Keeping to the schedule

Peter J. McDonnell, MD

He is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

Digital Edition, Ophthalmology Times: January 2021, Volume 46, Issue 1

Sometimes, physicians may find that falling behind is the right thing to do.


Like many
physicians, I am not the most patient person in the world. I do not like waiting for responses to my emails, so when people email me I try to respond quickly (assuming it is a straightforward question to which I know the answer). I do not like wasting time when meetings start late, so when it is my meeting I always try to start on time. And I definitely do not like sitting in doctors’ waiting rooms, so I have always tried to run my clinics like a well-oiled machine.

Some physicians I know show up in clinic an hour or two after it “starts.” They figure it will take their staff some time to check people in, for the technicians to bring them back to the exam room, for the technicians to do their thing (checking vision, pupils, IOP, etc.) and maybe put in dilating drops. These physicians arrive at 9 or 10 am to see patients scheduled at 7:45 am.

Previously by Dr. McDonnell: Thinking and rethinking ophthalmology: Are you?

My practice has been to arrive at the clinic when my first patient is due to arrive so that I know that everything gets off to a quick start. Some patients do not need a lot of testing, so I can see them right away.

Other patients might need testing and dilation, and I will pop in to see them as soon as they are ready, while clearing out every patient as soon as I can with the goal of never getting behind.

One day, I was cruising along in clinic and everything was going perfectly. As soon as a patient was ready, I popped in and did my thing.

All the postops were doing great, all the corneal ulcers were responding to antibiotics as they should, and any needed suture removals or little procedures took only seconds to perform.

Then I grabbed the chart in the door (yes, this happened before we went electronic) of my next patient. This nice lady was about 20 years older than me and I had performed phacoemulsification/IOL surgery on her second eye after the first eye went perfectly. The technician had recorded 20/15 uncorrected vision and normal IOP. Everything looked perfect.

“This will go fast,” I thought to myself. “I will tell her everything is perfect. She will thank me and tell me I am a wonderful doctor. I will feign humility, accept her praise and send her on her way. I will be in and out in a minute and everything will stay right on schedule.”

Also by Dr. McDonnell: Oh, the people we meet

I walked in the room and stood next to where she sat in the exam chair. “How are you?” I asked, and waited for her to thank me. She looked at me and burst into tears.

The sobbing continued for what seemed like a long time but was probably only a few minutes. I gave her a tissue, sat down next to her and held her hand. After a while the tears abated and she could talk. “I am sorry,” she said. “My husband died this week.”

I told her I was sorry. He had never accompanied her on her visits so I had not known him. “Would you tell me about him?” I asked.

The words came pouring out. He was a very successful businessman but always came home at 5 pm to be with her.

Every day, he would open a bottle of wine, pour 2 glasses and sit in the backyard with his wife and tell her about the challenges he had faced that day, ask her about what she had done that day, and ask her advice about things. He made her feel that she was the most important person in the world to him.

“Boy, he sounds like a great husband,” I said. “Oh, he was,” she responded, “and I will miss him so.”

“I hope that when I die, someone will remember me the way you remember him,” I said. She squeezed my hand and said she hoped so, too.

Related: Planning is important — even when “nobody knows nothing”

After a while, she thanked me for listening to her, told me she felt much better and was ready to go. She apologized for taking up so much of my time. I wished her well and we walked together out to the waiting room.

My technicians clearly wondered why I had been in the examination room so long. And we were now running behind. But I did not mind.

Read more editorials by Dr. McDonnell

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