Why is my medical oncologist never on time for my appointment?

My daughter’s biggest fear before starting kindergarten was would she have enough time to finish her lunch in the time allotted. Luckily, she is not a busy medical oncologist in clinic. A medical clinic is not set up for those who take their time. Modern medicine is predicated that within a fifteen-minute visit, you are expected to see the patient, address their issues, place orders, and come up with a plan. Fortunately, one of my patients taught me the importance of trying to be efficient, yet still being present for them.

When I first started practice, I wanted to do my best to respect my patients time. Patients make arrangements and block time during the day and also have the expectations to not have to wait. Adding to the difficulty is the unpredictability of an Oncologists day. I may have to call the ER to address a patient issue, talk to a family member about a patient’s diagnosis, or talk to a radiologist about a STAT result that I need to address. I may have a set schedule, yet the fear of the unknown remains. I find I am always trying to just stay ahead, but the reality is I am falling behind. By the time I enter a patient’s room, I am already looking at my watch with concern of how many patients are waiting. Fortunately, one patient taught me that this mindset would have to change.

I inherited this particular patient from one of my previous partners. His cancer was in remission for many years before I met him. He came into my office with progressive fevers, chills, weight loss, and night sweats. I knew that the scans would only prove my concern that the lymphoma had decided to return and ravage his body. We discussed treatment options including the pros, cons, and alternatives. After weighing the options, he was on board with chemotherapy. The chemotherapy attacked his tumor but unfortunately also his body. He suffered from multiple complications, yet he fought through and persevered. Thankfully the tumor was responding and slowly was shrinking. We smiled when follow-up scans showed no evidence of cancer, but I could sense something was wrong. Before we could proceed, I knew I had to address the elephant in the room.

“Doctor thanks for all you did for me, yet my quality of life is terrible.”

I was taken aback. I had another three patients in the room ready for me and was concerned how long this conversation was going to take. I knew they would have to wait for now.

“Doctor the chemotherapy has taken away my passion.”

I sat down, and we talked, and I learned that he was an artist. He was an avid painter who true love was turning nature’s landscapes into works of art. The chemotherapy had caused a severe neuropathy that took away his true passion. He wasn’t able to fulfill the one hobby that made him whole. I mentioned to him how sorry I was. Why had he not brought this to my attention during his treatment? We had talked about the potential risks of this complication, but he never communicated his symptoms to me during his visits.

“Doctor it was clearly my fault. I just felt you were always so busy and had so many other sick patients to see that I just managed.”

There is where I realized that things had to change.

Where had I failed? How did this happen during my watch? The fact that the patient felt that I did not have time to listen to him was clearly the problem. Like anything in life we realize that we must evolve for the better. I brought my patient back, and we focused on his neuropathy. We started treatment and luckily the damage was not permanent. He slowly recovered, and he was able to get back to the same level of function prior to his treatment. He was painting, and his family commented that he was back to the man they once knew. Time flew by, and his scans continued to show no signs of cancer, and we continued to share in our success. During one visit, I mentioned I was about to become father and his face lit up. He said there is no better gift than a child, and he wanted to give me something for the occasion. I, of course, said nothing was necessary, and we parted our ways until the next scans.

Eight years have passed, and since then one thing has remained constant. I make an effort to try to be present for my patients. I make a policy and tell my new patients the same thing every time. My motto remains, “I value your trust in me and I respect your time very much. I will do my best to run on schedule, yet sometimes that doesn’t happen. It is usually because I am helping another patient. Rest assured I will do my best to see you as quick as I can. Rest assured though when you are in my room, I promise that the time here is yours and only yours.”

It is not perfect and does not always work. Yet trying to be present and available for our patients allows them ability to tell us their story so we can help them along the journey. You also learn more about their goals, fears, family, and maybe that their neuropathy is affecting their life.

My patient was correct; there is no better gift in this life than the birth of a child. He captured the beauty of this special moment with a special present that humbled my soul. He gifted me a painting of the most beautiful landscape of the ocean splashing across rocks that still remain hanging in my home today.

And in case you are wondering, my daughter still doesn’t finish her lunch, yet always finds time to finish her dessert.

Prateek Mendiratta is an oncologist.

Image credit: Shutterstock.com

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