An Illustrated Guide to Primary Care: The DoorPeople

As the leaves of fall change, and the mucus starts to run the green and yellow of cough ‘n’ cold season in the waiting room, a subspecies of parent begins to populate the clinical areas of pediatric offices and emergency rooms across the country.  You can spot them by their particular posture and body language—hunched shoulders, crossed arms, raised brows and piercing glares—as they lean out from the thresholds of the clinic rooms in which their charges are placed. They are Those Who Cannot Wait, they are the parents whose looming presence and stare intends to light a mighty fire under the backside of the layabout clinician, to move it along already, to get in here and get ‘em seen before a supervisor needs to be called. This is their season. They are the Doorpeople.  And, I reckon, this is sort of an ode to them.

I first encountered the Doorpeople during my intern year of pediatric residency, while working in the busy emergency rooms of the hospitals I trained in. Downtime doesn’t happen very frequently in an ER I soon learned (and it turns out, rarely does it in primary care!).  Then and now, my shifts required a pace that was something like a canter (a bit more than a trot, but less than a gallop), in order to multitask successfully, while getting patients seen, giving the care needed, and keeping the flow going.

While most clincians may perceive themselves as hurrying—or even harried—it remains incumbent upon them to  to cone down their focus and chill the hurry when entering the room of a child and her family. While we all desire to be seen quickly, no one wants to be rushed through a visit. And, as a parent and consumer of pediatric services myself, I observe that the toil and output of a clinician may be barely perceptible. People appear to walk around…doing what? Physicians dart in and out of rooms, clutching files or scribbling notes. It isn’t like they are making balloon animals or producing widgets or some measurable outcome. Progress, in terms of how long til we see the next patient is impossible to measure from an outside persepective.

And hence: the Doorpeople. Why do they stand there?  For some, it may be a sort of ritual or a staking of turf; “this is my room, while I’m in it. You wanna enter? Go through me.”  For others, there may be a belief, however mythologic, that exhorts us to tarry faster, to arrive sooner through their force of will, personal charisma, or at times, frank intimidation.  All to render a faster arrival of the doctor to their quarters. Does it really motivate me to work faster? I’d say not. And, as clinical areas are a peculiar but necessary waystation in our lives, like the drycleaners or the body shop, they elicit an interesting spectrum of behaviors, a virtual party tray of colorful responses, such as standing with crossed arms in a doorway. Waiting. Fortunately, most folks sit politely, offer their kind and understanding for the many times we are running busy, and behind.

How to approach the Doorpeople in the wild? Most are benign, and entirely pleasant. Even the more aggressive posers abandon these behavioral displays as soon as we enter the room (though some subspecies bark at office staff and nurses, saving saccharine sweetness and respect for the doctor. Hey, it’s complicated). For my part, I assume what I hope is an appropriate blend of apology and humility for their understanding in the busy season of winter—and most especially—the year of H1N1. I sympathize, having done my own time waiting in my children’s pediatricians office (where, I might add, I refrain from doorsurfing).  Changing gears from waiting to visiting, a family and I begin our encounter, seeking to keep the well healthy, and investigating how to make our unwell children better.

Meanwhile, in the corridor, the cycle begins anew. New patients are roomed and situated, and from their ranks, a new Doorperson will arise, stationing themselves in their room’s threshold, beckoning us to carry on, faster please, in our day.