Unfiltered Story #189001

(I work in a specialty clinic that, due to the nature of certain chronic conditions, also functions as a primary care clinic to a select group of patients. Follow ups with these patients tend to be fairly routine. We rarely see them for urgent issues, as any serious illness is easily enough to sent them to the hospital. Since we are fairly specialized, and contracted with a local hospital, we often get last minute add-on consults from the Emergency Department up the street, when the patient isn’t ill enough to be admitted. On this particular day, we have a completely full schedule from 0830 to 1700, with no breaks, even for lunch. We have also been booked out for several weeks, so everyone on the schedule has been there for quite a while. We also get a call from the hospital, saying there’s an emergent patient who needs to be set up with specialty infusion services, and we’re the only clinic around who can coordinate that. Cut to: it’s 1500 and we’re booked solid, with hour-long consults squeezed into 15 minute slots and bored children running around while their parents are seen. No one in the back office has eaten. Patience is in short supply for anyone who isn’t both very ill and very polite. A man, one of our primary care patients, comes up to the front desk.)

Patient: I’m here for my (routine follow up) appointment with [Doctor].

Patient Services Representative: I’m sorry sir, I can’t find you on the schedule. Let me check with the medical assistants.

(She comes back to my desk with the patient’s info. He’s not on the schedule, he doesn’t have any upcoming appointments, and there is no record of anyone in our office having spoken to him at all in several months. All patient calls are documented, and even canceled or rescheduled appointments remain in the patient’s record, so if there are no notes it means no one spoke to him.)

PSR: I’m sorry sir, I’ve checked with the back, and unfortunately we have no record of that appointment. Do you remember who you spoke with?

Patient: NO! You should know who I spoke with. I want to see [Doctor]!

PSR: I’m afraid that’s not possible, sir, we’re already overbooked today. I would be happy to make you an appointment for tomorrow, if that works for you?

Patient: Absolutely not! I will see [Doctor] today. I’ll wait here. I want to speak with a medical assistant and [Doctor] immediately. I’m not leaving until I have.

(She comes back again to tell all of this to us. At this point I am tired, hungry, and have 3 patients waiting on me, as well as a procedure to assist on. My coworker has been on hold with an insurance company for 2 hours and can’t leave her desk, so it falls to be to make this man leave.)

Me: Good afternoon, [Patient], what seems to be the issue?

Patient: I have an appointment with [Doctor], but your stupid secretary won’t check me in!

Me: I reviewed your chart myself, sir, and we have no record of any contact with you since [date several months ago]. I apologize for any miscommunication, and we would be happy to set up an appointment for another day.

Patient: YOU have no idea how busy I am! *shoves his computer with his iCalendar on it in my face* I cancelled meetings to be here! The appointment is right here! How do I have this appointment written down in my planner if I never made it, huh?

(He looks at me smugly as if this is a particularly clever point.)

Me: I’m not sure, sir, but I can tell you with confidence that we do not have you scheduled to see [Doctor] today and he will not be able to work you in, as we are already overbooked. What else can I do for you today to make this easier?

Patient: I want to talk to [Doctor]. I’ll wait here. Go and get him. He knows me personally.

Me: That won’t be possible sir. He’s currently performing a surgical procedure, and he’s got back-to-back patients for the next 2 hours. He won’t be available until 1630 or 1700 at the earliest. I would be happy to have him call you this evening when clinic is over.

Patient: FINE. This is ridiculous, I am incredibly disappointed with your patient care.

Me: I sincerely apologize for any inconvenience, sir. If you’ll just come up to the front desk, we’ll get you scheduled and on your way home.

(He does so, grumbling the whole time. When I tell the doctor about all of this, he barely remembers the man, not having seen him for nearly a year, and tells me he has far too many notes to write and therapies to arrange to call him before 1730, at which point he will be going home. I’m so looking forward to this man’s next appointment, I’m sure he’ll be just delightful.)