Family Medicine: Saturday Morning in the Office

Patients are different on Saturday morning. Family physicians often have Saturday morning hours which serve many purposes, including timely service to patients and minimizing the total calls to the physician on call for the practice.  It also serves a quality enhancement purpose by allowing the "Saturday physician" to see the patients of the other physicians in a cross covering role.  This keeps us aware of how we compare in our treatment patterns of various conditions and diseases and allows us to become familiar with some aspects of the families of our colleagues.  I've been doing Saturday hours since I started my family medicine residency training at the Penn State Hershey Medical Center. 

We try do avoid doing complex disease management on Saturday due to limited staffing and partly out of consideration for the physician's need to focus on acute illness and recover from the sometimes more chaotic weekday work.  Complex thinking about multiple diseases and therapies is done all week, but less of a priority on Saturday when the acute illnesses, especially infections, abound.  A very sick person with pneumonia who "crawled through" a work week while having shaking chills and shortness of breath could present the doctor with a very satisfying encounter involving a blood test (cbc w/ differential white blood cell count and possibly a basic metabolic panel), nebulizer treatment with albuteral, injection of Rocephin and maybe an urgent chest x-ray to clarify presence or amount of pneumonia.  That's fun because of the opportunity for quick improvement and positive vibes for both patient and physician .

There is "special needs" time on Saturday also for more time consuming discussions with patients and families, such as end of life discussions with a roomful of people about grandma or "Pop" when more relatives are available to interact.  Sometimes this is the best time to see persons with quadriplegia who may need more time for a vast array of concerns.  A complex hospital follow up, due to list clarification of drugs and specialists, may best fit on Saturday AM. The type of visits are driven by staff availability to assist with patients and procedures.  Doctor engagement and thinking is balanced against staff availability and mental energy of all concerned.  One long family visit for detailed engagement fits nicely but two may exhaust the team and disappoint the participants.

Young athletes are another good group of folks to see on Saturday AM, since they usually need to know what's wrong, how to get better and when they can practice/play again.  They sometimes want to find a way to stop playing, if they are misplaced in a sport or not getting to participate.  In family medicine we help them to identify the meaning of their situation and to move ahead accordingly.  Parents "own" the young athlete and I enjoy helping the family with their need to understand the whole set of options relative to their "child".  Having x-ray availability can make this part of the practice even more fun with the diagnosis and management of simple fractures (or the ability to quickly rule them out when the doctor needs imaging help).

Each office of family physicians decides how they wish to address the opportunity for Saturday practice, hopefully deciding on strategies that are of mutual benefit to their patients, their family/career and their community.