Why am I only allowed to ask you about one problem during my visit?

Q: When I called to make an appointment, the nurse told me I could only ask you about one problem at my visit.  What’s up with that?

A: OK… Here’s the deal.  For every appointment I must:

• Review your history. If I’ve never seen you before, this means complete past medical history, surgical history, medications, drug allergies, family history, smoking, etc.
• Review why you’re here today, including your current symptoms, when they started, what you’ve done for them, what makes them better or worse, how they’ve changed since they started, etc.
• Perform a physical examination
• Order any necessary diagnostic testing (labs, x-rays, etc.)
• Use my amazing medical superpowers to figure out what is going on; explain to you what my plan is to remedy it; and answer any questions you might have
• Order prescriptions
• Type every single word into our occasionally truculent electronic health record and assign a diagnostic code that tells your insurance company why you were here. Then I assign another code for the level of service provided, which (theoretically) determines how much SHS will be paid for providing those services.
• Clean my room for the next patient.

For all of that, I have 20 minutes. 20 minutes!  For many routine situations – a sore throat, a simple urinary tract infection – that’s actually pretty doable.  And if your other question is as simple as, “While I’m here, can I get a refill on my allergy medication?” then fine, no sweat. 

But if you say, “I also want to ask you about this chest pain I’ve had for a while… or my stomach has been killing me for 2 weeks… or I get dizzy every time I work out” then the 20-minute time limit becomes impossible. These symptoms could be anything from simple stress to a life-threatening condition and it takes me a lot of time to figure it out. 

Which isn’t to say that I don’t want to figure it out. I do! But the clock is ticking, and there are other sick students waiting to be seen. If you tell our schedulers exactly why you need an appointment, they’ll do their best to help you, either by scheduling extra time or by working with you to figure out what the most pressing issue is today.  At Student Health Services we really do want to help, but we walk a tightrope. We are happy to see you for whatever you need, but there are thousands of you and only a few of us and only so many hours in the day.

John A. Vaughn, MD (OSU SHS)