Friday I had 31 patients scheduled. The only doctor who was working with me had 45 scheduled. I did pretty good at keeping up with the schedule. I am getting faster at charting and doing my exams. That’s a good thing. The bad thing is I am not able to give the care I would like. Most of my visits went well. But one is bothering me.
One patient came in for heavier menstrual periods. She is in her late 40’s and the heavier periods are probably a normal side effect of pre-menopause. Usually I spend a lot of time discussing the possible causes of the bleeding, taking a history which includes how much stress, exercise, sleep etc they get. And then we spend time discussing the treatment alternatives including drugs, surgery, non drug and non surgery alternatives. Lastly we come up with a plan that the patient wants.
For this lady, I didn’t have time to do anything but a cursory history. I had to just touch on the possible causes. When she said she didn’t want to go on hormone therapy, I didn’t take the time to find out why. I just rushed into an explanation of an endometrial ablation and set her up for lab work, pelvic ultrasound and an endometrial biopsy. Her eyes got wide and she said she hadn’t even made up her mind about what she wanted to do. I told her that if we wanted to possibly get her to see an MD for the surgical procedure in anything less than 2 months, we needed to start the process. I handed her a promotional brochure about an ablation and told her that if she decided she didn’t want the procedure, she could cancel the EMB and we could discuss other options at that appointment.
I walked out of the room and I was dissatisfied with the entire encounter. If I could have spent more time with her, I might have been able to avoid all the other appointments, surgical procedures etc. Maybe all she wanted was reassurance that her bleeding was normal. Or maybe she really hates having her periods and would love to have an ablation and I hastened the process along. I don’t know.
I just know that I can’t give the best medical care when I am expected to see that many patients in a day. And I KNOW that 45 patients in a day can’t be done with any kind of safety or patient satisfaction. How can you provide good care when you have an average of ten minutes to review a patient’s chart, get a history, do an exam, and chart? Not to mention that you also need time to review the labs of all the patients you saw the day before. There are phone calls to do and paperwork to complete.
I’m glad I’m getting faster and more efficient at doing exams. I’m trying to see that I am helping an underserved population and that I really can make a difference. But boy does it get frustrating at times. And sometimes I am disappointed in myself.
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4 comments:
This blog really helps me to see things from another angle.
As someone who has a huge amount of anxiety around gyn. visits and pregnancy in general, I often left my OB's office feeling like I was rushed and like she didn't take time to hear my fears. The whole experience was so scary and stressful for me, and I felt like she didn't even know who I was let alone understand how much I was struggling. When I called to ask for a longer appt to share my feelings and and ask questions about the birth, etc, I was told this isn't possible because she doesn't have time for anything longer than a 15 minute appt. (anf most appts were closer to 5 minutes).
The sad thing is that I know she's a kind and well-meaning person. I think she is just overbooked like you are.
It's a sad situation, because I think some of my postpartum depression was caused by feeling out of control, not like a person, run over by the medical side of the birth process. I'm sure my OB would hate to hear that, but what can she do?
Thanks for sharing!
I feel your pain.
I actually try never to go into treatment options tilll the work up is done - you end up spending all your time discussing what ifs. A simple statement "there are a number of possible causes for your bleeding, almopst all of which are benign and treatable, and in your age group, probably just perimenopause. But until we work you up for the cause, I'd rather not get too much into the treatment" satisfies most patients.
And as you did, I get the labs that day and set them up to come back for the biopsy and sono.
I find it's more important to the patient that I get them in soon after they call with a problem - then they understand that I may not have a whole lot of time that day to spend in conversation.
You started the wrok up, and that was the right thing at the right time.
Don't be so hard on yourself. You done good.
I can understand why you'd feel bad. You know what really works? Call her. My doctor called me once to check in about something and that was about the nicest thing I could have had happen.
Courtney: Glad to see it helped you see things from a different perspective. Most of us in the medical profession do really care about our patients and we are stuck in a system that is hard on us all.
TBTAM: thank you. I just might try your suggestion.
Rhea: I do call my patients a lot. I also have a great medical assistant who also checks back on patients for me.
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