In the clinic, there are sick visits and routine follow-up. Although it sounds counter-intuitive, you want the sick visits. The sick visits are supposed to be about one thing. One specific problem. They come in, tell you the one problem, you come up with a treatment plan, and they leave. The "routine" visits instead often involve a laundry list of issues that have come up since the last visit, we're talking about weight loss, we're talking about diabetes management, we're talking about depression screening, foot pain, headaches, cataracts, anything and everything they're worried about. Which is fine, and that's what we're here for, but a sick visit is supposed to be so much easier. One problem. And we write a prescription for an antibiotic and off they go.
Problem is, the patients know the system even better than the doctors do. They know that routine follow-up appointments are six weeks out, and the fifteen-minute sick visit slot can be available the same day if you're willing to wait for a while in the waiting room.
"So what brings you in today?"
"I don't know, I just don't feel great."
"Is there a specific problem?"
"No, but I knew it would be a month before I'd get a regular appointment, so I told the secretary I was having chest pain."
"You know, that's not fair to the people who are actually having chest pain and need these slots. There are only a certain number of slots set aside for acute issues."
"They can find a different doctor."
"You know it's not that easy."
"Well, I didn't do anything that anyone else couldn't do."
"For next time, I'd appreciate it if you didn't make up a story to get a faster appointment."
"Like you'll be my doctor next time."
"I could be."
"I know how the clinic works. You won't be."
"Tell me what's bothering you."
"Well, first there's my life and how it's a total mess."
"I'm sorry to hear that. Do you have a specific medical complaint?"
"I want someone who will listen."
"Can I refer you to the mental health clinic?"
"I'm not crazy."
"I didn't say you were."
"Then let me talk."
And she talked. For twenty minutes about her ex-husband and her boss and her ungrateful daughter and the rude clerk at the Department of Motor Vehicles.
"I really have to see the next patient, if you don't have a medical issue that I can help you with."
"But I'm not done telling you about my neighbor's dog--"
"I'm going to have to cut you off."
"Okay, okay, okay-- I'll go. Just one more thing."
"I have a lump in my armpit."