Carry-on luggage

We had run the gauntlet of TSA screening. Actually, it was more of a shuffle. We both had our shoes back on, and I rethreaded my belt as Marilyn and I walked toward our gate. Next, of course, was waiting and more waiting. Eventually, there was the call from the podium that boarding would start.

First were those obnoxious medallion people. You know, I never see any of them actually wearing their medallions. Then it was time to load by the letters. We were in D, which isn’t as bad as E or F. And I guess I wouldn’t want to be in A and risk sitting too close to the restrooms in the rear.

As I watched the A, B, and C folks troop by, I was impressed at the astounding variety of what they had self-proclaimed as carry-on luggage. It varied in size from large to enormous. I swear I saw something moving inside a duffle bag dragged by a college student. Some pieces had sharp pointy features. There were long tubes and plastic bags bulging with who knows what. Often, it was hard to tell what was a "personal item" and what was luggage.

Once seated on the plane, the entertainment continued as the E and F people struggled to stow their stuff. Clearly, some of them had no plan for what they would keep with them and what would go in the overhead. A small herd of passengers would back up in the aisle as minutes of indecision ticked by.

As the flight attendant began her seatbelt monologue, my mind floated back to last week’s all-provider meeting, at which one of the administrators announced that the long-promised patient Internet portal was on the launch pad. In concept, I’m a big fan of giving patients better access to their records and lab work. I think a portal will allow us to guide patients to health information sources we deem reliable, but I get a bit uncomfortable when I hear that patients will be able to make their own appointments.

Filling a physician’s schedule is a lot like loading a plane. Just like airline passengers, patients arrive at the doctor’s office with a wide variety of baggage. Some have a single issue that is troubling them. Others have been collecting complaints for months. Some have organized their questions on written lists. Many haven’t given much thought to prioritizing their issues and the physician is left to sort out what is the real problem. I suspect that most patients assume that all of their complaints will fit into a usual-length office visit, just as they assume their luggage will fit in the overhead bin or under the seat in front of them.

There are only so many hours in the day, and the physician and his staff must figure out how to get all that baggage stowed away safely in a reasonable time and with a minimum of unnecessary waiting for the other patients.

An experienced receptionist understands that different chief complaints require visits of different lengths. She or he also knows the patients well enough to realize that Mrs. Drifty’s visits are always twice as long as Mr. Organized’s, and that Dr. Speedy can see two patients in the time it takes Dr. Pokey to see one. A good receptionist/nurse team also can identify the patients who should be seen early in the day, regardless of what the schedule looks like.

It scares me to think of what might happen when patients are allowed freehand to make their own appointments. I fear that many will underestimate the amount of time their complaint takes to resolve. I dread the thought of what might happen if, at 8 a.m., the parent of a child with a fever and a purpuric rash clicks on a 4 p.m. slot instead of speaking to the nurse.

I can envision a few strategies that might avoid some of the potential scheduling disasters. The best option, I suspect, is going to be a carefully crafted hybrid that includes live receptionists. I’m sure some of you already have experience with patient-portal appointment schemes. I am interested to hear what’s working and what’s not. I’m afraid I’m going to have to buckle up because it’s probably going to be a bumpy ride.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. This column, "Letters From Maine," appears regularly in Pediatric News. E-mail Dr. Wilkoff at [email protected].

We had run the gauntlet of TSA screening. Actually, it was more of a shuffle. We both had our shoes back on, and I rethreaded my belt as Marilyn and I walked toward our gate. Next, of course, was waiting and more waiting. Eventually, there was the call from the podium that boarding would start.

First were those obnoxious medallion people. You know, I never see any of them actually wearing their medallions. Then it was time to load by the letters. We were in D, which isn’t as bad as E or F. And I guess I wouldn’t want to be in A and risk sitting too close to the restrooms in the rear.

As I watched the A, B, and C folks troop by, I was impressed at the astounding variety of what they had self-proclaimed as carry-on luggage. It varied in size from large to enormous. I swear I saw something moving inside a duffle bag dragged by a college student. Some pieces had sharp pointy features. There were long tubes and plastic bags bulging with who knows what. Often, it was hard to tell what was a "personal item" and what was luggage.

Once seated on the plane, the entertainment continued as the E and F people struggled to stow their stuff. Clearly, some of them had no plan for what they would keep with them and what would go in the overhead. A small herd of passengers would back up in the aisle as minutes of indecision ticked by.

As the flight attendant began her seatbelt monologue, my mind floated back to last week’s all-provider meeting, at which one of the administrators announced that the long-promised patient Internet portal was on the launch pad. In concept, I’m a big fan of giving patients better access to their records and lab work. I think a portal will allow us to guide patients to health information sources we deem reliable, but I get a bit uncomfortable when I hear that patients will be able to make their own appointments.

Filling a physician’s schedule is a lot like loading a plane. Just like airline passengers, patients arrive at the doctor’s office with a wide variety of baggage. Some have a single issue that is troubling them. Others have been collecting complaints for months. Some have organized their questions on written lists. Many haven’t given much thought to prioritizing their issues and the physician is left to sort out what is the real problem. I suspect that most patients assume that all of their complaints will fit into a usual-length office visit, just as they assume their luggage will fit in the overhead bin or under the seat in front of them.

There are only so many hours in the day, and the physician and his staff must figure out how to get all that baggage stowed away safely in a reasonable time and with a minimum of unnecessary waiting for the other patients.

An experienced receptionist understands that different chief complaints require visits of different lengths. She or he also knows the patients well enough to realize that Mrs. Drifty’s visits are always twice as long as Mr. Organized’s, and that Dr. Speedy can see two patients in the time it takes Dr. Pokey to see one. A good receptionist/nurse team also can identify the patients who should be seen early in the day, regardless of what the schedule looks like.

It scares me to think of what might happen when patients are allowed freehand to make their own appointments. I fear that many will underestimate the amount of time their complaint takes to resolve. I dread the thought of what might happen if, at 8 a.m., the parent of a child with a fever and a purpuric rash clicks on a 4 p.m. slot instead of speaking to the nurse.

I can envision a few strategies that might avoid some of the potential scheduling disasters. The best option, I suspect, is going to be a carefully crafted hybrid that includes live receptionists. I’m sure some of you already have experience with patient-portal appointment schemes. I am interested to hear what’s working and what’s not. I’m afraid I’m going to have to buckle up because it’s probably going to be a bumpy ride.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. This column, "Letters From Maine," appears regularly in Pediatric News. E-mail Dr. Wilkoff at [email protected].

We had run the gauntlet of TSA screening. Actually, it was more of a shuffle. We both had our shoes back on, and I rethreaded my belt as Marilyn and I walked toward our gate. Next, of course, was waiting and more waiting. Eventually, there was the call from the podium that boarding would start.

First were those obnoxious medallion people. You know, I never see any of them actually wearing their medallions. Then it was time to load by the letters. We were in D, which isn’t as bad as E or F. And I guess I wouldn’t want to be in A and risk sitting too close to the restrooms in the rear.

As I watched the A, B, and C folks troop by, I was impressed at the astounding variety of what they had self-proclaimed as carry-on luggage. It varied in size from large to enormous. I swear I saw something moving inside a duffle bag dragged by a college student. Some pieces had sharp pointy features. There were long tubes and plastic bags bulging with who knows what. Often, it was hard to tell what was a "personal item" and what was luggage.

Once seated on the plane, the entertainment continued as the E and F people struggled to stow their stuff. Clearly, some of them had no plan for what they would keep with them and what would go in the overhead. A small herd of passengers would back up in the aisle as minutes of indecision ticked by.

As the flight attendant began her seatbelt monologue, my mind floated back to last week’s all-provider meeting, at which one of the administrators announced that the long-promised patient Internet portal was on the launch pad. In concept, I’m a big fan of giving patients better access to their records and lab work. I think a portal will allow us to guide patients to health information sources we deem reliable, but I get a bit uncomfortable when I hear that patients will be able to make their own appointments.

Filling a physician’s schedule is a lot like loading a plane. Just like airline passengers, patients arrive at the doctor’s office with a wide variety of baggage. Some have a single issue that is troubling them. Others have been collecting complaints for months. Some have organized their questions on written lists. Many haven’t given much thought to prioritizing their issues and the physician is left to sort out what is the real problem. I suspect that most patients assume that all of their complaints will fit into a usual-length office visit, just as they assume their luggage will fit in the overhead bin or under the seat in front of them.

There are only so many hours in the day, and the physician and his staff must figure out how to get all that baggage stowed away safely in a reasonable time and with a minimum of unnecessary waiting for the other patients.

An experienced receptionist understands that different chief complaints require visits of different lengths. She or he also knows the patients well enough to realize that Mrs. Drifty’s visits are always twice as long as Mr. Organized’s, and that Dr. Speedy can see two patients in the time it takes Dr. Pokey to see one. A good receptionist/nurse team also can identify the patients who should be seen early in the day, regardless of what the schedule looks like.

It scares me to think of what might happen when patients are allowed freehand to make their own appointments. I fear that many will underestimate the amount of time their complaint takes to resolve. I dread the thought of what might happen if, at 8 a.m., the parent of a child with a fever and a purpuric rash clicks on a 4 p.m. slot instead of speaking to the nurse.

I can envision a few strategies that might avoid some of the potential scheduling disasters. The best option, I suspect, is going to be a carefully crafted hybrid that includes live receptionists. I’m sure some of you already have experience with patient-portal appointment schemes. I am interested to hear what’s working and what’s not. I’m afraid I’m going to have to buckle up because it’s probably going to be a bumpy ride.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. This column, "Letters From Maine," appears regularly in Pediatric News. E-mail Dr. Wilkoff at [email protected].