"Patients grow suspicious of a practice that doesn’t require a wait"

in Uncategorized | 14 responses

Patients have been conditioned to expect a wait when seeing a doctor.

Comments

RJS
Yeah, what the hell ever. I just walked out of my doctor’s office this afternoon, in fact, after waiting an hour to see the MD. (Never did get to see him.)
There was still one person in front of me when I left.
Given that this is my first time at this practice, that’s not a very encouraging way to greet what is essentially a new customer. (I have a primary, but I’m trying to switch to a GI doc outside Boston.)
I have not decided whether I am going to go back to this office again, or find someplace new.
Anonymous
I hope the GI doc can sleep tonight. I bet he is inconsolable due to your absence. I just hope he has a good social network to help him out.
RJS
I don’t really understand your comment.
It’s purely a business decision both ways. He clearly has enough patients, and my time is too valuable to sit around and wait for him.
I sure hope he doesn’t take it personally. He’s in the wrong field if he does.
I do think it’s disrespectful to run a business in such a fashion however, hence my debating going someplace else. I also think it’s questionable to book two patients for the same time (2pm) which came out in the very cozy (read: small) waiting room. (“What time is your appointment?” “Oh 2 o’clock.” “Really? Mine, too. Who are you seeing?” “Dr XYZ.” “Really. Me too. They booked us both for 2.00? That’s a little strange…”)
Conversations like that are telling.
Anonymous
The reason you were booked at the same time usually is because practice management software is antiquated and often only allows every 15 minute scheduling. When you have 6 to 10 appointments an hour, you will have 2 to 3 patients booked into the same slot. Also, depending on your cancellation or “no-show” rate, as well as unexpected emergency appointments, you overbook. Nobody likes this to happen, least of all the doctor. And of course different patients require different amounts of time. Have you ever had to tell someone they have cancer? Think this is a 5 minute appointment?
The alternative is to see fewer patients, which results in longer waiting time for an appointment, and the need for higher reimbursements for the (fewer) patients you do see. Not likely to occur anytime soon.
Do go ahead and vote with your feet. Hope you are a marathom runner.
RJS
“Do go ahead and vote with your feet. Hope you are a marathom runner.”
Actually, I haven’t waited for more than 15 minutes for a doctor’s appointment in over 15 years. My current primary care physician and the one I had before that both have signs that say “If you have waited for more than 15 minutes please see the receptionist.” My average wait time is usually 5 minutes — just enough time to get into an article in a magazine and then I get called.
“And of course different patients require different amounts of time. Have you ever had to tell someone they have cancer? Think this is a 5 minute appointment?”
Yes I understand that sometimes there are circumstances that can’t be helped. This happens in retail pharmacy as well. Not every prescription can be done in 15 minutes, as much as we’d like to be able to. Being an hour late to an appointment — while there’s still someone who’s been waiting for 90 minutes still ahead of you — is a little over the top.
And telling someone that they have cancer can be done within a 45 minute window easily enough. It happened to my closest friend, because you’re usually referred to an oncologist ASAP. His appointment lasted 30 minutes.
You can play the devil’s advocate all you like, throwing “what if” scenarios at me until the cows come home, but it all comes down to this: Being on time is something that CAN be made a priority. Successfully. The question is whether it is important enough to you, the clinician, to make being on-time a priority.
And yes, there are times when you will fail for one reason or another. These will be the exceptions, however, not the rule.
For what it’s worth, I have made another appointment at this office with another doctor (as this was the first appointment there, I wasn’t particularly attached to seeing the doc recommended by my PCP), in part because the office staff was good, and when I asked if this was the norm, they said no. If the experience is a duplicate of this one, I WILL vote with my feet. Finding another gastroenterologist is an easy as letting my fingers walk through a phonebook and calling my PCP for a referral.
Anonymous
What exactly is an acceptable wait time depends on your specialty and location. Obviously a FP in a saturated market, new to the area is going to have to run a tight ship. There are other extremes though, I worked with an orthopod that was routinely 2 hours late by mid morning and on really bad days we were 4 hours behind at the end. When you are one of the only trauma trained orthopedic surgeons in the area you can get away with that. Exactly where are the patients going to go? If you have a smashed distal femur and are in an external fixator, you know what you are going to do. You will suck it up and wait. New patients would complain, but the answer was the same “I take as much time as I need with other patients as I will with you. You are welcome to find another orthopod to take care of your fracture if you so desire.” And if they left early they would usually come back because no one else wanted to take care of alot of these cases.
Anonymous
RJS:
You really want to compare what is done in a retail pharmacy with telling someone they have cancer, going over chemo,talking to family, etc. Trust me I am an onc doc.
Carol
My current PCP works in a group office with 9 other doctors. My original PCP there retired and I chose another physician there. I always schedule “first morning appt”. After waiting almost an hour for my first two appts with her, on the third one I fired her. On two of these, she breezed into work 45 min. after my appt time – she walked right through the waiting room! When I fired her I told her “You’re obviously a good doctor but you are a very poor business woman.”
I went to the office manager and told her why I was firing the late doctor and asked her to honestly tell me which doctors in the group keep the most on-time schedule. She was kind enough to be frank with me and I chose one of her suggestions. After six years with my new PCP I’ve only waited more than 15 minutes once and the first thing he did when he walked into the exam room was sincerely apologize. He explained that his wife had given birth the night before and he was up with her at the hospital all night. He had overslept. I wished him great happiness with his new daughter and had no problem with the wait!
This new PCP takes as much time as needed with all of his patients. The difference between him and the prior PCP was that he respects his patients as much as he would like us to respect him. And we do. He is not only on time, but he is attentive, honest, very human, and a wonderful diagnostician. I hope he NEVER retires!
DJS
What is important about this discussion is how it reflects on the “Market forces” issue that medicine is currently struggling with. For years it was an authoritarian guild. Sit there and wait and shut up and pay the bill. And as people “shopped” for doctors the longer the wait the better the doctor. (Infomercial on late night TV says ‘You’d have to wait six months for an appointment with Dr. XYZ, who developed our skin care product).
One of you anonymouses said” She’s obvoiusly a good doctor, but a bad businessperson.” How do you know she’s a good doctor? Just by the way she listens, spends time? Measurements of quality aren’t available. No EPA Cafe standards. You got the license, you can dispense, you got the priveledges you can operate…
But I agree. Wait that long you should leave. And I agree, that doctor won’t learn a thing from it. He probably makes too much money anyway.
Anonymous
“On two of these, she breezed into work 45 min. after my appt time – she walked right through the waiting room!”
Carol:
A real misconception is medicine is nothing but a business. That we make widgets or something. Did you ever stop to think that mabe the PCP was making hospital rounds and had a complication? Especially 6 plus years ago when hospitalist’s were less common. Many doctors (myself included) round on hospitalized patient’s in the early AM, then clinic all day, then round again at night with PM admits. Trust me when I am late I am not having my AM coffee and paper, I am at the hospital with a critically ill patient. Don’t get me wrong the doc should have explained why he/she was late, but the point I am making is there may more going on than just your clinic appt. food for thought.
Carol
DJS: my comment wasn’t anonymous. I felt she was a good doctor because each time I finally got to see her she paid close attention, asked intelligent questions, made careful suggestions, and did a good job determining what was wrong with me and then treating it. Those are just about the only ways I know of to judge if a doctor is “good”.
Anon: Your point that med is much more than a business couldn’t be more true. I require both from my PCP – be a great doctor and a good business man. If you can’t run your business you won’t be there the next time I need you! Purely a self serving position of course. And the group office where I go has used hospitalists since I started with them 10 years ago so I know she wasn’t rounding. On the second hour wait, she actually told me her nurse had called in sick so she had come in late because she knew the nurse who was coming in to cover wouldn’t be there on time. Honestly.
Understand, I have a huge amt of respect for the people who have the motivation and dedication to become doctors. Most of them come out of school in huge debt, get paid for crap, are overwhelmed by paperwork and have to almost beg insurance companies to pay them for their work. They’re constantly aware that if they even offend a patient they might get sued. At the same time, being a doctor can be the most personally rewarding profession. It’s all a balancing act. Some just balance better than others.
Anonymous
“They’re constantly aware that if they even offend a patient they might get sued.”
Carol: The inverse is also true. Patients now must be very careful with every word they say as well, or risk being terminated by a doctor who does not take the time to communicate and understand.
Regardless, on the subject at hand: I’ve rarely experienced unacceptably long waits. In fact, I recall only one, when I waited over two hours for a surgeon to do a quick post-op check up. No exaggeration, my actual time with the doctor was under two minutes, and I don’t understand why — when a patient is there only for such a small thing — s/he has to wait in queue behind people with complaints that will take substantially more time. It would seem like simple, sound time management to get the “quickies” out of the way so they’re not cluttering up the waiting room.
Anonymous
In the ER we try to get the quickies out of the way with the Physician assistants in fast track. Of course then those that are “sicker” and waiting for a bed and to see a doctor are peeved that the minor quickis are getting care first.
Can’t win.
Anonymous
Onc Doc, not all Doc’s are like you. Hell mine told me over the phone. Thats right, a phone call…Took maybe 3 minutes total…
“Listen, we got your biopsies back and I have made you an appointment with a really good oncologist out of town. You will get something in the mail from them in the next week.” Yes, your biopsies show you have cancer and it is growing. thats why I went ahead and made your appointment.” “Try not to worry to much”.
The problem with waiting so long in waiting rooms is that we have lives also. Maybe we had to try and get an hour or two off work to come to an appointment. If we can’t get in then we must leave or suffer the consequences when we are back to work.
Most important is that it is YOUR staff who makes these appointments. They tell us that you will be available to see us on this day at a certain time. Waiting for awhile is usually not a problem but when you always wait 2-3 hours with a certain doc, something is wrong.