Sunday, May 29, 200523
Spectrum of waiting
Reading these comments got me thinking - Where in the spectrum of waiting are you?
Are you, fellow physicians, the type who is always on time, every 15 minutes? Or do you spend as much time as it takes with each patient?
Do you, as a patient, want a physician who runs on time, every time? Or do you mind waiting 1 hour for a visit where all your problems are addressed?
Because you can't have both. It is impossible. Hence, the spectrum of waiting.
A typical visit to a primary care physician's office is allotted 15 minutes. Each physician session lasts 4 hours. Think about that. If the doctor merely spends 5 "extra" minutes with each patient, the last patient of the session will be over 1 hour late. Guaranteed.
Is that acceptable? It depends. Some will find going in and out of a visit in 5 minutes, but on time, to be satisfactory. Others will find waiting 1 hour for a doctor to spend 30 minutes on them to be just as satisfying.
The key as a patient is to find a physician whose view of the spectrum matches yours. Those patients who are unhappy are those who are matched with a doctor with a differing view of the spectrum.
There are doctors who practice at both ends of the spectrum: some like clockwork, running on time; others running late, but taking the time. There are infinitely more who practice somewhere in between.
As a physician, ask yourself where in the spectrum you fit in.
As a patient, ask yourself where in the spectrum you would like your doctor to be.
Are you, fellow physicians, the type who is always on time, every 15 minutes? Or do you spend as much time as it takes with each patient?
Do you, as a patient, want a physician who runs on time, every time? Or do you mind waiting 1 hour for a visit where all your problems are addressed?
Because you can't have both. It is impossible. Hence, the spectrum of waiting.
A typical visit to a primary care physician's office is allotted 15 minutes. Each physician session lasts 4 hours. Think about that. If the doctor merely spends 5 "extra" minutes with each patient, the last patient of the session will be over 1 hour late. Guaranteed.
Is that acceptable? It depends. Some will find going in and out of a visit in 5 minutes, but on time, to be satisfactory. Others will find waiting 1 hour for a doctor to spend 30 minutes on them to be just as satisfying.
The key as a patient is to find a physician whose view of the spectrum matches yours. Those patients who are unhappy are those who are matched with a doctor with a differing view of the spectrum.
There are doctors who practice at both ends of the spectrum: some like clockwork, running on time; others running late, but taking the time. There are infinitely more who practice somewhere in between.
As a physician, ask yourself where in the spectrum you fit in.
As a patient, ask yourself where in the spectrum you would like your doctor to be.
Comments
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Anonymous
Thank you for addressing the topic. There are other variables at work other than nature and habit: some days are full of problems and others run smoothly, even for someone normally punctual. The annoyance is arriving to find one's slot triple booked and the dr already behind. Receptionists are often not inclined (and perhaps not permitted) to tell an inquiring patient whether the dr is on time, for fear of not having a steady flow of bodies into the little rooms. I don't mind waiting when there have been emergencies, and don't need an explanation for each of them...and getting drs to self-identify as chronically behind schedule is not likely to happen -- runs counter to human nature. But it's a good start to raise the topic. That's constructive, so let's hear what others have to say.
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Judy
I'm definitely of the "willing to wait" sort. The doctor is definitely not the only factor in time management, though.
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Anonymous
I recognize that the doctor can't always fit everyone into a standard 15-minute window. Many of my own appointments have gone past 15 minutes, due to my complicated history. I don't mind waiting as long as the doctor apologizes when s/he's more than 30 minutes behind. (I once had to wait 1.5 hours for the very first appointment of the day, but my doctor volunteered that she had just come from the hospital, where a mother who had just given birth had sudden onset of post-partum depression. I don't need those details, but they sure did help.)
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SAM
AT FIRST I WANT FROM YOU AS A DOCTOR IMAGE THAT YOU ARE SICK AND IN VERY BAD STATMENT .IN THAT TIME OFCOURSE NOTHING IS NOT IMPORTANT FOR YOU EXCEPT VISITING DOCTOR .FOR A PATIENT ANY REASON CAN NOT JUSTIFY NOT BE ONTIME OF DOCTOR .BUT AGRRE THAT IN SOME TIMES A DOCTOR CAN NOT BE ONTIME IN ANY WAY .I THINK A DOCTOR SHOULD TRY VERY MUCH FOR TO ONTIME AND FOR THIS I THINK VISITING PATIENT SHOULD BE VERY VERY VERY WITH REGULARY AND DOCTOR SHOULD
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Anonymous
Obviously a doctor's waiting room is not an exciting place, and you have little to do but to obsess on how miiserable you are, which certainly doesn't put you in the right sort of mood.
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Anonymous
The answer, as any economist will tell you, is for doctors to adopt tiered pricing. If you want a guaranteed time, you just pay more. Doctor's happy--as he received compensation for scheduling fewer patients, and patients are happy: if they want prompt service, they get it.
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Anonymous
"I suspect doctors wouldn't like it, however, because it would make them seem like they work in a service industry."
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Anonymous
As a patient, I find that amusing: doctors don't seem to have a customer service ethos to me.
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Anonymous
" As a patient, I find that amusing: doctors don't seem to have a customer service ethos to me."
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Anonymous
OK, How about if I make you an appointment to see a house I have on the Market, and we agree to meet at 10:00 am. I understand up front that you are a very busy Physician so time is of the essence. You must be in your office seeing patients by 11:00 am. But hey, I'm trying to close a deal on a bigger house that I will make alot of money off of. I need to spend an extra 45 minutes more than what I planned with the folks I had scheduled at 9:00 am. Will you still be there, in a good mood, waitting for me at 10:45?
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mamalife
That is always such a dilemma... to schedule appropriately so as to make money, to allow enough time for each patient, and to hopefully not run too far behind. I've seen both sides of it. As an RN in a pediatric practice, I know that it takes one really sick wheezer who needs to be admitted to the hospital to throw the doctor behind by an hour. It never fails to amaze me how gracious MOST of our moms and dads are when you apologize for the wait, even if it is an hour or more. As a mom of a 13 month old I recently spent lots of time on the patient end of things at my OB's office. Often I'd breeze in and out in 2 minutes as everything was fine. Several times I had issues going on and either was worked in as an unscheduled appointment or needed longer than I imagine was alloted for me. I don't mind waiting as I know I've also been the cause of others having to wait - I appreciate the doctor's extra time when I've needed it and don't mind for others to also have the same when they need it.
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Anonymous
The point is CONTROL, not the relative moral merits of being sympathetic to doctors' schedules or others' sufferings.
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Anonymous
Personally, I try to stay on time. Most docs I know that don't ever seem to run on time tend to be unrealistic about how much time it takes to see someone, therefore the schedule is unrealistic.
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Anonymous
That is the real problem, indeed. The relationship is distorted because of insurance companies.
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Anonymous
..."When I have an appointment in your office a 9:45, I don't care if you only spend 5 minutes with me if we can cover what needs to be covered"...
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Anonymous
My doctor ALWAYS apologizes to me when he knows I have been waiting a long time for him. Therefore, he will continue to be my doctor of choice.
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Flex
Strange,
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JK
I've dealt a with a lot of doctors (a few on time, most not) and I tend to be real patient if the doctor takes the time to take care of my problems.
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Anonymous
>>There are other solutions. Maybe find ways to train more doctors.
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SteveF
I can't believe people get upset because they have to wait at the doctor's office. I love my doctor, he never rushes me, always listens. There have been a few times when I had to wait a little longer, but what's the big deal? He's helping other patients, not playing a video game or something. The receptionist keeps us informed. Besides the two docs, an RN and a Physican's Assistant work there. We can see them for minor things.
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Dex
I rotated with a Family Practice doctor, an osteopath I might add, who had a great system. No appointments. For followup, he would say, "Come back in two weeks." The new patient would then ask the secretary for anappointment. She would say, "Just come. No appointments. First come, first served." They have a list that you sign when you come in, and you knew exactly your place in line. Too long a wait? Come back in a couple of hours. They would lock the door at closing time, and the doctor would see anyone left.
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Anonymous
I waited 3 hours past my appointment with no explanation at a doctors office for a Thyroid check. When I returned for a follow up I was told the wait would be at least an hour and a half. I rescheduled at that point and left. My family Doctor was reluctant to send me to this Doctor because he has a reputation of always running behind. I am in the process of trying to write or design a billing schedule to send to this doctors office for my lost time. I plan to charge $60 per hour for my time. Since I am retired that is the least I will charge for my free time.
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Anonymous
My hair dresser knows how to schedule appointments base on the needs of there clients, a cut 15 minutes, perm, color and cut and hour and a half. Putting all your patients in a 15 minute window does not seem practical. Why not notify appointments over a certain time that there running late, my time is also worth something.
Post a Comment »2:28 AM
I needed to make an urgent appointment because of a problem that developed on Thursday. I was told to come at 9:30 on Friday. When I arrived, I was told that I wasn't on the schedule, but "don't leave." Good thing, my only other option would have been the ER and I really didn't want to go there.
I was finally seen at 10:45 and the doc was a thorough in evaluating my situation as I always expect from him or any of his partners. As I was leaving, I overheard him asking one of his office personnel why he couldn't seem to get past 9:45 on the schedule.
I've waited 3 hours to see the kids' pediatrician for a sick visit, but he's nearly always on time for well checkups. They're scheduled differently and at different hours from the sick visits. You always get seen same-day for sick visits, but you might wait 3-4 weeks to schedule your physical. He also allots more time for those periodic checkups so he can address developmental, emotional, and learning issues you're facing and make any appropriate referrals.
11:23 AM
6:52 PM
GIVE SAME TIME TO ANY PATIENT AND IF SOME PATIONT NEED TO MORE TIME THEY SHOULD WAIT OR REFER TO DOCTOR IN NEXT DAY.I HOPE IN ONE DAY IN ONE DAY PAIN OF ANY PATIONT WILL NOT INCREASE WITH WAITING FOR VISITING.
4:24 AM
On the other hand, it's also very easy to feel resentful against doctors, because their whole day seems to be programmed to minimize the amount of time they spend with you. Surely you should not have to wait hours to get a visit of minutes!
And yet, of course, there are some patients with minor problems that won't even fill up the time alloted, and the whole system wouldn't work well if there weren't some benchmarks for time.
All this being said, I think I have a good partial solution to this problem that would minimize grumbling.
If there was a computer system that showed a queue of patients and where you were, and your latest estimated visit time, that would be great. Then if the wait was over an hour or so, I could hit the mall bookstore, have lunch or do something otherwise productive with the time.
Apple's Genius Bar for their retail stores has a similar problem and handles it very well. You might want to go to an Apple store and try setting up an appointment to see how the system works. If a similar system was set up for doctor's offices, I think there would be much less friction on this issue.
Hope that helps.
David H Dennis
david@amazing.com
10:26 AM
Could this be done in an insurance-dominated market? I dunno. I suspect doctors wouldn't like it, however, because it would make them seem like they work in a service industry--and, they don't like to be reminded of that.
12:33 PM
Uh, we already are. Medicine today is nothing but a customer service business.
12:44 PM
12:52 PM
It takes two to tango. When you waltz in with your Aetna or Cigna or Medicare card, remember you are demanding the blue-light special, whether or not you care to think of your insurer as someone who speaks for you in that way, that is what is happening. So practices have to adapt. You want an appointment long enough to present your concerns and have them addressed? That makes sense. You want to have it soon? That is understandable. You want someone besides yourself to pay most of the bill and someone else still to do all the paperwork and the total cost should not cause your premiums to rise? That is impossible. So something has to give. Either you settle for the shorter appointment, or you pay more for the service you want. As for running behind, the fact that the doctor isn't there for you when your appointment starts is often because someone else has taken that time, usually without thinking of how it is costing someone else the inconvenience of waiting: another patient, someone calling in who demands to talk to the doctor, another physician, the E.R.
The idea of computerized queue postings is charming; too bad most practices aren't funded like retail computer stores (back to the blue-light special).
As for those who want to gripe about consumer service being lacking, all I can say is that as long as you are willing to pay, someone will probably be willing to give you what you want. But you have to be willing to pay.
CHenry
4:10 PM
When I have an appointment in your office a 9:45, I don't care if you only spend 5 minutes with me if we can cover what needs to be covered but I also have a job and responsibility and when I'm expected to wait for 2 hours past my appointment time to see you, then you have just lost my business.
5:57 PM
7:42 PM
If you want a prompt appointment and are willing to pay for it, you should get it. DOctors should adopt tiered payment systems: one price for instant service, the other for service in an hour or two.
There isn't that choice in the medical system, largely because as CHenry's comments demonstrate, doctors are the employees of insurance companies, not healthcare consumers. Insurance companies, once they have their money, have every incentive to limit consumers' choice and decrease the quality of their healthcare.
Until consumers take more control of their healthcare budget and DEMAND better service/treatment from their doctors, there will be no change.
9:12 PM
At the same time, much of the anger directed at doctors about waiting, I think, has to do with people not being happy about seeing a doctor in the first place.
Just think about it: how many people in the world run "on time"? You set up an appointment for someone to do work at your house, he shows up hours late or calls and says he'll be by "tomorrow."
You make a reservation at a restaurant -- is it that unusual to be seated 15-30 minutes late? Many restaurants don't even take reservations, they tell you, "It's a 30 minute wait." Forty-five minutes to an hour later you sit down (if you're still there).
One thing we could do as physicians is make our offices more interesting to wait in -- have something more entertaining or instructional that the raft of magazines and plants or fishtanks or whatever. There probably could be an industry develop to make these things for doctors and doctors would pay for them (if it helped keep the restless natives occupied and happy).
9:49 PM
10:22 PM
Right.
And if we can't cover "what needs to be covered" in that time?
Then what?
Out the door with you in mid-sentence and a followup next week to continue? Right in the middle of your "By the way, I've been having this odd chest pain lately ..."?
Or have the next patient wait a bit till "what needs to be covered" is understood and dealt with?
Once again, you can't have it both
11:31 AM
10:02 AM
I have a little problem accepting that a patient can determine the seriousness of their medical problem by the quantity of money they have.
The idea presented above that patients who want their primary care physician to schedule their appointments based on how much a patient is willing to pay just sounds like a bad idea. "I'm sorry Mr. Jones, I have to reschedule your appointment again. Mr. Smith wants the doctor to look at a wart, and is willing to pay more than you possibly can afford."
I do like the idea of a computer monitor showing the queue. I might suggest a little privacy be observed. Maybe by giving people numbers and showing the numbers on the monitor. I wouldn't necessarily want to display my name and reason for visit to an entire waiting room. "Flex - Awaiting Rectal Exam in Room 3." Not so good.
There are other solutions. Maybe find ways to train more doctors. Or allow a certain level of problem to be treated by a non-physician. If I know that I need a salve for a rash, I don't necessarily need to see my primary care physician. There may be ethical concerns with this type of solution, but they may be addressable.
Personally I am a rather calm person, and usually schedule a good deal of extra time when I go to my primary care physician's office. I realize that there is a wide variety of conditions that a physician may see in a day. Some are easy to diagnose and treat, others may be very difficult. What would be very helpful, and I'm just thinking out loud here, is a way for a physician to get some idea of the patient's condition before an appointment is scheduled. Reducing the surprises for the physician may go a long way toward allowing them to create a manageable schedule.
Can you tell it's the end of a workday and I'm ready to go home?
Cheers,
-Flex
2:53 PM
My PCP is usually behind schedule, but she doesn't rush me, answers my questions completely, explains things with out being prompted, and seems to be actually in treating me. Since she doesn't rush me, I can't really complain that she didn't rush the guy before me. She's a good doctor, so I cut her a lot of slack on the scheduling issues.
On the other hand, I used to go to an idiot of a urologist who was a little better about seeing me on time, but he always seemed to get out a fast as possible, never gave more than the shortest possible possible answers to the most direct questions, and never seemed to listen. I was less inclinded to feel understanding and eventually "fired" him about a year later than I should have. (A long story, but looking back there were so many things screaming "change doctors" )
Not rushing patients and saying "Sorry that we're are running behind because..." can make up for a lot of lateness.
That being said it would be nice if the receptionest could say something like "It's been a busy morning and we are running an hour behind" or something to that effect.
As for paying more to get longer appointments, I would be glad to, but it can't happen in todays system. Most people have no choice in what insurance plan they use. You use what your employer picks and most insurance plans set the price period. That's just the way it is. In a sane world the doctors would set the price and the insurace companies would decide whether or not to cover that doctor, but in the real world it's the opposite.
Finally, to all of the other patients out there : please be on time or even a little early. Remember, when you are late and they fit you in anyway, you are not just wasting the doctor's time, you are wasting the time of every patient after you.
8:19 PM
Being done. The MD programs are growing, though a little. The osteopathic side, they opened two or three schools in the 1990's. By absolute numbers and percentage growth, the osteopathic schools grew a lot more, and their historical trend was primary care, I assume that is still the case as far as I know.
>>Or allow a certain level of problem to be treated by a non-physician.
Also being done. A lot. It varies state-by-state, though. Nurse practitioners have independent licensure in many states. They can go out and set up shop in my area. And they do. There are at least three independent nurse practitioner clinics in my county. That "certain level of problem" that a nurse practitioner can handle in my state, is just about anything.
9:37 PM
4:17 PM
It is a great system, and it works well. I have come to think that doctors have appointments in order to maintain an illusion of control, as mentioned above. If nobody came, so what? Slow day, that's all. The other doctors in the practice used appointments, and saw half as many patients, and people would say when my doctor was covering their patients, "wow, that was much nicer than with that other guy."
10:52 AM
3:00 PM
12:02 PM