The Ubiquitous Doctor's Visit

Over the years I have come to the conclusion that there is a certain ubiquity to visiting a doctor's office. While some procedures, office decor, personalities, and competencies can be found along a predictable spectrum, it all boils down to the commonalities - the sameness of each and every experience.

This struck me yesterday as I waited for quite a long time to see a doctor at a local walk-in clinic. I avoided the Urgent Care I was familiar with because I knew it would be horribly crowded and I would need to take provisions. I didn't feel strong enough to haul provisions.

I have a "real" doctor. But in all the occasions I have visited his office, I have never actually seen him. I saw his colleague when I had pneumonia in 2001 and the nurse practioners when I visited with minor ailments, but never the man himself. I didn't go there yesterday because they were "closed" for two hours for "lunch." I knew from previous experience that I probably wouldn't get an appointment anyway, due to the flu bug going around, and tendency of his office to over-book. Time and again I have sat there, wedged in between other hopeful and weary patients, competitors for time and attention. There was a time or two when I visited and there was nobody there - yet I waited at least an hour to see somebody. I couldn't help but wonder if the "somebody" I would see was piddling around back there, ensuring and maintaining the balance of power. The balance of power here will never, ever, be in favor of the one seeking medical care. Unless you are President Bush or Leonardo diCaprio.

So I went to this clinic with the tentative hope that I could see a doctor. I have been sick with the flu and its plethora of unpleasant symptoms for two weeks as of tomorrow. The traveling virus lodged itself over the weekend in my ears - probably migrating from my throat, where it had moved in and set up camp, in preparation for colonization.

There were few people in the waiting room and they all had appointments. As I waited, I reflected on the things that make these visits, although conducted rarely, familiar and predictable.

1. The procedures: There is always a clipboard with paperwork attached. This paper work requires signatures and information. It asks all kinds of irrelevant questions that I doubt the doctor actually sees. I think the answers serve as fodder for the morbid curiosity of the staff member who inputs the stuff into the computer. You have to fill out the paperwork on the clipboard if you haven't seen the doctor in awhile. I can understand this to a degree, but really - the dates of my childhood apendectomy and gall bladder surgeries never change. I make the effort to make the appointment and keep it - surely they can make the effort to keep that information in some sort of permanent file. Ask me if I hemoraged last week or had any major collisions with immovable objects. That makes more sense. Ask me about my aversion to needles.

2. The Waiting Room: Doctors with decent cash flow often hire decorators to spruce up the waiting room. The best feature of my "real" doctor's office is the fish tank. It is a saltwater wonder, filled with beautiful fish, exquisite hardscape, and clear, clean, bubbly water. It sits on a shelf that separates two waiting rooms. Other than the fish tank, the decor is interchangeable, dark, and lacking in warmth.

Most of the decor from "decorators" looks like it came from the same stash used in hotel rooms. The furniture, the bland "artwork," the shelving, knick-knacks, wall-mounted television - all the same. The color scheme is a variation of pastel with little to no interest or texture whatsoever. One of my doctors has a mural on the wall, which is interesting but loses flavor after about five years. I am past that now and really wish I had the nerve to offer my decorating services. But this doctor has access to needles.

Most doctors seem to just have a family member or a staffer add "daycore" to the waiting room. Off-balance pictures are placed willy-nilly with medical supply posters suggesting we ask the doctor about this drug or that treatment, and some variation of potted or artificial plants. The magazines are spotty in variety and not recent. It is all I can do, at times, to not get up and fix things. "How 'bout some color on this wall?" I want to shout.

3. The appointment: The cardinal rule about appointments is that they are merely suggestions or guidelines. God help you if you are late for the appointment. The punishments vary but suffice to say that there will be one. But for the staff, appointments are merely a mechanism for adding you to the pool of waiting applicants. There is a point of "critical mass" the scheduler will not exceed. They don't want you waiting outside, for example, because they don't want to be to be viewed as "tacky." Which is humorous when you juxtapose the condition of the waiting room.

They think nothing of giving you a time, expecting you to be there, and then closing the little window with an invitation to "have a seat" so you can develop bedsores while you wait. And wait. They open the door and call a name and for the longest time the name isn't yours. Sometimes it belongs to somebody you didn't realize was there. You wait. Nobody talks. You adjust yourself in the seat, pulling up the legs, crossing and uncrossing ankles, slouching, jerking upright, and perhaps getting up to peer at something.

4. The second wait: This occurs once you have been weighed and measured and led to an examining room. The weighing and measuring always occurs, even if you are coming in for an infected hangnail. The fact that you are wearing five pounds of clothing is never accounted for by the staffer who does the weighing. The disapproval and barely masked glee that registers when your weight comes past the point of social respectability, oozes as the staffer records it on the chart. Don't bother to bring up the heavy clothes thing or the fact that you ate before arriving. The patronism just oozes. The ironic thing is that they are usually housed in scrubs or clothing that disguises their less-than-perfect physiques. If the staffer is obese, the irony fairly drips.

In the examining room you wait. How long you wait is variable because sometimes the staffer stays with you and continues with the measures and terse questioning about why you are here today. Sometimes the tone of voice is a kind of boredom verging on hostility. You carefully explain but for naught because you have to tell the doctor all over again. Clearly, the doctor has not read or heard any of this - which makes you wonder why the staffer asked in the first place. Maybe it is triage.

Then you wait and it is not comfortable. Sit here, lay there, perch on this chair, it doesn't matter. You will wait. The doctor rarely comes right in and this is a fact. You are moved from the waiting room just to keep the assembly line moving. There are mild diversions, if one is brave enough, like the rolling stool, the drawers and countertops, the posters on the walls ("The Amazing Knee;" The Circulatory System;" "Advanced Heart Disease.")

In the veterinarian's room, there are cross sections of dog and cat anatomy, kitchy plaques about dogs having owners and cats having staff, and posters explaining obesity in dogs or the importance of regular teeth-cleaning. This doesn't distract the dog or cat of course. The dog or cat is too busy dropping hair and fur all over the floor, in anticipation for what is bound to be animal cruelty that borders on abuse.

5. The knock: The knock comes after you are finished with all the diversions in the examining room. Rarely, the doctor will catch you looking at the poster or sitting on the stool. Sometimes they look bemused. I think you garner a few points if you look like you have used your time productively. If you had to disrobe for the visit, there is always fear that "the knock" will come while you are in a state of nakedness. This never happens, but the fear remains.

6. The protocol: You must never complain about the long wait or the discomfort of the room temperature, or the tackiness of the waiting room decor. This just isn't done. You are free to go elsewhere and this is understood. Doctors have emergencies and some patients don't arrive exactly on time or require more attention than the time allocated. You won't get an apology for this - it is just understood and accepted. This protocol shows up on the final examination in medical school. Any inclination to do things differently is beaten out of them by the fourth year.

I made the mistake once of questioning the nurse practicioner about the long wait, which was almost an hour, when I had made the appointment more than a week earlier. She looked appalled. "We have patients!" I felt like a third-grader questioning WHY the cursive "Q" looked like the numeral "2."

I explained my rationale for asking but her countenance told me I had crossed a line. Their failure to properly plan somehow constituted inconvenience on my part and the fact that I questioned this was simply beyond her comprehension. It was lucky my visit didn't require a needle that day.

7. The aftermath: The visit itself is a nanosecond compared to the wait time. Questioning, examining, perhaps another question, brief discussion, diagnosis, protocol for treatment, and follow-up. Then, like a flash, off the doctor goes and you won't see the likes of him/her again - unless you are brazen enough to catch him/her in the hallway with a new question. The staffer completes the visit and you either leave or schedule another appointment.

I am often tempted, when I look at the appointment books they keep, to ask the scheduler to block out the appointment in front of me - so I won't have to wait so long.

But one never knows if the next visit will will require a needle.

:-)K