I don’t do walk-ins for the most part. My hours are by appointment and, generally, patients who ask to be "squeezed in" can’t be.
I run a small, solo practice. My work hours are set in stone by having to pick up my kids after work, and I can only absorb a certain number of delays in a given day.
If I have the time and someone shows up, I’ll see them, but on a busy day, I usually can’t. In my experience, the person who walks in and says they’ll need "just a few seconds" will be 30 minutes minimum. So it’s best not to start.
I’ll catch flack for this, as I know some doctors will see any established patient who shows up saying they have an urgent issue. But let’s face it – most things patients consider urgent are not. Their reason for coming to my office might be a typical migraine they want treated (when they could have just called for a prescription refill), a drug side effect (which could be handled by phone), or because they woke up with a pulled muscle. None of these are medically urgent.
This isn’t to say that real emergencies don’t come in. But, for those cases, I can’t do very much. Stroke? How many of you have a CT scanner or TPA in your office? Status epilepticus? I don’t carry controlled drugs here and never will. The only thing I can do is send these people to the emergency department immediately.
Even then, I’ve had a frightening number of my patients show up here with acute issues that are entirely non-neurologic. This has included crushing chest pain, unilateral leg edema, acute dyspnea on exertion, and (once) an obviously broken arm. So I send them to the ED, too.
I’m sure some people will say I’m uncaring, but that’s not true. Most days usually have 30-60 minutes of space where I can see someone in a pinch (noon, usually). So I can do the occasional legitimate work-in, and I do. Some patients try to take advantage of this more than once and quickly learn not to.
The problem is that if you accommodate everyone who wants to be worked in, your practice becomes a free-for-all. People cry "Wolf!" A line has to be drawn somewhere.
Dr. Block has a solo neurology private practice in Scottsdale, Ariz. To respond to this post, e-mail him at clinicalneurologynews@elsevier.com.