Navigating your Healthcare Appointment

Things you learn in high school: angles of triangles, themes of Beowulf, noble gases.

Things you SHOULD learn in high school: how to change a tire, how to do your taxes, how to navigate the healthcare system.

I think there are a few things that would be useful to know to have a more successful appointment with your provider. Some may seem really basic, others I hope are a bit more helpful. This will likely be a post I add to over the years but at least a place to start!

If you’re seen by a specialist you sometimes may have a bit more time. I’m crafting these recommendations based off of the clinic I work at. Currently, telephone visits are slotted for 20 minutes, and in-person visits are slotted for 30. Typically all appointments with providers are 20 minutes, but given the constraints of the pandemic and that it takes longer to turn rooms around, they are 30 minutes.

So hopefully these tips result in a slightly less frustrating experience.

Before beginning, I think it’s first beneficial to discuss the RED FLAG symptoms of medicine. Or at least a few of them. These are the SCARY ones where we want to rule out the very concerning things immediately.

Red flag symptoms:

If you’re having any of these symptoms, you should tell your provider right away. These symptoms pretty much guarantee a work-up and will bypass any other concern you present with. If you have these symptoms, probably a good idea to seek emergent care. Or at the very least bring them up at the VERY BEGINNING of the visit so that your provider can rule out anything medically dangerous.

• Chest pain – you’ll most likely get an EKG to monitor your heart’s rhythm and ensure no overt abnormality, lab work to monitor for electrolyte imbalances, possible monitor to better understand the nature of the pain / palpitations, as well as chest x-ray and/or trip to the emergency department. All very variable depending upon your specific symptoms.
• Blood in your stool / black stool: you’ll likely get a rectal exam to ensure no overt structural abnormalities, CBC to monitor for anemia, possible refer to GI for colonoscopy depending on frequency/duration of symptoms
• Headaches resulting in passing out, that wake you from sleep, occur with sneezing or orgasm to name a few – very variable on the work-up, but certainly a work-up or ED trip. Likely a full neurological exam and some imaging +/- neurology referral
• Back pain: losing control of bladder/bowel function, urinary retention, numbness when seated. These are very concerning and will land you an MRI imaging right away. If you’re being seen for back pain for the first time, you’ll likely get a full neurological exam, too.
• Dizziness / passing out (syncope)– this will get you a neurological exam, likely orthostatic vital signs (blood pressure and heart rate when you’re lying down, sitting, then standing), labs, and possibly imaging. Keep in mind the full neurological exam takes ~10 minutes in duration.
• Intractable abdominal pain, especially as a female: aka pain that is constant, 10/10 and won’t go away – we have to rule out things like appendicitis, ovarian torsion, tubo-ovarian abscess, bowel obstruction, etc (big, scary life threatening things!!). This will definitely land you some imaging and maybe a trip to the ED
• Recent unintentional weight loss or drenching night sweats: this is the scary one for cancers and will definitely be looked into in depth with labs and imaging and likely referrals.
• Shortness of breath: concerning. A long history and physical to better characterize the pain, questions / lab work / imaging regarding history of blood clots.

This is not a comprehensive list, but hopefully you get the idea. Even if you’re not presenting classically with the scary version of these symptoms, you’ll often be asked lots of questions to definitively rule out that your concern can be managed as in outpatient and doesn’t require emergent care, aka going to the ED for labs, imaging, etc.

 

Getting the most out of the time constraints:

Oftentimes, there are limited time windows for appointments, which I understand can be incredibly frustrating. Especially if you have lots of things you want to address. But if you spend the first 20 minutes of the appointment discussing all of your different symptoms, it’s really challenging to address any in detail. So you’ll leave the appointment feeling like you didn’t really get any answers.

A few tips:

• Go in one with one thing in mind that you REALLY want to address.
• If you have more than one thing (or multiple things that you THINK are related to one thing), start with a thesis statement of the multiple things and ask if there is something your provider would like to address first. If not, pick the one you are most itching to have answered/addressed.
• Lay out your list at the beginning of the appointment, but don’t go into them in detail. This is kind of like the thesis statement. Let your provider know which one is most important to you, and which one you’d like to discuss most during your appointment. That way there’s a decent amount of time to discuss this one (or two if time allows) thing in depth.
• Flat out ask, how much time do you have? I want to prioritize this one specific symptom and talk about it with you for as long as I can before I know you have to run off and see other patients.
• If you do have a few questions, present them at the beginning and ask “what do you have time for today and can I schedule a follow-up to discuss the others.”
• Make close follow-ups to discuss your other concerns. Now most clinics are operating from telephone visits and it’s a bit easier to schedule close follow-ups to address the concerns you weren’t able to get to during the appointment.
• Set expectations. If there’s something you’re looking to get out of the appointment, ask at the beginning. Again then you can spend the majority of the time weighing out the pros/cons as to if your request is suitable with symptoms.
• If you say ANY emergent buzzword “blood in stool, dizziness, chest pain, etc” (see the ones listed above) then pretty much nothing else matters and the provider is then in triage mode, ruling out the very scary things before moving on to your original concern. Again, familiarize yourself with the list above. If you say one of those things, it AUTOMATICALLY bypasses all other symptoms and the concerning things absolutely have to be ruled out before moving on from the appointment. So there’s a possibly if you have those symptoms that you’ll spend the whole appointment not even talking about the thing(s) you originally came to the appointment for.

This is equally my most frustrating thing, too. I desperately want to address every single thing in an appointment and wrap it up in a clean, red bow. But oh goodness is it so impossible and then you are just impossibly behind the rest of the day – frustrated, exhausted, and ready to dissolve into a puddle of tears. And by trying to address EVERYTHING I actually didn’t end up addressing anything. Made zero headway. So stay focused on your one thing. If asked “any headaches or dizziness?” and it’s not your principal concern, or not something that’s constant, chronic, and debilitating (aka “now that you mention it sometimes when I stand up too fast I DO feel very dizzy” – which then goes down the rabbit hole of needing an EKG, orthostatic vital signs, neurological exam), then it may not be that relevant. 

And I also think this is where the “I’m not listened to” question plays a role. Ie providers talking over you. They want to talk so much to try to cover everything! And it’s just a horrible cycle. If this happens, I think it’s absolutely fine to say, “I understand what you’re saying but I’m not sure that’s really the issue I was trying to get at. Is it okay if I phrase it differently and speak uninterrupted for 2 minutes?”

Keep in mind, western medicine is first and foremost about ruling out the VERY concerning, life or death, black or white, symptoms and making sure there isn’t anything life threatening. And then making our way through the other symptoms and doing the real investigating.

 

But whyyyy does it take so long?

See above. A lot of the time, providers are only slotted 20 minutes per patient. If someone comes in with the laundry list of symptoms or responds “pan positive” to a review of systems (think, responds yes to nausea, vomiting, diarrhea, abdominal pain, headaches, dizziness, chest pain, shortness of breath, cough, pain with peeing, weakness – all positive, which happens far more often then you’d think), some of which are in that “red flag category” ie headaches, chest pain, dizziness – it’s a LONGGGG exam. An EKG takes somewhere around 10 minutes, neuro exam another 10 minutes, detailed history, ordering labs, sometimes calling to give an ED expect (aka calling the ED to tell them a patient is coming) another 20 minutes. Suddenly an hour passes and you’re 3 patients behind.

I know it’s so unfair but however annoyed you are for waiting, your provider is deeply frustrated they’re making you wait! And overwhelmed knowing each subsequent patient is beginning the appointment annoyed and frustrated. Kind of guaranteed the tone of the appointment is set negatively.

 

Why can’t they just schedule more time?

Physicians are paid off of their productivity. To be at full panel and make your salary, you must see a certain number of patients per day. It’s a very broken system so this post really won’t focus on that. And instead will emphasize maximizing the time you DO have.

 

Wanting a diagnosis

As above, western medicine is quite good at getting to the root of black and white issues. If you have a heart attack, stroke, bowel obstruction, pulmonary embolism, western medicine WILL save your life.

If you have more subtle and curious symptoms, the western medical model gets tricky. As providers, we love getting the diagnosis and being able to treat it and make it go away ASAP. But the majority of outpatient work is this grey zone – you’re not really sure what it is and there’s no clear cut way to treat it. Most diagnoses don’t present classically like a textbook, which is both the really frustrating but also beautiful thing about medicine!

Rather than getting hyper-fixated on the diagnosis, I think it’s important to just measure the progress. If you’ve been having symptoms for quite some time for something you don’t want medication for, ie fatigue, intermittent dizziness, headaches, the first appointment will likely be spent ruling out the scary stuff, making sure there’s nothing life threatening occurring. I think it’s important to go into your appointment with that knowledge.

At the end, especially if you didn’t receive the results you wanted, ask to book a close follow-up appointment to discuss the symptoms in more detail. ESPECIALLY if you’re someone who doesn’t want medication, I would frame the appointment as “Getting to a definitive diagnosis isn’t as important to me. I just want to feel better and I’m really motivated to continue with my diet and lifestyle changes for health optimization. My goal is to live well without needing medication.”

State your symptoms and motivation for lifestyle over medication. Rule out the red flags. Make a close follow-up appointment to continue investigating.

Quick to throw a med at me

If you don’t want medication as a solution to a symptom, know that you are in the DRASTIC minority. I think it’s absolutely wonderful and how I personally live my life but before addressing this question, I want to first and foremost challenge you to widen your perspective and lens.

Most patients (in my experience) do in fact want a medication, a quick fix, a “solution” to a symptom. They come to their appointment with that expectation. And most providers want to be able to give their patients SOMETHING, since they’ve just waited all that time to get an appointment and then sat in the waiting room for years to see them. It is oh so unsatisfying to say to a patient “there’s nothing I can give you!” And ask yourself – would I be okay with this appointment if I were given nothing. So yes, there is a lot of medication pushing. 

How to prevent that? START the appointment by saying, “I prioritize my health and am very motivated to make lifestyle changes and avoid medication as much as I can as you would see fit as safe for me. It’s okay if I leave this appointment without any prescriptions, in fact I would prefer it.” And then go into your symptoms, what you’ve tried so far, and what you’re hoping to get from the appointment.

 

Getting to the root cause

I feel like I’m repeating myself a million times over, but we learn how to rule out and treat life threatening illnesses and how to treat with medication. And by life threatening I mean things that you could die of within the next hour. In my education at least, there was some emphasis on preventative care, but mostly in how to prevent cancers (ie getting your mammogram, pap smear, and colonoscopy on time). Rather than reaching for nutrient dense foods, optimizing sleep, managing stress, and prioritizing movement – they were often just bullet points on a slide rather than a detailed review of how to accomplish these things and how they could be relevant as medical interventions.

I do have hope that medicine is slowly changing. Especially after seeing my coworkers in action and how committed they are to true healing. Some of the MDs do osteopathic manipulation and even hypnotherapy (!!!) in my clinic, and are very current on nutrition guidelines and interventions. But as is everything in life, change is slow. It’s not a simple solution.

Western medicine doesn’t have hormone balancing, adrenal relief, and gut healing in its teachings in the same way that functional / integrative healers do. Because in the grand scheme of things, these things feel very new to western medicine. If you are determined and patient, I do think it’s possible to work with your provider to help assist with these things. But it will take educating them and it will take a certain personality of provider to be open to this education – work on both parties. Once you form a partnership, however, that’s where the magic and the change happens.

 

Requesting imaging/labs

I think it’s perfectly reasonable to request things from your provider. You’re the one living with the symptoms after all! It’s best to make these expectations and desires clear at the beginning of the appointment. The only caveat to this is imaging like CT/MRI. Oftentimes there are constraints in terms of what insurance would cover. For example, insurance often requires 6 weeks of physical therapy and Xray imaging prior to approving CT / MRI. So there’s a good chance you’ll have to trial this first before getting approved for imaging.

I am always game to order labs for patients when they’re requested. Just know, again it’s a game to see if insurances will cover it/them. It will require more research on your end, to call your insurance, ask what they will cover, and see what it will cost you out of pocket. This is definitely not common knowledge and not something your provider would know off hand. So just know that going into it.

I think the main point of most things here is phrasing. Here is how I would go about it: “I value your input and am at a point in my life where I know I don’t classically fit a diagnosis. But I don’t feel my health is optimized despite making lots of lifestyle changes. And I also want to keep investigating rather than jumping to medication(s). Here are some labs I’d like to order due to these symptoms ____. Is this something that feels reasonable and you’d be willing to order or have any advice about?”

The best thing you can do is call your insurance before, ask if they’ll cover the labs/imaging you’re hoping for. Ask what your copay will be. OR before your provider orders labs/imaging, ask if they will place them as “future orders” so you can call your insurance, ask if they’ll cover, and come back for a lab only appointment once you feel confident they’ll be covered. You can even ask your insurance “what symptoms would make it so this lab / imaging will be covered.” Literally ask for the ICD codes and bring them in. I can only speak for myself, but I’m sure any provider would be happy to accommodate with the codes if someone went through all the effort of doing the research.

 

Prescribing scheduled medication

This includes: narcotics (oxycodone, Percocet), benzodiazepines (Ativan, klonapine, etc), or stimulants (Adderall). There is a deep seated history in this country (USA) of over prescribing this medication and patients becoming addicted and then withdraw. And either overusing or abusing this medication. As a provider, I HATE prescribing it and would so much rather the original subscriber do it because I don’t know the patient, I don’t know their history and if there is risk of potential harm to the patient while using it. Truthfully, in my opinion, it should be done by either a pain management team in the case of narcotics, a psychiatry team in the case of benzodiazepines/stimulants, or the original prescriber / PCP team only in the case of stimulants.

This medication should be refilled by your provider and your provider only. It’s not to be prescribed lightly, and is typically used as a last chance resort when you’ve tried EVERYTHING else. Many times in fact, there are pain management specialists who will prescribe the narcotics, as it’s not something a primary care provider is comfortable doing.

In regards to stimulants for ADHD, at my clinic you must have had neuropsych testing prior to receiving this prescription. It is no longer prescribed by primary care clinicians by symptoms alone (at my clinic anyways). If you are going to run out, let your prescriber know as early as possible. Do NOT wait until 4pm on a Friday to send a panicked message that you need a refill.

Also, expect to sign a patient provider agreement and agreed to get drug tested regularly. And to have to have some sort of touch point with your provider every 3-6 months to discuss the medication.

 

Sending your provider a message online

Because providers are consumed with seeing patients, when you send a message it is often sent to a pool that is addressed by nurses and providers alike. Sending a message like “THIS IS URGENT CALL ME BACK ASAP” is very concerning to see. And the message back will be from nursing (usually) advising you to seek care in the emergency department for said urgency/emergency.

Make it kind and polite (please, as someone who is also helping with the influx of these messages), and be direct with what you’re seeking, knowing it likely will be viewed by many eyes and isn’t going directly to your provider. Every clinic is different, but this is how mine is operating!

 

Getting weighed with history of ED or just getting weighed in general

Make it a point to ask for a blind weight. This is a very easy request and one that most clinics are more than happy to accommodate! Ask to permanently put it in your chart that you don’t see the numbers.

You can even ask to be weighed every few years. TALK to your provider and discuss how this is very triggering for you and in fact detrimental to your health. If you are in the depths of your eating disorder and not yet in recovery or at a stable weight, first know I am feeling for and with you. At these appointments, however, a weight is very important. For others, however, especially if you feel your weight is stable, it’s not.as relevant. So just ask why it’s clinically necessary (sometimes it is based on other diagnoses, ie if you’re on medication known to have metabolic side effects) and if it can be postponed.

Let them know that rather than weight, you’d like other lab markers to be the clinical indicators of health – ie A1c (blood sugar trend over the past 3 months), cholesterol, triglycerides, how you’re physically feeling.

 

BMI

I too agree that BMI is outdated and not at all a good measure of health. Challenge your provider on this! Ask about your cholesterol, triglycerides, A1c – these are far better indications of health. If it were me I would say “I know that BMI was typically used as a quantitative indication of health, but I feel very well! I would so much rather be evaluated on how I’m feeling and some more concrete lab values than just this number.”

As a tangential aside, many charts used to have the diagnosis of “obesity or morbid obesity.” Now, under the Care Act (in Massachusetts at least), patients have easier access to view their charts and lab-work immediately when they become available. Given this, some diagnoses are changing to sound…less harsh. Aka “morbid obesity” will change to “BMI of 45.” Medicine is not kind and in my opinion never has been. It’s brutal. As evidenced by the names of diagnoses. So while I don’t think BMI is a good indicator of health, you may begin to see it a bit more often.

 

SHUT UP ABOUT MY WEIGHT ALREADY!!!!!!

This sucks. It just sucks, it sucks, it sucks! I’ve definitely heard this first hand, especially in relation to joint pain. “If you just lose weight then x,y,z will improve!” As if the weight loss will **poof** make every other problem disappear.

It’s not right and many things are missed because of it. So I’ll start with acknowledging that.

A higher weight is negatively stereotyped to be associated with laziness, poor lifestyle, poor diet. This is a LONGGGG standing history with its roots clawed very deep in medical doctrine. I do think things are starting to come around and change a bit. But it’s will be quite a slow change.

Medicine looks for patterns and things that are common. Some diagnoses are more common with certain weights. Again, it’s not right and in fact quite lazy to just blindly associated these things together.

If the conversation starts to head in this direction, and you move your body regularly, eat foods that make you feel well, and your routine lab work is within the normal range (cholesterol, A1c, etc), then shift the conversation.

“I know that I am a different weight than what is traditionally and historically viewed as “healthy” but I am active, I eat well, I FEEL well, and I am happy with my body and weight. I would like to explore other reasons as to why I’m having these symptoms. Would you be willing to have that conversation with me?”

 

Spending the entire time looking at the computer

In addition to seeing a patient every 20 minutes, you also have to write note for every patient, documenting every single thing you did in the appointment – your history, all of your symptoms, physical exam, labs you ordered, and medical decision making aka the assessment and plan. In 20 minutes. For patients who typically come in with 5-7 concerns.

I try to do a lot of pre-charting but I do type when I’m in the room, at least for the first half. This is more so for the patient’s benefit, so I’m writing down exactly what they’re saying, rather than paraphrasing in my own words. This is vital information and I don’t want to miss anything! Especially if you’re being seen by another provider in the future – they can then clearly read everything I asked you so hopefully don’t need to repeat it all.

Ugh it really is so frustrating, but do remind yourself your provider takes no joy in feeling like a robot and having to type while you’re there. But if they didn’t, they’d work 22+ hours a day catching up on all the charting, labs, follow-ups, referrals, call-backs, paperwork to sign out, etc. It’s not a good answer and it’s unfair. There is so much pressure to see more patients, especially in a time when patients really need to be seen after not being seen for so long, so it’s really hard to answer.

 

Diagnoses in your chart

There are diagnoses that exist that are just very unfortunate from a vocabulary perspective – “morbid obesity” for one (eek). In my clinic, it’s mandatory to assign every order to a diagnosis. This is kind of like saying you have to explain why you’re ordering something. For example, if someone comes in for fatigue and I order a thyroid panel, I have to assign the thyroid panel to the diagnosis of “fatigue.”

In order for insurance to cover certain tests, ie routine STI testing, there’s a diagnosis called “high risk sexual behavior.” Most of the time, it’s really not high risk. It’s just this ploy for insurance to cover certain lab tests.

As you can see, it’s kind of a game. So if there’s a diagnosis in your chart that makes you uncomfortable, go into it with the mindset of curiosity rather than condemnation. You can always ask for things to be removed!

 

Insurance woes

I won’t touch much on this because frankly it’s not something I really handle. I do the billing based off of the appointment: how much was reviewed in the history, how much I did for a review of systems and physical exam, extra testing, labs, and time spent during the appointment. It’s coded based on allllll of these different things and very specific. For example, to bill a level 4 (billing goes from level 1 to 5), you have to do ask a certain number of questions about personal, family, social history, review of systems (are you having headaches? Dizziness? Ringing in your ears? Nausea? Vomiting? Weakness? – things like that), physical exam (did I do just a heart and lung exam or a full neurological exam, heart, lungs, and pap smear aka pelvic exam), problems addressed, medical decision making, and time spent in the appointment.

The best thing you can do is call your insurance before, ask if they’ll cover the labs/imaging you’re hoping for. Ask what your copay will be. OR before your provider orders labs/imaging, ask if they will place them as “future orders” so you can call your insurance, ask if they’ll cover, and come back for a lab only appointment once you feel confident they’ll be covered. You can even ask your insurance “what symptoms would make it so this lab / imaging will be covered.” Literally ask for the ICD codes and bring them in. I can only speak for myself, but I’m sure any provider would be happy to accommodate with the codes if someone went through all the effort of doing the research.

 

Saving time by succinct describing your symptoms:

OPQRST model (this is what we learned in school):

• Onset: when did your symptoms start
• Provocation/palliation: what makes them better/worse
• Quality: describe in more detail – what does it feel like / is it constant
• Region/radiation: where is the pain/symptom exactly and does it radiate anywhere
• Severity: how bad is it
• Time/Triggers: how long have you had it for / have you ever had it before

Sometimes it’s hard to describe / know what’s relevant. And then we spend so much time trying to describe EVERYTHING. So this is a good way to go about it.

Example:

Pain:

I’m having intermittent stomach pain that started a month ago. It feels dull and achy and is located near my sternum and doesn’t radiate anywhere. It’s not terrible pain but enough to bring me in, maybe around 4/10. This is the first time I’ve been having something like this. I think it gets worse when eating certain foods, but I’m not too sure. I can’t think of anything that would have triggered it either. Nothing really makes it better and I haven’t tried taking any medications or supplements for the pain because I prioritize lifestyle changes over medication intervention.

***regarding pain. if something is 10/10 pain, it is recommended to seek urgent/emergent care for evaluation.

Fatigue:

I’ve been tired for quite some time. It’s been going on for years so I don’t think it’s anything life threatening. It’s pretty constant, I wake up tired and feel tired throughout the day. I’m not really sure if anything makes it better or worse. While I know medication is a great option for so many, at this point I’d really like to prioritize lifestyle and nutrition changes vs trial of a medication. I’d love any advice/recommendations.

BOOM 30 seconds vs 10 minutes.

 

Setting expectations

If you go into the appointment frustrated, you’ll likely end it frustrated. Honestly the doctor’s office is a recipe for disaster. You start anxious, your blood pressure rises, you sit there wondering if you’ll get any of the answers to the questions you’ve finally built up the courage to ask, you wait for an hour, you feel rushed, get none of your questions answers, don’t feel heard, get flustered, and then want to dissolve into a puddle of tears.

 

So here are the takeaways to try to have a slightly more positive experience:

• Go in one with one thing in mind that you REALLY want to address.
• If you have more than one thing (or multiple things that you THINK are related to one thing), start with a thesis statement of the multiple things and ask if there is something your provider would like to address first. If not, pick the one you are most itching to have answered/addressed.
• Bring something to DO/read in the waiting room. Practice deep breathing, do a guided meditation, review/rehearse what you’d like to get covered with your provider.
• Try to avoid getting hyper-focused on THE DIAGNOSIS or getting everything you want from one single appointment. Because oftentimes, especially if you don’t want medication, the diagnosis doesn’t really help the treatment plan. You may need multiple appointments to address one issue. The first one may be ruling out the very concerning things. The second may a deeper discussion of what you’ve tried so far. And the third may make a little bit of headway with recommendations.
• Make a close follow up to discuss other issues. The more you focus on just one thing, the more that thing can ACTUALLY be addressed.
• Call your insurance before, ask if they’ll cover the labs/imaging you’re hoping for. OR before your provider orders labs, ask if they will place them as “future orders” so you can call your insurance, ask if they’ll cover, and come back for a lab only appointment.
• If your provider is running really late, tell yourself “okay maybe someone with a life threatening condition got extra time today and their life was saved.”
• At the end of the day, if you have multiple encounters of not feeling listened to, heard, understood, or shamed, it’s time to ditch your PCP and find a new one!!

Other tips:

1. Know the names of your medications you’re on and bring a list with you!
2. Don’t take medications that don’t belong to you. Oftentimes in the ED you hear things like
   1. Provider: “have you taken anything for the pain?
   2. Patient: “yes, something my aunt gave me.”
   3. Provider: “Oh what was it?”
   4. Patient: “idk.”

 

The last little bit I will leave you with is this:

Your experience: You’ve been waiting for your appointment for two months. You start anxious, your blood pressure rises, you sit there wondering if you’ll get any of the answers to the questions you’ve finally built up the courage to ask, you wait for an hour, you feel rushed, get none of your questions answers, don’t feel heard, get flustered, and then want to dissolve into a puddle of tears.

Provider experience: You’re seeing patients all morning and have a patient in the middle of the morning with past medical history diabetes, hypertension, congestive heart failure who presents with worsening shortness of breath, chest pain, fatigue, lower extremity swelling, blood in their stool and unintentional weight loss. They have a family history of colon cancer and are not English speaking, so utilize an interpreter for the encounter. The things you’re concerned about: worsening heart failure and malignancy, both of which are life threatening in this very moment. By giving care to this patient who you are extremely worried about, you are now a full hour behind seeing the remainder of your patients, who begin each appointment visibly upset and frustrated with you. You’re trying to remain calm, but feel like you’re rushing the subsequent patients, don’t answer the questions they want to get answered, get flustered, and then want to dissolve into a puddle of tears.

Moral of the story: it’s extremely frustrating from both sides.

 

More questions? Leave them below!