Hinderance #1

Pondering if there’s anything that makes it easier or harder to speak up at the doctor’s office, I realize that there are definitely things that make it harder.  First, I find it hard to speak up and say what’s on my mind when I feel rushed.  This seems pretty obvious, but I wondered why sometimes I feel rushed and sometimes I don’t.  Is it me?  Is it the doctor?  Both?

Context is everything.  When a doctor asks me, “Do you have any questions?” how it’s asked matters.  I might have a question, but feel like the doctor was too rushed to want to hear it.  If the doctor is standing at the door, reaching for the knob, I feel like it was a rhetorical question and the doctor can’t wait to leave.  On the other hand, if the doctor is sitting down and looking at me, I feel like it’s okay to ask for clarification because the doctor is willing to take an extra minute.  Sitting isn’t a requirement, though.  My PCP often stands leaning against the counter, rather than sitting, and the same message is conveyed.  He’s there, not rushing off elsewhere. 

I’ve noticed something interesting about how exam rooms are set up, too.  Most rooms have the usual contents; it’s how they’re arranged that makes a difference.  Some rooms are set up so that the doctor can rush through the door, immediately drop the patient’s chart on the counter, talk at the patient who’s perched on a cold exam table, then flee again without ever seeming to be in the room.  It’s much better when the furniture arrangement requires doctors to move away from the doorway in order to see patients.  When the exam room is set up so that it seems the doctor is hovering near the door, anxious to make an escape, it’s hard to speak up.

Clocks make a difference, too.  Some exam rooms have a loud tick-tick-tick filling the silence, a constant reminder of time marching on.  If it seems like the doctor is watching the clock, I feel rushed.  I’ve been in exam rooms where it seemed that the clock was the focal point.  Other exam rooms have no clock at all.  One might think that the lack of a clock keeps patients from realizing how long it takes the doctor to enter their room (“I’ve been waiting twelve minutes!”), but there’s another aspect to that idea.  Once I asked the nurse at my PCP’s office why there wasn’t a clock.  I had a lengthy list of questions – basically asking for an interpretation of what a different doctor had diagnosed but not explained – and wanted to make sure I stayed within the time frame scheduled for my appointment (that’s hard to do when you don’t have any concept of what time it is).  The nurse replied that the staff had tried to get the doctor to put clocks in all his exam rooms, but he refuses because he doesn’t want patients to feel rushed.

I know that doctors complain about the time constraints placed on them by insurance companies.  From what I’ve heard, their frustration is justified.  Taking it out on patients, though, isn’t.  (fwiw, I think I know a solution, but nobody’s asked for my opinion).  The particular events that cause scheduling conflicts vary from one person to the next, but everyone has more things to do than they have time to do them in.  This phenomenon isn’t unique to doctors.  Some people can handle it gracefully, as opposed to those who inflict their stress on everyone around them.

For example, I once took my baby to a doctor after being told we’d be squeezed in around 1.  It was 5:30 before we were taken to an exam room.  NB: this is not the “handle it gracefully” example.  The doctor came flying in, white coat flapping behind him, as he dictated notes about a previous patient into his hand-held recorder.  He introduced himself, glanced at the chart, asked a couple questions, and was gone again like a whirlwind.  A minute or so later he was back, asked a couple more questions, did a quick exam, and departed once again while telling his recorder what he’d discovered.  A third time he appeared, wrapped up the appointment, and hustled me out of there.  If it had been an appointment for me, I never would have tolerated that treatment, but my baby was in pain and needed help.  We never went back there; I was fortunate enough to find a doctor who stays in the room long enough to talk and doesn’t rush me out the door.

Another appointment, different doctor. I had a 3:30 appointment, but at 4:45 was still sitting in the waiting room (very unusual for this doctor).  Eventually the nurse took me to a room, apologizing profusely for being so behind-schedule.  She took all my vitals, wrote whatever hieroglyphics it is that tells the doctor why I’m there, and apologized once again for the delay.  That late in the day I expected the doctor to be in a hurry, but he came in with my chart, sat down like he had all the time in the world, and calmly gave me his undivided attention.  He was behind schedule, but not rushed.

I’ll go out on a limb here and guess that I’m not the only one who thinks that feeling rushed makes it hard for patients to talk to their doctors.

So What?

When it comes right down to it, the above are just observations.  There’s nothing that I, as a patient, can really do anything about.  Truth be told, I’m not a big fan of pointing out problems without proposing some sort of solution, so the question is this:  As a patient, is there anything I can do to minimize the chances of feeling rushed?

The common tips that can be read just about anywhere say to always schedule either the first appointment of the day or the first appointment after lunch.  The doctor isn’t usually running late for the first appointment of the day.  While that might usually be true, it’s not always the case.  It’s also not very practical.  It’s not possible for everyone to be first. 

As a patient, I have no control over whether or not the doctor sees me at my appointed time.  Retraction – if I’m running late and not there, then I won’t be seen.  Actually, I know that I won’t be seen at 9:00 if I arrive at 8:58.  The receptionist needs time to sign me in and check over the paperwork.  Rule number one, be punctual and allow enough time to check in.

Another thing I can do is arrange my schedule to accommodate the unexpected.  Regardless of how rushed or relaxed the doctor is, if I have another appointment to keep, I feel rushed independent of how the doctor’s schedule is running.  I used to schedule a twenty-minute appointment at 10:00, allow an extra ten minutes, a little travel time, and schedule an appointment elsewhere at 11:00.  When I did this, the entire time was spent anxiously hoping that I’d get out of there on time.  Things feel much less rushed when I schedule one appointment for 10:30, plan a break (sandwiches in the park, or perhaps order take-out somewhere and surprise my husband at his office with a bite to eat), then have my second appointment right after lunch.  Building in extra time to allow for others to be behind-schedule is a great way to minimize that rushed feeling.

Another thing I’ve discovered is that I can choose how I respond to stressful situations.  A perfect non-medical example occurred recently when I got stuck behind a car whose driver erroneously believed the speed limit to be 45.  This happens frequently on that particular road, and it drives me crazy.  First, because I’d like to drive about ten mph faster so I’m travelling the speed limit (or, maybe even a tiny bit more); second because I drive a large vehicle, and it’s big enough that nobody can see around me to know that it’s not my fault!  It’s the tiny car ahead of me causing the backup.  But I sighed and travelled at the pace set by the guy ahead of me.  Yes, I had an appointment, but honking at the guy or riding his bumper would only raise my blood pressure, not his speed.  The pickup behind me didn’t see it that way.  He zoomed up close and tailgated me.  I could see him pounding on his steering wheel, gesturing, and yelling right up until the end of the no-passing zone; he zipped out into the oncoming lane – and discovered that he had two people to pass, not one.  He made it.  Barely.  We travelled on up the road another ten miles, and when we reached the traffic light, he was the first car in the right lane; I was the second car in the left lane.  All that rushing only gained him a few extra feet.  He sat there at the red light, fuming, pounding more on his steering wheel, glaring at the slow little car beside him.  Another mile up the road, Mr. Inahurry turned right and I turned left.  At.the.same.time.  He gained nothing by getting upset about the trip taking longer than he’d planned.

Now, I realize that when I point my finger at someone else, there are many more fingers pointing back at me.  I know about the guy’s reaction not just from watching him, but because I’ve done it, too.  I grew up watching someone stress over things that weren’t worth it.  And I know that it’s possible to change.  Relax and enjoy the ride.  Choose to act not react.  It took me years to learn not to stress out over things that are out of my control.  This definitely helps with traffic delays, but it helps at the doctor’s office, too.   I can choose how I respond to stressful situations; I’m there for help, and it takes however long it takes.  I try to focus on being thankful that I could get an appointment, rather than on what a disruption it is to my personal schedule.

I can think of other things that doctors have done to make it easier/harder to talk to them, so this will be part of a series.

Do you have other tips on how to feel less rushed when you see your doctor?