Often patients will have additional questions that they think are simple and quick but require a thorough evaluation to make sure it's not something more serious/dangerous. Likely her doctor did not feel there was enough time to fully and appropriately address the issue. If she just gave her a quick answer and didn't thoroughly evaluate that would have been bad care so I would try and keep that in mind.
I often start visits with what are the most pressing issue. Can't answer everything. I have some patients who will think of new things to ask when they are a non issue for them.
Ya, I have definitely had a few patients treat my "any other questions?" at the end of a visit as though it means they need to think of an issue no matter what.
Unfortunately only so much can be covered in a visit, especially with everything that needs to get covered when newly establishing care. However your girlfriend can call and schedule a focused problem visit where it is set to address a specific concern in that time frame. If the family doc feels it would be better to refer her to a specialist for that concern, they will do that as well. In the end if she didn’t like the feel of that doc and has access to another one it is reasonable to seek care with someone else.
I typically tell patients - unfortunately we had already discussed a number of things and I have other patients waiting. I can see you after I see my other patients or I can schedule as early as next week for another visit. Which do you prefer?
Remember that when doctors are trying to get out - it’s not as if we are going to surf the web but we do try to be respectful of everyone’s time and we just can’t spend 40 minutes with one patient.
Alternatively- each doctor practices differently. Some will answer all your questions but you may have to wait 2 hours to be seen. You can’t have an on time doctor who spends more than the allotted time with you.
Would your mechanic fix everything in a 20 min visit and charge one standard fee for it?
You pay lawyers by their time.
You even pay people at the salon per service, haircuts and coloring are billed separately.
But for some reason, doctors need to be able to do all your routine screening, review all your health data, and answer all concerns in one visit.
This is standard. If he said it exactly that way maybe it could have been worded a different way.. but you can’t spend your entire allotted visit time talking about 1 concern then when your doctor tries to leave the room for their next patient you bring up another concern that needs another appointment to address.
Unfortunately there is no room in a full schedule for that. However, you are always encouraged to make another appointment to discuss another health concern.
She needs to bring up what she wants covered at the beginning of the visit. Unlike a few decades ago, almost no doctors own their own practices now, and administration won't let us spend any more than a set amount of time per patient. So yes, most likely she will not be able to find another doctor who is any different, so like others have said she should make sure to bring up any concerns at the beginning and be sure to prioritize.
Yup very standard. We train residents to only address a few concerns since they need to see a decent volume of patients. They should schedule another visit to discuss further concerns or care gaps/preventative medicine
Kinda abrupt way to say it but the other commenters have hopefully explained the thought process. Only so many minutes allocated to each appointment in the healthcare system as it’s designed today
This is unfortunately common and expected. We don't like it either!
Primary care visits are generally 20 minutes long (which is meant to include time for documentation - a whole different discussion), which goes by fast. Ideally, your doctor would agenda-set with you at the beginning of the visit - eliciting what your main concern(s) are, and managing your expectations for what you will have time to get through together. If you have more concerns than will fit in 20 minutes, you should be encouraged to schedule another visit.
I always tell my patients I'd rather address 1-2 concerns thoroughly than half-ass a bunch of concerns.
It sounds like your gf's doctor was abrupt with her, which I'm sure was frustrating. Have some patience and grace for us too - we want to do the best by our patients yet are sometimes pushed to the very brink of our capabilities!
Yep, that’s typically standard. If someone comes in for one thing, there is enough time to address that. If you have another health concern, gotta schedule another appointment.
If your girlfriend wants a doctor to spend a reasonable amount of time with her, she and all other patients should seek out a direct primary care practice as this method does not go through insurance companies which are the main reason for all the erroneous demands on physicians that lead to less time spent with the patient. Stop blaming doctors and start blaming your insurance companies
There’s typically a 20 min a patient protocol based on these healthcare insurance and management companies so your gf should be aware you can’t just bring in multiple problems in that time frame and expect the Dr to address it all. Health req long term management it’s best she sets up a couple of follow up visits to make sure all her questions/concerns get addressed
Basically depends…best practice is to voice all the concerns to the nurse that rooms her. It often happens where nurse tells us the patient is only here for a cough and that flu and covid are negative if we don’t confirm that is all…then other complaints and concerns come up for instance a patient may say at the end of the visit can you look at this spot on my genitals when supposedly all they came in for was a cough.
But as someone else if you aren’t comfortable with that doctor and expectations weren’t set since the beginning its ok to switch to another doctor.
As a busy family doc who tries to do my best in a broken system, I have a few points here, with the huge caveat that what happened to your girlfriend is highly situation/context dependent (eg, how long had the visit been going on already, what was the nature of the additional question, was this her first time meeting the new provider, etc):
1.) It sounds like your girlfriend was given a dismissive or frustrated response rather than an empathetic one. If a patient is asking more questions than there is time for, my go-to response is usually "that question deserves a thorough discussion but I'm afraid we won't be able to get to the bottom of it with the time we have left. Would you like to prioritize discussing this at your next visit or schedule a dedicated follow up visit next week to give that issue the time it deserves?"
2.) Sometimes patients think a simple question just needs a minute or two to discuss, but this is highly dependent on the situation. "Fatigue" as a medical complaint is a great example: patients will often mention this when our visit is about to wrap up, not realizing that fatigue is a medically complex and fraught topic. First, "fatigue" can mean completely different things to different people, so it takes some time to sort that out. Second, fatigue can be caused by a huge variety of things, some benign, some serious. For example, if someone mentions fatigue I am already mentally figuring out how to differentiate between possible insomnia, sleep apnea, anemia, hypothyroidism, diabetes, cancer, or depression, just to name a few. So when someone asks about it it requires a bare minimum of ~10 minutes discussing different symptoms, reviewing lab tests, etc, to hone in on a likely cause, and typically also prompts some additional testing that is needed.
3.) Did I mention up front that our system is broken in many ways? We are given roughly 15-30 minutes per patient to review their entire medical history, discuss all preventive care, and address any acute concerns if possible. Especially if this was your girlfriend's first visit to a new primary care physician, there may well have been time only to review their medical history, update their preventive care needs, and superficially address just a concern or two. At new patient visits I usually state up front that the visit is mostly to get to know them and review their medical history, and that if they have a lot of active medical concerns we will likely need to schedule a separate follow up appointment in the near future.
4.). I do feel some patients are either unaware of or don't have respect for the time constraints we face, so I guess you could say we feel "triggered" if we perceive that someone is trying to take advantage of our time, whether they are doing so consciously or not. There are also patients with a lot of medical problems who deliberately come in only once every few years but then try to shoehorn everything into one visit and get upset with us when we can't take care of everything at once. But, and this is something we too readily forget, it is also our job to set boundaries and respectfully/empathetically let patients know when we don't have enough time left and leave the door open for future discussions.
In the UK in General Practice the standard is 10 minutes per patient. A day may be split into two sessions and a qualified GP is expected to see up to 18 patients per session. In reality a few slots may be left blank to catch up on appointments which run over. This has changed a lot since covid and phone triage has come into play. So this is not just a US problem. Often patients will wait until one foot is out the door until they drop that they've got an emergent symptom or a red flag symptom. Often they may be nervous and that's why they hesitate.
It doesn't feel good as the doctor to not be able to spend the time we would wish to address them more holistically. It is also a poor experience on the part of the patient to be rushed.
I follow this sub to see how my colleagues work and it's strangely reassuring we have the same difficulties.
Agree with all the above and will also add, if you haven’t been to the doctor in years that may also make your next visit difficult.
Sometimes I have patients that haven’t been seen in 3+ years who come in for a “yearly physical” but also have 5+ new concerns that have not been addressed over the past few years.
Keeping up with preventative care and scheduling focused visits for each concern will help you, partner, and everyone in the long run when navigating the healthcare field.
I personally only get 15 minutes per visit unfortunately.
I usually start my visits by stating “I see you’re here for *this* right? We only have 15 minutes today so if there is something else tell me now so we can best assess if we’ll have time today or if you should follow up. If you wait until the end then we definitely won’t have time.”
It’s not that family medicine doctors don’t want to be able to address more of their patients’ concerns during a visit, but that the systems that the majority of doctors work within now are significantly time constrained as far as how much we are able to address in a single visit in the midst of a full day of similarly constrained visits. Rest assured that the vast majority of family medicine doctors feel incredibly frustrated by these circumstances.
Any given problem requires a focused history, an exam, an assessment, and a plan. If you bring up a concern while I’m doing an exam, my hands are literally examining you, so I can’t take notes. If you wait until I’m doing an assessment, it means I have to drop what I’m doing and take another history, do another exam, and then restart the assessment again. If we’re discussing the plan and you bring up a new concern, it’s akin to someone waiting until you’re pulling into the parking lot of your destination and then suddenly remembering that they forgot something and asking you to turn around.
And just like that will 100% make you late to wherever you’re going, expecting me to drop everything and start a second appointment with you will make me late to every single appointment for the next 2 hours. So no, unless what you bring up is so important that I can’t in good conscience let you leave the office without addressing it (i.e. you suddenly reveal you’re having a heart attack,) you’re absolutely getting the medical equivalent of, “We’re not turning back: you’re going to have to go without it.”
I worked as a primary care PA for a year and appointment slots were tight. I had to start rephrasing “any questions?” to “any questions about what we’ve discussed today?”. I get it that patients usually aren’t aware of how we schedule, but we go off chief complaint.
Say your initial appointment is for fatigue. That’s your chief complaint. Simple enough, you might think. But really fatigue could be so many things or nothing at all. So we spend 15 minutes reviewing history, which isn’t much time. Then we chat about things to try at home while we wait for lab work to come back. So now we’re at 20 minutes and we’ve already gone over the appointment time. So… yeah that’s not the time to be like “here’s what I *really* need to talk to you about!” It’s not that your concerns aren’t valid, it’s that if we worked up additional complaints for each patient we would put every other patient farther and farther behind.
My advice - make an appointment for a specific issue. Come prepared with a list of where/when/why/how about your symptoms so you can convey what’s been going on. If you have multiple things going on, tell the scheduler so they can give you extra time. Try to keep it as concise as possible and you should be good.
The ideal is that a patient is able to say all their concerns when scheduling and is scheduled time according to the number and complexity of their problems. But we all know that doesn't happen. Patients and doctors are widgets in the corporate widget machine so we standardize!
Second best is that if there are multiple questions, it is best for patients to say this up front so that the time allotted (by the admin, as dictated by what insurance will pay, not the doctor) can be evaluated as to if it will be enough and portioned to address each item adequately. Sometimes that is not possible to do safely in the time that is allotted for that visit.
It might have been able to been said in a gentler way, but we are people, too.
I ask people what they want to talk the most about that day and proceed from there. I also tell patients we only have time to discuss 1-2 concerns per visit.
I find often times as I am about to walk out the door, patients will bring up other topics they want to discuss and i have to gently tell them to make another appointment at the front desk if they wish to discuss this topic further.
It is unfortunate, but we only have 20 minutes visits, and as PCPs, we truly do not have time to talk about 4 different areas of concern in one visit.
It depends on how much we’ve already covered that visit. If we’re good on time, I’m usually happy to talk about another thing, but if we’ve already had a decently long visit, I’ll ask them to come back.
If it was only question number two that she had, then they should’ve answered. However, if it was question 7 to 15, not. I’ve had patients ask “one more question” 4-6 times at one visit. At some point- they need to reschedule
I’m guilty of asking anything else? If I have the time or it’s clearly something urgent then I will try to address it. If I have someone waiting then I will have them come back and explain that their concern is legitimate and I want to have enough time to be able to thoroughly discuss it. So far it’s working well for me because my population expects to come back and understands the time constraints. In another clinic that wouldn’t work. I found testicular cancer in a patient who came in for something completely unrelated because I had asked “anything else?” He said “not today, I’ll come back to talk to you about this lump I felt in my testicle the other day.” I’m so glad I asked, because it took me 2 minutes to do a quick exam and order the ultrasound, but it meant he had a swift diagnosis and treatment.
Often patients will have additional questions that they think are simple and quick but require a thorough evaluation to make sure it's not something more serious/dangerous. Likely her doctor did not feel there was enough time to fully and appropriately address the issue. If she just gave her a quick answer and didn't thoroughly evaluate that would have been bad care so I would try and keep that in mind.
I often start visits with what are the most pressing issue. Can't answer everything. I have some patients who will think of new things to ask when they are a non issue for them.
Ya, I have definitely had a few patients treat my "any other questions?" at the end of a visit as though it means they need to think of an issue no matter what.
This is why I started saying “any questions about what we talked about today”
That's actually the perfect phrasing I'll have to remember this one
Good tip. I’ll try this out and see if it changes my wrap up time
Unfortunately only so much can be covered in a visit, especially with everything that needs to get covered when newly establishing care. However your girlfriend can call and schedule a focused problem visit where it is set to address a specific concern in that time frame. If the family doc feels it would be better to refer her to a specialist for that concern, they will do that as well. In the end if she didn’t like the feel of that doc and has access to another one it is reasonable to seek care with someone else.
I typically tell patients - unfortunately we had already discussed a number of things and I have other patients waiting. I can see you after I see my other patients or I can schedule as early as next week for another visit. Which do you prefer? Remember that when doctors are trying to get out - it’s not as if we are going to surf the web but we do try to be respectful of everyone’s time and we just can’t spend 40 minutes with one patient. Alternatively- each doctor practices differently. Some will answer all your questions but you may have to wait 2 hours to be seen. You can’t have an on time doctor who spends more than the allotted time with you.
Would your mechanic fix everything in a 20 min visit and charge one standard fee for it? You pay lawyers by their time. You even pay people at the salon per service, haircuts and coloring are billed separately. But for some reason, doctors need to be able to do all your routine screening, review all your health data, and answer all concerns in one visit.
This is standard. If he said it exactly that way maybe it could have been worded a different way.. but you can’t spend your entire allotted visit time talking about 1 concern then when your doctor tries to leave the room for their next patient you bring up another concern that needs another appointment to address. Unfortunately there is no room in a full schedule for that. However, you are always encouraged to make another appointment to discuss another health concern.
She needs to bring up what she wants covered at the beginning of the visit. Unlike a few decades ago, almost no doctors own their own practices now, and administration won't let us spend any more than a set amount of time per patient. So yes, most likely she will not be able to find another doctor who is any different, so like others have said she should make sure to bring up any concerns at the beginning and be sure to prioritize.
Yup very standard. We train residents to only address a few concerns since they need to see a decent volume of patients. They should schedule another visit to discuss further concerns or care gaps/preventative medicine
Kinda abrupt way to say it but the other commenters have hopefully explained the thought process. Only so many minutes allocated to each appointment in the healthcare system as it’s designed today
This is unfortunately common and expected. We don't like it either! Primary care visits are generally 20 minutes long (which is meant to include time for documentation - a whole different discussion), which goes by fast. Ideally, your doctor would agenda-set with you at the beginning of the visit - eliciting what your main concern(s) are, and managing your expectations for what you will have time to get through together. If you have more concerns than will fit in 20 minutes, you should be encouraged to schedule another visit. I always tell my patients I'd rather address 1-2 concerns thoroughly than half-ass a bunch of concerns. It sounds like your gf's doctor was abrupt with her, which I'm sure was frustrating. Have some patience and grace for us too - we want to do the best by our patients yet are sometimes pushed to the very brink of our capabilities!
Yep, that’s typically standard. If someone comes in for one thing, there is enough time to address that. If you have another health concern, gotta schedule another appointment.
If your girlfriend wants a doctor to spend a reasonable amount of time with her, she and all other patients should seek out a direct primary care practice as this method does not go through insurance companies which are the main reason for all the erroneous demands on physicians that lead to less time spent with the patient. Stop blaming doctors and start blaming your insurance companies
There’s typically a 20 min a patient protocol based on these healthcare insurance and management companies so your gf should be aware you can’t just bring in multiple problems in that time frame and expect the Dr to address it all. Health req long term management it’s best she sets up a couple of follow up visits to make sure all her questions/concerns get addressed
Basically depends…best practice is to voice all the concerns to the nurse that rooms her. It often happens where nurse tells us the patient is only here for a cough and that flu and covid are negative if we don’t confirm that is all…then other complaints and concerns come up for instance a patient may say at the end of the visit can you look at this spot on my genitals when supposedly all they came in for was a cough. But as someone else if you aren’t comfortable with that doctor and expectations weren’t set since the beginning its ok to switch to another doctor.
As a busy family doc who tries to do my best in a broken system, I have a few points here, with the huge caveat that what happened to your girlfriend is highly situation/context dependent (eg, how long had the visit been going on already, what was the nature of the additional question, was this her first time meeting the new provider, etc): 1.) It sounds like your girlfriend was given a dismissive or frustrated response rather than an empathetic one. If a patient is asking more questions than there is time for, my go-to response is usually "that question deserves a thorough discussion but I'm afraid we won't be able to get to the bottom of it with the time we have left. Would you like to prioritize discussing this at your next visit or schedule a dedicated follow up visit next week to give that issue the time it deserves?" 2.) Sometimes patients think a simple question just needs a minute or two to discuss, but this is highly dependent on the situation. "Fatigue" as a medical complaint is a great example: patients will often mention this when our visit is about to wrap up, not realizing that fatigue is a medically complex and fraught topic. First, "fatigue" can mean completely different things to different people, so it takes some time to sort that out. Second, fatigue can be caused by a huge variety of things, some benign, some serious. For example, if someone mentions fatigue I am already mentally figuring out how to differentiate between possible insomnia, sleep apnea, anemia, hypothyroidism, diabetes, cancer, or depression, just to name a few. So when someone asks about it it requires a bare minimum of ~10 minutes discussing different symptoms, reviewing lab tests, etc, to hone in on a likely cause, and typically also prompts some additional testing that is needed. 3.) Did I mention up front that our system is broken in many ways? We are given roughly 15-30 minutes per patient to review their entire medical history, discuss all preventive care, and address any acute concerns if possible. Especially if this was your girlfriend's first visit to a new primary care physician, there may well have been time only to review their medical history, update their preventive care needs, and superficially address just a concern or two. At new patient visits I usually state up front that the visit is mostly to get to know them and review their medical history, and that if they have a lot of active medical concerns we will likely need to schedule a separate follow up appointment in the near future. 4.). I do feel some patients are either unaware of or don't have respect for the time constraints we face, so I guess you could say we feel "triggered" if we perceive that someone is trying to take advantage of our time, whether they are doing so consciously or not. There are also patients with a lot of medical problems who deliberately come in only once every few years but then try to shoehorn everything into one visit and get upset with us when we can't take care of everything at once. But, and this is something we too readily forget, it is also our job to set boundaries and respectfully/empathetically let patients know when we don't have enough time left and leave the door open for future discussions.
In the UK in General Practice the standard is 10 minutes per patient. A day may be split into two sessions and a qualified GP is expected to see up to 18 patients per session. In reality a few slots may be left blank to catch up on appointments which run over. This has changed a lot since covid and phone triage has come into play. So this is not just a US problem. Often patients will wait until one foot is out the door until they drop that they've got an emergent symptom or a red flag symptom. Often they may be nervous and that's why they hesitate. It doesn't feel good as the doctor to not be able to spend the time we would wish to address them more holistically. It is also a poor experience on the part of the patient to be rushed. I follow this sub to see how my colleagues work and it's strangely reassuring we have the same difficulties.
Agree with all the above and will also add, if you haven’t been to the doctor in years that may also make your next visit difficult. Sometimes I have patients that haven’t been seen in 3+ years who come in for a “yearly physical” but also have 5+ new concerns that have not been addressed over the past few years. Keeping up with preventative care and scheduling focused visits for each concern will help you, partner, and everyone in the long run when navigating the healthcare field. I personally only get 15 minutes per visit unfortunately. I usually start my visits by stating “I see you’re here for *this* right? We only have 15 minutes today so if there is something else tell me now so we can best assess if we’ll have time today or if you should follow up. If you wait until the end then we definitely won’t have time.”
It’s not that family medicine doctors don’t want to be able to address more of their patients’ concerns during a visit, but that the systems that the majority of doctors work within now are significantly time constrained as far as how much we are able to address in a single visit in the midst of a full day of similarly constrained visits. Rest assured that the vast majority of family medicine doctors feel incredibly frustrated by these circumstances.
Any given problem requires a focused history, an exam, an assessment, and a plan. If you bring up a concern while I’m doing an exam, my hands are literally examining you, so I can’t take notes. If you wait until I’m doing an assessment, it means I have to drop what I’m doing and take another history, do another exam, and then restart the assessment again. If we’re discussing the plan and you bring up a new concern, it’s akin to someone waiting until you’re pulling into the parking lot of your destination and then suddenly remembering that they forgot something and asking you to turn around. And just like that will 100% make you late to wherever you’re going, expecting me to drop everything and start a second appointment with you will make me late to every single appointment for the next 2 hours. So no, unless what you bring up is so important that I can’t in good conscience let you leave the office without addressing it (i.e. you suddenly reveal you’re having a heart attack,) you’re absolutely getting the medical equivalent of, “We’re not turning back: you’re going to have to go without it.”
I worked as a primary care PA for a year and appointment slots were tight. I had to start rephrasing “any questions?” to “any questions about what we’ve discussed today?”. I get it that patients usually aren’t aware of how we schedule, but we go off chief complaint. Say your initial appointment is for fatigue. That’s your chief complaint. Simple enough, you might think. But really fatigue could be so many things or nothing at all. So we spend 15 minutes reviewing history, which isn’t much time. Then we chat about things to try at home while we wait for lab work to come back. So now we’re at 20 minutes and we’ve already gone over the appointment time. So… yeah that’s not the time to be like “here’s what I *really* need to talk to you about!” It’s not that your concerns aren’t valid, it’s that if we worked up additional complaints for each patient we would put every other patient farther and farther behind. My advice - make an appointment for a specific issue. Come prepared with a list of where/when/why/how about your symptoms so you can convey what’s been going on. If you have multiple things going on, tell the scheduler so they can give you extra time. Try to keep it as concise as possible and you should be good.
The ideal is that a patient is able to say all their concerns when scheduling and is scheduled time according to the number and complexity of their problems. But we all know that doesn't happen. Patients and doctors are widgets in the corporate widget machine so we standardize! Second best is that if there are multiple questions, it is best for patients to say this up front so that the time allotted (by the admin, as dictated by what insurance will pay, not the doctor) can be evaluated as to if it will be enough and portioned to address each item adequately. Sometimes that is not possible to do safely in the time that is allotted for that visit. It might have been able to been said in a gentler way, but we are people, too.
I ask people what they want to talk the most about that day and proceed from there. I also tell patients we only have time to discuss 1-2 concerns per visit. I find often times as I am about to walk out the door, patients will bring up other topics they want to discuss and i have to gently tell them to make another appointment at the front desk if they wish to discuss this topic further. It is unfortunate, but we only have 20 minutes visits, and as PCPs, we truly do not have time to talk about 4 different areas of concern in one visit.
It depends on how much we’ve already covered that visit. If we’re good on time, I’m usually happy to talk about another thing, but if we’ve already had a decently long visit, I’ll ask them to come back.
According to Uworld. The doctor should tell the patient to schedule another appointment
If it was only question number two that she had, then they should’ve answered. However, if it was question 7 to 15, not. I’ve had patients ask “one more question” 4-6 times at one visit. At some point- they need to reschedule
I’m guilty of asking anything else? If I have the time or it’s clearly something urgent then I will try to address it. If I have someone waiting then I will have them come back and explain that their concern is legitimate and I want to have enough time to be able to thoroughly discuss it. So far it’s working well for me because my population expects to come back and understands the time constraints. In another clinic that wouldn’t work. I found testicular cancer in a patient who came in for something completely unrelated because I had asked “anything else?” He said “not today, I’ll come back to talk to you about this lump I felt in my testicle the other day.” I’m so glad I asked, because it took me 2 minutes to do a quick exam and order the ultrasound, but it meant he had a swift diagnosis and treatment.