I get a lot of complaints from patients in the hospital that things take too long or that they don't get to see me enough. I feel for them and I agree. It's not going to change, though, so I thought a bit of an explanation might help.
So you are a patient in a hospital, and I am your doctor. You like me at first. When you get in the hospital, I spend like an hour with you and meticulously go through every inch of your complaint. I am sympathetic (unless you curse at me or hit me) and I smile a lot, and you feel reassured that this hospital stay will be useful, albeit stressful because you are sick.
The next morning, I burst in on you at an hour that is proof of our fallen world. You are still rubbing sleep from your eyes when I turn on the dazzling light behind your bed and start throwing questions at you. Five minutes later you have been stethoscoped briefly and I am gone, and you feel bemused, slightly irritated, and potentially slighted. You don't see me again for the rest of the day which seems unfair. Aren't you sick? Shouldn't you be seen by a doctor?
This pattern continues for your four-day hospital stay, with the exception of one day where I come in during the afternoon as well so we can discuss some important test results. During that talk I have magically transformed back into the doctor you met on the first day, sympathetic and ready to listen, free with my time - until a high-pitched beeping interrupts your tearful admission about how afraid you were that you had cancer. I apologise and breeze out of the room, leaving you uncomfortable and wishing you hadn't said anything. I don't come back for half an hour (what could have taken so long??) and the mood is clearly broken as I stick to medical topics, listen to your lungs again, then leave.
The next day, you can leave! Finally! You are overjoyed when I tell you this under the piercingly bright lights at 5:30am. You are, however, considerably less overjoyed when seven hours later you are still sitting in the hospital. I'd warned you to give it some time, but come on! You ask the nurse to call me, and the response is basically nothing. Wait. The doctor hasn't forgotten about you. Yeah, clearly. You can't leave until 3pm, and though my card is sitting in your folder of discharge paperwork so you can see me in the clinic, you aren't sure if you will. I certainly wasn't on top of things in the hospital; why would that be different in clinic?
Let's switch our point of view here.
I am a first year resident physician, and I am terrified. I go to admit you, my patient, and get you all tucked in for the night. In engrish we would say: strong success!
The next morning I start work at 5am after finishing at 8pm the night before. I have three hours to see six patients, by which I mean examine/ talk to the patient, write a note on each person's progress, examine labwork and other doctors' notes, and decide what to do for the day to help make the patient better. I really hope all of my patients are fairly quiet so the exam part can go quickly, because it takes so long for me to really think my way through their plan of care. Apparently I'm the doctor now and I need to do these things. I hate being awake so early, let alone inflicting that on others, but this is my only opportunity to do this, so I turn lights on and speak clearly so that hopefully some of what I say sinks in. It doesn't feel like it, but this is my visit for the day, and I hate that my patients are always sleepy and out of it and not in a place to discuss anything important when I see them, but I don't have a choice. My time is not my own.
Work for me goes like this. I work an average of 14 hours a day. I probably take about 40 minutes a day for myself, what with lunch and
various bathroom breaks. Actually, I take that back; I normally work
while eating lunch. So I take about 20 minutes a day for myself. 5am - 8am, I see patients and write paperwork. 8 - 9 is academics. 9-11, my fellow interns and I present our patients to the senior residents and the attending (= fully licenced supervising physician) and have our plans tweaked. The rest of the day is unscheduled. This means it is time for discharging patients, admitting new patients, following lab results, talking to specialists about our patients, and doing procedures. If I have time, I like to go back to my patients and talk with them a bit more, as this is excellent time for counselling, information-gathering, and ministry.
The thing that makes all of that a total mess is that all of it happens simultaneously. Several days later when I am trying to discharge you, I cannot work on your paperwork until lunchtime because morning presentations run late, so I start your paperwork (and paperwork for two other people who are also being discharged) as I eat lunch. Except before I can do that, I need to get some specialists on board for other patients who are currently way sicker than you. That takes some doing and multiple phone calls, but once it's done, it's paperwork time. You know all that paperwork you receive when you leave the hospital? Yeah, I put all of that together. I evaluate all of your prescriptions and your discharge instructions, make sure you have the right contact numbers for clinics, etc. You know not to expect to leave until around lunchtime because I told you that morning. As I am working on your discharge, however, a very sick person arrives in the emergency department and needs to be admitted. Remember that hour I spent with you working through your medical issues? I have to go to the ER now to do that for someone else, leaving your paperwork undone for the moment. I am paged five times during that admit which adds easily 30 minutes to the process because some of the questions I am asked I have to run by my senior. One of those pages is actually from your nurse, and I have nothing to offer you except I'm sorry. I'm admitting a patient and I can't get away. Please be patient. It takes about 90 minutes - 2 hours for me to work through admitting a patient because I am slow at this right now and scared I'll miss something important.
Finally it is midafternoon and I am trying to go through your paperwork. It takes some research to make sure I am making the right decisions, but ultimately I'm satisfied and send you on your way. I poke my head in to let you know and you are clearly angry. You have been waiting for ten hours to go home, you say. What is wrong with this place, you say. I apologise again.
Then I walk down the hall and discuss a lady's suicide attempt with her, finding out that she was a victim of child rape and prostitution and she's never recovered from that despite trying to be strong. Then I go down two floors to explain to a man that there's nothing we can do and he needs to start making end-of-life arrangements. My pager goes off during this discussion. There is another patient in the ER who needs to be admitted.
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I am tired enough that my brain is taking my hand-eye coordination away, so I think I will go to bed now. I really hope this post is coherent.
