I can’t think of many professions in which an introduction to your client or customer includes an apology. I suspect mine is one of them.
“Hi, my name’s Jason. I’m one of the doctors. I’m sorry I’ve kept you waiting for so long.”
I find myself apologising to almost all of my patients as a way of introducing myself. My job title is senior house officer in ophthalmology – that is, I am a “senior junior” doctor. It’s taken me more than 10 years since I finished high school to get to where I currently am, and I now run a busy eye clinic in a tertiary public hospital with just one other colleague. We receive referrals from GPs, emergency doctors and optometrists and patients are welcome to walk in. Some patients have had chronic red eyes for months with no explanation. Others have woken up suddenly blind in one eye, while some have been brought in by ambulance from work after getting hot concrete, battery acid or a nail into their eye.
A typical day at work for me goes like this:
My first patient of the morning is a review patient – he came in earlier in the week with an infected ulcer on his cornea as a result of wearing his contact lenses overnight. He is responding well to treatment. My second patient is another review, this time for anterior uveitis, a condition in which the immune system mistakenly attacks tissues within the eye. She is responding well to treatment also. I write her a written treatment plan and organise to see her in another two weeks. These consultations take only 10 minutes and I secretly hope that every subsequent patient will be this quick. But for the patient, to see me for just 10 minutes, they need to take the morning off work to drive to the hospital; queue at reception to be registered; queue again for the nurse for an initial assessment; and then wait to be seen by me. They often need to stop by a pharmacy on their way home. This whole process takes hours out of their day and I often need to see patients multiple times over a month before I can fully discharge them.
The worried-looking nurse enters my room and tells me of a patient who has just arrived, complaining of blurry vision, headaches and vomiting. I have to assign priority to this patient over the already-full waiting room at 9am. I examine this young mother of two and find that her optic nerves, the two data cables that connect each eyeball to the brain, are swollen and look angry. I can’t let this patient leave until I’ve proven that this isn’t being caused by a tumour in her head. To fully assess her, I need to insert a cannula, organise urgent blood tests, request a same-day CT scan from a radiologist and organise her to be seen by a neurologist. All of this has taken over an hour, and meanwhile, all of the patients from the morning are still waiting. The receptionist reminds me that I have three WorkCover certificates to fill out and a patient is on the phone asking about the results of his tests.
I continue to see patients, apologising to all of them as I introduce myself. Almost all of them take it well. A small number, understandably, are frustrated. Often they are in visible pain as they wait hours to see me. As late afternoon approaches, I haven’t had lunch yet but there are patients who have been waiting five hours to be seen. I’ll just have a bigger dinner when I get home at 8pm. I have lost two kilograms in the last month.
The nurse brings me three charts for patients who left the clinic without waiting to be seen. The referral letter for one of them says that the patient has noticed double vision and a misalignment of his eyes – if this is caused by an aneurysm, which can rupture in a matter of days, the patient could die. I ring his mobile and leave a message after nobody answers.
It is usually impossible to keep to a schedule because medicine is complex and the needs of patients cannot possibly be met in the fixed time period that the schedule permits us. Quality patient care comes first and that inevitably means that serious or unexpected problems will occupy more time and make us run behind schedule even further. As much as we try to work in a timely manner, emergencies and high-priority cases will inevitably occupy us as well as calls to and from other specialty units for advice. Many patients have complex, difficult-to-manage conditions that require the input of multiple doctors. And doctors are only one link in the chain of healthcare for every patient. To run on time requires a large number of often unseen team members doing their jobs well, such as the receptionists, the nurses, the pharmacists, the radiographers, the wardies transporting patients throughout the hospital, and so on. A delay from any one of us can result in a delay for everyone else.
I could try to see every patient faster in an attempt to keep everyone that little bit happier, but to do that would be unsafe. Mistakes will be made and fine details could be missed. I would be practising negligent, irresponsible medicine. To practise medicine requires an oath to do no harm, whether by act or omission. Errors and mistakes in medicine can cause pain and suffering or cost lives.
So the solution is that patients sadly must continue to wait as we constantly run behind schedule. I’m sorry for making you wait for so long, for having to pay exorbitant parking fees and parking fines, and that you probably had to take an entire day off work just to see me. But if it allows me to do my job safely, hopefully it will have all been worth it.
* Jason Yosar is an ophthalmology senior house officer working in a Brisbane public hospital and an Associate Lecturer at the University of Queensland School of Medicine.