Waiting and Waiting and Waiting

How often have you shown up on time to see your doctor and spent the next hour waiting to be seen?

A couple of weeks ago a patient of mine experienced this when a mix-up in the clinic resulted in her waiting an hour for me to come into the exam room. At the same time I erroneously believed she hadn’t shown up yet and was waiting on her. I couldn’t apologize enough to the poor lady who probably felt as though she’d been abandoned to old issues of Good Housekeeping and looking for hidden pictures in last month’s Highlights magazine.

Waiting on a doctor is as much an age-old stereotype as bad penmanship. Despite how often the waiting room serves as the setting for single-panel cartoons, few affected patients find much humor in it. The experience seems to be ubiquitous with nearly everyone having a story of an afternoon wasted in a stale waiting room wondering if their doctor snuck out to the golf course.

Plenty has been written on the subject (web sites offer tips on what to bring with you to kill time as you wait—knitting and novels seem to be the universal recommendation) and research studies (in a silly attempt to codify the obvious) show that patients’ clinic experience worsens as their delay lengthens.

While some patients are highly tolerant of delays—viewing the boredom as a chance to catch up on their latest reading—most are appropriately put off by what they perceive as poor scheduling and insensitivity on the part of medical offices. One patient was insulted enough that he launched a lawsuit to recoup the money he lost while camped out in his doctor’s holding cell. The court sided against the patient—I guess this indignation is so common that even jurors feel it is an expected part of life: death, taxes, and wasted hours in doctors’ offices.

I try my hardest to keep my patients from waiting, and I think most doctors would say the same thing. Admittedly, I know colleagues who don’t place a premium on promptness and will knowingly make a patient wait so they can chat in the doctors’ lounge or catch up on email, but these bad apples are in the minority. Despite our best efforts, it is inevitable that some patients will end up staring at their watches as their appointment time goes by. Why is this?

• Doctors are frequently called away for emergencies or have procedures that last longer than planned. We try hard to build into our schedules an accurate estimation of how long a surgery will last but can’t always plan for unanticipated complications or difficulties.
• A patient showing up even a little late for an appointment can throw a schedule off for hours. Similarly, a person with complicated problems can slow things down tremendously. In my clinic, a visit with a stable patient can take no more than 10 or 15 minutes, whereas a sick individual that I end up hospitalizing can consume more than an hour of our time.
• Sometimes we end up scheduling more patients that we can accommodate in a timely manner. Most often this is not done on purpose but rather out of medical necessity—it’s not uncommon for patients or other doctors to request an immediate visit for an urgent problem. These add-on appointments obviously delay the schedule for other patients.
• Finally, some of us just aren’t that quick. This is not necessarily a bad thing and may come as a result of the doctor being extra vigilant and thorough.
• Simple economics predispose offices to suffer this problem, especially in the primary care arena. These hard-working doctors are often inundated with dozens of patients on a typical day (not to mention the numerous phone calls, medication refills and laboratory results that need attention) and simply cannot afford to voluntarily lighten their schedule without risking the solvency of the practice. The only real fix for this particular aspect of the problem is a much-needed restructuring of the national reimbursement system.

I am not providing this list in an attempt to excuse tardiness on the part of the medical establishment. On the contrary, I would make the case that none of these issues are inevitable and all are modifiable. But for any changes to be made, they will likely arise not out of the good will of the doctors or clinic staff but from the complaints of our customers.

That’s right; it’s in everyone’s best interest for you to lodge a complaint if you end up waiting too long for your appointment, especially if this is a recurring problem with your doctor. A physician who is perpetually tardy may need fewer patients on the schedule, longer times apportioned for surgeries, a limit to add-on visits, an assistant (nurse practitioner or physician assistant) to help with the work flow, or simply a kick in the pants for wasting time gabbing with colleagues or showing up late to the office. Medical practices should take into consideration the work style of its members—a doctor who is painstakingly thorough should be able to see fewer patients in a day without undue financial penalty and without sentencing the patients to an afternoon sitting in front of CNN (I guess I should say Fox News, seeing as how Nebraska is a solidly red state).

Furthermore, if a delay can’t be avoided, the office staff should keep the waiting patients posted about how long they can be realistically expected to wait. This way a busy person could have the option of rescheduling, returning later in the day, or simply taking their business elsewhere. Above all, we need to offer an apology (preferably from the doctor) and recognize the value of the patients’ time.

I don’t dispute the fact that People and Us magazines are engrossing reading, but they hardly make up for the frustration and hassle that patients incur when their doctor runs late. When this happens to you please let us know—it’s the only way for us to begin to fix the problem.