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Schedules, appointments, time. Also, I'm bored.

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I love my job. Love it. I can't express to you how interesting, challenging, joyful, agonizing and marvelous it is to get to do what I do. I share with people, I counsel people, I grieve with people, I rejoice with them. I get to learn and I get to teach. And that's all before lunch time on an average day.

I'm not perfect and I'm certainly not the smartest doctor in the world. I try pretty hard to keep a life/work balance. I try even harder to stay current, to challenge my knowledge, and to be compassionate and kind.

I love my clinic: we have a very personalized approach to excellent care that is affordable. We maintain a high ethical standard of practicing medicine with up to date knowledge and patients as a priority. Are we perfect? By no means. Do we strive for excellence? By all means.

Having said that, there are days when the job can really feel like a drag. I'm not talking about days with irascible patients or bad outcomes, which happen no matter how hard you try to avoid it. The worst days for me are the ones with cancellations.

Now, there are many reasons you might cancel your appointment: you got a flat tire, your boss changed your work schedule, your kid is sick, you forgot you had the appointment and there's a conflict in your schedule. I don't blame people at all for having lives outside of my office. However, there's little for me that is more disappointing than checking my upcoming schedule for the next day when I go to bed, and then arriving at the office only to find a couple of gaping holes in my schedule due to cancellations.

Our office doesn't over book. Of course, occasionally we get a few appointments at the same time, generally during cold and flu season when everyone is sick and walking in to be seen. But the advantage of our care model is that each patient is allotted an appointment time that varies between 30 minutes to an hour, depending on their need (routine follow up is 30 minutes, a physical is an hour or more). We don't over book. We don't book 4 patients per hour. We don't overlap appointments. Ten to twelve patients a day is a busy day for any one of our providers.

That means a couple of things:

  • When you come to our office, you see your doctor for more than 7 minutes, which is the average amount of time that a family physician in a traditional out patient office spends with each patient. You'll probably spend more like 15 to 20 minutes in face to face time with the doctor, if not more (given the 5 to 10 minutes it takes to be checked in).

  • Our doctors (specifically, me) tend to be closer to on time. I remember when I worked in Alabama at my first job out of residency, I had a patient who said that she could drive to Birmingham, 45 minutes away, see a doctor there, and be back home in less time than it took to be seen in the clinic where I was working. Why? That clinic was driven by getting high numbers of patients to be seen every day. So, routinely the providers had anywhere from 25 to 40 patients scheduled each day. We also did obstetrics and some limited gyn surgery. So the other providers not only would schedule a solid wall of patients each day, they would break out to deliver a baby or do a tubal ligation while patients were waiting in the office through their appointment times.

  • We tend to be less distracted. As any medical provider knows, the winding down end of an appointment is often when the "oh, Doc, by the way" problem pops up. Sometimes it's as simple as a toenail fungus that needs treatment, other times it's as serious as a heart attack. "I have chest pain when I walk up a flight of stairs, is that a big deal?" is an actual question a patient asked me as an "oh by the way" on the way out the door. If we can wind up without the press or rush of knowing other people are waiting in the other exam rooms, I'm much more likely to be still focused on you and what you are saying to me.

This is the beauty of working in an office where we aren't pressed to see 20 to 30 people a day just to stay liquid. It's also the agony. If you call at 8:30 am to cancel your 10:00 am physical, I now have an hour long gap in my day. It's boring. It's a total drag on the rhythm of a good, busy day. Sure, I know I can read, I can catch up on email and paper work (and blogging), but I want to be busy, to see patients, to care for people. Add to that the fact that patients who no show or who cancel last minute actually cost any doctor's practice money (we have the staff here and the lights on whether you show up or not) and it's frustrating.

The same is true in a beauty shop, an auto repair place, or even a restaurant that requires reservations. There is a reason places charge a "missed appointment" fee.

As Americans and as consumers, we take for granted that we can just walk in anywhere and get anything we want at any time. We also assume that not only can we, but that we deserve to be able to get what we want the second we want it. And this is because, frankly, as Americans in this age of convenience, we generally can. We can decide at 2am that we need to go to a grocery store for milk. We can stroll into an urgent care or Minute Clinic and see a provider for our med refills within a relatively short period of time. We can drive up to the oil change chain store and get our car repairs done. But none of that care is personalized or tailored to our needs, it's just shaped to fit our demands. And it often lacks the continuity that we need to truly experience high quality of care (from our doctor or our mechanic, frankly).

So, whether it's your stylist, your dentist, your mechanic or your doctor's office, keep track of your appointments. Keep a calendar, use reminders (email yourself appointments). That way when you get that flat tire or sudden schedule change, we might wave the missed appointment fee because we understand. But make an appointment, carve out the time, give it importance.

If your doctor's office keeps you waiting for hours after your appointment time, fire them and tell them exactly why. Find a place that respects your time and your needs, and then do them the same courtesy of respecting theirs.

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