I Need 36 Hours in a Day, Part 2

May 24, 2010

My most precious resource of time is of limited quantity. And I can’t blame the pseudo-patients when apparently physicians don’t know when it is appropriate to refer either.

A few posts ago, I brought up my problem with scheduling patients because there just isn’t enough time in a day and I can only be in one place at one time.

And patient are upset because they need to be seen “right away.” Because, they "just feel awful,” they’re “terribly sick,” or because by the time their appointment which is scheduled in eight weeks rolls around they’ll be dead/bald/as big as a house.

I have considered telling patients that they need to have their physicians refer them regardless of whether or not their insurance requires it, so I can weed out the “it must be my thyroid,” tired, overweight people with perfectly normal labs, and the “I’d like all my hormones checked because I think something is missing” (oh something’s missing all right) people. That would allow me to schedule the pregnant type 1’s and the thyroid cancers and the possible pheochromocytomas in a more timely manner.

But what to do when even the referring docs refer inappropriately? And not just referring - calling to squeeze in, to move up, to twist arms, for patients who don’t need me, or at the very least don’t need me emergently.

Take for example a phone call, actually a series of phone calls, from one doctor's office to get one of her diabetic patients in. The man had called, made an appointment for about six weeks from the time he called. Then the calls started. Can’t I see him sooner? His numbers are all over the place, he is not well controlled, he is old and has complications. Fine. We find a place to squeeze him in.

We call him, can’t reach him. Well, we can’t hold the spot forever because there are other “urgent” patients. We get another call. My staff tells the other doctor's staff (Oh by the way, at this point, the doc herself had yet to speak to me), that she tried to reach him but couldn’t. We get another call. Can’t we please move him up? Not top of the waiting list is not good enough. By this time, the man’s appointment is four weeks away.

Then I get the call from the doc. Why can’t I see him sooner? Well, I’m open to suggestions. First of all, when? Secondly, how, if I can’t reach him?

Fortunately (sort of), a cancellation called, and we were finally able to reach this man. And when he came for his appointment, he was a lovely older man. On a couple of oral agents, with a slightly elevated creatinine, with blood sugars between 70 and 130, WITH A HBA1C OF 5.6!!! Seriously? This was the emergency? For this, precious time was wasted on the phone? For this, other patients who had been on the waiting list longer than this man had to wait? For this, I was about to have a major coronary, and it took unquantifiable amounts of energy to not call Dr. So-and-So and say, “Are you freaking kidding me?!?!?”

What am I to do? My most precious resource of time is of limited quantity. And I can’t blame the pseudo-patients when apparently physicians don’t know when it is appropriate to refer either. Want to talk about wasted health care dollars? Let’s start here.