Waiting for the Doctor –by Jacqueline Galloway

News From The Domestic Church

Waiting for the Doctor –by Jacqueline Galloway

When our health declines or because of having a chronic illness, we see our primary doctor regularly. If the course of sickness progresses, we are often sent to other specialists for additional diagnoses and care. When being treated by doctors on a frequent basis as opposed to just periodic checkups, it is not unusual for patients to become experts on doctors and their office patterns.

Because of the high cost of medical care, patients rarely make ambivalent trips to the doctor, and I have noted from casual discussions in waiting rooms that even patients scheduled for just an annual checkup are more observant and sophisticated than in the past.

Over the past several years, as my systemic lupus erythematosus (SLE) manifested itself in ways beyond what my rheumatologist could treat, I have been directed to several other specialists. Recently, as I was waiting in a new doctors office, I reviewed my pocket calendar and realized that I had been to ten different specialists within the year!

Since I am an author and journalist, it is natural for me to notice in detail aspects of experiences that cause a significant affect. However, I also believe that most patients with chronic or terminal illness are also greatly influenced by medical environments.

I realized almost at once that this particular waiting room was unique and that it strongly influenced me. What was it about this office that caused me to pause and analyze what was happening? That day, I gradually settled into a sense of calm and comfort that had previously eluded me in doctors’ offices. Yet, I was in a foreboding place; the John Wayne Cancer Institute at Saint John’s Medical Center in Santa Monica, California. It occupies an ingeniously designed new wing. I was at first apprehensive, fearing a new examination, a new physician and possibly surgery and/or a new course of treatment. I considered how alarming a disease can sound when we read about it in popular periodicals. Traditional medical stories are often based on the worst cases and complicated scenarios. Although I have learned to seek accurate data from scientific papers and journals, since advances in health care can rapidly change, even being fortified with information from trusted medical annals does not always allay our deepest concerns.

My thoughts then changed to reviewing the procedure that had just taken place. The first stop was at an intake desk where I was directed to a small, private room to give my insurance information to the secretary, much like an admitting office in a hospital. I appreciated the seclusion and the confidentiality.

From there, I was escorted to a waiting room situated across the hall, quite apart from the sights and sounds of the intake desk or any other medical area. In fact, the large room was decorated like a library in a private home. It had thick carpeting, assuring excellent acoustics and softly lighted table lamps instead of harsh, overhead fluorescent lighting. I had the choice of sitting on a straight-back chair, at a desk, or on sofas situated in small groups throughout the spacious room. A coffee machine was kept warm, and the reading material was diverse. The time I spent in this room generated an optimal attitude within me, and I began to relax.

Thus, the environment of the waiting room seemed to me to be as essential as the expertise of the physician I was about to see. The anxiety I had originally felt diminished, and what I realized in this distinctive setting was the absence of heavy, noisy doors opening and closing constantly, ringing phones, sliding glass partitions, harsh fluorescent lights (which cause a rash in many SLE patients), heavy file cabinets being opened and closed, typewriters, clicking computer keys, and most important, I was apart from the intake personnel, and I was also not being subjected to the name of each patient checking in. I realized that those seemingly ordinary sounds were obstacles that kept me in suspense and preventing me from relaxing in some doctors offices. These typical things can be easily overlooked when one sees a doctor only a few times a year. However, when a patient is regularly in the office, perception becomes second nature, and one can almost sense the vibes the moment the door to the office is opened.

In certain adverse conditions, by the time my name was called and I did see the doctor, I was fatigued from all the activity to which I had been subjected. I discovered that I was tense and that I had lost my own sense of self and was so fatigued that I could not focus on my symptoms. At times, I was really agitated to the point when I saw the physician, I was almost “testing” the doctor because I had become exhausted and lost patience. I even downplayed my problems to escape as soon as possible, surely defeating the purpose of my visit. I recall withdrawing at times and never could identify the reason until being in this serene library.

Perhaps, the reasoning behind the physical setup of typical waiting rooms with glass petitions and bright lights is that they suggest a sense of professional and scientific proficiency. However, I have never looked forward to sitting in close proximity in chairs arranged almost elbow to elbow next to a stranger, sharing not only possible infections, but also the conversations of other family members of knowing each of their names and insurance companies from the audible signing-in. At times, I resented the glass barrier separating “us” from “them”, as if “they” would be free of our germs or “they” were linebackers to the examining rooms. As I would stare at those glass windows, I found myself reflecting on the conversations of the appointment secretary. If I heard “when would you like to come in,” I sensed a cooperative and not overbooked office. Whenever I heard “the only time the doctor can see you” (giving no choice), I decided it was an office that failed to recognize the value of the patient’s time. It was almost as if the patient were the low priority.

My examination this particular day led to hospitalization and surgery. I was convinced that my stress was reduced to a minimum not only because the first encounter had set me up for an affirmed sense of self-confidence, but also because the ambiance of that waiting area reflected the attitude of the inner office, the nursing staff and the doctor. The climate of most waiting rooms, in fact, communicates the doctor’s attitude and demeanor.

I acknowledge the need for certain stark areas such as Intensive Care Units, Emergency Rooms, Operating Rooms, and so forth. I suggest, however, that in this modern age of bringing more sensitivity to the doctor-patient relationship, the ideal first step is a pleasant, relaxing waiting room. Tranquility attained through the personal comfort felt in distinctively designed waiting rooms can be conducive to having a genuinely positive influence on the patient’s state of mind. When we reach our destination, the examining room, we might arrive with less anxiety and bring an energetic enthusiasm to the examination instead of defeatism and exhaustion.

During a recent visit to another specialist’s office who has also taken extraordinary measures to ensure the patient’s comfort, I requested an interview to discover just why the office schedule was consistently OnTime. Throughout my years of visits, I had never waited an unreasonable amount of time to see this doctor. What I discovered during my subsequent meeting was that the appointment secretary had a precise schedule and anticipated the times required for certain procedures. Then every five slots, one blank appointment was left for specific “catch-up-time” so that when visits exceeded the predicted time, the doctor would not fall far back behind the schedule. That is the epitome of respect for patients and caring! It is the patients responsibility to consider the doctors time as precious. Emergencies and surgeries can occasionally delay the most precise calendar of appointments and most patients are very understanding. Physicians must also realize the natural anxiety that each patient brings to the office and give careful attention to the appointment schedule as well as to the environment of the office waiting room. Circumstances surrounding treatments can affect their results. These are not subtleties or luxuries but perceptions that many patients record after serious reflection.

We patients want our doctors to be as human as we are. Most of us are reasonable and seek both expertise in our physician and a fair degree of sensitivity that does not just begin with the examining process. When patients see their doctors on a regular basis, they become keenly aware of the tapestry created by the staff and the office setting. Medicines and surgeries can heal our bodies, but mental images have a powerful effect as well. An inviting office can suggest “I am at peace and I feel relaxed” regardless of the physical or emotional pain accompanying the wait.

____________________

“Galloway, Jacqueline: “Waiting for the Doctor”
NY State J Med 1992: Vol. 92 No. 6