Every patient so far today has had "...Just one more thing!..."

[Aristus]

Remember, if you have "just one more thing", you're stealing time from the next patient. That's not fair to them.

[Sneederbunk]

1. To quote Steve. Martin: "Well, excuse me."

[lapfog_1]

2. anyone there named Columbo?

[5X]

3. I know I am waiting a long time between appointments,

and often have multiple issues I need to discuss.
I don't always remember to mention everything at the beginning.

[In_The_Wind]

4. It's a common complaint ...

from doctors and their assistants.

I must not be a "just one more thing" complainer. Cause the on my last visit the doc ask me if I had any thing we still needed to talk about.

[RiverbendsJoe]

5. Stealing time, huh?

So... it's not part of your job to make sure that each patient is allotted enough time to ask all of the question he or she has? Instead, the each patient is responsible for squeezing all questions into however much time you've allotted? Do you even tell them how much time you have allotted before accusing them of thievery, or are they just supposed to guess? Asking for a sick friend.

[Aristus]

8. Actually, no. That's not part of my job.

Administration calls the shots. The shots include a fifteen minute appointment for any case that's not an annual physical exam or a procedure. I want to provide good medical care for my patients. Admin just wants lots of profitable patient encounters (even though we're registered as a not-for-profit!)

If the problem is clinically significant, I'll address it.

Usually it's an as-long-as-I'm-here kind of thing.

"What's this little thingy on my finger?" (Got that one again just yesterday.)

The stark reality is, there just isn't enough time to hit everything in one clinic visit. And if we're double-booked, as we often are, sometimes my patients and I will prioritize their medical concerns.

[Jirel]

10. This!

The people “stealing” are the administrators and complicit doctors and staff who are happy to trash their medical oaths for a paycheck, while patients’ health suffers.

For shame.

[Midnightwalk]

6. To be fair it is difficult to schedule more than one thing

If I had to go to the doctor in the next month, I’d also try to schedule a flu shot. I’ve been told in the past that each visit has to be for one thing.

It wouldn’t surprise me if insurance companies only allow one charge per visit so scheduling 2 or 3 reasons for a visit is not allowed.

We play by funny rules from insurance companies.

I have no argument with what you said though. If you scheduled one thing it isn’t fair to delay everyone else waiting to get one more thing taken care of.

[Aristus]

11. Immunizations don't throw my schedule off, and are actually an integral part of a patient visit.

My staff takes care of the immunizations after I've finished with each patient and moved on to the next.

Anyway, I'd much rather take extra time with a patient on vaccines then to have to arm-wrestle them best two-out-of-three just to get them to take their immunizations in the first place.

[Jirel]

7. Bullroar!

It is not the patient’s job to protect doctor or staff scheduling. They are there to try to get better. They are already fighting hard enough to get in and be seen in a reasonable amount of time.

Patience fo not “steal time” from other patients. Clinic managers who insist on overbooking, and complicit doctors and staff who say nothing about overboooking, are stealing time and needed health care from patients.

Patients, insist on having your needs addressed. All those sick people falling out of work, or winding up on disability, or dying prematurely, are suffering due to the merciless, for-profit care system.

Decades ago I managed a clinic for an honest and caring doctor. She would allow no more than 12 patients to be scheduled per day. Now clinics are scheduling over 2-3 times that, per doctor. It’s garbage health care, and this stuff about shutting up and not “stealing time” from another patient is also garbage health care.

[Aristus]

9. Yeah. I routinely see at least twenty patients a day.

It gets frustrating. For me and for my patients.

[SeattleVet]

12. Just one more thing...

[Aristus]

13. "Okay, Jerry; You should probably have led with 'my balls are burning.'

Let's discuss some risk factors, okay? First of all, how old did you say your wife was again?"

[Laffy Kat]

20. ...

[ismnotwasm]

14. When you're a nurse, there are days like this

Are my pain meds due?
Oh and I’m feeling nauseous
Oh and My pain meds haven’t worked since I got here
Also I want half a cup of coffee with cream, just half
And can you make it not too hot?
Also can you hand me my phone? Oh I forgot, I need my charger, I can’t find my charger, maybe my family member took it can you charge my phone?
Can I get a cup of ice?
Also I need to talk to my *insert unavailable specialist* they told me they would stop by today
*begins to talk shit about previous nurse AKA “staff splitting” also talks shit about very hard working residents, I deflect and redirect*
That pain med didn’t work can I have something else?
Also, I just ordered breakfast you can take my blood sugar now.
The food is cold, can you heat it up?
Also, No, I never take that much insulin, just give me xx units
Also I have to go to the bathroom *proceeds to give specific instructions about how this is going to happen, turns into about a half hour*

Just as an aside, I personally, take pain management VERY seriously, and “pain meds not working” is going to get a strong response from me as does nausea. The rest is usually a lonely And anxious patient who is either newly diagnosed or chronically ill with too much hospital experience

Still. This is mostly separate requests.

[Midnight Writer]

15. I write down my questions on an index card before my appointment.

Then, when I see the doctor, I pull out the card and go through them with him.

[ailsagirl]

16. Lt Columbo did it constantly

But you're right, of course

Maybe look at your watch when they say that...

[3catwoman3]

17. I start each of my well visits by asking the parent...

...or the patient, if old enough, “Are there any particular questions or worries we need to deal with today?”

At the end of the exam, I ask, “Any questions about today’s discussion?” An open-ended “Any questions?” is an invitation to open Pandora’s box.

Schedules are dictated by those higher up on the ladder than those of us actually seeing the patients. I know I have ZERO power over the scheduling pattern. I do my best to stay on time AND give the patients the time they need. It is a very difficult balance, and I often fall short. Say there are 15 patients on the schedule, and everyone wants 10 minutes more than the 20 minutes allotted. That’s 150 extra minutes, and where am I going to find that kind of time and not fall hopelessly behind by mid-morning, and have parents pissed off at me because I am keeping them waiting?

I get no charting done during the work day, as the face-to-face time with the patients takes up every moment of the 20 minutes. I take 2-3 hours of work home with me every night, done without any pay.

[Aristus]

19. Oh yeah. I learned years ago not to ask: "Any questions?"

I usually phrase it as "Any questions about what we just discussed?"

It mostly, but not always, works...

[3catwoman3]

22. If I were teaching nurse practitioner students, this would be...

...one of the very first pearls of wisdom I would pass on.

[blaze]

18. Good morning Aristus.

Here's to a better day.

[zanana1]

21. You make me want to avoid my doctor.

I know you don't use names, but I wonder if my own doctor talks about his patients, too.

[Aristus]

23. Yes, he does.

We all do, Physician Assistants like me, included.

We talk about the patients we love, as well; and that's most of them. There are people we see sometime two or three times a month for years. We love them. We know what's going on in their lives outside of clinic, and do what we can to make those lives easier from a medical standpoint.

Sometimes those patients die, and we mourn their loss. Then we get back to the business of saving lives and improving quality of life. The process of clinical care never gets any easier. But it's worth it. The rewards are worth the sacrifices and annoyances. We never lose sight of the fact that our patients are people; human beings. Loveable, likeable, frustrating, sometimes infuriating, but always worth the effort to evaluate and treat.

[blaze]

24. We adore my Mom's (94) doctor.

And I suspect her response would pretty much match what Aristus said.