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?

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7 thoughts on “Hinderance #1

  1. Excellent post, Socks. The only thing I’d add to your tips is one you’ve suggested yourself in earlier posts: Come to the appointment prepared, with a list of any questions you’d like to have answers to, and then be sure to ask them, regardless of how rushed the doctor seems. You’re in his exam room because you have a problem that needs to be addressed; your questions are important. And you are paying the doctor, as well, for his expertise. Finally, if you only get to see your doc every two or three months, then this is YOUR time with him. It’s frustrating to realize after you’ve left that you forgot to ask this or that, and that now you’ll just have to wait another 12 weeks or more.

    My own VA doc IS always rushed; he sees a huge handful of patients during his Saturday clinic at the VA Med Center. I’ve learned to try to make my appointment as early as possible in the morning; fortunately, it seems that he doesn’t have a lot of patients that prefer that first appointment of the day. To his credit, he’s rarely made me feel as if he hasn’t time for me, and I’m appreciative of that. But even so, following your advice and bringing my questions with me, written down, has greatly improved my appointments with him.

    And, I absolutely agree with you that the best thing we can all do is simply slow down and enjoy the ride. I tend to do that naturally — I’m made that way. (probably drives my family nuts!) But really, life’s too short to spend it in a huff, blood pressure up, hating everything and everyone. Finally, I think one of the best lessons we can learn regarding having a chronic illness is to be our own advocates. No one else will (or can, easily) do this for us.

    Thanks for the thoughtful post. Have a great weekend!

    • Good point. I think my doctor likes it when I write my questions. He doesn’t have to wonder how long the inquisition will go on, so rush through every answer hoping the questions will eventually end. I’m prepared, not rambling, and have a finite list. When I realized that my doctor kept reading my question list upside down, I started taking a copy for him. It works for us, but I don’t know how others would do with that system.

  2. Warm Socks:

    Well written post!!!

    I’m not sure how differently things run from where i am, and where you are. But for sure, the first appointments in the morning or after lunch are the worst ones. Firstly, because the doc comes in late from rounds and thus you’ll only get to see the doc 1-2hrs after your stipulated appointment time. Secondly, the doc will be in a rush to catch up on the patients he’s seeing for the day(if not, his day ends 2 hours later if he starts 2 hours late). I’ve done this before, and boy did i hate it. Never again!!!

    I now schedule my appointments, whenever possible, as the last for the day in the late evening. When i’m the last patient, i feel i get more time and attention from my doc, because it seems like the doc can get a breather and a sigh of relief at last! I actually feel like i have the real attention of my doc! But no luck having the last appointment slot before lunch. I’m out of there rather quickly too!

    I learnt that i can’t do much if i’m running late as well. I’d always be so anxious when the bus is running extraordinarily slow, or when all the traffic lights turn red when i’m running late. I’d be in a state of distress whenever this occurs! But now, i’d just sit in the bus and wait patiently till my stop comes, because there’s simply nothing i can do, unless i hop off the bus and make a run for it. It does help tremendously!

    Steph:)

    • Thank you.

      You make a very good point. Just because “the experts” say that the first appointment is best, that doesn’t mean it applies to all situations. It sounds like you’ve done a great job of figuring out what works best at your doctor’s office.

  3. Pingback: more on speaking up « ∞ itis

  4. Kinda Tongue-tied. I don’t know how else to describe it or explain it. I’ve had the same rheumy for years now, and yet somehow, even with notes (sent ahead of time, etc), I can’t seem to find quite the communication I think we should have? Maybe I expect too much? We get some things discussed, but usually miss some things, and then I still leave feeling not quite understood fully.

    It doesn’t help that I’m usually not feeling too bad when I see her for a regular appointment. I like her, so maybe that helps in that aspect, but it doesn’t help in driving home how I feel on a day-in-day-out basis. Maybe it’s because I can’t put her in my shoes, and she can’t put me in hers. I dunno…..

    Today I think some of my notes may have been too much to a point in some areas, not enough in others – I hope they didn’t insult her somehow. I thought for sure she’d increase the methotrexate, and I was ready for that, but she didn’t want to – but didn’t say why. I said I knew I needed to get off of prednisone, but didn’t get across that I’m not ready to do it right away. I’m down to 5mg, sort of by accident, and think that is part of why I’m feeling even crappier lately – and it makes it sooo hard to get through a work day, or even days off. But she wants me to add Plaquenil and then try to start cutting down on prednisone in 8 weeks. I really think that I need my adrenals checked by an Endo, yet here is one area where she’s not willing to relinquish and wants to keep control of. I just don’t think she understands that I think I’m one who is not going to be so easy to get off of prednisone – I really CANNOT take another increase in the pain and still get through work and home life and I just don’t think that adding Plaquenil is going to make enough of a difference. It might if I could add SSZ, but I can’t. She did say everyone responds different to the drugs, which is true, but I’m still skeptical about Plaquenil being able to make up for the prednisone. I think lowering the prednisone below 7-10mgs makes a huge difference in my pain. If she had to live with the pain and make it through everyday, I’m sure she would understand, but alas….

    And I’ve told her I don’t know how many times about pain in my shoulders over the years, but does she xray those? No. But she decides to xray the neck today. She’s never asked about it and I’ve only brought it up this once. The shoulders bother me more than the neck. Unless perhaps the neck is affecting the shoulders, but I don’t think so, at least not the majority of the time. At this time I’m only concerned about the neck in relation to potential hand or later shoulder surgery, but I guess I can ask for local as opposed to any anesthesia that would require intubation – intubation can be more difficult if there are problems in the neck. I have read that shoulders need to be inspected before planning surgical strategy for RA hands, which I’m just going to get started being assessed for. Do I need to scream when she checks the shoulders just to get those imaged so we can see what’s going on with them? I dunno, I give up. Can I just crawl into a hole and hibernate and hope it’s all just a frustrating dream? That’s what I feel like doing right now.

    And ya know, I was hoping to ask her about how she and her son are doing, and I forgot about that! Well, tomorrow’s another day. PS – do any of you get compliments on your “pink cheek” prednisone complexion?

  5. Pingback: Shock « ∞ itis

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