I paused as my hand was on the doorknob, mentally gritting my teeth. Then I turned around with my professional face and pleasantly asked the woman sitting on the exam table, “Yes? Did you have another concern?” I’d already spent over 20 minutes going over a multitude of issues and tried to make sure we covered every one. I had also asked her if she had any other questions or concerns before standing up to leave.
“I think that I may be...well, maybe it’s nothing...but I feel like I might be depressed.”
Uh oh. There goes my morning schedule. Then I put myself in the patient’s shoes...and realize that this was the primary reason for her visit...even if it took awhile to get there.
I walked the two steps back to my stool, sat down, opened up my laptop, re-opened her chart on my EMR, and we continued the visit.
My office staff estimates that I get about 90% of the oh-by-the-way discussions from patients. My collaborating doctor gets some, but he apparently is more adept at fielding them, because I am usually the provider running 20 minutes behind due to those “by-the-ways.”
Over the years, I’ve gotten much better at fielding the non-emergent issues. For anything that cannot be handled relatively quickly, I will say, “That sounds like an area of concern for you. I would like to make sure that I have enough time to focus on that problem, in addition to the ones we have discussed today. Let’s make an appointment to review [the problem].” However, I don’t feel that I can safely let someone who confesses she may be depressed out of the office without doing at least some initial screening. Especially when there may be a suicidal risk.
Sometimes patients will balk at coming back, because they will have to pay another co-pay or, if they have a high deductible, the entire cost of another visit. Or they have to take time off from work. I try to be cognizant of that fact when I decide if I have enough time to address another issue and not get too behind in my day. However, I point out to them that other patients are on my schedule, and in fairness to them, I need to stay relatively on-time.
When the oh-by-the-way statements occasionally drag me down, I try to keep one particular patient in mind...Mrs. H. I met her over one year ago, when she came into the office for a cough and URI. I wrote her prescriptions...and as I turned to go, she mentioned the oh-by-the-way pesky numbness & tingling in her left leg. She had some low back pain as well, and my assessment showed a decreased patellar reflex and some weakness of her left leg. I ordered an MRI...which showed spinal metastasis. Further work-up revealed a Stage 4 lung cancer with metastasis to the brain, multiple areas of the spine, and ribs. Today, she has undergone palliative radiation and chemotherapy, and she remains a joy to see.
So when I get those “oh-by-the-way” statements, I will try to always remember that the additional moments I spend with a patient may be crucial in their whole diagnosis and treatment. Even if it wasn’t part of MY initial plan.
Kim Spering is a family nurse practitioner who currently works at Brndjar Medical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYN settings. She currently serves as a NP preceptor for her graduate school alma mater, DeSales University, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPs and PAs in meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
