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July/August 2006


Patient: Are Noun and Adjective the Same?
By Richard P. Mills, MD, MPH
Chief Medical Editor, EyeNet

Most physicians I know are impatient by nature. Turnover time in the OR drives many surgeons to distraction, and this in large part explains the trend toward ambulatory surgery centers, where wasted time is kept to a minimum. I don’t know why we physicians are so impatient. Maybe we have the idea that our time is more valuable than anybody else’s. Maybe our drive for personal efficiency in the controllable aspects of our lives spills out into the sectors over which we have no control. The bottom line is frustration, even anger, about delay.

Most delays that I encounter are unmodifiable. When the car in front of me gets into an accident, I’m toast. On the freeway, the offending vehicle is seldom visible, and by the time I conjure an alternate route, thousands of fellow motorists have already chosen that alternative. (Impatient as I am, I refuse to dart ahead in the lane that is disappearing, only to nudge in front of some poor sap who has been waiting in line.)

But my heart soars when a delay is modifiable. Like at the supermarket, the home improvement store or at customs at the border. Lines of people, and I get to study who is waiting before I choose a lane. At the store, avoid the overfull cart, and the slow cashier I’ve encountered before. At customs, avoid suspicious-looking characters. Despite my careful strategy, I usually choose wrong. In my line is the man with three items, who scans his debit card (wait while it is electronically checked), finds lack of sufficient funds, and then tries three other cards to no avail. Then there is the little old lady with a little-old-lady-sized pile of items that she can carry home in her canvas shopping bag, standing in line just in front of me. She waits more patiently than I, and when she has observed her items scanned, bagged in her canvas bag, and a receipt printed, then she begins rummaging through her purse for her wallet. Finding it in a compartment she had least suspected, she produces the bills and then pokes through the coin purse looking for exact change. While I wait, I look to my right and discover a package of formerly frozen peas resting quietly in the Big Red chewing gum display.

At customs, the Caucasian dressed in the blue serge suit in my line is exhaustively questioned, has his bag emptied and searched, and finally he is escorted to immigration services purgatory. I reassure myself that lightning seldom strikes twice in the same line.

I’m also thinking about the clerks who finally get to serve the people who have been waiting in line. The longer the line, the more insistent the people are when they get to the front. At these times, I also think about my patients. How curious that patience is pronounced the same as patients. People who are used to waiting in line, like my Russian immigrant patients, are obsequiously grateful, yet confrontational. They have learned that once you get to the front of the line, it is important to befriend the clerk (doctor) and get your problem solved in one encounter, lest you have to go to the back of the line to start over. But patients don’t have to be Russian to behave that way, which is why, when you are seriously behind at the office, it is almost impossible to catch up. When they are finally seen, patients are more demanding than they would have been if they had been seen on time.

What really troubles me is that I am headed for that phase of my life when I will be a patient, and I am ill-equipped to be a patient patient. Either I’m going to have to learn patience quickly, or I’m going to be one of those patients you mutter about when you get home.