Monday, August 30, 2010

Eureeka! I have figured it out!

Before I was in Fire and EMS I was a normal person with normal thought patterns and responses. During that period I was always curious about why the wait was always so long in most Doctors Offices when you had made an APPOINTMENT days, weeks, or months in advance. They knew you were coming. There was no surprise. They had LOTS of time to prepare for your arrival. What was the problem here?
 Now when I was a child, everybody in my family saw the same GP. Good old Dr. Hennighan. The Doc was old school and didn't even have a receptionist. He did it all himself. All he used was a service to schedule his appointments. We never waited more than 15 minutes past our appointment to see him unless he had an emergency. In this case his daughter (the Doc's house was next door to his practice), would come over and announce to the waiting room that "Daddy just called from the Hospital and says he is very sorry, but he has an emergency. He will be about an hour. If you want to leave and reschedule, that would be fine. If you don't mind waiting he will see you when he gets back. Mommy is making some coffee and cookies to bring over in a few minutes. My Daddy is very sorry to have put you all out."  Everybody understood, and either stayed or didn't. It was the way things went. Of course I have fond memories of this Doctor walking into my bedroom when I was sick to check on me. He would write prescriptions, but then drop them off at the pharmacy on his way to the next call. The pharmacy would deliver the prescriptions within two hours, no extra charge, unless the Doc asked them to rush it, then we might see it in 30 minutes.
 Yes, this is true, it was the way things were when I was a kid, really. (Important to note: I am NOT as old as you think, I am still interior certified.) No not every Doctor was like that, but MINE was. He passed away when I was in my twenties and I cried when I heard the news. He was truly a good, compassionate, and excellent man. The last time he treated me ( I was around 20) was for a spontaneous pneumothorax. My Surgeon told me that there wasn't 1 GP in 500 that would have picked that out on an x-ray and I should count myself lucky. I did, all the time.

 Today, things are a bit different. I am spending a CONSIDERABLE amount of time in Physicians offices as we tend to the last years of my 2 aging parents. GP, Cardiologist, OB/GYN, Wound Care Center, Urologist, and a couple of others. WE average an appointment a week. I take care of the home care medical needs and when I am traveling I have a blessed fellow EMT on my Squad that covers for me with my folks.
This past Monday I spent 2 1/2 hours in an Office so my Dad could get 5 minutes of Physician Contact time and 10 minutes of skilled nursing time. We waited 45 minutes to get in (first appointment of the day, so HOW can they be 'behind'?), and they had him on the table in an uncomfortable position for another 45 minutes, and eventually he felt the call of nature. This patient is 91 years old. The nurse says, "we should be done in just 15 minutes". I said "I don't think he can wait that long, it's been a long time already and he is in a lot of pain. Getting up and then back on the table again is going to be very difficult on him." I wanted to say "I t SHOULD have taken 15 minutes and HOUR AGO". But I didn't. My Pop started to get up, but then the Doctor came in and made fairly quick work of the exam and told the Nurse to bandage him up. She began to collect the things she would need to do the bandaging job. I'm thinking 'was this a surprise to her?' Then she leaves the room to get some more 'stuff'. Pop is really uncomfortable now and I know this won't end well if we don't kick it up a notch. I put on a pair of gloves and started prepping the wound site and cleaning it up. (This whole thing is more of a procedure than just slapping a bandaid on, I've been trained by this very office to do this and I do it at home for him all the time). The nurse returns and look in horror that I have gloves on and am working on HER patient. I just said "he can't wait much longer, lets do this". She looked at what I had done (mouth still hanging open) and says "Hey that's pretty neat work, you've done this before." "Yup", I grunted and we finished it up in about 2 minutes. We got him to the bathroom just in time.
 On Friday we spent 2 1/2 hours at Mom's Cardiologist for 8 minutes of Physician contact time and 5 minutes of Nursing time. This was for a bi-annual checkup with nothing new to report, no blood tests, no med changes. Most of the time was spent trying to remind the Doctor of my Mom's issues.
 Someday soon my employer is going to start complaining about the time I am taking from work for all these appointments.

 So I mentioned before that I am a manufacturing professional. In MY field we are constantly re-evaluating how to do things better, faster, and with higher quality. Time is money. We are routinely re-tooling to improve our work. So it drives me crazy to sit in a Doctor's office with plenty of people running around and NOBODY concerned about moving patients through. Yes, obviously, I get that patients need to get the time they need. But the 'value added time' here is actual patient treatment, counseling, and support. Everything else is waste and should be eliminated from the process. Wasted time, wasted movement, no value added.

 So at the top I said I finally figured it out. Here is the answer. Are you ready?

They don't care.

 Just like sloppy Medics, Sloppy EMT's, sloppy E/D's, they just stopped caring. They forgot what their mission is.  They don't see good patient flow as part of a quality operation. They don't think it matters and they think everyone should just accept it. After all, where would they be if they weren't here? Sitting at home watching TV? They can do that here, we have cable. I'm inclined to think they should get rid of the cable and get on with doing their job in a satisfying manner.

Well, at least now I know why.

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