Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Friday, November 13, 2009

One Quick Question

One quick question. What could be wrong with one quick little question? Just this: if I hear the words, "I just have one quick question" one more time, someone will be ripped limb from limb and fed slowly to the great Sarnack to be slowly digested over a thousand years, while I set my hair on fire, yank my fingernails out one by one, and shriek for mercy to the heavens above. Also, I may get a little upset.

Here's why.

It's flu shot season. This means that in addition to scheduling patients for regular visits, we have people coming in just for a flu shot. We pull the chart (so we can document the flu shot), but they're squeezed in and around the other patient visits. Given that it takes me about 15 seconds to draw up a flu shot and literally less than one second for the actual injection (not counting however long it takes them to roll up sleeves/remove jackets/unbutton shirts/whatever it takes to get to bare skin), we usually get these folks in and out pretty promptly. In fact, we count on it.

So when they start in with other stuff, like "I need a couple of prescriptions," or "Can you check my blood pressure?" or "Can I just see what I weigh?" or the infamous, dreaded "Can I ask one quick question?" my blood pressure starts to rise, as do the hairs on the back of my neck, and my hackles.

It sounds (and feels) so petty to say, "NO! You're just here for a flu shot. Not a blood pressure check; not a weight check; not for prescription refills; and certainly not for a visit, which is what we call it when you have questions -- quick, slow, long, short, whatever -- that require my professional expertise to answer. I mean, that's why you're asking me, right?" So I don't say that. Even if I'm thinking it; I somehow manage not to say it.

Instead, I swallow hard and say, "Sure."

And they ask their question, which often needs an office visit, which I try to get then to schedule. And I'll write a prescription or two; if there are more, I'll ask if they can come back later; they're usually okay with that. But I won't weigh them or check their blood pressure when there are other patients waiting for scheduled appointments. Mostly, they understand. I hope.

Because one quick question is seldom quick.


At Sat Nov 14, 07:16:00 AM, Anonymous Anonymous said...

A quick question: how many patients could you have seen during the time it took to write this blog?

At Sat Nov 14, 09:46:00 AM, Anonymous Anonymous said...

You mean you don't weigh and get a bp on everyone so that you can bill at a higher level?

At Sat Nov 14, 11:08:00 AM, Blogger Unknown said...

@anon1: how many patients do you think are sitting around waiting at 7:48 AM? I don't know about dino, but my doctor doesn't open until 8.

Now, for "can I see what I weigh?", can you just say "sure, scale's over there, don't get in anyone's way"? BP really *is* a pain, as, first of all, it does take a little time and a little skill, but more importantly, it can be done fairly accurately by an unattended machine that can be found in many pharmacies. So that's just completely lazy and inconsiderate on the part of your patients as far as I'm concerned. As for needing a few prescriptions, that's pretty rude too. If they had called an hour or two ahead of time and asked "can I pick up these prescriptions when I come in for my flu shot?", then that gives you a chance to fit that (relatively small) amount of time into your schedule, as opposed to jamming up your process.

So, for prescriptions and questions, would it do any good to say "sure, I can do that for you, but I'm running a little behind right now, could you wait a half hour or so to let me take care of what I need to do?"

At Sat Nov 14, 11:28:00 AM, Anonymous lastprimcaredoc said...

There are people who realize that they are not the only patients in the office to be seen, and there are those who do not.

The first two anonymous posters are in the second category.

At Sat Nov 14, 01:27:00 PM, Blogger Amanda said...

Loving the book Dr. Dino. So excited to finally get my signed copy from my family member who attended your book signing. (I think she read it first... too me almost 2 months to get it from her. lol)
I am sometimes a "quick question" person, and I can see where your frustration comes from. For me, I struggle with getting to the office in the first place first place, and am almost never there alone. So, I admit that I am sometimes a "one quick question, door handle patient." On the flip side, our family doc whirls in and out so fast, if I don't ask when his hand is on the door, I don't get the chance to ask!

At Sun Nov 15, 08:37:00 PM, Anonymous mamadoc said...

We have flu shot clinic twice a week. It is made very clear at the outset that this is only for flu shots AND NOTHING ELSE IS DONE.The rest of the week flu shots are given during office visits. You have to be a little firm sometimes, but that's worked for us.

At Sun Nov 15, 10:27:00 PM, Anonymous Anonymous said...

I wonder if this is why so many places have nurses administer flu shots. My internist only does it herself if it's available during an office visit (which is how I got mine Sept. 14); when I don't have a regular visit scheduled & just go in for the shot, I get it from a nurse.

At Mon Nov 16, 09:49:00 PM, Anonymous Anonymous said...

There was a great Far Side IIRC cartoon captioned "the reason alien abductions stopped" and a typical far side middle aged woman sitting on an exam table surrounded by several aliens with long written lists. She was saying "...and another thing..."

One of my favorite docs had it on his office door.

At Tue Nov 17, 08:30:00 AM, Blogger Jon said...

All that and they cough their congagious viruses on you, too. Don't envy you, Dino.

At Tue Nov 17, 01:02:00 PM, Anonymous Anonymous said...

The offices I've been acquainted with have the nurse / medical assistant give a flu shot under standing orders. Heck, one clinic even had "Drive by shots" where they would literally give out about 400 shots in an afternoon in the parking lot.

At Tue Nov 17, 04:06:00 PM, Anonymous SHG said...

You forgot to include the time it takes for you scrape those of us who are needle-phobic off the floor after the shot. While I have your ear I have one quick question....

At Tue Nov 17, 05:09:00 PM, Blogger #1 Dinosaur said...

@SHG: Nah, I just leave you needle-phobes sprawled on the floor while I go see my next patient. Oh, and the answer to your question is No, I still don't have H1N1 vaccine.

At Wed Nov 18, 01:26:00 PM, Anonymous Anonymous said...

I rarely ask my doc "one quick question" but my sister: always!


Kensington MD (parent to a fully H1N1-vax'd child under ten years old!! That's one exclamation point for each shot.)

At Thu Nov 19, 03:38:00 AM, Anonymous Anonymous said...

Quick questions questions require quick appropriate answers,
1 yes
2 no
3 I need more time than we have now you'll need to schedule time for us to discuss this in more detail.

At Wed Dec 02, 12:23:00 PM, Anonymous Anonymous said...

Well, as a cancer patient at a large teaching hospital, I rarely get more than 10 minutes with my doctors. It's like they have an internal alarm clock: ten minutes and they start backing out the door.

It makes me, a usually calm person, anxious and hyper, blurting out questions as fast as they can answer, because I know my time with them is short. I always leave without all my questions fully answered.

But I guess I'm not as interesting as their studies, or their room full of more patients than they can see.

I don't know what your practice is like, but both my oncologist and GP schedule so many patients back to back that they don't have time for maybe one question.

This is not satisfying or sufficient for their patients. It's bad customer relations but those of us with HMOs have little choice.

I feel more for the patients than the docs.


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