Jul. 13, 2002 - 19:24 MDT

THE WONDERING JEW

Outer Limits

I'm thinking, and wondering (mostly about me).

At the check in counter at my HMO I have been told that an appointment can only be held for a person for 15 minutes after the time it was set for. Yeah, I can see that, it even makes a bit of sense.

Once in a great while when checking in for an appointment it will be announced that that doctor is out on an emergency. It is easy to think, now if that were 'my' emergency I would want my doctor attending me. So weighing the values makes it easy to either schedule another appointment or see one of the other doctors on the team, maybe even a Nurse Practitioner.

When I have an appointment toward the end of the day, due to the pile up of days work -- a minute here, a minute or two there, it is to be expected that maybe my waiting time will be on the order of an hour. An hour after the doctor's supposed quitting time.

Early in the day I expect to see my doctor in a reasonable amount of time. And it does sometimes happen. Playing a game against the odds my appearance at the doctor's will be maybe half an hour early, sometimes it turns out in my favor and I get called in early.

Some time ago my dear Heather had an appointment for a medical procedure for 6 AM. We showed up there a bit early and sat in an empty waiting room, empty by golly for over an hour before she was called in. No one advised us that maybe the doctor would be a bit late, nothing was said at all. Of course nothing was said by Heather about this to the doctor or staff. Why commit an act of foolhardy hari kari with one's doctor or his staff as witnesses ?

Seriously, it seems to me that a degree of diplomacy should be exercised by the patient in relation to dealing with the medical staff as a whole. I could never work at full efficiency if someone was in the process of being overly critical of what I was doing or the time it was taking me to do it or how late it was when I could get to it.

Sometimes in my nightmares I am back in a place or six where I was employed and some bean counter decided to push a quota on us working stiffs. Down the line a bit when asked how long it took me to do a certain thing I would say something like this, "It depends on whether things go perfectly or if a fly lands in the ointment -- which it often does. Now I do the work as fast and as well as I can and have never had the time to keep track of how long it takes, even on the average. I do the work and don't have time to supervise myself." That of course is not what they wanted to hear. They wanted an answer something like, "It takes five minutes (insert the time) to do this operation." Those people who are trying to establish a quota never take into account machinery acting up, materials not being in the condition to be worked on without extra trouble, tools breaking and almost any number of other complications which can and do come up on jobs, whether with machinery, assembly, paper work, book keeping -- you name it. Nothing flows smoothly at a certain rate all the time, there are too many variables. The inevitable breakdowns in machinery, paperwork and or communications do occur all too often.

So, just what am I trying to say about HMO's and the medical profession as an entity ? I guess it is simply that the first patient of the day should be seen at the exact time of his appointment. All else seems to be in the arena of chance. The delay usually begins to build with the first patient or two of the day and adds up with the passage of time.

The fifteen minute rule ? If a patient doesn't show at the proper time within the fifteen minute limit, the next patient can be called in early, if he or she is there. I do notice that many people checking in at the counter are showing up there at the precise time of their appointments. Some early bird in the waiting room gets a bonus perhaps. This medical bit is much like a race, starting on the precise minute but not knowing just when or where the finish line is.

So, first patient of the day should be seen on time I think.

Then there are the people who work and can only see a doctor by taking time off their jobs. A no win thing for them, see the doctor or stay sick, they are well into the realm of the Outer Limits . . . . . . . .

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