Psychiatric Appointments: Fighting Against the Clock

For me the best part about my job is being able to listen to people. It sounds cliche, but it is the truth. When a patient is in front of me, it is as if the rest of the world falls away. Everything I might have been worried about or distracted by slips from my mind, and the patient I am looking at has my entire focus. It is honestly a mindful experience that I hope brings as much peace to others as it does to me. It is something I thoroughly enjoy. Unfortunately, as easy as it is for me to lose myself in my search to enter the experience of another person, there is one ever looming adversary to my peace: the clock. I loathe the clock. Really! Yet, I live in a world of appointment times that gives the clock mastery over my work life. Fortunately for me, even the pressure of the clock almost always falls away when I am speaking to a patient too, but there must be some nagging reminder tucked away in my mind that makes me aware that I have to keep going to reach the conclusion of the appointment, because usually someone else is waiting for their appointment. 

I cannot speak to the experiences of other psychiatric providers, but one thing I believe is likely to be true for most people is that it is harder to be compassionate and caring when you are in a rush. In 1973, Darley and Baston [1], published a study evaluating the helping behavior of students in a seminary school, people seemingly likely to want to help others. These students were placed in a situation where they were being told that they needed to give a talk in the next building. Some of the students were told they were late for the talk. Some were told that they were right on time. Some others were told they had a few minutes before the talk. In the process of walking to the next building next door they passed a person acting as a victim, sitting slumped in a doorway, not moving, eyes closed, and head down. This person coughed twice and groaned as the student passed. Only 10% of those students who were told they were late for the talk, stopped to offer help to the person acting as a victim. Of those who were told they were on time, 45% stopped to offer help. However, 63% of those students who were told they had a few minutes before their talk stopped to offer the person acting as victim help. Despite personality measures being administered and various conditions of the study being different for different students, perceived availability of time was the only thing that was found to be significant for making a difference in whether someone stopped to offer help.

For many psychiatric providers, they are scheduled to see a patient every 15 minutes, sometimes after not having seen the patient for more than a month. While I personally feel that having appointments with such small amounts of time and large gaps in-between is not the ideal way to provide psychiatric care, it does appear to be a standard within the field. For this reason, I encourage you to be an advocate for your own care and take any steps you can to help your psychiatric provider rush less and have more time to focus on your needs. I recognize that as the patient you often are not responsible for your provider feeling rushed. I also believe firmly that you deserve compassionate care. I hope that the field of psychiatry will change to reduce the time pressure placed on appointments. Until that time, try taking the following steps to help prevent care that is rushed.

1. Arrive at Appointments a Few Minutes Before the Scheduled Time: I want to be clear: I am not telling you to show up a little early as a benefit to your psychiatric provider.  I am encouraging you to show up a few minutes early so that you will have taken care of any administrative issues and be available when your provider is ready to see you so you will get the maximum amount of time from your appointment. Unfortunately, I am aware that there are some providers out there who make choices resulting in patients having to needlessly wait, and then they try to rush through appointments to catch up, which is not respectful to their patients time or care. However, I would like to believe that most providers are trying to be on time, but if their patients are held up in the waiting room (real or virtual) completing forms at the time of the appointment, they then start to try to balance time concerns with providing care. In that situation, the provider might start to feel rushed, which may mean your care could be impacted.
   

2. Bring Hospital Discharge Paperwork, Lab Results, and Medication Lists to Your Appointment: Being prepared with this information can reduce the amount of time your psychiatric provider has to spend to go find it. Hopefully, this will increase the amount of time your provider has to address your concerns and reduce the feeling of being pressed for time. I can speak from personal experience that it is very stressful to realize that the lab results were not received from the lab or hospital discharge paperwork was not sent over, and then having to spend half the appointment trying to obtain it. If your provider is using the time to obtain this information they are likely to have less time to spend with you and may feel rushed, which may have a negative impact on the quality of care you receive.
   

3. Lead with What You Need to Have Your Psychiatric Provider Address: If you are having a problem or concern with your treatment, it is best to make sure that the conversation with your psychiatric provider starts with that issue. Allowing the provider the most time possible to address those concerns may improve the quality of the decision making process. It is completely understandable that some other issues may be on your mind. Perhaps something happened that was bothersome, but does not necessarily require the attention of your psychiatric provider. I know I would like to hear about what is going on in your life. Understanding your lived experience is important to me and to your care. However, if a serious issue is not addressed until near the end of the appointment, this potentially could result in your psychiatric provider not having enough time to come up with the best treatment plan with you.
   

4. Focus On What Is Important to Communicate to Your Psychiatric Provider: When discussing issues you are having, be sure to stay focused on the information that is most important to your psychiatric provider for them to provide you with the best care possible. As a patient, it is completely understandable that you may not know what is the most important information to share. Feel free to ask your provider what information they may want to know about the issue you are concerned about. If after your provider asks questions and you have a feeling that there is information that is important about your situation that your provider did not ask about, be sure to mention it. The goal is to work together with your psychiatric provider as a team to help you receive the best care possible.
   

5. Request a Follow-Up Appointment in a Short Period of Time if You Have Several Issues: It may be that you have several issues happening at once. That can happen. There may be too many things to deal with during your appointment time. If you know there are many things to address, come prepared in order of importance. Review the list with your provider and ask if another appointment can be scheduled very soon to address the remaining issues that can’t be dealt with that day. It may be better to have multiple appointments than to try to rush through all of the issues in one appointment. That way, each problem can receive adequate attention to help you receive the best care.

Ideally, the relationship between a psychiatric provider and a patient should be as a team. Afterall, the psychiatric provider is an expert on various psychiatric treatments, but only you are an expert on you, your life, and your goals. Having a teammate who is rushing to help you with your care may result in less than ideal outcomes for you. Taking these 5 steps may help to facilitate an interaction that allows for more time and less rushing, which may ultimately benefit you. Wishing you continued success on your mental health journey!

David Newby, APRN, PMHNP-BC

Breezy Mental Health, LLC

Disclaimer: This article is for informational purposes only and should not be used as a replacement for medical advice. Always consult with a healthcare professional for accurate information for your situation. 

References:

1. Darley, J. M., & Batson, C. D. (1973). "From Jerusalem to Jericho": A study of situational and dispositional variables in helping behavior. Journal of Personality and Social Psychology, 27, 100-108. Retrieved from https://greatergood.berkeley.edu/images/uploads/Darley-JersualemJericho.pdf