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Why am I only allowed to ask you about one problem during my visit?

Posted: December 30, 2009

(3) Comments

  • photo: getty images photo: getty images

Q: When I called to make an appointment, the nurse told me I could only ask you about one problem at my visit.  What's up with that?

A: OK... Here's the deal.  For every appointment I must:

  • Review your history. If I've never seen you before, this means complete past medical history, surgical history, medications, drug allergies, family history, smoking, etc.
  • Review why you're here today, including your current symptoms, when they started, what you've done for them, what makes them better or worse, how they've changed since they started, etc.
  • Perform a physical examination
  • Order any necessary diagnostic testing (labs, x-rays, etc.)
  • Use my amazing medical superpowers to figure out what is going on; explain to you what my plan is to remedy it; and answer any questions you might have
  • Order prescriptions
  • Type every single word into our occasionally truculent electronic health record and assign a diagnostic code that tells your insurance company why you were here. Then I assign another code for the level of service provided, which (theoretically) determines how much SHS will be paid for providing those services.
  • Clean my room for the next patient.

For all of that, I have 20 minutes. 20 minutes!  For many routine situations - a sore throat, a simple urinary tract infection - that's actually pretty doable.  And if your other question is as simple as, "While I'm here, can I get a refill on my allergy medication?" then fine, no sweat. 

But if you say, "I also want to ask you about this chest pain I've had for a while... or my stomach has been killing me for 2 weeks... or I get dizzy every time I work out" then the 20-minute time limit becomes impossible. These symptoms could be anything from simple stress to a life-threatening condition and it takes me a lot of time to figure it out. 

Which isn't to say that I don't want to figure it out. I do! But the clock is ticking, and there are other sick students waiting to be seen. If you tell our schedulers exactly why you need an appointment, they'll do their best to help you, either by scheduling extra time or by working with you to figure out what the most pressing issue is today.  At Student Health Services we really do want to help, but we walk a tightrope. We are happy to see you for whatever you need, but there are thousands of you and only a few of us and only so many hours in the day.

John A. Vaughn, MD (OSU SHS)

Comments

  • Wednesday, December 30, 2009 9:48:48 AM Posted by: longtimebucki As someone very familiar with the scheduling system at Student Health, I can also add to this. Say I want to schedule a visit for a bad cold or something, but I know that I need to talk to them about a longer term problem, too. Usually you can see someone right away for the cold, and also book another visit later for the other problem. The wait is not that long either, most of the time. Much quicker and more efficient than my home doctor’s office, where they get backed up for weeks.
  • Friday, March 12, 2010 12:53:12 PM Posted by: professional student The first three bullets above are exactly the reason why you should schedule more than one issue per appointment. As things currently stand, a patient must schedule two appointments (on separate days) to have their medical needs met. This means the patient must: choose which medical issue is more important and schedule that first; make two trips (have you tried to park near Wilce as a student? To say it is a challenge is an understatement); wait two times in the main waiting room; get two sets of vitals taken by the nurse; wait twice for the doctor after having vitals taken; explain their history and complaints twice; have two PEs performed; and wait for medications in the pharmacy twice (if applicable). This is not only a poor use of doctor and nurse time but also provides sub-optimal service to the student population. Graduate and professional students who rely on the Student Health Center Services especially feel the inconvenience of the current system. As a professional student in the medical field, it is nearly impossible to schedule one visit during the quarter, let alone two. I agree that 20 minutes is a short period of time and that it is insufficient to develop a list of differentials, order tests, and write prescriptions if necessary. One should never criticize without offering a solution, so here is my proposal: When scheduling an appointment, ensure that patients list all medical problems Create two categories of appointments: “Basic” and “Complex” Basic: 20 minutes duration, patient has one complaint Complex: 40 minutes duration, patient has two complaints Each appointment would have only one trip, wait, exam, history, and set of paperwork. There are many ways to set up an alternative appointment structure, and the current system does not accommodate the population using the Student Health Center services. Please consider revising it!
  • Monday, March 15, 2010 12:36:31 PM Posted by: BuckMD You raise some interesting points, but schedules are slippery things; every solution you come up with to solve one problem creates another and maintaining a good balance is tough to do. Keep your eyes peeled for a follow-up post where we will address these issues in more detail. Thanks!

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