Every evening before I go to bed, I check my schedule one last time to determine what the next day is going to look like. How many patients are there in the hospital for me to check on before office? How many inductions? Any meetings or scheduled surgeries on my lunch hour? How does my office schedule look. I attempt to schedule my time appropriately, but it seems no matter how hard I try, I will often end up running late. Looking back on each day, it almost never went as expected the night before.
I don’t run late every day. Our office is often complimented that it runs smoother than most. We have an awesome nurse practitioner, Ashley, who helps out on days I am delayed. I build in flex time into my daily and weekly schedule to help accommodate the need for emergency patients and unforeseen circumstances, but despite these efforts some days everything just gets out of control.
The reasons I run late are innumerable: patients in labor, emergencies, surgery that didn’t start on time, a wreck on I-65 that makes my first 5 patients late creating a snowball effect for the remainder of the morning, patients who get lost (our address is not in most GPS systems). It seems to never fail that on days when one of these things happen, I will also have a return OB patient come in that will have an unexpected complication requiring an additional 30 minutes to admit to the hospital. In other words, things will run smooth for days, then everything seems to happen at once, which is also usually going to coincide with half our staff calling out sick and our computer system crashing.
One of the reasons that I run late is that when patients have a problem and call for an appointment, they don’t know what the problem is: THAT’S WHY THEY COME TO THE DOCTOR. I cannot hold that against them in any way. For example, a patients requesting an appointment for a yeast infection is given a 10 minute slot by the receptionist. This is the amount of time it takes me to diagnosis and treat someone for a simple yeast infection. However, it is rare that things are that simple.
Here are some examples of what I have actually found when patients have come in to be seen for a yeast infection:
Retained tampon- time 15 minutes
“Doc I’ve had this ‘yeast infection’ ever since my period two weeks ago, the smell keeps getting worse and worse. It smells like something crawled up my vagina and died.” This is the classic description of a forgotten tampon. This visit takes about 15 minutes. Five minutes to remove said tampon, 10 minutes to deodorize the room.
Suicidal patient – time 1 hour
I have had more than one patient come to see me for ‘ yeast infection’, only for them to tell me on arrival that they also want to kill themselves. I’m not sure why they would come to the gynecologist for this. They must trust me and feel comfortable with me. Obviously, it takes time to talk with someone in this situation and arrange to get them the appropriate help.
Herpes-30 minutes to 1 hour
Sadly, this is one of the more common diagnoses I have to relate to women.
The conversation goes something like this: “Doc, I have this yeast infection that’s just not getting better, and now I have these little blisters everywhere… it must be a reaction to the Monistat.” Often when I am telling women that they have herpes, I am also telling them that there husband has been unfaithful. This is a very difficult conversation to have.
The Chatty Patient (or doctor) -time ???
Some patients give a VERY thorough history that might entail everything that’s happened in their life over the last two weeks since this yeast infection has developed. I will also admit that I can get chatty as well. Come in for a yeast infection, but mention you are applying to adopt a baby and I will talk to you so long, my nurse Kim will start knocking on the door to hurry me along.
The Hormonal Patient– time 30 minutes
“Doc, I just know this yeast infection is caused by menopause, as are all my problems. Should I take hormones?” Hormone replacement therapy is a highly individualized decision that takes a lot of discussion and counseling. It does not fit in the 10 minute slot.
The Chronic Issue -time ???
“So how long have you been having the symptoms of this yeast infection?”
Patient, “Seventeen years.”
“Alrighty then.” Once again, not going to fit in the 10 minute slot.
The Worried Patient
The patient who thinks they have a yeast infection, but is actually fine usually takes longer to see than the one who actually has a yeast infection.
“Are you sure everything’s OK? Three weeks ago I had a little bit of itching and then last night I think I saw some discharge when I wiped. Here’s my toilet paper, I saved it for you.*”
Yes, all is fine down there, I explain.
“Then what caused the itching three weeks ago?”
I am not sure.
“I MUST know.”
I could probably come up with a similar list for each appointment type, but I think you get the gist. SO, for any patient of mine who has had to wait in the paper gown, with cold toes, while sitting on the the exam table for longer than you felt necessary, I am sorry. It’s not purposeful. I and my staff do make an effort to keep things running smoothly, but it is also impossible to control or predict how much time each patient will need. Also realize that if the day comes that you are there for an unforeseen diagnosis, I will give you the the time and attention you deserve.
*REALLY, not necessary!