Anatomy of a Medical Visit
The Miserable Morning
Lindsey woke up in the morning with a terrible sore throat and fever. As she tried to get ready for work, it was clear that she was going to need some sort of medical care.
Did you know that the vast majority of medical care provided in the world is not provided by trained, medical professionals? Before accessing organized medicine, most people try and take care of themselves.
First, you have the issue of pain. Most people with a severe sore throat will reach for their trusty bottle of acetaminophen or ibuprofen. Some people even have a hoard of prescription pain medications lying around, such as codeine or Vicodin. If the pain is bad enough, you skip directly to the stronger medications.
Second, you try and remember what your parents told you to do for a sore throat. Ah, yes, gargling. You grab the box of salt and dump in a healthy amount into a glass of warm water and head for the bathroom. Of course, you soon realize that you have created a saline solution stronger than the Great Salt Lake or the Dead Sea. After a few attempts to gargle with this unbelievable salty solution, you give it up.
Third, you examine yourself. You find a flashlight and a mirror. The throat looks terrible. It is red, angry-looking; not normal at all. This is probably Strep, Lindsey concluded. She wanted to take her own temperature, but had no idea where she put the thermometer. Oh, well, she felt her forehead and concluded that she was hot; about 103 she estimated. Her glands hurt, too.
Again, she searched the medicine cabinet. It was filled with mostly-expired prescriptions that she never finished. Lindsey found some ciprofloxacin, but couldn't remember if it's an antibiotic or something she took for diarrhea. (It's an antibiotic). She had only one tablet anyway, so you swallowed it, even though she knew this was not a good practice.
Making The Appointment
Lindsey looked at her watch. It was 8 AM, so she called her doctor's office. The phone rang constantly. After about 200 rings, a woman answered. Based on the distant, nasal tone of her voice, she knew it is the much-feared Doctor's Answering Service.
"What time does the office open?" She was told 8 AM, so she reminded the answering service that it WAS after 8 AM now. She was told to call back in little while later. She tried again at 8:15 AM, but the phone was now busy. She tried again; still busy. She called in sick for work; and tried yet again. This time the phone was answered but she was put on hold, less than one millisecond after the words "Doctor's Office. Please hold". She waited, clutching her sore throat. She waited some more. She started a load of laundry with the phone resting on her shoulder.
Eventually, the receptionist answered the call. Lindsey briefly explained her problem and asked for an appointment. She was offered an appointment in three weeks. This was unacceptable. She told the receptionist that she would prefer to be seen on the day she was ill; today. The sound of rapid keystrokes filled the silence.
"Can you be here in ten minutes?"
Standing in her robe; hair looking like she lost a dog fight, breath smelling like salted cod, she respond, "Yes, if I can find my time machine." Strep throat seemed to unusually sharpen her normally-suppressed sarcasm skills.
"Well, can you come in at 3:20 PM?"
"I guess I will have to, assuming that I do not die between now and then." The receptionist added her name to the other three people scheduled for the same appointment time.
As the morning progressed, she felt more and more like crap (Crap is a frequently used medical term for extreme malaise, body aches, fever, and frustration). She popped some more ibuprofen and gargled with the brine.
The Waiting Room
Lindsey arrived early, at 2:30 PM, hoping that her medical provider might fit her in earlier. She waded through a sea of coughing people, kids in strollers and approached the front desk. Another woman was complaining about her bill while simultaneously talking on her cell phone. She was told to sign in and be seated. She was also chastised for being early.
She couldn't help but notice the twelve people on the list in front of her whose names weren't crossed out. For one quick moment, she considered sneaking her name higher on the list and writing down an earlier time, but she didn't. She found a seat next to someone who was madly scratching. After sitting there a few minutes watching this display of digging, she spotted another chair near a greenish man holding a barf bucket. She decided to take her chances with the scratcher.
Leafing through a boating magazine, having nothing better to do, she wondered what kind of boat her doctor must have. Somehow, that ticked her off, but she was not sure why. She looked around the crowded waiting room, trying to guess what other people had. That woman definitely has Chlamydia or worse. Both of those children have pink eye. It doesn't take a medical degree to figure that one out. They were wiping their noses and eyes on the chair. An older woman with a walker smelled like pee. Oh, how she loved the waiting room.
Her appointment time of 3:20 came and went. She guessed that this is why it was called the Waiting Room. The barfing man and the scratcher had already been called back. Maybe, she was next. No...there went the pink eyes. It was now 4:00 PM, so she approached the front desk czar. She was told that the doctor was running a bit behind. Running behind what? A turtle? She sat back down.
The Indignities
At 4:18, a medical assistant, thirty years younger than her, mispronounced her first name. She was lead to a scale for the first of her ritual indignities. The medical assistant loudly announced weight so that everyone could hear. She ignored the fact that Lindsey's shoes weighed 16 pounds. A temporal thermometer streaked across her face and she was told that her temperature was normal. Damn! She shouldn't have taken that Motrin, she thought.
She was then led into a small examining room and asked why she was being seen today. Lindsey gave her a five-minute, detailed, chronological history of her current illness, her allergies, and her concern about Strep. After carefully listening, the medical assistant wrote down "sick" and headache on her chart and told her that the doctor will be with her in a moment. Lindsey did not tell her that she had a headache, but that was okay. She had one now.
The Doctor Arrives
A "moment" in doctor-time is really about a half-hour. She wished she still had that boating magazine. She stared mindlessly at the beige walls and the torn anti-smoking poster. Time stopped. A child is screaming in the distant.
Some time later, the doctor barged in without knocking, performed a cursory examination, and pronounced his verdict: It didn't look like Strep. It was just a virus. All she needed to do was take Motrin and gargle.
"Aren't you going to do a Rapid Strep Test?" she asked.
"If you want, but I think it is a waste of money." He swabbed her throat like he was cleaning out a rain gutter and left the room with the swab.
"It will just be a 'moment'," he said. She waited some more.
Another fifteen minutes dragged by.
"Your Strep test is positive, so you will need to go on some antibiotics. Are you allergic to anything?" He was writing before she answered.
He wrote out a quick prescription, and again tells her to gargle with salt water and take Motrin. He handed her a paper to take to the front desk to pay. It was now 5:45 PM.
The Tag Line
Office visit: $75. Strep test: $24. Prescription: $30. The fact that she proved him wrong about the Strep: Priceless.
On the way to the car, Lindsey started to scratch.
The End
Related Topics:
Technorati Tags: flu, strep, doctors, primary care
Lindsey woke up in the morning with a terrible sore throat and fever. As she tried to get ready for work, it was clear that she was going to need some sort of medical care.
Did you know that the vast majority of medical care provided in the world is not provided by trained, medical professionals? Before accessing organized medicine, most people try and take care of themselves.
First, you have the issue of pain. Most people with a severe sore throat will reach for their trusty bottle of acetaminophen or ibuprofen. Some people even have a hoard of prescription pain medications lying around, such as codeine or Vicodin. If the pain is bad enough, you skip directly to the stronger medications.
Second, you try and remember what your parents told you to do for a sore throat. Ah, yes, gargling. You grab the box of salt and dump in a healthy amount into a glass of warm water and head for the bathroom. Of course, you soon realize that you have created a saline solution stronger than the Great Salt Lake or the Dead Sea. After a few attempts to gargle with this unbelievable salty solution, you give it up.
Third, you examine yourself. You find a flashlight and a mirror. The throat looks terrible. It is red, angry-looking; not normal at all. This is probably Strep, Lindsey concluded. She wanted to take her own temperature, but had no idea where she put the thermometer. Oh, well, she felt her forehead and concluded that she was hot; about 103 she estimated. Her glands hurt, too.
Again, she searched the medicine cabinet. It was filled with mostly-expired prescriptions that she never finished. Lindsey found some ciprofloxacin, but couldn't remember if it's an antibiotic or something she took for diarrhea. (It's an antibiotic). She had only one tablet anyway, so you swallowed it, even though she knew this was not a good practice.
Lindsey looked at her watch. It was 8 AM, so she called her doctor's office. The phone rang constantly. After about 200 rings, a woman answered. Based on the distant, nasal tone of her voice, she knew it is the much-feared Doctor's Answering Service.
"What time does the office open?" She was told 8 AM, so she reminded the answering service that it WAS after 8 AM now. She was told to call back in little while later. She tried again at 8:15 AM, but the phone was now busy. She tried again; still busy. She called in sick for work; and tried yet again. This time the phone was answered but she was put on hold, less than one millisecond after the words "Doctor's Office. Please hold". She waited, clutching her sore throat. She waited some more. She started a load of laundry with the phone resting on her shoulder.
Eventually, the receptionist answered the call. Lindsey briefly explained her problem and asked for an appointment. She was offered an appointment in three weeks. This was unacceptable. She told the receptionist that she would prefer to be seen on the day she was ill; today. The sound of rapid keystrokes filled the silence.
"Can you be here in ten minutes?"
Standing in her robe; hair looking like she lost a dog fight, breath smelling like salted cod, she respond, "Yes, if I can find my time machine." Strep throat seemed to unusually sharpen her normally-suppressed sarcasm skills.
"Well, can you come in at 3:20 PM?"
"I guess I will have to, assuming that I do not die between now and then." The receptionist added her name to the other three people scheduled for the same appointment time.
As the morning progressed, she felt more and more like crap (Crap is a frequently used medical term for extreme malaise, body aches, fever, and frustration). She popped some more ibuprofen and gargled with the brine.
Lindsey arrived early, at 2:30 PM, hoping that her medical provider might fit her in earlier. She waded through a sea of coughing people, kids in strollers and approached the front desk. Another woman was complaining about her bill while simultaneously talking on her cell phone. She was told to sign in and be seated. She was also chastised for being early.
She couldn't help but notice the twelve people on the list in front of her whose names weren't crossed out. For one quick moment, she considered sneaking her name higher on the list and writing down an earlier time, but she didn't. She found a seat next to someone who was madly scratching. After sitting there a few minutes watching this display of digging, she spotted another chair near a greenish man holding a barf bucket. She decided to take her chances with the scratcher.
Leafing through a boating magazine, having nothing better to do, she wondered what kind of boat her doctor must have. Somehow, that ticked her off, but she was not sure why. She looked around the crowded waiting room, trying to guess what other people had. That woman definitely has Chlamydia or worse. Both of those children have pink eye. It doesn't take a medical degree to figure that one out. They were wiping their noses and eyes on the chair. An older woman with a walker smelled like pee. Oh, how she loved the waiting room.
Her appointment time of 3:20 came and went. She guessed that this is why it was called the Waiting Room. The barfing man and the scratcher had already been called back. Maybe, she was next. No...there went the pink eyes. It was now 4:00 PM, so she approached the front desk czar. She was told that the doctor was running a bit behind. Running behind what? A turtle? She sat back down.
At 4:18, a medical assistant, thirty years younger than her, mispronounced her first name. She was lead to a scale for the first of her ritual indignities. The medical assistant loudly announced weight so that everyone could hear. She ignored the fact that Lindsey's shoes weighed 16 pounds. A temporal thermometer streaked across her face and she was told that her temperature was normal. Damn! She shouldn't have taken that Motrin, she thought.
She was then led into a small examining room and asked why she was being seen today. Lindsey gave her a five-minute, detailed, chronological history of her current illness, her allergies, and her concern about Strep. After carefully listening, the medical assistant wrote down "sick" and headache on her chart and told her that the doctor will be with her in a moment. Lindsey did not tell her that she had a headache, but that was okay. She had one now.
A "moment" in doctor-time is really about a half-hour. She wished she still had that boating magazine. She stared mindlessly at the beige walls and the torn anti-smoking poster. Time stopped. A child is screaming in the distant.
Some time later, the doctor barged in without knocking, performed a cursory examination, and pronounced his verdict: It didn't look like Strep. It was just a virus. All she needed to do was take Motrin and gargle.
"Aren't you going to do a Rapid Strep Test?" she asked.
"If you want, but I think it is a waste of money." He swabbed her throat like he was cleaning out a rain gutter and left the room with the swab.
"It will just be a 'moment'," he said. She waited some more.
Another fifteen minutes dragged by.
"Your Strep test is positive, so you will need to go on some antibiotics. Are you allergic to anything?" He was writing before she answered.
He wrote out a quick prescription, and again tells her to gargle with salt water and take Motrin. He handed her a paper to take to the front desk to pay. It was now 5:45 PM.
Office visit: $75. Strep test: $24. Prescription: $30. The fact that she proved him wrong about the Strep: Priceless.
On the way to the car, Lindsey started to scratch.
Related Topics:
Technorati Tags: flu, strep, doctors, primary care
Labels: medical practice
12 Comments:
This kind of reminds me of when I was sick a couple of months ago. I did not show up for my appointment early though. I got there 5 mins. before and waited in the waiting room for a half hour then waited in the exam room for 20 mins. then was told by the P.A. that I had the flu. I ended up back at the office two days later to be told I have pneumonia not the flu.
I routinely wait 30 to 90 minutes for my doctor's appointments, but it is not always the doctor's fault. The HMO's who own/run the clinics schedule patients every 10 to 15 minutes, and double or triple book patients during "sick" aka "high volume" times. A good doctor can not see 4-6 patients per hour for 8 hours a day and do an appropriate, decent job, not to mention when they are scheduled to see twice that many. And it is true that doctors get so "booked up" that you must wait 1 to 3 months just to get an appointment, so people resort to "urgent care" or ER's just to be seen when they are sick because they can't get into their own clinics. These are systemic problems caused by the corporations that run big business--the business of medicine. So, don't always blame the doctors.
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My doctor's office is amazing. I don't believe I've ever waited more than 20 minutes in the waiting room - even during flu season. Sometimes the wait in the exam room can drag on but never more than 20 minutes before the doctor comes in. Another thing I love - 7 am appointments. I just breeze right in - pick up my prescription at the pharmacy if needed - and am back home in bed by 8!
I consider myself very lucky to have found this office and wish more doctors were as organized and patient friendly!
We have a wonderful family doctor, one we have seen for close to 20 years, and his office manages to see schedule patient appointments in a timely fashion. It helps our doctor doesn't deliver babies, as babies can mess up office appointments, which helps with office scheduling. (I don't have anything against babies as I have two children, just a comment about how delivering babies makes scheduling trickier).
While it's true that sometimes offices do run behind, I'll have to defend this post as a worker in such a profession.
First, I work in a specialty office, which means that when people call for same day appointments for sore throats, etc, we usually try to send them to their primary first. Primary physicians should have slots open for emergencies just as Lindsey's. However, if it's necessary to go to a specialist, be prepared to wait, as they probably had to work you into an already packed schedule. There is also such a thing as someone who is sicker than you; someone who may not have strep, but may need an emergency surgery. Yep, strep sucks, but having an emergency surgery probably sucks a lot worse.
Lastly, it's a rare occasion that you know more than your doctor. They did go to medical school, so if your doctor cannot recognize strep, it's probably just time to get a new doctor!
PS Rude office staff is a good reason to leave your doctor as well. I found this post irritating, as we look at patient care like customer service, and try our best to reasonably help our patinets. However, I have also been a patient at other offices and know how it should work. You may love your doctor, but you have to get through his or her staff to get to them, and sometimes they are impossible! :)
I love your comments, everyone. Thanks for posting.
WOW, this blog entry that I find at one of the sites that I go to is really eye opening. So, thats why I would never do this again as the woman he was talking did.
Thank you.
Jessica
Sometimes the doctor isn't aware that his/her staff is overbooking the schedule.
I told my doctor she wasn't being fair to herself or her patients by allowing her staff to schedule appointments for 9 a.m. when she doesn't get to the office before 10:30. It wasn't fair to her because she was running behind from the minute she walked in the door. And it wasn't fair to us patients because our time is as valuable as her's.
That's when I found out she was unaware that early appointment were be made. Since our little talk her patients might wait 15-20 minutes...a vast improvement for everyone.
This is unfortuately the norm for most people when they need a same-day appointment. That's one reason that I have specialists lined up already - if I have a severe sore throat, I call my ENT. I have always had problems with my ears and throat, and also have hearing aids (first pair was at age 16), so when I have problems of this kind I get to see a specialist - yay! If I have sharp pains in certain parts of my back or legs, I call my physiatrist. If I feel like hiding under my bed for more than two days, I call my shrink. She's my favorite doc, even though she only does meds. She has a great bedside manner and is very funny.
I have had depression and panic disorder for 17 years now, but thanks to numerous visits to the ER when I thought I was "dying" (panic can make you feel that way if you don't know what it is!), I was FINALLY diagnosed with panic disorder and sent to a psychiatrist (sp?). It's been a long road, but I haven't had a panic attack in ages - thank you, to the docs who knew what I needed and provided the time and expertise to help me!!
I was also diagnosed with some back and neck problems, went through a few MRIs, CT scans, X-rays, etc., and found out I had fibromyaglia, degenerative disk disease, spondyliosis or whatever it's called, a few herniated disks that wouldn't heal, and sciatica. Yippee! Talk about a VERY long road - compared to beginning a pain management quest, the average same-day doctor's appointment is a nice spring picnic in the park! After seven years and more pain pills I can count, I'm finally okay enough to lead a normal life. Whew!
I may not have to wait like many others must, but my doctors know that there are times I can't wait. With all my darned medical problems, knowing I will be seen ASAP is one of the few things I can count on.
So here's my point: would anyone like to change places with me so you can be seen within five minutes of walking through the door?
Count your blessings and have a healthy, happy life!
I just want to say you HAve no IDea what its like to work at a doctors office huh? I'm talking about a family practice. Medical assistants in dr.offices do just as much as nurses, receptionist and physician assistant all in ONE. Yes the appointments are tripled booked because we want to fit in the patietns that are sick. The schedule is already full to begin with. ITS NOT THAT simple to just throw you in when you want. ALso because we are fitting patietns in that is why the M.D runs late. Sometimes the medical assistants act the way they do because they are being rushed by physicians or other employees. But that is great when they call at 8am. You shouldn't cal and expect to get put in when you want. Also you shouldn't expect to be squeezed in because you came in early. THere are other pt's in front of you. THat have been waiting a long time to. ANd the HMO;s don't make the decision as to who gets double booked. THe doctors tell the STaff to do that. As to strep tests the med assistant should of tested her. And remember we are being rushed by the M.d. to get in there take vitals and get out. Because the M.d reviews the symptoms after anyways.
Working at a doctors office isn't easy. Its like being rushed 40 hours a week. We try out hardest but if you don't understand what goes on behing the scenes then you can continue thinking its the staff fault.
This reminds me of the day I got my cast (About a week ago). My appointment was at 11, as in the time the doctor saw me. They called my name at 11:45. Then, I had to wait in the room for ANOTHER HOUR. So, they saw me at 12:45. I left at 1:30.
It's not really the same, but I wanted to mention it. :)
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