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It's About Time

It was a busy night in the emergency department as many nights are. All of the rooms were full and there were 6 to 8 patients waiting just to get back to the emergency department. I hadn’t taken a break in several hours, and though I was hungry I just drank sips of Gatorade and ate handfuls of cashews between patients to keep my energy up and to keep my stomach from growing too loudly at me.

Sometimes during nights like this it seems like the “powers that be” try to mess with your mind. Every time you discharge one patient, two more patients register to be seen. If you discharge two patients, three patients register to be seen. The more you try to get ahead, the more behind you get. Then you start thinking. If I didn’t discharge anyone, th-e-e-en how many patients would register?

Snap out of it WhiteCoat. Looks like another “no dinner” night.

The next patient waiting to be seen was a middle-aged man who was suffering from a cough and sinus drainage for the prior three weeks. The patient was going to be seen by his primary care physician the following morning, but did not want to wait for the appointment. He had been waiting a little more than an hour to be seen. As I opened the door, the man was laying back on the bed watching something on his iPhone. His wife sat in the chair across the room and was apparently typing out a text message on her flip phone. I could hear the Morse Code-like beeps every time she entered a letter.

As I walked in the room, the woman looked up, let out a dramatic sigh and said “F-i-i-i-i-nally.”
I tried to explain. “I’m Dr. WhiteCoat. I apologize about the wait, but it is a very busy night this evening. I’m trying to see patients as fast as I can. What can I help you with?”
“Huh. It’s about time.”
“Ma’am, I haven’t gone to the bathroom in three hours and I haven’t eaten a meal since my bowl of cereal at breakfast this morning. I’m going as fast as I can.” I then turned to the patient and asked “What is it that I can help you with?”
The wife then butted in again. “Honey, can you even remember what’s wrong? It has been a while that we’ve been waiting here.”
That ticked me off. Actually, I was ticked off by the wife’s attitude to begin with, but that comment was it. Rather than lash out, I decided to take a break. “Pardon me. I need to go check something.”
I got up, left the room, told the charge nurse that I was taking a short break, and went to the doctor’s lounge. I emptied my bladder. Then I went down to the cafeteria and got a small dinner plate. I brought it back to the doctor’s lounge and ate while talking to one of the other staff physicians. After finishing my dinner, I went back to the emergency department.

One of the nurses told me that the patient’s wife had been out to the desk to complain during the 15 minutes I was gone. The nurse had ordered a chest x-ray just to appease the patient and his wife. I nodded.
I discharged a patient whose chart had been placed in the discharge rack after labs had come back normal and he was feeling better.
Then I went back into the coughing patient’s room. He was still in the radiology department finishing up with his chest x-ray.
The patient’s wife looked up at me, scowled, and asked “What … is taking you so long?”
I smiled back at her and said “You were right, it was about time.”

Strange. She wasn’t in the room when the patient got back from x-ray.


  1. Heh. I like your style, Doc! Maybe next time those two morons will refrain from using an emergency department for a NON emergency. …No, wait. That would require something neither of them seems to possess: intelligence and common sense.

  2. What an idiot. I might complain about some things, but I have NEVER complained about waiting in the ED as long as everyone was breathing, etc. If it’s busy, and you’re ok, you’re gonna wait.

  3. Another satisfied customer. Unfortunately, you just described the people that actually send back the Press-Ganey survey.

  4. “Ma’am, you seem very upset. I’ll just give you a few minutes to calm down and then we’ll try this again.”

  5. She’s lucky. My hospital would have punted them out of the room, into the hallway, next to the screaming drunk in 4 point restraints.
    (Under the guise of needing monitor room)

    Time weighing heavy on your pin size brain? Enjoy your free floor show.

    Props for knowing you needed a sanity break.


  6. Haha another win for the WhiteCoat.

    “Do you even remember whats wrong since its been so long?”

    My thought: “Well since you cant remember whats wrong then it must not be an emergency and you can go now, just remember to fill out the satisfaction survey!”

  7. apparently the clipboards (yes, i realize i am technically one of them but i do still work clinically) are upset because patients during our recent month-or-so surge in patient volume have started complaining on their surveys that they are being made to wait too long (to be seen, to have tests performed/resulted, etc) because their nurse/doctor is overwhelmed taking care of too many other patients. “how can i get good care when my nurse has 12 other patients to look after?” one survey said.
    they would like us to stop complaining to, or within earshot of, the patients that we are overwhelmed, because we are “airing our dirty laundry.” this from an administration that is hell bent on never being on diversion, no matter how dangerous conditions get in our department (are routinely boarding 20-30 inpts nowadays).
    the question is, given that the actual wait times they are complaining about is not going to change, would it be better received for us to apologize for the wait time but not offer any explanation?
    i tend to thank people for their patience rather than apologizing… don’t really care to apologize for something i have no control over and quite frankly i feel like the patient, the nurse and i are all victims of the overcrowding problem.

  8. I recently ended up in the ED within the last week for dehydration – first time there in over 8 years. I was sent by my regular care provider for IV rehydration. I didn’t want to go, because in my mind the ED is for heart attack/stroke/compound fractures/etc. I called the nurse advice line with my insurance company to see if I had any other recourse, and even she said with the other extenuating circumstances in my medical history right now, I really needed to go. Fine.

    I had to wait about an hour to be taken back. After back there, I had to wait again for my nurse to come. Then for my doctor to come. They hooked me up to an IV (after waiting for my tech to come do it) and left me for awhile for it to run… and probably about another 30-45 minutes after it was done to come check on me. Then they hooked me up to BP and pulse monitors and left me again.

    You know what? I’m THANKFUL. The fact that they weren’t in there unfortunately meant that there were a LOT (they were very busy) of people that were in MUCH worse condition than I was. Ambulance calls came in over the speaker in my room constantly – I didn’t fall 12 feet off an icy ladder on my head onto the concrete. I didn’t have sepsis. I wasn’t having stroke symptoms.

    Stop being so self-focused! (Not you, WC) Seriously – be thankful they didn’t kick you out when you said you had an appointment with your doctor the next morning and didn’t feel like waiting. What the heck is that?! And if your spouse/friend/neighbor is being rude to the caregiver when you’re there and you’re not incapacitated – tell them to SHUT UP and have some respect! I don’t fault you at all for walking away for a break, WC. I hope the powers that be don’t give you crap for that decision.

  9. A restless job you have.

  10. Last time I was at the ED, there was someone complaining about the wait, in a similar manner to the EB* you describe. I told her, “Hey, be thankful: That they’re not rushing us back right away means we’re not dying.”

    She gave me the evil eye and moved to the other end of the waiting room, where I assume she was hoping for a more sympathetic audience.

    * EB = entitlement b****. Customer service slang for a customer (or patient, in this case) who feels hard-done-by that you can’t drop everything to fawn over them and give them everything in your store for free because their visit wasn’t good according to their impossibly high standards. Can be used to describe both males and females. Example would be someone who goes into a fast food joint in the middle of a rush, orders $500 of fast food without calling ahead so you could get it ready ahead of time, asks to get it for free because it took you thirty minutes to fill the order, and throws a (possibly violent) tantrum when the manager rightly refuses.

  11. I would have just said ‘OK, if you can’t remember what your complaint is, it must not be an emergency. I’m going to go see the people with emergencies first. I’ll be back in two hours to see if you’ve remembered. If you’re still here. Otherwise, door’s to your left.’

  12. I just say ” What is your EMERGENCY ? The one requiring me to leave three strokes and a heart attack to come see you ? The one you already have an appointment for the very same problem?”
    My PressGainey’s aren’t always the greatest but they’re not bad either.
    And I agree on the admin pukes refusing to let us go on divert- from the comfort of their house. I’ve threatened them with calling the news station to send a reporter down and see how the administration is only worried about money and not patient’s safety.

  13. Good for you! :)

    And then you get the little old people with chest pain that don’t want to rush you because they can see your busy.

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