Canadian Journal of Rural Medicine

 

Chaos in the office

Suzanne Kingsmill, BA, MSc
Shawville, Que.

Can J Rural Med vol 2 (4):194-95


We welcome any tales you might have about rural practice or any particularly interesting places that you have visited. Please send submissions to the Canadian Journal of Rural Medicine, Box 1086, Shawville QC J0X 2Y0.

© 1997 Suzanne Kingsmill


What do you do when 1 of your 2 medical secretaries is on a long-overdue holiday and the other needs 2 hours off to go to a funeral on the only morning of the week when all 3 doctors are in the office and you have no other staff to take up the slack? With no back-up pool of medical secretaries a phone call away, as would be available in the city, often the only recourse for rural doctors is to rope in unsuspecting neophytes or family members. In this case, a spouse with a day off work but no experience in a medical office was asked to join a nursing student with 1 day of supervised experience under her belt.

It looked innocent enough at 9:30 in the morning when I arrived. All was peaceful and quiet. The secretary was explaining patient procedure to the student nurse. She was to do all the chauffeuring of patients to the examining rooms and get their vital stats. I would run the office.

Things were in full swing by 10:00. I'd learned how to swipe the card through the thingamy and stash it in the patient's file and then stack the files in order of appointment. Meanwhile, after a number of false starts, the nurse was getting confident at showing the right people to the right examining room for the right doctor to see.

At 10:15 the secretary left a peaceful, smoothly running office -- only 2 patients had arrived. "It'll be a breeze. Nothing to it," said the departing secretary, who didn't seem to realize how invaluable she is. It didn't take long for everyone else to find out. By 10:30 we were off the rails, as the waiting room filled up and requests to be squeezed in came at me like machine-gun fire. What was a novice to do? Each call sounded like an emergency. I pencilled them all in.

The 2 phone lines jumped into action with people asking for information they absolutely had to have but which I couldn't find or didn't understand. Try listening in on a conversation with a pharmacist reading out what he thinks the doctor wrote to someone who doesn't have a clue what the pharmacist is saying because he's talking in medical abbreviations. (QID? Quit In Disgust?) Or try being patient with someone who is calling for the fifth time in 15 minutes to recount his life history while Frank Sinatra croons full blast in the background.

Cradling the receiver on my shoulder I stuck both lines on hold while I tried to figure out what to do with a drug rep loaded down with samples and fielded requests from the doctors, ranging from "Where is so-and-so's allergy serum?" (where indeed?) to "Why is my patient in exam room 3?" or, worse, "Where is my patient?" Meanwhile, the 3 doctors either valiantly tried to pretend they didn't know that their office was being run by 2 complete neophytes or were totally blind to the simmering panic emanating from their very temporary staff.

One of the doctors was called away to the hospital for 15 minutes, and I was left to placate his patients, when the upstairs tenant burst upon the scene saying her pipes were leaking. The drug rep, cooling her heels in the back room, confirmed it by pointing to our ceiling, where a nice large wet stain was spreading. As I dialled a plumber I wondered if this was supposed to be part of the secretary's job.

Some of the folks in the waiting room were beginning to get antsy about having to wait, when a large, beefy woman staggered up to reception. She was cradling her jaw in her hand and mumbled something about a horrible toothache. All I could see was the grey pasty look of her face and the panicked look in her eye. It was contagious -- the panic I mean. I pencilled her into the already-well-pencilled-in schedule of her doctor, never suspecting that the doctor she asked for was not her doctor at all. Only an experienced secretary would be wise to the wily ways of desperate patients who think they are dying -- except that she looked as though she was dying. I finally collared her doctor and pointed her out to him. "Who the hell is that?" he asked. As the student nurse helped her into the examining room I got more nasty looks from those in the waiting room for letting someone jump the queue, especially someone it turned out no one knew. In everybody's hindsight I should have sent her to the dentist, pronto.

I tried to ignore the ominous sighs of growing impatience coming from the overstuffed waiting room and fielded another batch of phone calls, including the fifth one from the guy who wanted to tell me his history. As I was hanging up, the nurse came in, looking as harried as I felt. Mrs. Toothache had been sick and had collapsed on the floor of the examining room. We needed an ambulance. I picked up the phone and was nearly blasted away by Frank Sinatra. Only in the country can you still be connected to a caller if they forget to hang up! I reached for the second line before it could ring again and called an ambulance.

It was not until later that I learned that that was the only time in the long history of the office that an ambulance had arrived to take a patient to hospital. Of course it was all around town within hours, every version of it from death by choking to a nasty midday mugging, to a false alarm, to the doctor making a huge blunder, to the stretcher getting stuck in the corridor on the way out, which, actually, it did. No word about the neophyte secretary jumping to conclusions and diagnosing impending death when it was just a toothache.

After the ambulance left there was an eerie quiet as the rest of the patients trooped in to see the doctors without a murmur of complaint, while I directed them to the right room and the student nurse cleaned up the third examining room. Even the phone had gone silent, and things looked so deceptively normal by the time the last patient left that when the secretary finally returned she took one look at the empty waiting room and said, "See? I told you it'd be a breeze."

Yeah. Right.


| CJRM: Fall 1997 / JCMR : automne 1997 |