Time and Caring

In July 1996, I published a letter to the Editor of the Journal of Bone and Joint Surgery about the pitfalls of managed care. There once was a day when insurance was for covering more major expenses. It was a time when doctors did not have such binding contracts with insurers, and although not an ideal arrangement for serving masses of people, the individual care a doctor could offer was immensely greater and more personal. 

Many of us doctors really meant what we said in our interviews for medical school. We want to help people, to care for them. We are rewarded by the feeling of being valuable to others in meaningful ways. This is done by looking, listening, thinking and feeling. It is easy to handle an ankle sprain, but providing care for complex problems is another story. The managed care environment is very conducive to simple maintenance and renewals of care.

Managed care and government programs are aimed at much more than your personal care, and they gather information for the population and health organizations. They answer big questions about what is called quality measures and severity scores. But at the time you make an appointment most patients are just concerned as to how to handle that injury or illness.

We struggle. We want to care. We want to help as many people as we can. This gets hard when people come in with more complex problems that require deeper insight and discussion. Patients rightfully expect a good, full consultation. How can a doctor do that when there are six to eight patients scheduled in an hour?

The trade-off is that we must be efficient. We use physician extenders such as physician assistants, nurses and medical assistants. This is a good system usually. The problem is that sometimes patients just want to see their doctor and lay it all out. Sometimes the solution is to split the visits up. Can you come back tomorrow or next week for part two of this discussion? Some people can. Others find it hard to take another sick-day off from work to be seen again. Elderly patients have trouble getting to the doctor sometimes.

It is not rare that a doctor must just stop all other discussions to listen carefully to a patient and let them have that long discussion. We do not get warnings in advance, so we cannot really carve out the schedule to make room for this. The other patients end up waiting. While the doctor is giving caring to one person the others feel neglected. By the time the doctor enters the next room he is WAY behind and has to make up time. Do YOU want to be the next patient?

So this article is an explanation and a plea for patience. Most doctors have good hearts in my experience. We have lots of data points we have no choice in filling for the charting needs. At the same time we want to help people in need and it takes more than just a walk through the room to really serve people. We do not like the feeling of being behind and we really do respect your time. While you may be coming in to have your own questions answered, the doctor needs to respectfully answer everyone's. The most common reason for complaints or one-star online reviews is that a patient thinks the doctor was arrogant or just not listening. Perhaps this is true, but sometimes it is just hard to keep the energy up every hour of the week.

So thank you for your understanding and patience. Caring takes time.