I am a dinosaur

What I want with my patients
is time

I have been jealous of specialists
for years
45 minutes spent
face to face
just on their heart?
While I rush through
high blood pressure
low sodium, diabetes
worsened kidneys
in 15 minutes

Various events
meant I switched clinics
two doctors left over the EMR
the busiest two
I help maintain their practice
I saw my opening
the deal is
I want 30 minute visits
to update the EMR

The administration caved.

I love 30 minute visits
it's not that I attract
complex patients
as my nurse once said

It's that everyone is complex
if you take the time to listen

In church the sorrows were
the death of a 3 year old
and of a young mom with three small children
poignant on Mother's Day

My husband turned to me and said
"There are always sorrows aren't there?"
Yes, and joys too.

I am told again and again that
I need templates for visits
I serenely assure the administration
My template is "Why are you here?"
and I can type fast

Mrs. Smith has hypertension, diabetes,
low sodium and hypercholesterolemia
Mrs. Jones has hypertension, diabetes,
mild renal failure and neuropathy
Would they write a template for each?
Don't be silly
Or a ten-minute-visit for each problem?
Ludicrous. And I can't lower the blood pressure
without attention to the sodium and diabetes
and everything else

I could go private and let people
schedule thirty or sixty minutes
but I love my diverse people and
my 80 year old ladies deserve
the same care and time
as the younger insured

I wish for a Congressperson or
Insurance CEO on my panel
rush them through in ten minutes
"We can talk about only one problem
you'll have to schedule another visit to discuss neck pain"
Ten minute visits
Make More Money
and destroy the soul

And it's Bad Medicine

I've talked to a psychiatrist
who works with doctors he says that
in Seattle primary care is pressed to see
a person every ten minutes
"They are burning out
and quitting in droves."

I think that he approves of
thirty minute visits

Every day people thank me
for spending so much time with them

I am a dinosaur doctor
I lumber from one room to the next
trailing my laptop

Slow, ponderous
and happy

Written May 2006. The administration changed my schedule back to 20 minute visits after a year. I am no longer there.

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