Waiting

Yesterday I saw a new patient: JW. She is a retired lawyer who became an author. We had a long philosophical discussion about language. It was fun. Unfortunately, it was long. So the patients after her were waiting for me.
I work very hard to stay on schedule. Patients shouldn't have to wait for me. Patients don't like waiting. No one likes waiting.
The medical practice is complicated. People are willing to wait for me because they understand that "things happen". A person is scheduled for only fifteen minutes because it is a routine follow-up of an easy problem. Then it turns out that there is something new wrong, or there has been some major development in their life that needs to be addressed. Then I'm late for the rest of the day.
Everyone I had to see yesterday after JW was very understanding. But they all made the assumption that there had been such an occurrence: an unexpected problem with a patient. I didn't volunteer to everyone that I had just been taking my time. I could have seen JW quickly. I could have averted the conversation entirely.
It's hard to say how much taking that extra time may have helped her, but I really don't think it helped her enormously. I know that there are some people that just need to talk, though. Perhaps she was that way. The "art" component of medicine goes largely unseen - even to me. I do many things out of a subconscious frame rather than a conscious frame.
Honestly, I think I was just "having fun". I do have fun doing my job, although some times are more fun than other times. The thing is that if I was just having fun and it wasn't so much of a great help to the patient I shouldn't have really caused people to wait.
I have some patients who I always schedule extra long visits with because they require more time. That's rarely due to the complexity of their illness. It's usually due to the complexity of the way they relate to the universe or the fact they're just more fun and I like to go slower with them. Some people just move at a different pace. So I change my pace to suit them. Again, it's part of the "art" - I don't exactly know why sometimes.
It's really important that I keep having fun at this job. Otherwise I'll turn into one of my colleagues who doesn't like what he or she does. That leads to not caring about the patients. That leads to not listening to the patients. That leads to missing details in the history that help with the diagnosis. It also leads to unsatisfied patients who know that their doctor doesn't really care about them. The problem with the schedule is that you can't really schedule fun. It isn't amenable to structure.
So yesterday, the patients had to wait for me to have fun at work. It wasn't quite right. Maybe it wasn't quite wrong. I don't know. It's hard to stay on schedule sometimes. The schedule is quite rigorous.