Today you have an appointment with your Doctor at 9am. You walk in the office, greet the receptionist and check in. Then you sit and wait…and WAIT AND WAIT AND WAIT. What the hell are they doing back there?? What the hell is taking so long? They cannot possibly be that busy. Your blood pressure slowly starts to rise every minute you sit. When the nurse comes out with a folder you feel a twinge of excitement because it must be your name they will call. But then it is Ben Dover and not you. After you absorb the disappointment you think WTF he walked in after me! This is bullsh**t, they must probably surfing the internet and chatting it up over coffee while ignoring a lobby full of patients. Now you are just angry and you think..I am going to give them 10 more minutes until I walking up there and demand to be seen. Then at the 9th minute they call your name, just in time..your blood pressure plummets and you suddenly feel optimistic. That is when a very pleasant medical assistant or nurse takes your vital signs and you are happy progress is being made. Until they leave and again you wait..and WAIT AND WAIT AND WAIT. Being in the exam room does not make it any more palatable, it just makes you more fired up because you are so close you can hear the doctor’s voice in the room next door and that paper on the table is sticking to your legs. Your patience has worn thin and you are on the brink of looking like that emoji with their head exploding..then the door opens. This emotional rollercoaster is one I have experienced as a patient myself so I can only imagine the magnitude of emotions must be ten-fold for those who do not work in the medical field.

So I am here to tell you what goes on behind the scenes in your doctor’s office and hopefully shed a little light on why it never goes as smoothly as you hope.

Scheduling

The next time you are sitting in the waiting area ask the 2 people next to you what time their appointment is scheduled.  More than likely the 3 of you are all scheduled at 9am. Why? Because there is limited availability on the schedule so instead of making you wait until the next available appointment which is 3 weeks away you are double or tripled booked at that time slot. Medical provider schedules are usually created in 4 hours blocks with time slots.  For example, my clinic runs from 8:30am to 4:30pm with patient slots every 20-30 minutes. It is rare that just 1 patient is scheduled at each time slot due to volume, demand and patient preference. Most patients want to be seen early in the morning or later in the day, so in an attempt to accommodate everyone, double and sometimes triple booking occurs. Is it ideal? NO. Last I checked I do not have a clone so I can be 2 places at once. Just know that we are doing our best to see everyone efficiently, but also take the time we need to with each person.

Documentation

You cannot imagine the amount of documentation required to see just 1 patient. Chief complaint, medical history, medications, allergies, past surgeries, physical exam, tests ordered, results reviewed, your assessment and plan, put in the follow up note for the schedulers as well as any orders, and bill..for EVERY SINGLE PERSON. On average it can take 5-10 minutes to document and bill on every patient using an electronic medical record. Multiple that times 20 patients being seen and the requirement of having to have your notes completed within 7 days for compliance reasons. I chart on every patient after I see them if possible otherwise it just builds up to an unmanageable number.  It is a necessary evil, but definitely slows down the clinic flow.

Phone calls

In the midst of a busy clinic day with face to face encounters, there are double the amount of phone calls that come in from patients at home, doctors needing consults, the labs with test results, you name it. Those patients that wait until they have 1 pill left to call for a refill on a Friday afternoon, those with questions about symptoms at home, follow up calls on results, you get the idea. Three quarters of the day can be spent answering all of these calls and coordinating care.  Yes, we are always on our smartphones, but not just surfing social media and internet shopping. It is where all the pages, emails and calls get answered in order to ensure quality care.

Difficult Patients

Unless you are there for a yearly physical, almost every person in the waiting room is there to address a concern. Whether it be an infection, a pregnancy, a cancer, people are not feeling well.  It is not always as easy as giving you Z-pack and sending you on your way. People in the US have multiple medical problems at one time like diabetes, heart disease, lung disease, and many others that need to be addressed during the visit in addition to the chief complaint.  Sometimes you can spend over 40 minutes just with one person knowing the others are waiting, but you cannot compromise care. I can tell you this, it does not make any medical provider feel good to be running an hour late. It is stressful, frustrating for EVERYONE and when you rush, mistakes happen.  So know that your doctor is doing the best they can to get to everyone, but it may take longer than you would like.

We are Human

Yes, sometimes I have to pee. I have to eat. I have to drink water. We are not having a party back there, trust me. I typically have patients booked right through lunch so I bring my own and eat it there. But I need a moment to breathe and do what others do during the day. Reset my mind and give me strength to move through the schedule. I have seen patients get upset when they see me walking back with my lunch bag as if I am not allowed to eat because they are waiting. Trust me, you DO NOT want a HANGRY provider. What we also don’t tell you is that we occasionally have sick medical humor, we need laughter to get through the day. I have been known to throw on a song for a 2 minute dance party to de-stress the room. We feel every emotion you do. We feel the tears you shed, the frustration in your voice, and feel the smiles you bring. I explain a lot about how my work in oncology and my emotions go hand in hand in a previous article, surviving a career in cancer.

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I love nothing more than to make people laugh and feel good, it makes my heart happy. It is why I am a PA and a coach.  If you want to laugh and see more behind the scenes, follow me on IG and IGTV! Or if you want to know more about becoming a PA or coach, email me directly!

Considering going to PA School?? Check out last week’s article How to Rock your PA School Application!