortunately I don’t have the solution, but it would be a good idea to put some smart guys in a room and have them work on this.
