Why is it so difficult for doctors to stay on time?

I said that phrase a lot last night during evening patient hours.

With an overfilled schedule, I mostly said it to patients who waited twenty, thirty, even forty-five minutes for me to see them. “I’m sorry for your wait. I appreciate your patience.” I say these sentences far more often than I should. Why is it so difficult to stay on time?

I could blame my inadequate supply of nursing staff; our health system thinks that I only need one nurse to room, vaccinate, and phlebotomize my patients. I could blame a convoluted rooming process and the occasional lack of available rooms. I could even blame my patients, who somehow seem to show up early or late but rarely within their allotted appointment time.

But, mostly, I have to blame myself. “Yes, I’ll freeze your warts” even though there wasn’t enough time for that when we also dealt with this patient’s recent emergency room visit. But I know that she can barely afford her co-pay and hated to ask her to return.

And I just couldn’t seem to rush telling another patient that his nagging cough and recent “bronchitis” was probably a new asthma diagnosis. Or telling the patient after him that her wet mount didn’t show yeast, as she predicted, but sheets of white blood cells – which, along with the frank cervical discharge on exam, indicated a likely STD from her new partner.

I believe that these issues deserve time, but I still don’t like inconveniencing the patients who come after. “Can I put off that bloodwork until the next visit, doc? I can’t keep the babysitter waiting much longer.” What else could I say but “of course”?

The worst “I’m sorry,” though, came with the last visit of the night. Follow-up high blood pressure with an overweight teen. While reviewing the labs from our first visit with her and her mother, I realized that the A1C I had ordered (given her weight, family history, and the acanthosis nigricans on her neck) was not there.

Correction: the A1C I thought I had ordered. The order was not there. And I would have to stick her again to get it.

“I’m sorry,” I said yet again. “Remember the test I ordered to check for diabetes? Well, it looks like I forgot to enter it into the computer. I’m very sorry that I made that mistake. To get that test, we’ll have to draw more blood from you.”

“You mean from the elbow, like before?” she asked calmly. When I nodded “yes,” she said nonchalantly, “okay.”

I was so grateful for her undeserved graciousness, as I was for my earlier patients who had shrugged off my apologies for my tardiness.

Thank you, my patients. Thanks for accepting me, mistakes and lateness and all.

Jennifer Middleton is a family physician who blogs at The Singing Pen of Doctor Jen.