“What can I do for you today, Cheryl?”
“I want a full check-up, and I’ve got a few niggly problems.”
“Sure. How about you list them for me?”
“The first thing is I’ve been having trouble sleeping and I’m snoring a lot. Second thing is that I’ve been getting pins and needles in both feet and my left arm goes numb. I also have this bladder weakness that’s getting worse. My heart races at times and I feel dizzy. Oh and sometimes I get pains in my chest. And in my head, especially behind my eyes. Also pains in my groin area, as well as a rash which comes and goes. And while you’re looking at the rash, I’ve got a heap if skin tags I want removed.”
“Hmm… anything else?”
“Umm… well I think I’m going through the change of life – I want to be tested for that. I also want you to find out why I keep putting on weight. I haven’t had a PAP smear for 4 years – so I want one of those – and I’m heading off to do an African safari next week and they said I’ll need some needles.”
“We’re not going to have time to address all of your concerns in a 15 minute appointment, Cheryl.”
“But I don’t come to the doctor’s much – I like to save the little things up and deal with them all in one go. And, I’ve been waiting to see you for 45 minutes. I haven’t got time to come back and wait again.”
Over my Weetbix that morning, I’d read about a recent US study* that looked at both doctors’ and patients’ perceptions of non-verbal cues during consultations. It concluded that although many doctors were highly aware of their body language, patients, in general, primarily focussed on those cues indicating that the doctor was running short of time, and that they were acutely sensitive to signs of time pressure. The implied message seems to be that patients know when their doctor is clock-watching and that they don’t like feeling rushed.
In an ideal world, GPs could spend as long as is needed with each patient, whether that be six minutes or sixty minutes, without having waiting-room backlogs and mutinous reception staff. Patients would never feel rushed, doctors wouldn’t feel any time pressures, and the working day would flow smoothly. If only…
There are many scheduling systems which lead to substantial improvements in patient flow, but the fact remains, because of the very nature of what we do, it’s impossible to get it right all the time. Forest Gump’s momma’s gem of wisdom, “…like a box of chocolates, you never know what you’re gonna get,” springs to mind.
The cold hard truth is that on busy days, general practitioners need to clock watch to have even a remote chance of running to time. Managing consult length without having patients feeling like they’re being rushed or fobbed off is about the best we can do.
I don’t always reach this goal, much as I try.
After dealing with the urgent issues, organising tests and negotiating for Cheryl to come back to see me at least twice more, she turned to me and said, “In the time you spent explaining why you couldn’t do everything today, I reckon we could’ve knocked off at least half my list. Oh, and I expect that you’ll bulk bill me for the other appointments – it’s not my fault that you were too busy to deal with me properly today!”
*Journal of Evaluation in Clinical Practice 2011; 17:933-939.
Published in Australian Doctor on 9th November, 2011: On Clock Watching