beetlejuice waiting room

My doctor was 2 hours late, why does he think his time is more valuable than mine?

Oh its the worst, my doctor only talks to me for like 4 minutes. If she took more time, I might get better sooner…

Have you seen how doctors act in meetings, like they are the only ones who matter?

You have probably heard one or more statements like these. Maybe you seen them tweeted. Confession: maybe I’ve tweeted one or two of them too.

It has to stop. I’m going to stop doing it. And I’d like you to join me.

Doctors, as individuals, are among the most nobel, well-intended people I’ve worked with. They are scientists, who excelled in school and worked for years in post-graduate studies to get where they are. They chose medicine to care for people. None of them set out to make us wait, feel undignified or inferior.

And yet, particularly as healthcare continues to proliferate the main stream conversations in this country, it is open season on doctors.

In the words of Ice-T: Don’t hate the playa, hate the game.

The game, in this case, is the onion layers of processes and bureaucracies in our health delivery system. And like any flawed process built over time, its the front line fighters who take the brunt of the force.

Let’s look at wait times in physicians’ offices, as an example. Not every visit in a primary care office takes the same amount of time. A physical may take 45 minutes while a prescription refill may take only 10 minutes - I’m rounding, stick with me. So the staff set up blocks on the doctors’ schedules. Maybe they can have two physicals in the morning, followed by three prescription refill visits. What happens if one involves resecting an ingrown toenail, or something else time-consuming? If you are the doctor, do you stop on the clock and ask your patient to make another appointment? Or do you spend another 10 minutes with them? Then that med refill appointment turns into questions about a serious complication. Maybe it requires lab work. Pretty soon, your on-track morning is completely off the rails.

Is that the physician’s fault? Is the the fault of the person scheduling the appointment? What about the staff, and nurses?

Or is it a process problem which has been so broken for so long that no one really knows how to diagnose it, let alone fix it?

I won’t belabor other process examples, although they are many - 4 A.M. blood draws, access to test results, long waits in the ER. Even with the example of office wait times, some will propose simple solutions - send text updates if the office is running late, or call patients before they leave work or home. Those are worthwhile suggestions and the kind of thinking we need to embrace.

But, before we can embrace solutions, we have to stop regarding providers as the enemy. We have to think of them as partners, who also suffer through flawed processes. (How many doctors left graduate medical school feeling prepared to run a business and be an employee manager?)

So, here’s my reminder to myself —I’m asking you all to help hold me accountable: its rarely one person’s fault. Most people, doctors included, are well intentioned. Even us administrative types have hearts. We all chose healthcare because we want to make things better.

From now on, when we have the urge to blame a doc, let’s think about root causes and what we all might do to fix them. I’ll bet everyone will be happier as a result.

Meanwhile, on the internet….

As I was drafting this post, two articles came to my attention today, from different sources. Both of the articles are relevant to this discussion.

Writing on KevinMD.Com, Carla J. Rotering, MD posts: Doctor Bashing has Become a National Sport: How to Stop it.

… many physicians today are demoralized because they have less time with patients, more demands and requirements, mounting stress and declining reimbursement, exacting public scrutiny, and a climate of negativity.

The article is worth our time and consideration. Rotering points out how a few bad apples —they are out there in any profession —spoil the bunch.

Here is Dr. Rotering’s closing statement:

Physicians need to proactively market themselves as the caring, highly-skilled professionals that we are. We can reduce the bad rap by aggressively making the truth known to patients, decision-makers and opinion-makers.

As an alternative, I suggest we ask: how might we identify root causes which inhibit us from demonstrating care, skill and professionalism in our actions? But then again, I’m kinda strange.

Also writing for KevinMD.Cm, Sarah Stein, MD offers: Your Doctor’s a Jerk: Professionalism Extends to the community

Being professional and focused is not about you, it’s about the work you do, and all of the support staff and patients and families who rely upon you to give direction and compassion. And it extends into your community.

Dr. Stein is writing about how a particular physician-in-training conducted himself outside of his professional setting. There are strong parallels to this discussion.