Kalee, you did a beautiful thing and even though it didn't have the exact desired result, you clearly set a chain reaction going in that waiting room. I would bet that lady remembers that although the staff/policy was rigid/ridiculous, there were a whole lot of people in the waiting room who were decent humans to her. That had to have made a difference to her.
When my clients get the wrong day or the wrong time I always laugh, do my best to accommodate, and tell them they're just making me feel better in the future when I do it to them. And I've done it - inadvertently double booked a time or fouled up in some way. My clients are lovely and always gracious and accommodating when I have something unexpected come up and need to change things around.
Thank you for the stories. I too have so many "life lessons" that have been taught to me by my patients. I share those in presentations I make it teaching physicians about the care experience. In the late patient story, we tell receptionists to give the patient the bad news about our unavailability: late patients we won't see, or almost every patient who calls in to get an appointment for which the wait is longer than most of us would accept. Allowing the receptionists to deliver our bad news, allows us to escape the discomfort of communicating our reality to patient. It is sad that we put people in that spot, and often without good options on how to meet the patient's expectations. I encourage every physician to provide their staff with options and scripting that they themselves would find acceptable to tell a patient when we can't meet their expectations. Only by feeling the discomfort will we strive to make improvements. So, yes, tell the patient yourself you won't see them is very powerful. Thank you again.
These are the patients and moments that are reminders of why we love what we do and the relationships that fulfill our lives. Some of the most difficult to manage at first visits become some of our dearest and most long standing patients. As I enter my 37th year of practice I am reminded every day of how blessed I have been. thanks for the reminder.
Thank you for this! I interviewed for a Stanford Oncology position and made a similar comment about a desire to care for those in need. Beloved Dr. Harlan Pinto looked me in the eye and said “They all have cancer. They are in need of someone who cares about them.” A quote I will never forget…
There are so many previous posts that I have to agree with... You write and share things that I feel and try to communicate to others! Thank You. I just converted another MD to Sensible Med/Life! Keep up the good work!!
Adam, first of all hello! it's Susan Longstreth, Haverford '89. Please say hi to Sarah for me!
I subscribed to Sensible Medicine and loved it before I noticed your name and realized who was writing it! This is a lovely essay/reflection, so sensitive and human and compassionate, and such a great contrast to what Alex Berenson just wrote this week (accurately) about the horrendous state of medicine these days.
In the past 24 hours, I had a phone call scheduled with a woman I'd never spoke to before. She started out the call by apologizing for being rattled, as she had just come from the Dr who told her: apologies, that COPD we told you that you have? it wasn't your result, it was someone else's. They had also called in a script for her but fortunately she hadn't yet picked it up and taken a medicine for a condition she didn't have after all.
Then today, I had lunch w/ a friend who told me about the hoops she jumped through to get her Dad, in his 80s, and her Mom, same age and w/ Parkinson's to an early morning scheduled surgery .. .only to find out that he couldn't have surgery that day after all because whoops! the surgeon neglected to tell him to stop taking one of his meds in advance of the surgery.
And don't get me started on the medical errors, negligence, and general indifference I saw over and over again throughout 10 years of Mom's illnesses before passing, 7 of Dads, and a shorter time with another relative - mostly when inpatient. It all is so appalling that I added medical advocacy on to services that I offer my clients.
But back to you: if there were more Adam Cifus who realized that their patients are human and treated them accordingly, wow! we'd be in a much better place. A few of Mom and Dad's doctors were lovely humans who I am grateful for to this day for pulling me aside and offering me words of wisdom, guidance, and support.
Thanks for all you are doing for your patients and for sharing your reflections here with us.
Susan. Thanks so much for connecting and for the kind words. (Sarah sends her best!) I am so sorry for what you have gone through. My experiences with my own parents' death (that I have written some about here) were also eye-opening -- for better and for worse.
All the best. Let us know if you're ever in Chicago!
I think that the patients who come late are often the ones who have limited resources, and need us the most. I doubt they choose to be late, and are often embarrassed. I always saw them.
What if they come late and you're still seeing patients. That's when a good nurse comes in. Mine was with me for 35 years. They might have to wait a bit, but you squeeze them in somehow. That's because we never had a quitting time. These days the PCP's follow a schedule which doesn't permit squeezing in or adding in at the end of the day. I ran behind a lot, but people never left me because of it as far as I know. They seemed to understand the situation, that everyone's problems didn't fit into a schedule and that we always gave 100%. The real problem was when I had to run out in the middle of office hours to see someone in the hospital with an acute problem. That was before hospitalists. My nurse worked it out somehow, God bless her.
I was 2-3 minutes late for a first appointment with a new dermatologist. Reception would not help me, I had to register through their free standing computer. It took me 14 minutes to fill out the form, which asked in three difference places if I had/if family members had a list of chronic diseases. Same list, three times. When I finished it, they told me I was late for my appointment and the dr would not see me. I had to reschedule. They looked embarrassed. They did not offer to set a new appointment. I left, never to return.
You are such a good storyteller. My nursing students tend to have very idealized beliefs regarding their future nursing careers. They were not appreciative when I told them that new grad nurses needed to learn the ropes and earn the respect of their colleagues before they would be in a position to begin effecting any improvements/changes, etc. I didn't mean to be a "Debbie downer". How do we interject reality without squashing their energy and dreams?
When I was a medical student on the medicine service in the mid 80’s in canada , I was the primary face for a 60 something woman whom we determined had lymphoma. One day, during an afternoon check-in, she gave me a fine bone china teacup, and insisted over my protestations that I accept it. I realized only later that she knew she was dying, and was giving away her possessions to the people who were important in her life. And, more crucially, that I — a 25 year old open-faced, innocent who saw her twice a day over a short time — had become one of those people. That interaction is one of my clearest memories of that period of my life. It still reminds me how our patients and their families depend on our simple human interactions with them for comfort and support.
Similar experience. 3rd year med student and still hadn't quite worked out the pecking order. We were the medicine service. The elderly woman under our care was suspected of having lymphoma. CT scan showed a mass and surgery had scheduled a laparotomy for biopsy. Being only slightly stupid I pointed out to the medicine resident Mrs. X had palpable inguinal and cervical nodes. Surgery cancelled and FNA confirmed lymphoma. I got a tie tack from the patient and a dressing down from the surgery resident for being so audacious. Oddly enough went into colorectal surgery. Still have the tie tack and remember her name.
Kalee, you did a beautiful thing and even though it didn't have the exact desired result, you clearly set a chain reaction going in that waiting room. I would bet that lady remembers that although the staff/policy was rigid/ridiculous, there were a whole lot of people in the waiting room who were decent humans to her. That had to have made a difference to her.
When my clients get the wrong day or the wrong time I always laugh, do my best to accommodate, and tell them they're just making me feel better in the future when I do it to them. And I've done it - inadvertently double booked a time or fouled up in some way. My clients are lovely and always gracious and accommodating when I have something unexpected come up and need to change things around.
Thank you for the stories. I too have so many "life lessons" that have been taught to me by my patients. I share those in presentations I make it teaching physicians about the care experience. In the late patient story, we tell receptionists to give the patient the bad news about our unavailability: late patients we won't see, or almost every patient who calls in to get an appointment for which the wait is longer than most of us would accept. Allowing the receptionists to deliver our bad news, allows us to escape the discomfort of communicating our reality to patient. It is sad that we put people in that spot, and often without good options on how to meet the patient's expectations. I encourage every physician to provide their staff with options and scripting that they themselves would find acceptable to tell a patient when we can't meet their expectations. Only by feeling the discomfort will we strive to make improvements. So, yes, tell the patient yourself you won't see them is very powerful. Thank you again.
These are the patients and moments that are reminders of why we love what we do and the relationships that fulfill our lives. Some of the most difficult to manage at first visits become some of our dearest and most long standing patients. As I enter my 37th year of practice I am reminded every day of how blessed I have been. thanks for the reminder.
Thank you for this! I interviewed for a Stanford Oncology position and made a similar comment about a desire to care for those in need. Beloved Dr. Harlan Pinto looked me in the eye and said “They all have cancer. They are in need of someone who cares about them.” A quote I will never forget…
There are so many previous posts that I have to agree with... You write and share things that I feel and try to communicate to others! Thank You. I just converted another MD to Sensible Med/Life! Keep up the good work!!
Thanks for the kind words Rudy.
Adam
Adam, first of all hello! it's Susan Longstreth, Haverford '89. Please say hi to Sarah for me!
I subscribed to Sensible Medicine and loved it before I noticed your name and realized who was writing it! This is a lovely essay/reflection, so sensitive and human and compassionate, and such a great contrast to what Alex Berenson just wrote this week (accurately) about the horrendous state of medicine these days.
In the past 24 hours, I had a phone call scheduled with a woman I'd never spoke to before. She started out the call by apologizing for being rattled, as she had just come from the Dr who told her: apologies, that COPD we told you that you have? it wasn't your result, it was someone else's. They had also called in a script for her but fortunately she hadn't yet picked it up and taken a medicine for a condition she didn't have after all.
Then today, I had lunch w/ a friend who told me about the hoops she jumped through to get her Dad, in his 80s, and her Mom, same age and w/ Parkinson's to an early morning scheduled surgery .. .only to find out that he couldn't have surgery that day after all because whoops! the surgeon neglected to tell him to stop taking one of his meds in advance of the surgery.
And don't get me started on the medical errors, negligence, and general indifference I saw over and over again throughout 10 years of Mom's illnesses before passing, 7 of Dads, and a shorter time with another relative - mostly when inpatient. It all is so appalling that I added medical advocacy on to services that I offer my clients.
But back to you: if there were more Adam Cifus who realized that their patients are human and treated them accordingly, wow! we'd be in a much better place. A few of Mom and Dad's doctors were lovely humans who I am grateful for to this day for pulling me aside and offering me words of wisdom, guidance, and support.
Thanks for all you are doing for your patients and for sharing your reflections here with us.
Susan. Thanks so much for connecting and for the kind words. (Sarah sends her best!) I am so sorry for what you have gone through. My experiences with my own parents' death (that I have written some about here) were also eye-opening -- for better and for worse.
All the best. Let us know if you're ever in Chicago!
I think that the patients who come late are often the ones who have limited resources, and need us the most. I doubt they choose to be late, and are often embarrassed. I always saw them.
Dr Cifu,
Thank you for your vulnerability in sharing your experience with us. I learn a lot from you, not only about medicine, but about life.
🙏
Love this. Your patients are truly blessed to have you as their doctor.
What if they come late and you're still seeing patients. That's when a good nurse comes in. Mine was with me for 35 years. They might have to wait a bit, but you squeeze them in somehow. That's because we never had a quitting time. These days the PCP's follow a schedule which doesn't permit squeezing in or adding in at the end of the day. I ran behind a lot, but people never left me because of it as far as I know. They seemed to understand the situation, that everyone's problems didn't fit into a schedule and that we always gave 100%. The real problem was when I had to run out in the middle of office hours to see someone in the hospital with an acute problem. That was before hospitalists. My nurse worked it out somehow, God bless her.
I was 2-3 minutes late for a first appointment with a new dermatologist. Reception would not help me, I had to register through their free standing computer. It took me 14 minutes to fill out the form, which asked in three difference places if I had/if family members had a list of chronic diseases. Same list, three times. When I finished it, they told me I was late for my appointment and the dr would not see me. I had to reschedule. They looked embarrassed. They did not offer to set a new appointment. I left, never to return.
😬
You are such a good storyteller. My nursing students tend to have very idealized beliefs regarding their future nursing careers. They were not appreciative when I told them that new grad nurses needed to learn the ropes and earn the respect of their colleagues before they would be in a position to begin effecting any improvements/changes, etc. I didn't mean to be a "Debbie downer". How do we interject reality without squashing their energy and dreams?
Your writings always make me smile. Love your stories and your life lessons. Such a gift!
Thanks so much, Nancy!
You are such an amazing storyteller.
Thanks, Ann. Warms my heart on a cold Chicago day!
--A
Every patient I saw in my ER career was approached as if a family member.
Some were impossible.
Drunks, belligerence, angry, could not easily be so approached but I tried.
Sounds like a pretty good way to approach patient care!
When I was a medical student on the medicine service in the mid 80’s in canada , I was the primary face for a 60 something woman whom we determined had lymphoma. One day, during an afternoon check-in, she gave me a fine bone china teacup, and insisted over my protestations that I accept it. I realized only later that she knew she was dying, and was giving away her possessions to the people who were important in her life. And, more crucially, that I — a 25 year old open-faced, innocent who saw her twice a day over a short time — had become one of those people. That interaction is one of my clearest memories of that period of my life. It still reminds me how our patients and their families depend on our simple human interactions with them for comfort and support.
Similar experience. 3rd year med student and still hadn't quite worked out the pecking order. We were the medicine service. The elderly woman under our care was suspected of having lymphoma. CT scan showed a mass and surgery had scheduled a laparotomy for biopsy. Being only slightly stupid I pointed out to the medicine resident Mrs. X had palpable inguinal and cervical nodes. Surgery cancelled and FNA confirmed lymphoma. I got a tie tack from the patient and a dressing down from the surgery resident for being so audacious. Oddly enough went into colorectal surgery. Still have the tie tack and remember her name.
What a wonderful memory.