Monday, January 22, 2007

A small indignation

A parent called this morning asking to have her 7-year old daughter seen for a cough. My receptionist offered her 11:00am today, to which the parent replied, "well, I can't wait that long. I'll just take her to the ER."
The parent called back 10 minutes later asking for the 11:00am appointment.

In my office we do our best to get sick patients seen on the same day. We'll sometimes double-book or tell people to come in at 4:00pm--"You may have to wait, but you will be seen." Children who sound really sick are asked to come in right away and squeezed into the schedule.

I have no patience for parents that think a same-day appointment is unacceptable.

First, two hours might get you seen in the ED. If they're busy, it might not. So we get you in for an appointment before the ED--a walk-in facility--could even see you. (Aside from the fact that the most demanding parents tend to have children with relatively minor problems which don't even warrant being seen in an ED.)
Second, try this with any other specialty. Call up your internist and ask for an appointment today. I'd suggest you could use a stopwatch to see how long they laugh before they compose themselves and ask you, "are you serious? Our first available appointment is in 1 week."
Third, try this with any other profession. Call up your auto mechanic. I dare you to throw a hissy fit if they can't squeeze in your timing-belt replacement in the next 2 hours. See if your hairdresser will bend over backwards to get you in for a perm in the next 20 minutes.

I understand we are dealing with sick children, and anxious parents. But we pediatricians seem to get the least respect and the most outlandish demands, for reasons that tend to have little to do with the acuity of illness and more with the convenience of parents. ("I can't make it at 3pm, I have an appointment. If you can't accomodate me at the time I want, I'll just find someone else who can.")

One of these days, in a world without HIPAA privacy regulations, I'm tempted to ask one of these demanding parents: here is a list of the patients already scheduled this morning. You're welcome to call them, ask if they would give up their spot for you, and call us back when you find someone willing to do that.

There's no upbeat ending or silver lining to this post, just something I had to gripe about.


BrooklynGirl said...

When you're a nervous parent, sometimes it seems like a perfectly reasonable thing to turn down the office appointment with your ped which might be in a couple of hours in case--just in case--the ER can see you sooner. It's hard to be calm when you're freaking out about your kid.

In terms of professional respect, I think teachers (a profession I call my own) ranks lower than doctor. I have parents call while I'm in the middle of teaching a class who don't understand why this might not be a great time to talk about why their child got an 88 instead of a 91 on their vocabulary test. Or better yet, parents who just show up in my room in the middle of the school day--no appointment, nothing. Of course often that's better than the parents who never return your calls, but in a very different way.....

Judy said...

My children's pediatrician offers same-day appointments for illness, but we generally have to wait a while. Not a big issue.

My internist has seen me on a same-day basis when my husband has called to tell them I really couldn't wait (ER would probably have been appropriate both times, but I was glad I didn't have to go there) and twice when I injured myself and would otherwise have had to go to the ER. Aside from that, I feel lucky if they can see me tomorrow instead of next week.

My dentist will see me today for emergencies. I haven't had to take advantage of that yet, but he's made it clear that includes weekends. I doubt he'd make that offer to someone who abused it.

Our "family podiatrist" gave me hell for taking a kid to the ER instead of calling him after office hours for a sprained ankle.

I know these people are exceptions, but that is one reason I like them so much

Jacqui said...

I think we must operate a bit different in Australia. I would die of a heart attack if our paed offered same day service. Usually the waiting list is 3 months long. Sick visits are handled by the family GP who will do same day visits for sick kids (though you do have to wait for a break). I've only ever used this once and ironically we were sent up by our GP to the ER cause it was over what he felt comfortable with.

mumkeepingsane said...

I always feel so thankful that my ped can get me in on a same day basis. She's wonderful at that. Her nurse is also very good at phone triage and helps me know "what to watch for" in case something gets worse. Several times I've not even needed the appointment after talking to the nurse I knew what would need checking and what wouldn't.

I know it must be difficult to deal with negative parents who feel every little thing is a crisis that needs fixing NOW!

Rachel said...

My ped gets my kids in right away & we are always seen fast. I agree that no other Dr. would fit you in same day & I have the utmost respect for Peds & the NP's. Thanks for doing what you do.

Ottgrrl said...

Right on my friend! I manage a doctor's office and some people have a lot of nerve! (I have made the same argument about the mechanic/hairstylist.) Argh...

mm said...

I can't even find a paed who will take any of my children after 4 p.m. in the afternoon... so I don't have to do the bus across town with three in tow.
Nary a doctor to be found.
And people think Universal Health care (Canada) is flawless... snort.

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