Thursday, February 04, 2010


I often get calls from patients who want to come in "as soon as possible." Especially new patients, but sometimes established patients. I try to be as flexible and accommodating as possible, but sometimes it gets a bit inconvenient. Now I'm in confabulation mode, but I'm curious about readers' opinions of how one should respond to emergencies. Often, I offer an appointment asap and the person requesting it can't make it and asks for another time. So it becomes a bit of juggling of priorities. And I'm left wondering how much the doc should be thinking about juggling (if at all). So let me fly some scenarios by you, and I'm curious as to what you think. The details are all confabulated, but the essence of the stories have gone down in some form over the past few years.

For both the doc and the patient, I'm going to use the example of a hair appointment as a non-urgent but meaningful conflicting issue. It can be hard to schedule hair appointments, they take a while so they aren't that easy to reschedule, and someone else is inconvenienced (the stylist) by a change, and the consequence of delaying the appointment is meaningful (ya gotta live with ugly locks until you can get rescheduled). For the sake of my confabulation, you don't have to pay for a missed appointment, and it's hair, life goes on even with a bit of frizz (tell me about it).

For the sake of the uncontrollable, I'm going to use the car breaking down-- no one asks for this, it throws a miserable wrench in life, it's unanticipated, and if you can't get there, you can't get there. It could be "I was in the ER with chest pain," or "my husband locked the deadbolt and took the keys to work (and oh, we live on the 10th floor so I couldn't crawl out a window") but the broken car is the example of beyond someone's control to a reasonable degree.

Story #1) So patient calls and wants to come in emergently (asap). I look at my schedule and I have lunch time free, I finish at 3, and I have a hair appointment at 4. I offer 12 noon. Not good, patient has a hair appointment at 11:30, can I see her at 4? I can't (though I don't say that it's because I have a hair appointment). What's a shrink to do?

Story #2) Patient is having an emergency. Ah, a few days ago I came to see pt outside of regular office hours because pt was so clear it was an emergency and it couldn't wait until next available appointment. It was an emergency and I remained worried about pt. Pt canceled follow up appointment because his car broke down, but it was still an emergency, so could I meet him later in the day when relative would be home from her hair appointment and could bring patient? I quietly think: it's an emergency, relative knows it's an emergency. Can't relative cancel hair appointment? But it's been presented as this is something that would either be unacceptable to relative, or pt would be uncomfortable asking this of relative (and this I understand). Patient asks if I can move appointment to later in the day, a time I'm usually in the office. Oh, but I didn't have any appointments scheduled that particular day that late in the day, and I guessed it...a hair appointment! We looked at our schedules and couldn't come up with another time for many days and this is what we scheduled for.
Do you want to know what I did? In the first scenario, I offered the patient a half appointment at the end of the day, and I was a late to my own "hair appointment," but every thing got done. I felt a little uneasy about it because-- The patient's other obligation actually felt a bit less conflicting then an actual hair appointment, and let's just say my own obligation got short-changed, and the issue at hand wasn't a psychiatric emergency.
In the second scenario, I felt more conflicted. I know the patient wanted to come and he was out of control of the some of the scenario (? did he ask relative to skip hair appointment? Did he offer to drive another family member to work and borrow their car?). If this same patient had called and did not already have an appointment for that same day, and if my schedule was completely booked, I would have come back in the evening after my new doo to see him.

So what do you think?