Monday, September 20, 2010

After 3 pm

There are days when I think that Central Scheduling makes an announcement:



 Heavens, it seems that way. I take pride that I take the time patients need during a visit. I run on time, almost all of the time, but there are days.........................

I retired from OB two years ago after about 4000 babies. Wheedoggies..that was a rollercoaster for me, the office staff, and my patients. When I entered the world of ambulatory GYN with Cleveland Clinic I thought the chaos was behind me. OH NO, not for me. You see, I am a gynechiatrist. That means that I dispense a healthy dose of psychiatry with each annual exam, consultation, and patient who is about to faint from fear.

This takes a certain amount of time, and finesse. Mostly I get it right the first time. Occasionally I have an abysmal flop, and read someone completely wrong. Oh well, lessons learned, apologies made, and then moving on.

Back to time. Lately I have noticed that the witching hour is 3pm. I suppose that the scheduling department starts at the 8am slot and fills accordingly. Somehow 3 pm and after is "bottom feeders only" time. That would be patients that need to get in "right away", have a time crunch for some other reason, or have kids they have to pick up in 30 minutes.

These patients come with predicatble problems.

For example, there are ladies who have seen three other physicians. All of  whom are of a single diagnostic opinion, offered all of the options, and they don't like it one bit. It is now going to be my job to figure out what they don't like, explain everything again, but this time they will get an explanation they understand ( or I die trying ). I help them get from confusion to a decision.

Other women haven't seen a doctor in years, and my name was on their insurance list. They decided to drop by for the afternoon. These good ladies have never heard of a primary care provider, let alone know what one does. They think everyone is Dr. Welby and does cardiac bypass surgery in the office while they have a pap. These folks need the Cliff Notes of managed care lesson, and I help them get a grip on reality.

Still others went to the family reunion last summer, found out someone's version of family medical history and have decided that their aches and pains are certain signs of the same thing Aunt Martha had just before she passed. They have had these symptoms for years, but today decided to "check out everything". These women get a lesson in what's inherited, and what's not.

Then there are the legions of the half informed. They come in and want "tests". Sometimes they want CAT Scans, MRIs, blood tests, ultrasounds, and all manner of breast imaging. When asked what diagnosis I should ascribe to the tens of thousands of health care dollars they propose to spend, they are not sure. I certainly should know. Doesn't everybody get "tests" ? They need some education in being a good steward of health care resources, and what sane health related maintenence entails.

So between the hours of 3pm and closing ( also known as TBD), I inform, assist, educate, reinforce, assure, diagnose, and explain my way through the day. By quittin time I am one pooped pup.

Until next time.................................:)

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