What does my doctor do all day (or… why are they always late???)

By Dr. Jeanette Dionne

You are sitting in the treatment room… hopefully one with a window. And musing on the word “patient” yup, you had better be patient because here you sit. Waiting and waiting. 
They should call these waiting rooms as well, not exam rooms.
Seriously, can that doctor not keep a schedule.  How hard is it to be on time…

Well my friend let me give you a brief view behind the scenes in a day at the office. 

Just so you know: this is my day (Dr D), not anyone else’s. I am not putting my thoughts or time management skills (or lack thereof) on any of my colleagues. BUT just so you know, they are crazy busy too. 

And it is FRIDAY.  Everyone’s favourite day of the week. Or is it? Friday can put a little fear in someone who has been hoping “that thing” they've been nursing along all week will clear up.  And now here we are. The end of the week. With a heavy sigh, you pick up the phone to call the friendly ole doctor's office, hoping to be popped in for a quick appointment. 

How does my day start? On Fridays I start seeing patients at 9:30. Usually. Sometimes an extra body is popped in at 9:15 because they need to be seen and there is nowhere else on the schedule to fit them in. 
But I don’t start work at 9:30. I usually arrive at the office anywhere between 8:45 and 9:00.
Other docs start earlier. I am so proud of them!

Today I got here at 8:45 because, well, you know, Friday. 

Walk into the office and fire up the computer.  

How can there be 68 NEW items in my inbox.  Must have been a lab dump last night of old reports. I mean, I was here till 6:30pm last night working on said inbox (FYI I saw my last patient at 4:30 so that is 2 hours of inbox management at the end of the day).

NOPE! The lab files are full of brand new shiny results to review and a pile of fresh reports from the hospital, x-ray, etc. 

BUT there are 12 messages that have arrived since the phone opened at 8am today. 
Some are the routine “I need my prescriptions for the weekend” but some are not that easy.  Requests for results and new plans,  sick children to be squeezed in and the occasional crisis call.  
Each of these has to be looked at individually and managed.  As I said some are routine and easy and some are not.  But they all take time.
  
I cruise through the messages and attack the ones that need looking at now.
Those refills will have to wait. 

* Did you know that the refills you send in via the Telus Connect App are reviewed by a nurse and then again by your doctor? The computer does not magically renew the meds. We look at each and every one of these requests to make sure all is ok. The people behind the screens *

Alrighty then, a few fires have been put out.  Messages sent, urgent spots found for people, results reviewed and commented on. 

It is now 9:15.  Patients in 15 minutes.  Scanning my list I see the name of someone who may still be in hospital.
I sign on the Ontario Clinical Viewer (this is fun. Passwords, security questions,  spinning wheel of death) ok, they are still in hospital.  Now I trot up to reception to get them to call the family to make sure the computer is not lying to me and cancel the appointment (woohoo it was a double slot so room for a couple of urgent calls or appointments). That took 10 minutes. 

9:25am.  Just enough time for a quick trip to the loo.  Doctors need to pee too. 

9:30am Ideally I am now walking into a room to see you! The waiting patient. Congratulating myself on my ability to get some stuff out of the way and start on time.  Yay me!

BUT not so fast.  A triage nurse has just popped around the corner, notebook and pen in hand. She just spoke with someone who is having confusing symptoms. We pull up the chart and create a plan. Do they need to come in? Do they need to go straight to the hospital? Can we manage this over the phone? And POOF 10 more minutes is GONE. 

9:40 Walking into the exam room to see my first patient.  I have been at work for 55 minutes and am already 10 minutes behind.

The morning is a series of rinse and repeat.  

On Fridays I usually do not have physicals booked; follow-ups and fit-ins are the words of the day.  Some are quick. Some are not. People sometimes just take and need more time. And that is OK, really it is. Medicine is not a series of check boxes and drugs given. People are complex in both mind and body.  

Believe it or not, I have breaks scheduled in my morning as well.  But… they are not really breaks.  We refer to them as “catch-up blocks”.  Blocks of time that are not filled in so we can answer messages (phone calls, little post-it notes stuck on our screens to check in with nursing or reception and so on), review cases with our PAs or other colleagues in our office, or just move on to the next person because the last one needed more time. 

Aaaand back to the schedule.  I have an hour scheduled for “lunch”. Usually this is a quick 20 minutes of eating, doomscrolling and chatting in the lunch room with the staff who are there.  Some docs eat at their desk multi-tasking. Some days I do as well.  But I usually try to take a little break from my computer.   

Quite often, the morning spills into “lunch”.  That is why it is an hour long…  And this is also prime time to finish up charting from the morning (HAHAHAHA- I kill me, not happening) look at the messages that have grown in number and possibly urgency, take a look at the labs reports that have come in over the past 3 hours and faxes (usually from pharmacies but not always, Emerg, I am looking at you).

Okie Dokie. 1:05pm?? How did that happen?  &^%#^*%^!

Friday afternoons are a funny time. They can be relaxed (Carp Fair weekend anyone?) or very hectic (March break is next week!).  

In general, there are booked appointments, lots and lots of phone calls, and the occasional emergency.  

I am sure all of you at some point have driven into the parking lot and seen the ambulance parked at the front door.  If this is my patient and I am involved, my list comes to a crashing halt until this person is cared for and is on their way to a higher level of care.  
And, as you are patiently waiting, you have that warm fuzzy feeling in your heart knowing that if it was you in that situation, all would stop so you could be cared for as well.  C’mon. I tried.

And some crises do not involve an ambulance. Sometimes I am sewing up someone’s finger, passing the tissue box to a crying soul or pondering some really confusing lab work that requires a smarter doc than me to figure out. 

Ok, I digress.  

It is 4pm.  The last deeply satisfied patient is out the door and we lock that puppy. 

What happens now?  

Well… just before 4pm the floor nursing staff have double checked with the Doc/NPs/PAs if they need anything from them.  At about 4:15 reception does the same.  At 4:25  it is the triage nurse’s turn.  These are the clean-up moments from the day.  Does something need to be faxed, a phone call done.  Do we need to set someone up to come into the urgent care clinic on Saturday.  Making sure nothing has fallen through the cracks during this wild and hairy day. 

Alrighty. The staff has left. The building is quiet. But you hear something?  Tap tap tap. Tap tap tap.  

This is the sound of the remaining people in the building.  Not just me.  There are a few other souls quietly working on their keyboards. Your doctor is still in the building.  

Well… what are they doing? The work day is done, isn't it?  Everyone else is gone.

I cannot speak for anyone else, but I am most likely charting. 

Charting refers to creating a comprehensive note about your office visit today. The ideal note is written so that another provider can look at it later and see what we talked about, your physical exam if required, and the ongoing plan of care.  Referral notes are completed, forms done and sent to the appropriate people for labs and investigations. And this takes time. 1-2 hours per day for proper documentation.  

Additionally, if I have been a supervisor for one of our wonderful PAs (physician assistants) I need to review and sign off their notes as well. 

And then the aforementioned inbox. I do try to pick at this during the day.  A minute here or there. But there are usually many things that have to wait until later.  And now that we are online all the time the inbox can never be emptied. Sometimes it is filling up faster than I can sign things off.  It is very demoralizing to think you got a lot accomplished and that little number on your screen keeps going up and up.

And don’t even think about forms.  What is it with insurance companies with their “one size fits nobody”  forms. Ugh. The pile grows and grows. 

Oh no… THE REFILLS! Remember them from this morning?   These need to be looked at, signed and electronically faxed out.  

AI says the average family doctor spends 10 to 19 hours per week on administrative tasks.  
No wonder I am cranky.  This is the part that wears us down.  

I love seeing patients, I know I am chatty and talk too much.  Human interaction is my thing. So as I plow through my virtual paperwork (funny we still call it that) I try to remember that each and every item is attached to a real person.  
You, my patient, who I try to serve and do my best for everyday.  Even when I am rushed, or distracted or flustered.  I am really trying to be the best doctor I can be.  Some days are better than others, I hope you get me on a good one!

Dr. Jeanette Dionne

Dr Dionne has been working in Carp since 2006 (except for that year she ran away downunder to work).  The 10 years prior to that she had worked in Kingston, Ohio and Nova Scotia (didn't know she was that old didja??) 
Her Practice interests are a bit of everything.  In the past she did both some emerg and hospital care but now is firmly entrenched in her office. She often will have students trailing and loves having residents to do her work for her.  Outside of the office she is usually in disguise in jeans, and a bit dirty from her hobby farm.