Balancing Patient Sympathy and Practice Policies

A couple of weeks ago, a patient I see for thyroid disease said to me, "I want your opinion on something. Last month, I developed Bell's palsy. I knew what it was. The next morning, I called a neurologist and asked the front desk if I could be seen that day. She said there were no openings that day. I asked if one of the neurologists could see me at the end of the day. I didn't want to make anybody else's appointment late, I didn't ask to be squeezed in, I just wanted one of them to see me at the end of the day. She said that they couldn't.  I started to cry. I said, 'Please, please, can't they just stay and see me?' She said she would check. When she came back to the phone, she said they couldn't see me. Can you believe that?!"

 What I wanted to say was, "I can't believe you are even asking me this question," but what I actually said was, "Well, I can understand why they wouldn't be able to accommodate you."  I said that if she felt it was an emergency, then she should have gone to the emergency room. She said she knew it wasn't an emergency. Then, she asked me if I would have seen someone who had called crying, and I said no. If I stayed late to see every person who cried on the phone or got angry or begged, I would never go home. She said when she worked as a teacher (which with all due respect was probably a good 40 years ago), she would have stayed late to help a student who needed it even if her boyfriend was waiting to have dinner. I wasn't going to argue with her about it. She said she wanted my opinion, but what she really wanted was affirmation, and she wasn't going to get it from me.

 I tell this story because it is a reflection of some patients' unrealistic expectations of physicians. It partly stems from their unawareness of what goes on behind the scenes and after hours. Long after the patient appointments are done, there are forms to fill out and phone calls to make. These are also part of patient care, and we need time to do it. It often takes me two hours to three hours to finish a day's worth of non-appointment tasks. It also partly due to the perception that the practice of medicine is just like any other consumer product - I want it, therefore, I should have it and have it my way. There are patients who get upset because our hours are inconvenient for them. We work five days a week, start at 8 a.m., see patients during the traditional lunch hour, and see patients until 5:45 p.m. twice a week. It is also partly because many patients forget that we are human, too. We get sick, we have family members who get sick, and we have spouses and children and aging parents. We need to sleep, eat, and bathe. We need to see our doctors, too, and guess what? We have to see our doctors during their office hours. No late night or weekends. And to better serve our patients, we need to pursue further education and attend lectures and conferences.

We continue to strive to provide good patient care, but there are only so many hours in a day, and tears won't make those hours multiply.