Running Behind

When the schedule harms both patient and physician.

“Oh, that’s great you started DPC right out of residency, but you’ll never know what it’s like practicing on the other side.”

I was working at one of my side jobs today and the other physician was curious about what else I did with my time. I shared that I run a direct primary care practice I opened after residency.

Her response is one I’ve heard often. I don’t take offense to this - it’s natural to compare one person’s journey to another. And sometimes I get far enough away that I forget how ideal DPC has been for my patients and me. At least, until I inevitably get re-exposed to how broken our healthcare system is. And then I remember why I chose not to enter it in the first place.

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The nurse handed me a gown and sheet before leaving the room. I quickly undressed and put it on. I could hear several voices in the hallway and was unsure when the next person would be knocking.

“Should I take off my shoes?”

It seemed weird to take all my clothes off but my shoes, so I settled for leaving my socks on. People did that, right? Being a doctor now in the role of being a patient was nerve-wracking. I was too conscious of everything. I had arrived 20 minutes early to allow a large buffer of rooming time in case they were running early and wanted to keep it that way. When the nurse called my name a few minutes after my appointment time, I began to worry about how far behind they were and if their basic needs were being met that day.

“Maybe if I leave now, it’ll give them enough time to catch up. Did they get to eat lunch? Use the bathroom?”

When I asked how busy they were today, the nurse replied it was quite busy, “But it keeps us out of trouble,” she half-laughed, half-sighed.

My internal worry grew. I had hoped maybe it would be a quieter day. Earlier, I had even prayed for cancellations and no—shows so maybe they could have a break that day. I felt guilty for adding to their schedule.

“My goodness. Is this how patients feel?” I wondered.

It had been about a year since I had been in the patient role. Dusting it off did not reveal a good picture.

I sat in the oversized chair for about 40 minutes. I wondered again if I should leave. If I should try to respond to emails. If the sheet covering my lower body should be wrapped around like a sari or draped like a tablecloth. If I should have kept on my shoes.

The doctor knocked and came in. She had taught me during residency, so she asked how my practice was going and made the usual requisite small talk for a minute. Then she was ready to jump into a quick skin check. I almost didn’t have the heart to tell her that wasn’t why I was there. That instead of the quick get-caught-up-on-the-schedule type of visit she was expecting, was a complex skin problem I had been trying to figure out off and on for 4 years. And yet that was the only reason I had noted for the appointment at all points in the process. Now I not only felt guilty for adding to the schedule of such a busy day, but also for catching her off guard with a less-straightforward visit. I tried to quickly tell my story in as few words as possible, conscious of the time.

Of course, she was a true professional and took great care of me in a few minutes. She quickly offered her assessment after perusing my chart and provided a few treatment options, for which I was grateful. She closed the visit with kind words again about seeing me and my practice and walked me to the door before heading to the next waiting patient.

As the office door closed, I breathed a sigh of relief that the whole experience was over. It wasn’t just the appointment. It was the whole process. It was calling the phone tree to get the appointment, the blocking out a wide chunk of time before and after, and all the little steps that comprise scheduling and completing a medical appointment in an insurance-based model of care.

-

The appointment reminded me again why I chose another path for my patients and me.

Unfortunately, a path that not all physicians are perhaps able to pursue or choose to pursue for one reason or another. My appointments are unrushed (2 hours initially, 30-60 minutes for follow-ups). Patients are welcomed to share their stories. They often note this sharing with someone who has the time to listen helps support their healing process. My waiting room has hardly been used: my patients know they can just arrive on time, and that I will be the one rooming them.

Truly DPC is an altogether different structure of offering care. So far I’ve been able to appreciate the positive benefit from a physician's perspective, but it wasn’t until today that I truly began to appreciate how much DPC impacts the depth of care that I can offer.