A day in the life of a primary care doctor: a harried pediatrician tells her story.

AuthorChen, Candice

I'm a primary care pediatrician in a clinic in Southeast Washington, D.C., that provides health care to a largely poor, urban, and underserved community. On Monday mornings, I look forward to going to work. I'm excited to see my patients--the babies, children, teens, and families I've watched grow up--and face the challenge of figuring out how best to help. I started working in this community during my residency training almost twelve years ago, and I've stayed here ever since.

As much as I love my work, however, my days are stressful and hectic and there is never, ever enough time. I start the day by looking at my schedule, which is typically booked full with patients scheduled every fifteen minutes, and the anxiety begins. My 8:30 a.m. appointment shows up at 8:44--just within our fifteen-minute late policy. By the time this family checks in and is in a room, it's well after 9:00, and my later appointments have started to arrive. I feel the pressure of people waiting, but when I go into that first room, I can't bring myself to rush this parent who's worried about her child. I sit down, quiet my anxiety, and listen to what the parent has to say. Meanwhile, I'm trying to find out, what were the results of the emergency room tests? What were the results of the tests we ordered last time? What did the specialist do? I ask these questions, knowing that time is ticking.

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If all of my scheduled patients show up, I spend the morning running from room to room and my lunch hour becomes fifteen minutes. If no one else is in the hallway after I leave a room, I run. The couple of seconds I save probably don't make a real difference to a waiting family, but it's all I can do. I apologize frequently to families for running late. Some families are forgiving; some aren't. I feel bad that my patients have to wait, and, being human, I feel worse when they're upset with me. By the end of the day, I'm physically and emotionally exhausted.

Some observers might make the obvious suggestion--stop scheduling appointments every fifteen minutes. But in the U.S. health care system, the only way to make more is to do more. In my clinic, those extra visits pay for important patient services, like a care manager, social work, and mental health and dental care. They also pay the salaries of the staff members who are needed to keep the clinic open five days a week.

Compared to other sectors of the health care system, primary care is disadvantaged...

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