These stories about maximally telescoped patients who don't have a problem make me a little nervous. I had to switch doctors to avoid being perceived that way. Plot twist: it ended up i was in fact seriously ill. It's all good now. If I see a primary care doc these days I have everything on a 3x5 card and I'm the most hyperfocused person they will see that day. Sometimes I will channel Adam and ask how a test will affect management.
At this point in my career I consider your patient time allotments
(20 minutes for return patients, 40 minutes for new patients, and 40 minutes for patients over 80 years of age. On any given day, some patients need a 60-minute appointment. They have multiple or complicated concerns. They need a detailed exam or a procedure. They require time to hear and process a diagnosis, a treatment plan, or a prognosis. ) a minimum.
I was offered a locum tenens position which scheduled 22-25 patients per day. These would all be new patients to me. On Tuesdays, the doctor saw 22-25 all new patients at 15 minutes per patient. I told them this was incompatible with quality care.
Comment about all of your podcasts: the volume is set way too low, even at maximum I often can barely hear you (you have soft voce). Set ceiling of volume much higher and we can always turn it down. Thank you.
++We don't reflect enough when things go well. A corrollary is that we often don't even understand what we do that we think is just common sense or common courtesy or just human nature that turns out to be uncommon and makes a huge difference in outcomes.
++The patient-doctor relationship includes more than just the people in the room. Also, don't forget the doctor's support crew. The worst mistake I've ever made was related to my not wanting to trouble a support staff who was already having a bad day due to home circumstances. I am a better doctor when there is no friction between me and my support crew.
++Do not cheat patients who are there only for your time. These are tough ones for me and I think this is related to point #1 above. Surely, anyone could listen to this patient. Is this really the best use of my 40 minutes? And, yet, I can see that if I stretch the visits out to every 3 months instead of every 2, that they end up in the emergency department. But other patients complain that they can't get in to see me and that I'm scheduled out so far. I have not figured out how to resolve this one.
++Don't feel proud because you care for a very old patient. Well said. Avoid doing stupid things. That is good advice.
Thank-you for this. I am becoming one of "those older patients" and have multiple conditions, while trying to appear normal. Diet is a huge challenge and yet it is crucial on my part, to do it right because my issues cause too many consequences if I do not follow the rules. I try to talk to all of my doctors about what my other doctors are doing and keep it as short as possible. It is always clear with every doctor and nurse that they need to hurry and move on.
These stories about maximally telescoped patients who don't have a problem make me a little nervous. I had to switch doctors to avoid being perceived that way. Plot twist: it ended up i was in fact seriously ill. It's all good now. If I see a primary care doc these days I have everything on a 3x5 card and I'm the most hyperfocused person they will see that day. Sometimes I will channel Adam and ask how a test will affect management.
At this point in my career I consider your patient time allotments
(20 minutes for return patients, 40 minutes for new patients, and 40 minutes for patients over 80 years of age. On any given day, some patients need a 60-minute appointment. They have multiple or complicated concerns. They need a detailed exam or a procedure. They require time to hear and process a diagnosis, a treatment plan, or a prognosis. ) a minimum.
I was offered a locum tenens position which scheduled 22-25 patients per day. These would all be new patients to me. On Tuesdays, the doctor saw 22-25 all new patients at 15 minutes per patient. I told them this was incompatible with quality care.
Thoughtful and reflective insights as always. Thank you Adam.
Comment about all of your podcasts: the volume is set way too low, even at maximum I often can barely hear you (you have soft voce). Set ceiling of volume much higher and we can always turn it down. Thank you.
Thanks. Does this apply to fortnight as well?
Yes. Thank you.
Fortnight is one of my favorites. I miss Vinay's oncology dissections.
++We don't reflect enough when things go well. A corrollary is that we often don't even understand what we do that we think is just common sense or common courtesy or just human nature that turns out to be uncommon and makes a huge difference in outcomes.
++The patient-doctor relationship includes more than just the people in the room. Also, don't forget the doctor's support crew. The worst mistake I've ever made was related to my not wanting to trouble a support staff who was already having a bad day due to home circumstances. I am a better doctor when there is no friction between me and my support crew.
++Do not cheat patients who are there only for your time. These are tough ones for me and I think this is related to point #1 above. Surely, anyone could listen to this patient. Is this really the best use of my 40 minutes? And, yet, I can see that if I stretch the visits out to every 3 months instead of every 2, that they end up in the emergency department. But other patients complain that they can't get in to see me and that I'm scheduled out so far. I have not figured out how to resolve this one.
++Don't feel proud because you care for a very old patient. Well said. Avoid doing stupid things. That is good advice.
Most important, do nothing stupid —great remix of primum non nocere
Thank-you for this. I am becoming one of "those older patients" and have multiple conditions, while trying to appear normal. Diet is a huge challenge and yet it is crucial on my part, to do it right because my issues cause too many consequences if I do not follow the rules. I try to talk to all of my doctors about what my other doctors are doing and keep it as short as possible. It is always clear with every doctor and nurse that they need to hurry and move on.
>>It is always clear with every doctor and nurse that they need to hurry and move on.
This makes me sad, Melissa. I hope you find one doc or nurse who doesn't need to move on quickly.
The last line is the most important part of that article.
I love the last line. Oh so true .Humility makes a better doctor than Hubris !