I walk into the exam room and the patient looks up at me with a surprised expression.  "Wow!  I didn't expect to see you so quickly!"

I smile and turn around to walk out of the door, saying: "Sorry!  I'll leave then and come back later."

"No, no!"  They respond, smiling.  "I'm happy to see you so soon.  It's just a surprise."

I walk back into the room with a smirk.  "I just don't want to offend you by being on time.  I'll try to do better next time."

I am not sure if I should be happy or sad with such an interchange.  On one hand, it feels good to stay on time with my appointments, holding up my end of the bargain of the schedule.  On the other hand, the patient's surprise betrays the fact that this is not the usual state of affairs.  And it isn't.  I generally don't run on time and don't expect to run on time.

When I first started practice, the stated objective was to get the person out of the office within an hour of their scheduled appointment.  This seemed a blend of realism and responsibility.  At first it was easy to stay up on things.  My schedule was sparsely filled, so I could make up time.  After sixteen years of practice, however, my schedule almost never has open slots; when it does have openings, they are quickly filled.  I still try to get them out within an hour.

I have patients scheduled, with a few notable exceptions, every fifteen minutes regardless of the appointment reason.  I don't expect to spend exactly fifteen minutes with people; some will be quick visits lasting 5 minutes and some will take 30.  Usually this averages out to keep me within 30 minutes of the scheduled appointment - something I've grown accustomed to.  Some days, however, conspire against my best attempts to stay within a reasonable timeframe.  Everyone is complicated or needy on those days, and I can get 60 minutes or more behind.  I absolutely hate it when that happens.

But as guilty as I feel admitting this fact, I don't think I will ever change things.  Some docs are obsessed with not falling behind.  I can respect that, but for me it is far more important to give every patient the time that they need.  If I have to spend 45 minutes talking to someone, I do.  My patients have learned this: they will always get my full attention and won't be rushed.  I do respect the fact that others have their own schedules, but the purpose of the visit is to handle their medical problems.  I don't want to hurry through a visit so I can stay on time, missing important things that take some focus or detailed questioning.

This is very hard when I am running behind.  It's hard not to feel rushed when you are already apologetic about being behind, but that is when I am most vulnerable to missing things, and I don't think people should be short-changed because folks earlier on the schedule took longer.  It all ends up making it hit-or-miss when people come to see me.  Sometimes I am right on time, and sometimes - especially at the end of the afternoon - I am significantly behind.

My long-term patients understand this.  They know they always get as much time as they need, even if it puts me more behind.  They understand that I get behind because of the time I spend.  They know I will chat with them and won't get rushed.

New patients are usually surprised they get as much time as they do.  This makes me wonder what other docs do, as I am just trying to do what needs to be done.  I suspect it is because I value the personal interaction and rapport as much as I do the medical knowledge.  I am building relationships, so I will always chat, find out what's going on in people's lives, and learn about them personally.  Primary care is for the long-haul, and it helps to know as much as possible.

I do write blog posts between patients (like this one), because much of my best stuff comes out of the raw emotion of the office setting.  I try to do it in small chunks, mostly when I'm waiting for people to be brought to the back, or when I'm waiting on some test results.

The bottom line?  I won't sacrifice being thorough for being on time, and I think one of the biggest parts of being thorough is to talk - even if that talk is about their grandchildren, vacation plans, or job situation.

Gotta go.  Got a patient waiting....

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