The Inappropriate Squeeze-in

The concept of the squeeze in patient visit is not a complex one. The patient should be an established patient with one straightforward complaint that will take 15 min or less to deal with (let's not forget it's an interpreted visit). In a perfect world, that is.

This week so far I have had some squeeze-ins of questionable appropriateness (note that I am powerless to control the patients that get fit into my daily schedule. My schedule is a living, breathing entity (sometimes a hot, stifling breath down my neck all day long), constantly in flux and unpredictable from moment to moment):

1. 45 year old woman (new to me) with "shortness of breath for 3 days". Upon further questioning, the patient has a longstanding diagnosis of sarcoidosis and has not taken her meds or followed up with her lung specialist in about a year. She has become very sedentary because of her shortness of breath (which has been more like months) and exercise intolerance. As a result she has gained some weight and was recently told she has high blood pressure (the other hidden reason for her visit). The list of things to be addressed: worsening chronic lung disease, new diagnosis of hypertension, new blood pressure medications, dietary modifications, and obesity. Sounds like a good ol' squeeze-in to me, right?

2. 43 year old woman for "follow up thyroid lab tests". Upon further questioning, the patient has been having chest tightness for a few weeks. Upon even further questioning, she is struggling with severe depression and anxiety since the recent death of her second husband, who dropped dead a few weeks ago at home at the age of 50. She is now left to care for her 2 sons, an 18 year old who dropped out of school and is not dealing well with the death of his father, and a 12 year old (with a different father who died suddenly in 2010). She is working 12 hour days to make ends meet, dealing with her own grief, and trying to organize the transport of her husband's ashes back to China. Things to be addressed today: new chest pain, anxiety, depression, grief, and hyperthyroidism (for which she is no longer taking her meds - probably not helping her anxiety).

3. 34 year old for "new patient". Ahhh! The kiss of death. We are never, ever supposed to have a new patient in a squeeze-in slot for obvious reasons (they are like a box of chocolates - you never know what you're going to get. Or maybe more appropriately a can of worms. A guaranteed 40 min can of worms fiasco). But alas, a 34 year old male, new patient to our clinic, with "abdominal pain". Chronic, long standing. Doesn't know his health history ("I think I have a fat liver. Or some liver problem.") The possibilties are endless!