Tuesday, October 17, 2017

Do Physicians Deserve Our Mercy? #silentnomore

This past week a video went viral when a woman complained about the lengthy wait time at a clinic.  On video, we see the physician asks if the patient still wants to be seen.  The patient declines to be seen, yet complains patients should be informed they will not be seen in a timely manner.  The frustrated physician replies, “Then fine…Get the hell out. Get your money and get the hell out."  While we do not witness events leading up to the argument between doctor and patient, we do know staff at the front desk called the police due to threats made by the patient to others. 
Based on the statement released by Peter Gallogly, MD, he is a humble, thoughtful, and compassionate physician who was very concerned for the safety of his staff, which he considers “family.”  Physicians like Dr. Gallogly do their best to serve patients, ease their suffering, and avoid losing ourselves to burnout at the same time. Every human being deserves our compassion, kindness, and clemency.  Patients and physicians must accommodate each other when possible.
Do physicians actually deserve our mercy when necessary?  Yes, they do.  I should know.  The kindness shown to me by my patients over the past month has been unparalleled, leaving this physician thankful beyond words. 
My father has been a practicing pediatrician in our community for 47 years.  As I type these words, he is dying in a hospital bed.  We have worked side by side for the last 16 years.  It is difficult to make it through the day, desperately hoping to hear his voice one last time in the clinic hallway.  He was carrying a full patient load before an unexpected cardiac arrest ended his career.  The patient load doubled overnight; it is a burden I am carrying alone.
Many families have brought their children, grandchildren, and great-grandchildren to us for more than 40 years.   We have seen them through the darkest moments of their lives, at their most vulnerable, and brought them into the light.  Now, our patients must guide me through unimaginable heartache and grief. 
Long wait times can be terribly frustrating.  Punctuality has long been a personal obsession. Lately, I have been unable to keep up; patients with appointments are waiting more than two hours to be seen.  Every new encounter begins with an apology for tardiness followed by an update on the condition of my father.  Most families are aware of my overwhelming task -- running a practice built for two when I am but one physician.  Not a single parent or child has complained, yelled, accosted, or threatened.  Each family has shown me desperately needed mercy.
Over the last twenty-one days, patients have provided 15 home-cooked meals.  Some have assisted by car-pooling my children or taking care of them when my presence at a last minute hospital care coordination meeting was required.  Others have simply offered a helping hand, by filing charts, running errands, or landscaping the grounds.  This is the physician-patient relationship as it was meant to be, simple, beautiful, and perfect. 
Yesterday, after apologizing yet again, a mother reassured me she would wait as long as it took to have her child seen, hugged me tightly, told me to take a deep breath, and offered me her chair to rest.  She reminded me to take care of myself.  In the next room was a grandmother who has been patronizing our practice since 1977, when I was barely three years old.  She offered billing services free of charge and emphasized how grateful she was for the loving care provided for two generations to her family.  
The clinic my father established is a place where mutual admiration between physician and patient has existed seamlessly for a half century.  Magic happens when patients walk through our doors.  The next time your physician is running late, consider the challenges they might have faced that day.  Accommodating their delay will be treasured more than you can possibly imagine.
Medicine is not a hospitality industry.  Patients are not customers and physicians are not restaurant wait staff.  We gave up our youth to become educated, skilled, and compassionate.  Saving the life of human beings is not equivalent to ordering a hamburger and having it served your way.  Physicians genuinely work hard to serve patients at their most desperate hour.  Remember, we are also human beings, who unequivocally need and deserve your mercy.      


  1. A sign in a non medical waiting room,..."This is not Burger King, you get it our way, or you don't get the son of a bitch thing at all".

    I really wondered when reading this story, why you couldn't partner with a physician assistant or nurse to triage some of the backlog. This impresses me as a business management issue, where you have failed, with information technology and hiring more staff, if you are that busy. You need work-life balance or your level of service will burn out, if it hasn't already.

    My level of mercy stops when doctors don't realize how inept they are at business management, and their public suffers. Error blindness grows with each passing day that you fail to find a better work around than the ones you have described.

    1. Really!?!? Bc she didn't plan ahead for the unexpected death of her father and business partner by hiring staff in advance this is her fault?!?
      I'm glad that your patients are supportive and compassionate...

    2. So to answer your question, I can and will partner with someone. This was unexpected. I suppose there are business managers who have multiple potential medical personnel waiting for doctors to pass away, but I haven't found that company yet. In your opinion, I failed. I can live with your assessment. In my opinion, and those of my patients, I needed mercy for a time and will transition over the next few months and move forward successfully. Thank you for your comments.

  2. We inform patients as they move through the office , but there are many reasons in spite of good planning that we can run behind. I do not like running late and I am always early to begin and do not take personal calls or manage my finances while patients wait. Most patients appreciate that they are usually close to time, but occasionally late. However there are always these other patients , who maybe are already having a bad day today , or who are always looking for a confrontation. Our staff take the brunt of that often and sometimes it is just too much. Can't tell you how many time over the years a patients has felt they could demean and berate a staff member but are perfectly pleasant with me. They use vulgarity and prejudicial words and we are almost always understanding. But a provocative threatening patient in the waiting room , I have no problem at all with the physician telling them to leave if they have an elective appt and calling the police.
    Excellent blog post and I caught this on KevinMD

  3. I salute Dr. Al-Agba on the practice she built with her father, which clearly transcends the impersonal world of the "business of medicine" these days. Her story reminded me of the Christmas special "It's a Wonderful Life". Through patients who felt the personal touch of her and her father, she will find the expert help and correct management footing in a short time. I have participated in the planning, review, and implementation of quality metrics and efficiency standards of the biggest name institutions in our country. The "administrators" who drove those agenda metrics had no clue what compassionate care was about_ except through our stories around the table. And even those efficiency "drivers" always selected the one physician who was knowledgeable, committed, AND spent the most time with his/her patients to care for their own family members. Go figure!!


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