I am being sorely tested...
by all involved parties. First we get smoked by our walkins today (3x the usual number) and then our staff is doing their best to give the exponentially enlarging snowball an extra kick before it gets to me. I love the fact that people who are not ultimately responsible to care for a patient are more than willing to sign them in when they don't have an appointment since it's my responsibility to take care of them. Soon I will be in a job that doesn't have walkins and I won't have subordinate personnel who can arbitrarily add to my workload.
Being a provider with a schedule of patients is an occupational experience that most people don't comprehend. When you have a schedule, you are locked into that schedule. Your day is dictated by the schedule and you must stick to it or suffer complaints and backlash from patients and staff alike. As a provider I accept this, because it's what I get paid to do. Where I get really frustrated is when other people through ambivalence, naivete or outright intention add to or otherwise complicate my schedule. I don't mind a busy, fully booked schedule. The busier I am at work, the faster the day goes by. I pride myself on staying ahead of my schedule, finishing my notes in a timely manner, and getting all the time sensitive issues handled as soon as safely possible. When it's up to me, this is very rarely a problem. The only time I typically fall behind is through the action or inaction of others.
Today we had 15 people signed in for sick call, and we only have 90 minutes to see them before appointments start. The frustrating thing is that most of these people don't truly have acute medical issues. Most of our sick call patients are here because they don't want to wait for an appointment, or they are trying to get out of work. Rarely do I see a patient on sick call that I think "It's good you came in when you did, because this was a serious issue". Most of the time I think "Why would anyone ever seek medical treatment for this issue?" This gets back to my fundamental problem with most clinic visits by soldiers which is that they get free healthcare and have the secondary gain of time away from work, duty modification, etc.
The NCOs responsible for triaging the acute patients are not very good at what they do. They have a tendency to not want to enforce sick call complaints to acute only, and if the patient argues with them or insists on being seen, they sign them in. Military patients essentially have no negative reinforcement system for spurious complaints. The worst thing that happens to them is being told they are normal or their issue doesn't require any more workup or treatment. Even in those cases, they were at least able to get out of pt and work for a few hours. Patients can no-show, malinger, drug seek, or engage in a multitude of fraudulent or exaggerative behaviors and they very rarely get held accountable. This is one of the reasons I have sought employment elsewhere. The secondary gain issue is fairly common with the normal active duty population, but it's the modus operandi of the meb patient. I don't know how any competent provider with military experience could tolerate long term employment with this population. "Never has so much been done for so few who are so less deserving" - this should be the clinic motto. I find myself less and less proud to be an American citizen and retired soldier the more of these types of patients I am exposed to. There is a significant portion of the young population who look at the world as a set of entitlements with no requirement to work or produce for those entitlements.
I'm rambling now. Rant over. I expect my relative attitude will improve here shortly.