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It’s a standard Tuesday afternoon clinic. The usual mass of overbookings means I am only half way through the list and already running significantly behind.
I glance at the mounting pile of case notes, and silently hope for some non-attenders to allow me to make up some precious time.
Patient number nine enters my clinic room 45 minutes later than his allotted appointment slot. Accompanied by his wife, he looks anxious. I smile to welcome them in.
Unlike the two previous disgruntled customers, they make no comment on my poor time keeping, but I apologise all the same.
He’s 54 and has been suffering with abdominal pain. We’ve never met before and he’s here for his scan results.
I look again at the report in front of me and my heart sinks. I’ve known him for all of 30 seconds and yet here I am, sitting opposite he and his wife, about to give them the news that will devastate their lives.
He entered my room with vague abdominal pain, and will leave with pancreatic cancer.
As I direct him onto an efficient yet impersonal pathway, involving countless different doctors and multiple appointments, I know that I am unlikely to meet him again.
Once upon a time, not so long ago, I knew the patients on my list. I’d met their families, seen photos of their dog. I had some understanding of how they viewed the world.
Caring for somebody with whom I had formed a personal connection was not only easier, it was more satisfying.
But no longer do we have the luxury of time to build a relationship with the patients for whom we care.
As the conveyor belt continues to turn, straining under the weight of more and more patients, one of the most beloved parts of my job, the part which sustains and satisfies me and helps me to care with compassion, is being diminished by the efficient necessity of pathways and protocols.
As doctors, at least part of the therapy we offer is not just the tablet prescribed, but the way in which we give it.
A treatment, offered within the safety of a trusting doctor-patient relationship might just be more likely heal. Much as the pain of a devastating diagnosis may be eased if delivered by a doctor who understands that patient’s world.
I am therefore left wondering how we can continue to touch the lives of our patients, when starved of our most precious tool, which is time?
Emily Claire Vincent is a gastroenterology registrar. She writes under a pseudonym
I too have been in similar positions of having to give difficult diagnoses/prognoses to patients whom I have never met. With more and more of these ‘straight to test’ referral pathways, it’s becoming an increasingly common part of my job. For both patient and doctor it’s a really difficult situation, for all those reasons you outline. In my trust, the management have continually failed to recognise the clear link between over-booking the clinic lists and the increase in patient complaints. It may save time and money but it is incredibly costly in many other ways. A perceptive piece, thank you.
Insightful and true
Doctor is a very popular and supportive industry
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