You may be a thorn in your doctor’s side if you show these symptoms…

Have you ever noticed that your doctor rarely says, “is there anything else you want to discuss today?”

Doctors and health care providers (HCPs) are under ever-increasing pressure to see more patients in a shorter time. This may be due to capitation (by HMOs) or because the doctor is trying to make up in volume what he loses in declining reimbursement (from Medicare or insurance companies).

Doorknob syndrome is a phenomenon that occurs at the end of an appointment, after all issues have been addressed. The doctor stands up to leave, puts his hand on the doorknob, and the patient says, “One other thing… I have this painful enlarging lump on my leg that I’ve been worried about – you don’t have to look at it now – I’m sure it will be fine. ”

This is also called “oh, by the way, doc…” syndrome.

Obviously the doctor can’t just dismiss such a complaint and go on to the next patient. Often the patient brings up an issue other than why the patient made the appointment originally. Examples include fears of cancer, depression, a recent death, sexual issues (impotence is a common one), addiction problems, family relationship disasters, etc.

Such a patient may need tests, time spent listening, reassurance, careful examination requiring changing clothes, x-rays, etc. This can dramatically alter the flow of the day full of appointments and puts the HCP in a difficult position. Regardless of your past impression of him, his response at this critical moment may forever color your view of him. At the same time, it’s not reasonable to expect him to disrupt an entire clinic due to your failure to address this critical matter earlier.

You want to avoid being the source of the problem in this scenario. The physician sees this as evidence that you don’t value his time – one of the worst positions to be in as a patient.

You can avoid being diagnosed with doorknob syndrome by bringing up these issues earlier in the visit. More importantly, anticipate the length of time the conversations will take and budget time accordingly. In a modern medical practice, each appointment has a well-defined length of time attached to it. Call the nurse most familiar with the schedule and ask her how much time is budgeted for your appointment. If it’s too small, ask what steps you can take to get more time – pay a premium if necessary! If a doctor knows that you’re being frugal with his time, he may even review things before you come in and (gasp!) call you back to clarify things.

I have never heard a patient ask me, “How much time do we have, doc?”. If my patient asked me that, I’d sit in that room until all his questions were answered.