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.
The Friday Reflections had been a highlight for me and I was sad when they became less frequent. I understand the reason but I was still sad. It makes them that much sweeter when they do come now. Thank you!
I was a patient in a large ortho practice where the doctors were consistently running late, not 15-20 minutes late, we’re talking hours behind.
The last day I was there, a disabled elderly black lady was brought in by ambulance. She was late, not her fault, as the whole of the waiting room soon learned as the driver and a scheduler loudly discussed the woman with no concern for her privacy or dignity.
She was late because she was so large they had to get the ambulance to accommodate her size. It turned out she was not that late just 20 minutes but the scheduler kept insisting it was too late because the office had a schedule.
At that point it was already 40 minutes past my scheduled appointment. I sat there looking at that poor woman who was quietly crying being humiliated for a situation not in her control and I stood up and said she can have my appointment. The stunned scheduler told me to sit down that the woman was supposed to see another doctor. The man beside me asked if she was there to see his doctor and was told no. Any one of us in that waiting room would have given that woman our appointment but according to the scheduler their policies were inviolate, the woman was late and could not be seen as she was late. Most of us in the waiting room were waiting well beyond their inviolate patient late point for a doctor who had no such time constraints.
I mentioned the waiting room incident to the doctor when I finally saw him an hour later and he said he only saw patients he had nothing to do with the waiting room, other staff, policies or scheduling.
The next day I called the practice manager to discuss the incident as I still felt very uncomfortable about the way that patient had been treated. In that conversation the manager blithely admitted that they triple booked. My turn to be stunned two or three people for every appointment? Yes because of potential no shows I was told. They had to stick to their strict policies to keep things flowing.
I told her that it was obvious their priority was not patient care, certainly not patient privacy and that no matter how respected and highly touted the young doctor I saw there was, I would not be back. My time was important too and it would not be spent on a doctor who was consistently 1 1/2 hours behind schedule, not I now find out because he was giving his best to another patient but because he was playing catchup to all the patients booked for one appointment.
I also told her that the patient rights of the women denied care were violated by the very public discussion of her care in front of a waiting room filled with other patients and that if she sued they deserved it. Sadly I doubt there was any lawsuit and my leaving the practice made no difference to them.
It is now a huge practice statewide with beautiful new offices, PT facilities, surgical centers, very well known and highly respected.
I still wonder about that lady and how many other late patients they have turned away? Have there been any lessons learnt? As others I know who go there always complain about the wait, double and triple bookings apparently continue, but I bet discussions about patients are now done in private to avoid waiting room reactions.
If a doctor I see now is late I no longer sit and wait, I inquire how much longer and reschedule if I don’t want to wait longer. If it’s habitual I change doctors. My time is important and I want to use it well.
But there are some patients who don’t respect our time. Some can’t help it yes, but many no show. I had a half day today, 9 patients scheduled. Only 4 came. Two cancelled same day and 3 didn’t show. I don’t terminate patients for no showing or being late, but I give them 15 minutes, then they have to reschedule. My time and sanity is valuable too.
I've never understand not seeing someone because they're late. I just never thought about it. We always saw everybody. now. I trained at a inner city university Hospital, where we never saw any 2%ers. So I just took it for granted and then I joined a small private practice and find my own practice and for the next 40 years, we just saw people as they came. We tried to schedule them intelligently so that no one would have to wait. I always loved a no show because it gave me time to catch up with my work. Then five years ago, I joined a residency teaching clinic where they had the 10 minute rule. I volunteered to see the late patients myself. I was turned down because my other colleagues who were running the place came from Gen Twit where rules are sacred. I left there and I'm back on my own seeing patients as they come and treating them with the respect which they deserve.
I do the same. It’s asinine that many clinics will refuse to see you if you’re late and charge a missed appt fee but think nothing of making you wait 2 hours or even more. Not just specialists either, even primarily care. And doctors wonder why direct care practices exist?? I have a direct primary care physician, a direct pay physical therapy practice, we even found a direct pay psychiatry practice when it was needed. I despise the standard insurance model system, and operate within it only when there aren’t other options.
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.
I wish I could have you as my PCP!
put me on the list!
Oh, you have so much compassion for your patients. They are lucky!
The Friday Reflections had been a highlight for me and I was sad when they became less frequent. I understand the reason but I was still sad. It makes them that much sweeter when they do come now. Thank you!
🙏 I’ve got a couple in the pipeline!!!
I was a patient in a large ortho practice where the doctors were consistently running late, not 15-20 minutes late, we’re talking hours behind.
The last day I was there, a disabled elderly black lady was brought in by ambulance. She was late, not her fault, as the whole of the waiting room soon learned as the driver and a scheduler loudly discussed the woman with no concern for her privacy or dignity.
She was late because she was so large they had to get the ambulance to accommodate her size. It turned out she was not that late just 20 minutes but the scheduler kept insisting it was too late because the office had a schedule.
At that point it was already 40 minutes past my scheduled appointment. I sat there looking at that poor woman who was quietly crying being humiliated for a situation not in her control and I stood up and said she can have my appointment. The stunned scheduler told me to sit down that the woman was supposed to see another doctor. The man beside me asked if she was there to see his doctor and was told no. Any one of us in that waiting room would have given that woman our appointment but according to the scheduler their policies were inviolate, the woman was late and could not be seen as she was late. Most of us in the waiting room were waiting well beyond their inviolate patient late point for a doctor who had no such time constraints.
I mentioned the waiting room incident to the doctor when I finally saw him an hour later and he said he only saw patients he had nothing to do with the waiting room, other staff, policies or scheduling.
The next day I called the practice manager to discuss the incident as I still felt very uncomfortable about the way that patient had been treated. In that conversation the manager blithely admitted that they triple booked. My turn to be stunned two or three people for every appointment? Yes because of potential no shows I was told. They had to stick to their strict policies to keep things flowing.
I told her that it was obvious their priority was not patient care, certainly not patient privacy and that no matter how respected and highly touted the young doctor I saw there was, I would not be back. My time was important too and it would not be spent on a doctor who was consistently 1 1/2 hours behind schedule, not I now find out because he was giving his best to another patient but because he was playing catchup to all the patients booked for one appointment.
I also told her that the patient rights of the women denied care were violated by the very public discussion of her care in front of a waiting room filled with other patients and that if she sued they deserved it. Sadly I doubt there was any lawsuit and my leaving the practice made no difference to them.
It is now a huge practice statewide with beautiful new offices, PT facilities, surgical centers, very well known and highly respected.
I still wonder about that lady and how many other late patients they have turned away? Have there been any lessons learnt? As others I know who go there always complain about the wait, double and triple bookings apparently continue, but I bet discussions about patients are now done in private to avoid waiting room reactions.
If a doctor I see now is late I no longer sit and wait, I inquire how much longer and reschedule if I don’t want to wait longer. If it’s habitual I change doctors. My time is important and I want to use it well.
But there are some patients who don’t respect our time. Some can’t help it yes, but many no show. I had a half day today, 9 patients scheduled. Only 4 came. Two cancelled same day and 3 didn’t show. I don’t terminate patients for no showing or being late, but I give them 15 minutes, then they have to reschedule. My time and sanity is valuable too.
I've never understand not seeing someone because they're late. I just never thought about it. We always saw everybody. now. I trained at a inner city university Hospital, where we never saw any 2%ers. So I just took it for granted and then I joined a small private practice and find my own practice and for the next 40 years, we just saw people as they came. We tried to schedule them intelligently so that no one would have to wait. I always loved a no show because it gave me time to catch up with my work. Then five years ago, I joined a residency teaching clinic where they had the 10 minute rule. I volunteered to see the late patients myself. I was turned down because my other colleagues who were running the place came from Gen Twit where rules are sacred. I left there and I'm back on my own seeing patients as they come and treating them with the respect which they deserve.
I do the same. It’s asinine that many clinics will refuse to see you if you’re late and charge a missed appt fee but think nothing of making you wait 2 hours or even more. Not just specialists either, even primarily care. And doctors wonder why direct care practices exist?? I have a direct primary care physician, a direct pay physical therapy practice, we even found a direct pay psychiatry practice when it was needed. I despise the standard insurance model system, and operate within it only when there aren’t other options.