It happened yet again.  I was running behind schedule, having sent someone to the ER with acute abdominal pain and dehydration, to rule out a bowel obstruction.  Now 20 minutes behind schedule, I looked ahead to my afternoon and mentally winced.  Patients 3, 6, and 7 were well-known to me with their mental health issues.  The schedule already noted that some of them were put in for mental health concerns.  I knew...without a doubt...a long afternoon awaited me.  Followed, of course, by a long evening of after-hours charting to document the visits. 

You see, when I run behind schedule, I will document the “essentials” of a visit, but I will finish my charting after-hours, so I don’t fall farther behind during the day.  It is a bone of contention with my family life...but I feel it’s necessary.  My memory isn’t THAT good to juggle the myriad of details of multiple patients to document my notes days after the visit.

So, onward I marched into the afternoon.

Patient # 3 was there for a physical...because his boss wanted to make sure the employees were “healthy” after a co-worker had a work injury.  The real “meat” of the visit, however, was his panic attacks, which had worsened due to staff cut-backs at his job, thus requiring him to do the work of multiple people.  He reached the realization that medication wasn’t “cutting it.” He needed the tools of psychotherapy to help him cope with the anxiety and panic attacks that threatened to unweave the fragile web of “normalcy” that he had attempted to forge.  I set him up with a favorite counselor friend...sent her a text to give her a “heads-up,” and sent him off.

Phew.  One down...More to go.  Level 4 visit.  Now I’m 35 minutes behind schedule.  Damn.

Fast forward through a few URIs...then I get hit with one ”oh, by the way,” and so-and-so hasn’t been seen since 2009 and stopped her statin and Topamax for migraines.  Her hubby, who tagged along, lost his insurance when he didn’t pay his monthly premium, so he’s tagging along for “free advice” about his issues.  Mind you, he had lymphoma 18 months ago, and he’s asking about dietary counseling, his own URI for 1 month, etc.  WTH?!?!

Somehow, by dumb luck, I’m now only 25 minutes behind.  Apologizing all the way to my patients.  Steaming inside that I haven’t charted a darn thing.

Patient # 7 is well-known to me...having treated her for anxiety for a long time.  I know her, the family dynamics of her mother and sister...and while I suspected issues with her husband, I did not fully realize the extent of his emotional abuse...until today.  I walked in, apologizing for my lateness, and immediately notice the dull affect, limited eye contact.  The listless, “OK,” when asked how she was feeling.

My “spidey senses” tingling, I raised an eyebrow.  (Which, if you know me, is quite the sight.)

“Really?  You’re...OK?”

Tears welled up.  Slowly at first, then with a burst, the story came out.  Emotional abuse from a husband, whose own insecurities had derailed a marriage to the point where my patient was avoiding him at all costs.  Limited conversation to the point where they merely TEXTED each other about their children.  All...for control...because, hmmm...her workplace hired a male co-worker...who happened to sit NEXT to my patient at the office.

I looked at this poor woman, thinking, “WTH?!”

Well, time be damned.  She needed me to listen.  So...listen, I did.  And gave her the number for our local women’s crisis center...and the same counselor from before.

We ended the session with a hug.  Only after I left the room did I think about checking my watch…

CRAP!  Now I’m 30 minutes behind.  (sigh)

Suffice it to say, without delving into the rest of my patient encounters, this is pretty representative for most of us in primary care, often on a frequent basis.  I absolutely HATE running behind.  I can stand 10 minutes on occasion.  But more than that, and (my staff will attest), I get crazy.

I hate to wait myself...waiting in line at the gas station, in a check-out line...it makes me nuts.  I hate when my own PCP runs behind.  I hate doing that to my patients. 

However, the fact is, emergencies happen.  Stuff happens out of our control, such as the unexpected hospital admission...the suicidal patient...the “oh-by-the-way” complaint that turns into chest pain.  We cannot plan for every unexpected contingency in our day.  I will NOT let someone with depression or anxiety walk out of my office without an appropriate assessment, especially for suicidal thoughts.

So far, my patients have understood.  You know why?  I spend an appropriate amount of time with all of them.

That’s right.  The usual URI visits are more than a two-minute in-and-out visit.  I use those moments to chat about preventative services as well.  I’ll check about flu shots, mammograms, etc.  It takes about two minutes to cover those issues (yes, I’ve timed it).

And yes, it takes a heck of a lot longer to chart on these patients afterward.  I acknowledge that.  However...I CAN SLEEP AT NIGHT if I’ve addressed these things.

One of my patients gave me a compliment of sorts this week.  As I rushed into the room, apologizing for my late entry, I sat down, computer unopened on the table-top.  She said, “It’s OK.  It’s worth waiting, because you don’t stare into the computer screen...you listen, and you will take time with me, too, even if I’m here just for a cold.  We all know that.”

I stopped for that brief moment.  And then, it hit me.  Much as I hate running late (and will continue to re-work my schedule to build in time for my talkative and complicated patients)...much as I hate staying late to chart or charting at home, THIS is what is important to patients.

Taking time.  Listening to them.  Answering their questions and educating them.  (And of course, making them feel better and properly diagnosing, treating, etc.)

Even...if coming in “just” for a cold.  This is, I suspect, what we NP and PA providers do best.

Kim

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