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Arrival and Departure Times.

Yesterday, I checked in at the Joslin Clinic in Boston and saw this screen on the wall:

“Are those boards new?” I asked the woman who was checking me in for my appointment.

“Which ones?” she said, acknowledging the on-going construction in the waiting room.

“The ones that look like they’re from the airport.  The arrival and departure boards for the doctors.”

“Those are new.  It helps keep people from asking when their doctor will be calling them in,” she said, scanning my insurance card.

In my twenty-eight years as a patient at the Joslin Clinic, I’ve never seen anything that noted how on time or late my doctor was running.  I remain a patient at Joslin because they have been taking good care of me and my diabetes since I was seven years old, but it is admittedly an all-day affair to make my appointments.  Driving in from Rhode Island takes about two hours, all told.  (Driving home, depending on how late I leave the clinic, could be a three hour endurance event, thanks to New England traffic on 95.)  Most of the time, I wait a significantly long time to see my doctor, but she doesn’t make me feel rushed when I’m in the office with her.  Usually, once we’re in her office, the wait seems justifiable because it’s clear she cares about her patients and doesn’t simply shuffle them out the door once the *ding* goes off.

My endo appointment yesterday was at noon, but the paperwork I received before the appointment asked me to show up at 11.30 am, so I structured my morning to pull into the Pilgrim Parking Lot at 11.15 am and be in the waiting room just before 11.30.  (I don’t make a habit of being late because there was one time I was fifteen minutes late due to traffic and they cancelled my appointment, so I’m paranoid and now perpetually early.)

My endo, according to the arrival/departure board was ON TIME.  Which is good, because I was also ON TIME.

After my pre-appointment work up, I waited in the waiting room to be called for my appointment.  As scheduled by Joslin, I had an endo visit at noon and an eye dilation at 1 pm, which the woman who scheduled my appointment on the phone said would be more than enough time between appointments.  At 12.15, I still hadn’t been called in to see my endo.  The board said ON TIME.  At 12.25, I was starting to get a little antsy and had my logbook and list of questions in hand so that I could get going as soon as my endo was ready.  When I was called in at 12.30, I called the board a liar because it still said ON TIME but things were not ON TIME and now I was going to be RUSHED in order to make my second appointment.

I have pockets of being upset about diabetes, but on the whole, I’m usually pretty okay.  But waiting for doctors and appointments and being on hold with insurance companies and having to have stupid fucking tests for c-peptide to confirm whether or not I have type 1 diabetes so that my insurance company will cover an insulin pump … this sort of thing makes me bananas.  Diabetes management on a day-to-day basis takes up significant brain space, but it’s necessary so I do it.  Sitting in a waiting room for an appointment that I was ON TIME for but the doctors are not turns me into a ball of rage.

I’m glad I have an established history of reasonable communication with my endocrinologist, or she would have thought I was unhinged.  I was so angry by the time I was called into the appointment at 12.30 because I knew that I only had 28 minutes to hash out six months worth of diabetes-related concerns (after she did the required hearing of my heart, checking of my thyroid, testing my feet for nerve damage, etc) and then run downstairs to the eye clinic for my dilation.

To make matters more frustrating, the c-peptide test that I had done was not in her file.  It was missing.  “I will find this,” my endo said, shuffling through the pile of papers on her desk.  “I will email the team now and have them follow up with your lab this afternoon.”

“This is making me crazy, and I feel bad complaining about it to you, but this is not cool.  The board says ON TIME and yet we’re just now in the room, and instead of being able to talk about what needs to be talked about, you are being forced to chase down paperwork for a lab I’ve already done to prove I have type 1 diabetes for a stupid insurance company.  And I have thirteen minutes before my eye dilation appointment downstairs.”

The look on her face was one of understanding.  She nodded, and I wondered what kind of boxes she was required to check throughout the day.  How many patients was she required to see?  How often are the patients ON TIME, or prepared with log books and questions?  How many times is my endo put through a discussion about what insurance companies do or don’t cover, when that is not her job?  My journey with diabetes is forced, but hers was chosen, and there are moments when I want to thank her for making this her life’s work.  And then I want to throw a rock at the arrival/departure board and shatter it into a million pieces because that day, it was just another, “Oh, what a good idea and this will really help patients!” but instead it’s another savvy-looking tool in place to keep patients sitting still and not asking questions.  “Yes, your doctor is ON TIME.  Look at the board.”  What is the point of this board if it’s inaccurate?  Just to look patient-centric?  How about being human-centric and requiring that patients and doctors alike be on time and prepared for their appointments?  And what are my options if the doctor is running terribly behind?  As a friend commented on Facebook:  “So what are the ramifications if it says ‘WICKED LATE’ next to one doctor’s name? Do you get to choose, as the patient, to leave and not be charged?”

We burned through my appointment in record time – my weight is down, A1C is fine, plan is to continue to be tuned in to diabetes – and then I was shuffled off to my eye appointment.  The eye appointments always take a long time (dilation) but that appointment was uneventful as well, with my macular edema holding steady where it was back in May (I’ll take “not worse” and “staying stable” as a good sign).

And then I was off home.

Later in the evening, the phone rang.  It was my endocrinologist, who was calling to say that the c-peptide test had been found and the results were in.  “This won’t be a surprise to you, but your c-peptide was undetectable.”

“So you’re saying I have type 1 diabetes?”

“Yes.  Just like we thought.”

“Well I’ll need some time to adjust to this new diagnosis, but thank you for letting me know.”

She laughed, and we exchanged other pleasantries before getting off the phone.  Birdy was sitting at the kitchen table, staring at me while I was talking with my doctor.

“Mom, you have diabetes?”

“Mmm hmmm,” I said absently, handing her a napkin while she ate her dinner.

“But mom, didn’t you already know?”

“I already knew.  But now it’s official.”

She looked at me with a mouthful of food.  “Well that doesn’t make any sense and anyway, you knew the whole time!”

I respect my endo.  And the Joslin Clinic.  But holy hell, yesterday’s healthcare excursion was an exercise in frustration and to boot, now I have diabetes officially, after all this time of not wondering.

 

22 Comments Post a comment
  1. Dave deBronkart #

    Yes, yes, yes!!

    You go to Joslin for the same reason I travel the same distance from New Hampshire to see Danny Sands and my oncologists. And I have the same issues with his office.

    Are you going to talk to their management about how that board gets updated? Because if it’s bogus – not talk info – somebody there needs a social media poke in the nose for bogosity of the wrist kind – the “get patients to stop asking questions” kind.

    02/27/15; 9:33 am
  2. Maybe their board has a margin of error like the FDA toward test strips? Either way, it sucks. Sorry your day was so rushed 🙁

    02/27/15; 9:37 am
  3. germanguy #

    I’m curious: are you allowed to drive with dilated pupils in the US or do they give you these drops to reverse the effect? In Germany, we’re neither allowed to drive nor get something to speed up the process back to working pupils.

    I’ve got a stable DME, too. I’m happy you’re fine!

    02/27/15; 10:04 am
    • I waited before driving home. We don’t have drops that reverse the dilation here (though I asked for them, and was told they once existed but now do not). :\

      02/27/15; 10:28 am
  4. For the amount of actual ‘work’ that you did in the appt., wouldn’t it be easier for the hospital to create some sort of confessional station – patient in a booth on one side and doctor behind the curtain on the other? Eliminate the fancy neon airport sign and go back to the basics, check under the doctor side of the stall to see if there are shoes showing…seems more efficient.

    02/27/15; 10:10 am
  5. Oh HELLZ yeah. So much of what healthcare deploys as “patient centric” patient engagement tools turn out to be patient enragement tools, don’t they? The doctors are enslaved, the patient are ditto, so who’s winning here?

    I keep flashing back to scenes from Terry Gilliam’s “Brazil,” which is really the ne plus ultra when it comes to the visual representation of bureaucratic insanity. Our overlords – who I have to suspect are the builders/sellers of the “enragement” tools – are keeping us penned up pretty tightly. Who brought the Semtex?

    02/27/15; 11:39 am
  6. ria #

    what ? no bar while you wait for your flight ?

    02/27/15; 12:03 pm
  7. Shelby #

    I am always infuriated by the signs I see in doctors offices that say ‘if you’re late for your appointment we will cancel it and charge you for it.’ What??? What happens when YOU’RE late for MY appointment? Every.Single.Time.?? Why don’t I get to charge you for that? This kind of thing makes me nuts. In other news, glad to hear the diagnosis is official 😉

    02/27/15; 1:50 pm
  8. My doctor was nearly an hour late last time I was at Joslin and that horrible board was taunting me the entire time with “on time”… I was ready to throw things too.

    02/27/15; 4:26 pm
  9. Nolan Kienitz #

    Thanks to unwanted government control for a lot of additional “stuff” … causes things like the “on time … or not” boards I guess.

    I’m going on Medicare in June and was just told that I need a c-peptide test to find out if I’m diabetic as well. Let’s see now … diagnosed as T-1 in September 1967, been wearing pumps for 25+ years and CGMS devices for 5+ years. I guess it would be good to find out if all this money I’ve spent on insulin, syringes, pumps, test strips, doctor visits has all been for naught? Humm, I wonder now??!!

    My larger battle will be to dig in against Medicare as they don’t currently cover CGMS and I have to wear mine 24×7 as I can’t detect low BGs anymore. Can’t tell you how many emergency room trips my Dexcom has saved me.

    Kerri … glad you made it through your effort to Joslin.

    Hang in there.

    Cheers,

    Nolan K.

    02/27/15; 7:33 pm
  10. GM #

    Sorry to hear you had such a frustrating day. And thank you for the explanation – in all seriousness, I was confused when I saw the photo of that board because my first thought was that every doctor running on time had to be . . . an IMPOSSIBILITY. For patients, part of what’s so frustrating about this is there’s very little we can do. I work in a client service business and if I ever kept a client waiting for a half hour, well, I would no longer have them as a client. I often wish the medical profession (and the hospitals and insurance companies dictating how doctors spend their time) thought the same way.

    02/27/15; 8:38 pm
  11. Georgia Caver #

    The insurance companies treatment of type 1 diabetics is horrible. My insurance company refuses to insure the sensors that are part of the pump. They ignorantly ask me to use mid twenty century technology for blood testing with a twenty first century pump, After I bit through my tounge during a low blood sugar episode, I thought surely they would cover same – no! Not needed according to the ignorant $&&@@& at BC$&. It is no doubt going to get worse with government control….

    02/27/15; 10:21 pm
  12. When I was pregnant with my 2nd child, I would call the ob/gyn’s office b/c she was always running behind. Usually, I could make my appointment for 3:00, work until 4:30 and then drive over and she would see me at 5. I changed insurance (and doctors) for baby #3. 🙂

    02/28/15; 1:46 pm
  13. Kate #

    I go to Joslin every three months from RI too and yes, it is an all morning affair….and expensive for me too. The gas, the outrageously expensive parking, the babysitter I hire to take care of my 4 year-old. I’m often torn….do I explore a practice in Providence and just go to Joslin once a year to “keep my connection” there?

    Somehow, I feel afraid that I’ll miss the great release of the cure that will naturally be heard about in Boston first…or not?

    Thanks for your post..it made me laugh:)))

    02/28/15; 4:03 pm
  14. I’m extremely amused by the ‘arrival and departure times’ board.

    I’m a doctor myself (in Singapore), but I’ve never seen anything like this. My guess is that it was probably the administrator’s idea.

    But adding time pressure to the doctor doesn’t mean quality of care improves. In fact, it may be the opposite.

    03/1/15; 8:25 am
  15. Cat #

    I know how frustrating the wait times are, as a practitioner and as a patient. I’m a physical therapist and treat complicated neurologically-impaired people, and it is rare for me to be on time. The problem is that often people will wait until the end of the session to drop a really serious complaint or medical problem, or in my case sometimes they fall. The patients are scheduled back to back with no margin for error, and once you are late for one, it cascades to everyone because you don’t want to cut anybody short. I’m never an hour late, but even 15 minutes makes me get a sick pit of anxiety in my stomach. Especially with how visits and reimbursement are structured, your doctor is probably rushing from person to person, likely without time to document notes or use the bathroom in her efforts to catch up. I completely understand the complication of how much time it takes, but perhaps just take a moment to appreciate that she doesn’t rush you and doesn’t try to make up for lost time.

    03/1/15; 9:15 am
    • Thanks for your comment, Cat. I hope you read the part of the post that spoke to how much I appreciate my endo. She’s terrific; the system sucks.

      03/1/15; 9:19 pm
  16. Jake #

    Kerri,

    First time reader. Really awesome blog. I’m type 1 for 26 years – got some minor background retinopathy but its’ “holding stable” not worse…..

    03/2/15; 5:18 pm

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