HNIMR: Case No. 2 KEEP PATIENTS WAITING?—NOT IN MY OFFICE Good doctor!at"e#t doctor!at"e#t re$at"o#s %e&"# '"t( %ot( !art"es %e"#& !)#ct)a$ *or a!!o"#t+e#ts. T("s "s !art"c)$ar$, "+!orta#t "# +, s!ec"a$"t,—!aed"atr"cs. Mot(ers '(ose c("$dre# (a-e o#$, +"#or !ro%$e+s do#t $"/e t(e+ to s"t "# t(e 'a"t"#& roo+ '"t( rea$$, s"c/ o#es0 a#d t(e s"c/ /"ds %eco+e *)ss, "* t(e, (a-e to 'a"t $o#&. 1)t $ate#ess—#o +atter '(os res!o#s"%$e *or "t—ca# ca)se !ro%$e+s "# a#, !ract"ce. O#ce ,o)-e *a$$e# +ore t(a# s$"&(t$, %e("#d0 "t +a, %e "+!oss"%$e to catc( )! ) ! t(at da,. da,. A#d a$t(o)&( "ts )#*a"r to /ee! so+eo#e 'a"t"#& '(o +a, (a-e ot(er a!!o"#t+e#ts0 t(e a-era&e oce !at"e#t coo$s ("s (ee$s *or a$+ost 23 +"#)tes0 accord"#& to o#e rece#t s)r-e,. Pat"e#ts +a, to$erate t("s0 %)t t(e, do#t $"/e "t. I do#t to$erate t(at "# +, oce0 a#d I do#t %e$"e-e ,o) (a-e to "# ,o)rs. I see !at"e#ts e4act$, at t(e a!!o"#ted (o)r +ore t(a# 55 t"+es o)t o* 633. So t(ere are +a#, GPs 7&rate*)$ !at"e#ts8 "# +, %)s, % )s, so$o !ract"ce. Pare#ts o*te# re+ar/ to +e0 9We rea$$, a!!rec"ate ,o) %e"#& o# t"+e. W(, ca#t ot(er doctors do t(at too? M, a#s'er "s 9I do#t /#o'0 %)t I a+ '"$$"#& to te$$ t(e+ (o' I do "t. 1OOKING APPOINTMENTS REA;ISTICA;;Y T(e /e, to to s)ccess*)$ sc(ed)$"#& "s to a$$ot t(e !ro!er a+o)#t o* t"+e *or eac( -"s"t0 de!e#d"#& o# t(e ser-"ces re<)"red0 a#d t(e# st"c/ to "t. T("s +ea#s t(at t(e !(,s"c"a# +)st !ace ("+se$* care*)$$,= rece!t"o#"st +)st %e corrected "* t(e, stra, *ro+ t(e !$a#0 a#d !at"e#ts +)st %e ta)&(t to res!ect t(e"r a!!o"#t+e#t t"+es. 1, act)a$ t"+"#& a #)+%er o* !at"e#t -"s"ts0 I *o)#d t(at t(e, %rea/ do'# "#to se-era$ cate&or"es. We a$$o' (a$* a# (o)r *or a#, #e' !at"e#t0 6> +"#)tes *or a 'e$$%a%, c(ec/ )! or a# "+!orta#t "$$#ess0 a#d e"t(er > or 63 +"#)tes *or a rec(ec/ o# a# "$$#ess or "#)r,0 a# "++)#"@at"o#0 or a +"#or !ro%$e+ $"/e 'arts. Yo) Yo) ca#0 o* co)rse0 'or/ o)t ,o)r o'# t"+e a$$ocat"o#s0 &eared to t(e 'a, ,o) !ract"ce.
W(e# a!!o"#t+e#ts are +ade0 e-er, !at"e#t "s &"-e# a s!ec"c t"+e0 s)c( as 63:B3 or 2:3. Its a# a%so$)te #o#o *or a#,o#e "# +, oce to sa, to a !at"e#t. 9Co+e "# 63 +"#)tes or 9Co+e "# a (a$*(o)r. Peo!$e o*te# "#ter!ret s)c( "#str)ct"o#s d"Dere#t$,0 a#d #o%od, /#o's )st '(e# t(e,$$ arr"-e. T(ere are t(ree e4a+"#"#& roo+s t(at I )se ro)t"#e$,0 a *o)rt( t(at I reser-e *or tee#a&ers0 a#d a *t( *or e+er&e#c"es. W"t( t(at +a#, roo+s0 I do#t 'aste t"+e 'a"t"#& *or !at"e#ts0 a#d t(e, rare$, (a-e to s"t "# t(e rece!t"o# area. I# *act0 so+e o* t(e ,o)#&er c("$dre# co+!$a"# t(at t(e, do#t &et t"+e to !$a, '"t( t(e to,s a#d !)@@$es "# t(e 'a"t"#& roo+ %e*ore %e"#& e4a+"#ed0 a#d t(e"r +ot(ers (a-e to $et t(e+ !$a, a'("$e o# t(e 'a, o)t. O# a $"&(t da, I see 23 to B3 !at"e#ts %et'ee# 5 A.M. a#d > P.M. 1)t o)r a!!o"#t+e#t s,ste+ "s e4"%$e e#o)&( to $et +e see 3 to >3 !at"e#ts "# t(e sa+e #)+%er o* (o)rs "* I (a-e to. Heres "s (o' 'e t"&(te# t(e sc(ed)$e. M, t'o ass"sta#ts 7t(ree o# t(e %)s"est da,s8 (a-e sta#d"#& orders to /ee! a #)+%er o* s$ots o!e# t(ro)&(o)t eac( da, *or !at"e#ts '"t( ac)te "$$#esses. We tr, to reser-e +ore s)c( o!e#"#&s "# t(e '"#ter +o#t(s a#d o# t(e da,s *o$$o'"#& 'ee/e#ds a#d (o$"da,s0 '(e# 'ere %)s"er t(a# )s)a$. I#"t"a$ -"s"ts0 *or '("c( 'e a$$o' B3 +"#)tes0 are a$'a,s sc(ed)$ed o# t(e (o)r or t(e (a$*(o)r. I* I #"s( s)c( a -"s"t soo#er t(a# !$a##ed0 'e +a, %e a%$e to s<)ee@e "# a !at"e#t '(o #eeds to %e see# "++ed"ate$,. A#d0 "* #ecessar,0 'e ca# %oo/ t'o or t(ree -"s"ts "# 6> +"#)tes %et'ee# 'e$$ c(ec/s. W"t( t(ese c)s("o#s to *a$$ %ac/ o#0 I+ *ree to s!e#d e4tra 63 +"#)tes or so o# a ser"o)s case0 /#o'"#& t(at t(e $ost t"+e ca# %e +ade )! <)"c/$,. Pare#ts o* #e' !at"e#ts are as/ to arr"-e "# t(e oce a *e' +"#)tes %e*ore t(e,re sc(ed)$ed "# order to &et t(e !re$"+"#ar, !a!er'or/ do#e. At t(at t"+e t(e rece!t"o#"st "#*or+s t(e+0 9T(e doctor a$'a,s /ee!s a# acc)rate a!!o"#t+e#t sc(ed)$e. So+e a$read, /#o' t("s a#d (a-e c(ose# +e *or t(at -er, reaso#. Ot(ers0 (o'e-er0 do#t e-e#
/#o' t(at t(ere are doctors '(o (o#o)r a!!o"#t+e#t t"+es0 so 'e *ee$ t(at "ts %est to 'ar# t(e+ o# t(e rst -"s"t. FITTING IN EMERGENCIES E+er&e#c"es are t(e e4c)se doctors +ost o*te# &"-e *or *a"$"#& to st"c/ to t(e"r a!!o"#t+e#t sc(ed)$es. We$$0 '(e# a c("$d co+es "# '"t( a %ro/e# ar+ or t(e (os!"ta$ ca$$s '"t( a# e+er&e#c, Caesarea# sect"o#0 #at)ra$$, I dro! e-er,t("#& e$se. I* t(e "#terr)!t"o# "s %r"e*0 I +a, )st scra+%$e to catc( )!. I* "ts $"/e$, to %e $o#&er0 t(e #e4t *e' !at"e#ts are &"-e# t(e c(o"ce o* 'a"t"#& or +a/"#& #e' a!!o"#t+e#ts. Occas"o#a$$, +, ass"sta#ts (a-e to resc(ed)$e a$$ a!!o"#t+e#ts *or t(e #e4t (o)r or t'o. Most s)c( "#terr)!t"o#s0 t(o)&(0 ta/e #o +ore t(a# 63 to 23 +"#)tes0 a#d t(e !at"e#ts )s)a$$, c(oose to 'a"t. I t(e# tr, to t t(e+ "#to t(e s!ace 'e-e reser-ed *or ac)te cases t(at re<)"re $ast+"#)te a!!o"#t+e#ts. T(e "+!orta#t t("#& "s t(at e+er&e#c"es are #e-er a$$o'ed to s!o"$ +, sc(ed)$e *or t(e '(o$e da,. O#ce a de$a, (ad %ee# ad)sted *or0 I+ o# t"+e *or a$$ $ater a!!o"#t+e#ts. T(e o#$, s"t)at"o# I ca# "+a&"#e t(at 'o)$d rea$$, 'rec/ +, sc(ed)$e "s s"+)$ta#eo)s e+er&e#c"es "# t(e oce a#d at t(e (os!"ta$—%)t t(at (as #e-er occ)rred. W(e# I ret)r#ed to t(e !at"e#t I-e $e*t0 I sa,0 9Sorr, to (a-e /e!t ,o) 'a"t"#&. I (ad a# e+er&e#c,—a %ad c)t 7or '(ate-er8. A t,!"ca$ re!$, *ro+ t(e !at"e#t: 9No !ro%$e+0 octor. I# a$$ t(e ,ears I-e %ee# co+"#& (ere0 ,o)-e #e-er +ade +e 'a"t %e*ore. A#d Id s)re$, 'a#t ,o) to $ea-e t(e roo+ "* my /"d 'ere ()rt. E+er&e#c"es as"de0 I &et *e' 'a$/"#s0 %eca)se "ts &e#era$$, /#o'# "# t(e co++)#"t, t(at I see !at"e#ts o#$, %, a!!o"#t+e#t e4ce!t "# )r&e#t c"rc)+sta#ces. A #o#e+er&e#c, 'a$/"# "s (a#d$ed as a !(o#e ca$$ 'o)$d %e. T(e rece!t"o#"st as/s '(et(er t(e -"s"tor 'a#ts ad-"ce or a# a!!o"#t+e#t. I* t(e $ater0 (e or s(e "s oDered t(e ear$"est t"+e a-a"$a%$e *or #o# ac)te cases. TAMING THE TE;EPHONE
P(o#e ca$$s *ro+ !at"e#ts ca# sa%ota&e a# a!!o"#t+e#t sc(ed)$e "* ,o) $et t(e+. I do#t. #$"/e so+e !aed"atr"c"a#s0 I do#t (a-e a re&)$ar te$e!(o#e (o)r0 %)t +, ass"sta#ts '"$$ (a#d$e ca$$s *ro+ !are#ts at a#, t"+e d)r"#& oce (o)rs. I* t(e <)est"o# "s a s"+!$e o#e0 s)c( as 9Ho' +)c( as!"r"# do ,o) &"-e a o#e,ear o$d? t(e ass"sta#t '"$$ a#s'er "t. I* t(e <)est"o# re<)"res a#s'er *ro+ +e0 t(e ass"sta#t 'r"tes "t "# t(e !at"e#ts c(art a#d %r"#&s "t to +e '("$e I+ see"#& a#ot(er c("$d. I 'r"te t(e a#s'er "#—or s(e e#ters "t "# t(e c(art. T(e# s(e re$a,s to t(e ca$$er. W(at "* t(e co$$ar "#s"sts o# ta$/"#& '"t( +e d"rect$,? T(e sta#dard re!$, "s 9T(e octor '"$$ ta$/ '"t( ,o) !erso#a$$, "* "t 'o#t ta/e +ore t(a# o#e +"#)te. Ot(er'"se ,o)$$ (a-e to +a/e a# a!!o"#t+e#t a#d co+e "#. I+ rare$, ca$$ed to t(e !(o#e "# s)c( cases0 %)t "* t(e +ot(er "s -er, )!set0 I !re*er to ta$/ '"t( (er. I do#t a$'a,s $"+"t (er to o#e +"#)te= I +a, $et t(e co#-ersat"o# r)# t'o or t(ree. 1)t t(e ca$$er /#o's I-e $e*t a !at"e#t to ta$/ '"t( (er0 so s(e te#ds to /ee! "t %r"e*. EA;ING WITH ;ATECOMERS So+e !eo!$e are (a%"t)a$$, $ate= ot(ers (a-e $e&"t"+ate reaso#s *or occas"o#a$ tard"#ess0 s)c( as a at t,re or 9He t(re' )!o# +e. E"t(er 'a,0 I+ (ard#osed e#o)&( #ot to see t(e+ "++ed"ate$, "* t(e, arr"-e at +, oce +ore t(a# 63 +"#)tes %e("#d sc(ed)$e0 %eca)se to do so 'o)$d de$a, !at"e#ts '(o arr"-ed o# t"+e. A#,o#e '(o "s $ess t(a# 63 +"#)tes $ate "s see# r"&(t a'a,0 %)t "s re+"#ded o* '(at t(e a!!o"#t+e#t t"+e 'as. W(e# "t "s e4act$, 63 +"#)tes !ast t(e t"+e reser-ed *or a !at"e#t a#d (e (as#t a!!eared at t(e oce0 a rece!t"o#"st !(o#es ("s (o+e to arra#&e a $ater a!!o"#t+e#t. I* t(eres #o a#s'er a#d t(e !at"e#t arr"-es at t(e oce a *e' +"#)tes $ater0 t(e rece!t"o#"st sa,s !$easa#t$,0 9He,0 'e 'ere $oo/"#& *or ,o). T(e doctors (ad to &o a(ead '"t( ("s ot(er a!!o"#t+e#ts0 %)t 'e$$ s<)ee@e ,o) "# as soo# as 'e ca#. A #ote "s t(e# +ade "# t(e !at"e#ts c(art s(o'"#& t(e date0 (o' $ate (e 'as0 a#d '(et(er (e 'as see# t(at da, or &"-e# a#ot(er a!!o"#t+e#t.
T("s (e$!s )s "de#t"*, t(e rare c(ro#"c oDe#der a#d ta/e stro#&er +eas)res "* #ecessar,. Most !eo!$e a!!ear #ot to +"#d 'a"t"#& "* t(e, /#o' t(e, t(e+se$-es (a-e ca)sed t(e de$a,. A#d Id rat(er "#c)r t(e a#&er o* t(e rare !erso# '(o does +"#d t(a# r"s/ t(e "$$ '"$$ o* t(e +a#, !at"e#ts '(o 'o)$d ot(er'"se (a-e to 'a"t a*ter co+"#& "# o# sc(ed)$e. A$t(o)&( I+ !re!ared to %e r+ '"t( !at"e#ts0 t("s "s rare$, #ecessar,. M, oce "# #o 'a, rese+%$es a# ar+, ca+!. O# t(e co#trar,0 +ost !eo!$e are (a!!, '"t( t(e 'a, 'e r)# "t0 a#d te$$ )s so *re<)e#t$,. COPING WITH NOSHOWS W(at a%o)t t(e !at"e#t '(o (as a# a!!o"#t+e#t0 does#t t)r# )! at a$$0 a#d ca#t %e reac(ed %, te$e!(o#e? T(ose *acts0 too0 are #oted "# t(e c(art. s)a$$, t(eres a s"+!$e e4!$a#at"o#0 s)c( as %e"#& o)t o* to'# a#d *or&ett"#& a%o)t t(e a!!o"#t+e#t. I* "t (a!!e#s a seco#d t"+e0 'e *o$$o' t(e sa+e !roced)re. A t("rdt"+e oDe#der0 t(o)&(0 rece"-es a $etter re+"#d"#& ("+ t(at t"+e 'as set as"de *or ("+ a#d (e *a"$ed to /ee! t(ree a!!o"#t+e#ts. I# t(e *)t)re0 (e "s to$d0 (e$$ %e %"$$ed *or s)c( 'asted t"+e. T(ats a%o)t as to)&( as 'e e-er &et '"t( t(e *e' !eo!$e '(o *o)$ )! o)r sc(ed)$"#&. I-e #e-er dro!!ed a !at"e#t *or do"#& so. I# *act0 I ca#t reca$$ act)a$$, %"$$"#& a #os(o'= t(e $etter t(reate#"#& to do so see+s to c)re t(e+. A#d '(e# t(e, co+e %ac/—as #ear$, a$$ o* t(e+ do—t(e, e#o, t(e sa+e res!ect a#d co#-e#"e#ce as +, ot(er !at"e#ts. ESTIONS: 6. W(at *eat)res o* t(e a!!o"#t+e#t sc(ed)$"#& s,ste+ 'ere cr)c"a$ "# ca!t)r"#& 9+a#, &rate*)$ !at"e#ts? 2. W(at !roced)res 'ere *o$$o'ed to /ee! t(e a!!o"#t+e#t s,ste+ e4"%$e e#o)&( to acco++odate t(e e+er&e#c, cases0 a#d ,et %e a%$e to /ee! )! '"t( t(e ot(er !at"e#ts a!!o"#t+e#ts? B. Ho' 'ere t(e s!ec"a$ cases s)c( as $ateco+ers a#d #o s(o's (a#d$ed? . Pre!are a sc(ed)$e start"#& at 5 A.M. *or t(e *o$$o'"#& !at"e#ts o* r. Ko,a":
S)res( Ma(a!atra0 a s!$"#ter o# ("s $e*t t()+%. K)#da os("0 a #e' !at"e#t. S(arad Pot#"s0 a #e' !at"e#t. A+ar Ga-(a#e0 632.> de&ree 7Fa(re#(e"t8 *e-er Sara( Merc(a#t0 a# "++)#"@at"o#. A%o$" Sardes(+)/(0 'e$$%a%, c(ec/ )!. Mar/ so)@a0 a #e' !at"e#t. a"ra 1(ard'a0 'e$$%a%, c(ec/ )!. S)$a%(a T)$!)$e0 rec(ec/ o# a s!ra"#ed a#/$e. Re%ecca S"-dasa#"0 a #e' !at"e#t. octor Ko,a" starts 'or/ !ro+!t$, at 5 A.M. a#d e#o,s ta/"#& a 6>+"#)te coDee %rea/ aro)#d 63:6> or 63:B3 A.M. A!!$, t(e !r"or"t, r)$e t(at +a4"+"@es sc(ed)$"#& ec"e#c,. I#d"cate '(et(er or #ot ,o) see a# e4ce!t"o# to t("s !r"or"t, r)$e t(at +"&(t ar"se. Ro)#d )! a#, t"+es $"sted "# t(e case st)d, 7e.&. "* t(e case st)d, st"!)$ates > or 63 +"#)tes0 t(e# ass)+e 63 +"#)tes *or t(e sa/e o* t("s !ro%$e+8.
