Shirah Vollmer MD

The Musings of Dr. Vollmer

Archive for January 31st, 2010

Time

Posted by Dr. Vollmer on January 31, 2010

      I have been taking time to think about time. In my work, being on time is critical. To show up on time is to show respect. There are many aspects to why people show up on time, and why people are chronically late. Here, I want to focus on my timeliness. In general, I run on time. I try to get to my office with time to spare, but like everyone else, there are times when this is not possible. The meaning of my being on time, or of my being late is always different. That is, sometimes I have an understanding why I am late. Other times, my patient “reads” into why I am late. This “reading” becomes grist for that therapeutic mill, but it does not excuse me for being late.

    I understand that it is a large effort for my patients to come to me. They have to leave what they are doing, they have to battle traffic,  find parking, and then they have to negotiate what feels like two flights of stairs. For me to be late, knowing the effort they make to come, feels horrible. So, I work to be on time. Yet, I am aware that the majority of physicians run late. I recently went to a doctor where there was a pre-printed sign in the waiting room which said “the doctor runs 60-90 minutes late, please be patient.” I said to myself “why is it OK that he routinely runs late, and I, as a psychiatrist,  have to be on time?” I thought further, and I said to myself “I am in the business of building self-esteem, being on time is one way to show respect, respect builds self-confidence, so I cannot run late.”   

    Once again, I am left to reflect why I am a physician, and yet, my “rules” are not the “rules” of my medical colleagues. I would think that all doctors need to show respect for their patients. People come in pain and they want help. To keep people waiting, adds to their pain. How can that be OK? It is not. On the other hand, I know that for a doctor to run an efficient practice, he should schedule his patients for one of two times, 8:00 am or 1:00 pm. This way, all the morning patients come at once, and he can,  like working on an assembly line, see patients rapidly with no down time in between visits. One might say that this “assembly line” mentality is a function of greed. In private practice, the more patients one sees, the more money one generates.  I would argue that although that might be a factor, it is also easier to work without a break. One gets into a certain patient-seeing zone and it helps if one can stay in that zone for the morning without having to transition to another mode.  Still, does efficiency,  staying in the zone, justify keeping patients waiting while they worry about what is wrong with them?

   I waited for my doctor for an hour. The sign prepared me. The person who referred me also warned me. I did not like it, but I trusted that I would get good medical care, and that is what I wanted most. Yet, I sat there thinking that I could never feel OK letting my patients wait for me for 60-90 minutes. Managing expectations is important. Clearly, if one expects to wait, then one does not get as angry. However, there is a certain message  in waiting that the doctors’ time is more important than mine. That does not feel good. I run on time, so if I am a few minutes late, my patients will get concerned. They are not used to that. But, it is not all about expectations,  and it is not all about respect either. Timeliness  is also about a certain mutuality in our relationship. My time is important, and so is theirs. There is something nice about that kind of reciprocity. The effort to be on time is worth it. My medical colleagues have a lot to learn.

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