Monday, November 30, 2009

Melissa Young, MD: Are patients expecting too much of me — or vice versa?

Last week, just as I was about to give up on my 12:15 patient, she called — at 12:25 p.m. — to say she was going to be at the office in 15 minutes. My receptionist, knowing full well what I was going to say, asked her to hold, turned to me and asked me if I would see her. See her? Twenty-five minutes into a 45-minute visit? When I had a meeting at 1 p.m.?

I said, “No.” Well, what I actually said can’t be published, but the bottom line was “no.” I listened to her politely explain to the patient that I would no longer be able to see her and that she was welcome to reschedule. I listened to her try to reason with her, saw her put her on hold and turn to me. “No.”
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She tried talking to her again, and then in exasperation asked me if I wanted to talk to her. Of course, I didn’t want to, but fine. Let me interject here that she had already “no-showed” for a new patient visit two weeks earlier and probably should have been given another appointment anyway. So I take the phone and try to explain to her that she was going to be too late, and that, no I would not, could not see her. She insisted that she was “right there,” argued that she was coming “all this way for nothing.”

I reminded her that her appointment was at 12:15, to which she replied “So? It’s only 12:20 now!” First of all, it was by then 12:30, and even if it was 12:20, she was still going to end up at least 20 minutes late. I finally said that she can reschedule or not come at all. To which she replied, “Well then I don’t want you for my doctor. You’re mean.”

I nearly laughed. Instead I said, “That’s fine,” and I hung up. She later called and left a message about how unhappy she is that we would “dare” to ask her to reschedule, and that she doesn’t want me as her doctor. Part of me wanted to say, “No, no, no. I don’t want you as a patient.”

Another patient, one I had yet to see, had called the office numerous times, asking my receptionist things such as, what is my feeling about alternative medicine, will I do a thyroid cyst aspiration on her first visit, can I order this test and that test before she comes.

One day she called and asked to speak to me, and I spent a good 15 minutes trying to tell her that I cannot make any clinical decisions on someone I haven’t seen. So no, I will not plan on an aspiration, no I will not order tests. I don’t care if your other doctor thinks you should have it; if that’s the case, he should order it. Then I finally have the, uh, pleasure of seeing her, and make it through without killing her or me with the sphygmo tubing.

The next day, according to our caller ID, she called at least 10 times. She left a message once asking to please send my notes to her primary. I did so immediately. Then two days later, she called again, and asked to speak to me, to ask me to send my notes to her primary. I said, “I did, why? Didn’t she get it?” Oh, she doesn’t know because she didn’t ask her primary. But she figured she could call and ask me?

Is it too much to ask that patients respect my time?

Melissa G. Young, MD, FACE, FACP, is an endocrinologist in private practice, an assistant clinical professor at Robert Wood Johnson, and a working suburban mother of two in Freehold, N.J. She is a regular contributor to Practice Notes.


  1. Let doctors bill like lawyers and see what happens. Fax? $10 a page. Phone call? 10 minute minimum charge. Cancel? One hour charge. Letter for your disability insurer? $250 per hour to dictate plus transcription costs.

    As to timeliness, I am like you- I run on time. Patients are told that when they schedule and if they are late they are asked to reschedule. Common Courtesy. I respect their time and they respect mine. Let them find another doctor and they will realize what they gave up!

  2. You're actually speaking on the phone with these issues??? that's what staff is for. If a telephone call requires more than a 5 sec answer unless someone's life depended on it, it should generate a visit for proper documentation//FP in Phx

  3. I agree with you Signaturedoc as long as the charges for the visit decrease on a per minute basis for every minute I wait after my scheduled time. Say 10%/minute? And then the counter starts again after you have been in the examination room for more than 10 minutes without the Dr. seeing you. Sound fair?