More than one problem? Make another appointment

So I’m currently rotating through an outpatient medical clinic, and despite all the hand-holding, kumbaya-ing, and “the patient is a person” mentality, beneath the surface an insidious beast lurks. This “beast” is the closely held belief that the patient is only allowed one complaint for each scheduled appointment. You made your appointment to get your blood-pressure meds refilled but you also have seasonal allergy concerns? Too bad, make another appointment so we can discuss the issue on a separate occasion.

Just recently I was (politely) scolded by my resident because I presented a 7-week-old baby whose mother had 3 concerns – the child had been throwing up his milk at each feeding for the past few weeks, he had a rash across his entire body for the same amount of time, and she was concerned that he might also have an umbilical hernia. “Try to keep them to one complaint” my resident told me. But the rash and difficulty feeding were likely related (milk-allergy), and the hernia concern arose because she was a new mother and didn’t realize kids usually outgrow those things – it took 2 seconds to say “oh, that’s normal and he’ll probably outgrow it. don’t worry.”

I have difficultly understanding where this idea, that we can only allow the patient one problem per visit, comes from. I understand that the appointments are booked closely together, generally with 15-20 minutes per patient (which includes the time it takes to fill out any necessary paperwork), but have these doctors lost their minds? Do they not realize that people who come into their clinics must take off work to get there, rearrange child-care schedules, etc? Even if they are retired or stay at home to take care of their children, they still have lives and would prefer not to spend most of it at the doctors office waiting in boring stimulus-free rooms.

I have to believe that if we actually had a free-market health care system many of these problems wouldn’t exist. Our society is accustomed to getting it all done at once – this is why stores such as WalMart or Target have achieved their level of success – you can get your grocery shopping done and stock up on anything else you need in one trip. People expect the same thing from their doctors, and I’m siding with the patients on this one. There is no reason why our system couldn’t adjust to accommodate the person who has a couple different medical problems going on. A more market-based approach would simply charge a bit more for the larger amount of doctor’s time the visit uses. As it sits right now the system is too rigid to adjust to these demands – everything must fit neatly into a 4-5 digit “code” for what the visit accomplished, and the doctor is paid according to that code. I understand doctors don’t like it when a visit they thought would take 15 minutes all of a sudden takes 45 because the patient has a lot of issues to bring up, but if you took your car to the mechanic to get the oil changed and they found a problem with your engine, wouldn’t they offer to fix it on the spot while you waited? Wouldn’t you be pissed if the mechanic told you to make another appointment (which would be at least 2-4 weeks from now) to get your engine fixed, and that in the meantime you would just need to deal with it and keep your fingers crossed while hoping that your car doesn’t break down? I would be pissed. No wonder people don’t like going to the doctor.

~ Lily

3rd year medical student extraordinaire (at least in my mind)

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2 Comments

  1. clare said,

    November 7, 2012 at 6:16 am

    Hi Lilly,

    I was working as a qualified registered nurse for over 27 years and have recently moved to an area where the trees have sparked off i believe an allergy related asthma.

    My new surgury that i joined in march has this factory mentality too, get them in and get them out and no more questions, infact the response is a rather looking down your nose and get out of my hair now, mentality.

    Its been incredibly frustrating as my old surgery only 6 miles up the road, did not have this culture and philosophy. I am deeply concerned, not only from a professional basis, but from the patient basis, that this is causing patients to go home and think twice about calling there surgery, and meanwhile developing other symptoms from only a one problem, one appointment mentality…………..and i feel it is a mentality.

    My asthma is still not controlled, and i challenged one of the doctors at the surgery, i feel now as a result because my symptoms are still continuing, they are fed up with me….literally, i was told by another doctor, there is nothing more we can do for you, i said absolutly nothing, she said, no, so i said it again and really looked at her, and she then said, ‘well apart from being referred to a consultant’………….my god i thought, how do those people from a non medical background cope with this sort of attitude and behaviour.

    Well i recently found out, having been out at the local shopppng centre a dear old lady complaining about her cramp in her leg and her ‘breathing becoming more difficult’, overhearing her she continued, ‘they dont like it you know, me taking up there time’ so no i havent mentioned it to them’ she then went on to name the surgery, i interjected and told her my story, and i too was from the same surgery, her friend then said ‘my dear, i moved to the practice over the road, THEY CARE THERE, THEY LISTEN’.

    So once i have my referral, i will also be leaving this surgery, as these two experiences from these 2 GPs have been very negative for me, ………its all in their body language :)
    i also feel, from a professional stance very very concerned that by this adopted culture and philosphy,the patient dissatisfaction, loss of confidence and really worrying, misdiagnosis of patients from not giving them the time to listen to the bigger picture, 10 mins with asking the right questions does can and does give you the big picture, i worked in A and E, i have proof it works, but by dispensing tablets to remedy a one problem from one appointment, we are going in blind to what is really going on with someone…………this is not a caring enviroment, culture or philosophy that i want to join up to and I certainly could not work in it.

    thank you for reading this email.

    I have to tell you that i have asked people i come across who live in the area what there experience s have been of the surgerys adopted culture, they have said, frustrating, rushed, short changed, a very small number have said good, and when asked what they went for, they were mild complaints.

  2. Libbie Coslow said,

    November 18, 2012 at 5:12 am

    Seasonal allergy is not always a problem since you can take some OTC antihistamines to manage its symptoms. :

    My own, personal internet page
    http://www.healthmedicinelab.com/warts-on-feet/


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