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September More Voices: Watching the Clock

Dear Pulse readers,

“My only enemy is time,” Charlie Chaplin once said. He was probably referring to the aging process, but he might just as well have been talking about the medical visit.

For me, the hardest part of being a doctor is time.

My first patient of the morning is scheduled for 8:20, but I rarely begin a visit then.


My patient arrives late. Or there’s an insurance issue, and registration is taking longer than expected. Or rooming is delayed because my nurse is tied up with something else, or the patient is a child who needs their hearing and vision checked or it’s an elderly adult, meaning a checklist of questions about home safety, perhaps through an interpreter if they don’t speak English.

I check my watch. It’s now 8:35. My 8:40 patient has just arrived, and my first patient is still being prepped.

I finally walk into the room at 8:37. My first visit begins seventeen minutes late, the closest to on time I will be for the rest of the morning.

My patient has diabetes and high blood pressure. Her sugars at home have been running high. The blood pressure obtained by the nurse is 154/96; I’ll have to double-check that manually. My patient is also reporting back pain, and the Tylenol I suggested isn’t helping at all. Sometimes she can barely walk!

A half hour later, I’m trying to wrap things up. Glancing at my schedule, I can see that my third and fourth patients have arrived.

My patient remembers that she needs a letter to present to housing so that she can get an apartment in a building with an elevator. (She lives in a fourth-floor walk-up.) Oh, and could I please refill her husband’s blood pressure medication? He’s about to run out.

I’m now thirty-two minutes late for my second patient, who is cheerful and forgiving. But she becomes tearful when I ask how she is. I reach for the box of tissues. She’ll also be needing a pap test. And she brings a physical form for work.

At the health center where I work, we’re scheduled for one patient every twenty minutes. As it generally takes me about a half-hour to see patients and listen to their concerns, by the end of a morning I can easily be running an hour-and-a-half late.

The last patient of the morning–it’s now nearly 1:00 pm–greets me with crossed arms and a scowl.

“I got here two hours ago,” she says. “This is ridiculous.”

Sadly enough, I agree. And there’s little I can do about it.

The clock reminds me of how far behind I am, how upset my next patient will be and how unpleasant this feels–despite years of trying to get used to it.

For patients who’ve spent too much time in the the waiting room, the clock is a reminder of how long they’ve been there, the job they’ll be late for, the parking meter that’s about to expire and the many other things they could be getting done if they weren’t having to wait.

And for family members sitting in a hospital lounge as their loved one has major surgery, the clock can mean something else entirely.

How about you? What’s your experience of Watching the Clock, this month’s More Voices theme? Use the More Voices Submission Form to send us your lived experience.

For more details, visit More Voices FAQs. And have a look at last month’s theme: Coping.

Remember, your health-related story should be 40-400 words. And no poetry, please.

We look forward to hearing from you.

With warm regards,

Paul Gross


3 thoughts on “September More Voices: Watching the Clock”

  1. If a patient arrives more than 10 minutes late for a 20 minute appointment, they need to be asked to reschedule or limit their discussion to one issue/concern. Additionally, if the phones are not turned on until after the first two patients are roomed, then staff are less likely to be tied up prior to rooming the patientson. If the first patients of the day are asked to come early to register so they can see the physician on time, at least you wouldn’t be starting late. It sounds like having a solution brainstorming conversation with the schedulers and medical office assistants and doing things differently using quality improvement methodology (plan/do/study/act, iterate, repeat) or lean efficiency mapping might provide some relief.

  2. I’m a Family nurse practitioner student with a background in inpatient nursing (where sometimes twelve hours with a patient doesn’t feel like enough) and I often fantasize about rallying together with future colleagues and increasing our visit times. These 20 minute visits are simply unethical. Thank you for portraying your experience. I’m emboldened (long visits, waiting for that late patient, simply allows us to provide better care) — we can’t afford to misplace value on speed instead of good, slow healthcare.

  3. Paul,

    It sounds as if the health centre where you work should schedule patients
    every 30 minutes,.

    I realise you, as one doctor, don’t have the power to make that happen,

    But what if many doctors got together, and pointed out that when afternoon’
    patients have to wait 2 hours, they may well look for another health centre?

    More importantly, when you have to cut patients off–because you are already
    an hour behind–they are not getting the chance they need to explain their
    problem. And you are not getting the chance you need to listen to them and talk to them.

    Paul, I realise that you know all of this.

    But couldn’t doctors get together to insist that that they have enough time to
    treat patients?
    (Maybe doctors need a union?)

    Definitely, doctors need to organise and stand up to a health centre administration
    that is preventing you from providing “patient-centered care.”

    This would be a good story for the New York Times–or a long story, involving
    many healthcare centres, for The New Yorker.

    Doctors need to band together and speak out!

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