Why doctors run late and how patients can help

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of my favorite blogs that have quite eloquently addressed this issue already (click below to read):

1. Lockup Doc
2. Common Sense Family Doctor

Dr. Rob Lamberts also designed a very concise  list of both patient and doctor “rules,” important for every patient and physician to read (click to read):

1. Patient Rules
2. Doctor Rules

I believe it worked, having her read these illuminating posts on why doctors’ offices do what they do. Then it dawned on me, if only I can convince all patients to not only read these eloquent posts, but to go one step further – to learn what they can actively do during their office visit, as well.

If patients simply learned “how to dance” while they are in my clinic, perhaps I wouldn’t be running as late, I’d be able to provide thorough and more focused care, and I’d be able to perhaps get all my extra work done on time, and maybe even have time to eat lunch. But every patient would have to be on the same page, learning the same dance moves. The clinic would run so efficiently if every patient learned these basic “dance steps,” and we’d all be doing the tango effortlessly.

Here are the 5 basic dance steps each patient should learn in order to dance like the stars at the doctor’s office:

Step 1. Arrive on Time to Dance Class: In fact, try to arrive 10 minutes earlier than your appointment slot. This will give you enough time to park, check in at the front desk, and compensate for the unpredictable. Like a domino effect, one late patient causes everyone else for that day to run late, including the doctor. And that may just cause the judges to deduct points during a poor dance performance – and we want that trophy now, don’t we?

Step 2. Don’t Try to Learn More Than One Dance at a Time: This is perhaps the most important lesson of all to learn. It will become much too confusing to learn the Samba, the Salsa, and the Merengue at the same time, wouldn’t it?

The doctor will have 15 minutes to spend with you at the most (some doctors even less). Therefore, your expectations need to be realistic. The doctor will not be able to address every single issue you may have on your list. Select 1, or at the very most 2 problems per visit. Why? Because each problem requires the proper line of questioning (called the history), the physical exam, and a possible work-up of tests.

If you come in with a longer list, your visit will not allow the greatest focus and proper attention that each problem deserves, and something’s got to give. I would assume you would want your doctor to be very thorough, no? You don’t want the doctor to gloss over something important in this very detailed and meticulous process by becoming distracted, and your health is too important for that.

Don’t risk it. If you need to be seen once a week every week until all your problems have been addressed, then so be it. Then, you will have learned each dance thoroughly well, ready to earn a perfect score in the end.

Step 3. Make Sure You Sign Up for the Correct Dance Class: Tell the nurse who takes your vital signs and places you in the exam room exactly what you are there for. If you have 1 or 2 problems, make sure you tell the nurse BOTH problems. If you need refills on your medications, make sure to tell the nurse that, too.

Why is this? Several reasons. First, the room will need to be set up a certain way depending on your symptoms. For instance, if you are there for a pap smear, the nurse will need to give you a gown to have you change into it and set up the proper supplies. If you are there for chest pain, they may need an electrocardiogram (EKG) before they see you. If you do this after you are already with the doctor, the doctor will need to leave the room (which may cause you to wait while the next patient is seen), ask the nurse return to set up the room, and then return again. This is very inefficient, and it causes a big delay in the patient schedule.

Second, the doctor really needs to know why you are there so that they can plan your 15 minute slot appropriately from the get-go. If you are there for headaches and a diabetes follow-up, and you also need your medications refilled, the doctor needs to know all of this before they see you so that they can come up with a timeline of how your short visit time will flow. Whatever you do, do not bring up a new problem after the visit has already begun. So when you sign up to dance, make sure your instructor knows which class you signed up for beforehand – you don’t want to show up for a tap class when you signed up for the tango!

Step 4. Don’t Forget Your Dancing Shoes: As important as those dancing shoes are to learn how to dance, so are your medication bottles when you visit your doctor. A simple “list” is not sufficient. Why? First of all, the amount of information you get from looking at the bottle is invaluable. When I look at the bottle, I can tell when the patient filled it, how many refills they have, when it expires, and how many pills are left in the bottle.

Just because a medication is on the patient’s electronic pharmacy records doesn’t mean that they are actually taking it. Also, I occasionally catch mistakes that the pharmacy has made on patient prescriptions in this way. Whatever you do, don’t tell your doctor that you don’t know the name of your medication, only that it’s a “little white pill.” Almost every pill is a “little white pill”!

Step 5. Don’t Forget to Practice Your Moves at Home: If you have diabetes, bring your blood sugar log with you. If you have high blood pressure, bring your blood pressure log with you. This information is very important. Although your doctor may check your blood sugar level or blood pressure while you are in the office, this is just one number for one day. What your numbers look like over time are so much more important, and are significant chunks of information for the doctor. No one wins the competition without practicing the moves at home!

Now that you have learned the 5 basic dancing steps to make the most of your visit with your doctor, go ahead and show off your dance moves!

Jill of All Trades is a family physician who blogs at her self-titled site, Jill of All Trades, MD.

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  • S. Biediger

    I would add that when your dance partner shows up, don’t scowl at him/her because you’ve been kept waiting. The doctor doesn’t like it anymore than you do. It puts the doctor on the defensive … not a great way to start the dance. And it just means that he/she is going to be in the office that much longer as well. If you value quality medical/health care, you should be willing to wait for it and pay for it.

  • apurvab

    Good post. Of all of those factors, for me thte greatest contributor is just wanting to address too many things at once. A “physical” for a person who has 1-2 chronic health problems is already a pretty tall order (lets say a 55 yo male with DM2 and COPD). Add a few skin lesions and BPH symtoms (before you know its BPH), and you’re behind by 5-10 mins (assuming you’re thorough in your history, exam, treatment options with risk/benefit analysis). Add anything else and its a disaster. Repeat this 3-5 times per day, and I don’t think its surprising that most docs either a) ignore everything except the main concern or b) run very behind.

  • A.N. Mousse

    I am struck that all of this puts ALL of the responsibility on the patient – as if the doctor cannot possibly be at fault – ever – as if the doctor has no responsibility in this. Doctor-centered care. More of the same comments – doctors agreeing with themselves – complaining that their lives would be so much better if only the patients were better – or sometimes – if they could find a way to be paid without ever seeing patients – that might be best of all. My only hope is that the good doctors are too busy being good doctors to bother with posting comments.

    • BusyDoc

      A.N. Mousse

      I’d love to have someone tell me how I can provide good medical care to all of my patients in 15 minute increments every time without going over. I certainly can’t cut out any personal time, as I don’t have any – if I’m not seeing a pt, I’m writing their note, refilling their meds, answering their messages, reviewing their labs, ordering their studies or talking with their specialists.

      Schedule longer appts? I’d love for my employer to figure out a way to do that without bankrupting the practice, but currently, most practices in the U.S. that are not subsidised in some other way (i.e. someone else is paying to keep it afloat) can’t survive financially unless they’re seeint 32-35 pts daily – that is an unfortunate reality of modern medicine. That comes out to 12-15 minutes per pt. If you have any suggestions, pleas share!

      • Alina Shipman

        BusyDoc,
        The answer is very simple – business planning, which goes well beyond payer mix review.

    • Alina Shipman

      I agree with your comments. To use the language of this article, it takes two to tango.
      Fortunately there are some physicians who do take their time and do their job right.

    • twicker

      Actually, when I read this, I did not think that it denied physician responsibility for possible tardiness. Quite the contrary, I thought it was nice to see someone provide us patients with some guidelines about how we can help.

      I think this points out a common problem facing blog posters today: if someone on Side A of an interaction (say, a doctor) posts information about how people on Side B of the interaction (say, patients) can improve the interaction (see above), for some reason, the Side A folks are supposed to rehash all the ways that they are wrong and should improve. Nevermind that there has been article after article, and blog post after blog post, about how doctors can do that; nevermind that those of us on Side B (we patients) have written post after post about the doctors. Still, even with all that, the doctors are supposed to issue a mea culpa before providing any advice.

      I think Jill of All Trades did us a service, and we’d be wise to follow her advice. Yes, also hold doctors accountable (see IVF-MD’s post below on a great way to do that), but we also need to hold ourselves accountable.

  • Diora

    This is fine. I do understand why the doctors are running late, and usually keep to the rules above (not having to take any medications helps).

    What I don’t understand though is some doctors being consistently late for the very first appointment of the day. Now, I do understand that sometimes there is an emergency in the hospital, but it doesn’t explain the doctor arriving at 9:15am for an 8:30am appointment every single time. If the doctor doesn’t start until 9:15am, why do they schedule appointments starting at 8:30 (and every 15 minutes thereafter) at least unless you have experience with a particular patient being chronically late.

  • HJ

    When I make an appointment, I allow time in my schedule for a late doctor. I bring a good book and wait. I understand things happen and was very grateful when my doctor spent that extra time with me during a rough time.

    I have found it difficult to “only learn one dance at a time.” At one point, I was dealing with 4 different issues and the resulting side effects of medication and stress. My best doctor was usually late but reviewed all the issues I had so he could give me the best possible care.

  • AnnR

    I like to arrive early so I can sit down in the waiting room.
    By the time I’ve fought traffic and found a parking place and gotten to the office my blood pressure is usually up.

    A few minutes spent relaxing gets it back down. I allow plenty of time for the appointment and try not to get irritated at the receptionist or anything else around me. That keeps the reading down as well.

    I only wish I could lose those extra pounds pre-weigh in as easily!

    • Molly Ciliberti, RN

      Before you get on the scale, remove every stitch of clothing and when on the scale flap your arms real hard for lift off. Tell the nurse you just ate 20 pounds of lunch before you came?

  • http://fertilityfile.com IVF-MD

    Here’s a hint that might be too obvious.

    If you like what your doctors are doing (keeping wait times short, giving quality service, working hard to make you happy) then let them know your appreciation AND let them know that you are spreading the word-of-mouth to recommend your friends and family to come see them.

    If you don’t like what your doctors are doing (ignoring your feelings, making you wait, giving you bad service), then why not let them know it? And if they don’t do anything about it, take your records and go find a better doctor.

    This works wonders towards getting the care and service that you deserve.

    My staff get rewarded for measures of patient satisfaction, such as positive feedback and referrals and it makes a world of difference in their happy diligent attitude. But it only works if we get feedback.

    I can only imagine practices out there which have long wait times and bad service and yet still get patients coming back year after year. Or practices that do a good job, but don’t get any thanks nor recognition. You can guess what will happen over time in this situation.

    • twicker

      IVF-MD — well said.

  • Dr. J

    Primary care is like a bad amusement park ride for both doctors and patients. We are both on the same ride, it’s making us both sick, but we don’t know how to get off. Primary care doctors complain that they don’t have enough time, can’t afford enough support staff, are always rushed and can’t keep up with the needs of their patients. Patients complain that they wait too long to be seen, aren’t listened to, are always referred on to specialists, and their appointments are too short. These are really the same complaints, just coming from two perspectives.

    There are 3 types of primary care visits; new problem evaluation, ongoing problem maintenance, and prevention/screening. The above perspective of one problem per visit and dancing the dance is only one way of looking at the primary care problem.

    The real problem is that PCPs are not actually being paid to do what patients want them to do. That’s right, patients want a doctor who sits down and listens to them, evaluates their problem and either solves it or puts them in touch with someone who can solve it. They want to talk about all of their problems on the same day because sometimes the insomnia due to breathless and the swelling in your feet all add up to a single diagnosis and can’t be addressed as simple single entities. They want a doctor who keeps track of the big picture of their health, who realizes that the beta-blockers the cardiologist started might make the depression the cardiologist doesn’t know about worse. They want PCPs who make sure that they are getting screened for early pick-up of problems and that this screening is tailored just for them based on their own history and family history. All of this is easily within the grasp of a good PCP, but this is not what PCPs are paid to do. Instead PCPs are paid by insurance companies in such a way that encourages them to see a very high volume of patients and act as a triage agent deciding who warrants alternative, and more expensive care. It feels horrible for doctors (who are chronically frustrated and feel run off of their feet), and it feels horrible for patients (whose needs are not addressed).

    A simpler solution than dancing the intricate dance of weekly 15 minute appointments is to get off of the ride. Primary care is valuable, but patients often don’t see this because with the current model even good primary care feels bad. The answer is to change the model, to charge patients directly for what you do (there are lots of ways and models to fairly charge for good service) and to do a better job with fewer patients. A well run cash practice (aka a boutique practice) has a doctor who sees fewer patients, but does more intense work for each of them, and patients who have same day access to their doctor, in person by email or phone and feel well cared for. Happy doctor, happy patients all we have to do is get off this terrible ride.

  • LynnB

    I am the doctor side of all this. I am seldom late for first appt, now that kids are off to college .But I am always late . If each of the 14 pre-lunch appts runs 2 minutes over , because the patient has a “hand on the doorknob” complaint, that’s 1/2 hour behind. If the ER or a referring doc or a consultant calls now its 45 minutes , and if GOD FORBID I have to go to the bathroom its 48 minutes . If there are 2 or 3 calls its an hour or even an hour and 15 minutes. That’s assuming no one codes in the office, hits the building with their car , throws up or faints, and that the computers miraculously function all morning with no hiccups. In an average week at several of these things will happen. The bad thing is they sometimes all happen on the same day.

    Time , both yours and mine, is a limited resource.I tried longer appt times, and it meant that rather than waiting 4 weeks for a routine appt , patients would have waited six weeks. I cut the # of appts per day, with longer “lunch” breaks, later start and earlier last appt. .When I did the math that is 2 more slots per day

    What I do is
    -less charting while patient is there more on weekends. I get in trouble for this but answering the 30 or so phone calls to me (and twice that many to my assistant ) daily actually impacts patient care. Notes wait, med list and problem list are updated at the visit.
    -all non-scheduled meds 3 months , 3 RF or if there is toxicity monitoring, 2 months, one Refill.
    -Routine labs like A1c or lipid panel are ordered a week before the visit, and lab results go out before the appointment in a letter format so the patient has that much info before we start
    -A goal is to use the patient’s time well in the chaos we call the waiting area . I believe the receptionists should be updating addresses and phone #’s and email addresses and pharmacy info and giving out that med list the patient is supposed to review during waiting time. I don’t hire them, train them or fire them.
    -I look over immunizations before “preventive” visits and write an order for the assistant (we can’t afford nurses) to do the immunization before I start with the patient–wait time is the same , but total time is less . Same if I know I need an EKG or spirometry
    -I have work-ins , 4/ day but they are filled all the time. In addition I arrive earlier , stay later and call hospital employees to come over on my “lunch” .
    -All coumadin management goes to the anti-coagulation clinic, thank goodness.

    Simple things for the patients
    1. Over 1/2 our calls come in after 3 pm. If you call earlier , you will get better service
    2. No responsible doctor refills scheduled drugs (lorazepam, hydrocodone, ) without either a very recent appt or a written agreement that these will be refilled r. Don’t even bother to ask . If I break the rules I am liable for discipline by my state board. I am too old and too cranky to be a waitress.
    3. I appreciate a list , and I want to hear or better yet see the list. Take a few minutes in the waiting room to think about which one is most important.
    4. Your FMLA, insurance, disability, or work excuse takes me 20 minutes at best and it can’t be done during a 15 minute visit visit.
    5. I wish we had more staff but I am making much less per hour than the CCU nurses already.I have work hours that would be abusive for a regular employee. Write your congressman about equalizing Medicare payments in the various regions, while you cool your heels in the waiting area but don’t expect quick solutions.

  • http://www.managemypractice.com Mary Pat Whaley

    From a post (http://bit.ly/aLs3bKI) wrote on this topic:
    “What I usually find is that certain patients are okay with doctors who are late, and will wait as long as it takes to see that doctor. Others will not wait, and therefore, will not return. I would let new patients know that the doctor takes his time with patients and that he often runs late and see if they can live with that. If that can’t, then they should be scheduled with another doctor or seek care elsewhere. If the doctor has a problem with that, he needs to know that a good practice manages patients’ expectations and that patients deserve to know that he typically does not run on time, and not have a surprise when they come to the practice.”

  • http://www.managemypractice.com Mary Pat Whaley

    http://bit.ly/aLs3bK
    Sorry, I put the wrong link in the comment I just submitted – will you substitute the correct link above?
    Thanks,
    Mary Pat

  • http://www.infogroupsolution.com medical

    Nothing peeves me more than sitting in a doctor’s office reading 4-month-old tattered magazines on topics I care nothing about (saltwater fishing, seriously?), and not because the doctor had an emergency (when is the last time a dermatologist had to run out to save someone), but because the office staff routinely double books. I can’t count the number of times I walked out (my limit is 30 minutes unless I’m in agony) after giving the front office a targeted piece of my mind.

    doctor run late

    • http://fertilityfile.com IVF-MD

      Well done! If more patients did this, you can bet that doctors will improve their service.

      Also, in the effort of being positive-minded, after you do find an office that is prompt and courteous and makes you happy, then share that with your friends and family and if you want to, even let the doctor know that you referred people because you liked the way he ran his practice. Feedback works!

    • http://www.cdsindiana.com Adam M.

      More than just double books. I have seen appointment systems that allow a physician to book up to 4 appointments in the same 15 minute time slot.

  • Greg

    Psychiatrists and Clinical Psychologists have had a solution to this for about a century – bill by time spent. If a patient comes late, they will typically be seen from when they came in until the scheduled end time. If the total appointment goes from 45 minutes to 5 minutes because the patient is 40 minutes late, then so be it. If the doctor is late, then the patient pays less, because less time is spent. It’s a system where both sides know their expectations and consequences, and it’s been working for a while now.

    • HJ

      Greg says, “If the doctor is late, then the patient pays less, because less time is spent.”

      I have never had my therapist short change me on time because she was late-and she is always late. She gives me time, not a discount. Are you suggesting that I wait two months with a painful medical condition for a 15 minute appointment and only get 5 minutes because the doctor is running 10 minutes late?

  • http://www.briannevillano.com Brianne

    Actually this article is very patronizing and self-serving. On the scale of humanity, your time as a doctor is worth no more than mine as a patient. Time for money. I agree with Greg’s comment.

  • Molly Ciliberti, RN

    Remember the time your doctor spent a little extra time with you when you were depressed or struggling to cope or whatever, he/she may be doing the same for some other patient just as worthy. Use the time to read a good book and relax. Life is too short to be so stressed out.

  • http://swdunn.blogspot.com Steven

    I don’t know where the fifteen minute rule came from but it’s wrong. Simply wrong. Okay, I know that less patients seen in a day translates into less money made and the practice is in danger of failing. And I don’t know how to fix that…in fact, no one seems interested in fixing it. It simply continues as a simmering war between Doctor and Patient.

    What if the medical profession targeted this problem and put great minds to work on it? What if?

    • stargirl65

      Because the insurance companies run the game and have no interest in fixing things.

  • Heather

    I am a self-employed person, when I am not at work there is no money coming in. If I am sitting in the doctors office for the entire afternoon (which has happened) I am out a significant portion of my income for the day. If 20 mins goes by and I haven’t been called. I am out of there. I tell the front desk staff that I need to be rescheduled.

    I also wanted to point out that there are hardly any nurses in the office where I go that actually take patients into the exam room anymore. They depend highly upon medical assistants. The nurses are usually seeing patients.

  • jkwrabbit

    I am in agreement with all of the doctors’ comments. I am a very “patient” patient and will wait to see the doctor with usually no complaint. But one thing I would suggest is that when a doctor is running late (and the receptionist can tell by when someone’s appointment time is) that they be told when they check in so they can reschedule if it is inconvenient to wait. It is always such a secret. I once waited two and a half hours in the exam room for a thoracic surgeon. After the first hour I went into the hall and asked what was going on. They said he had an emergency surgery. But I had to go out and ask. Why didn’t someone come and tell me??

  • cc

    I wish (1) doc’s office would text me when they are running more than 30 minutes behind and (2) doc’s office could provide a beeper to call us back should we go walking around during a long wait. The anxiety of staying tethered to the staffer calling folks back can get pretty heavy over hour after hour, day after day for those living with serious chronic conditions, the doc’s office becomes home away from home. We now have cheap tech tools to improve this experience – let’s use them. Everyone’s time should be valued.

  • Katherine

    I agree with the need for greater transparency about time. It wasn’t until I had a recent conversation with a resident in training, that I learned that he only had 15 minutes or less to see a patient. In my 63 years as a patient, I have never been told that my doctors only had 15 minutes with me. So it is no wonder that patients complain about how little time the doctor spends with them, thinking that it is the doctor’s choice to be fast. If the doctors’ offices tell patients up front, when they schedule, that they have 15 minutes or less for the appointment, and some tips like think ahead about why you are there, make a list, tell the nurse or MA, plan to deal with problems at separate appointments, etc. then there might be less patient discontent. For years, even without knowing about the 15 minutes, I have sent a fax ahead of time, telling my doctor what I wanted to cover, what meds I needed renewed, and any questions I had. I’ve been called the “fax lady”, but also been told how much they appreciate this. I started doing this to make sure I remembered what I wanted to tell the doctor, and to have it put in my chart. Too often I had called the nurse with a critical issue, left a message, which was not accurately transmitted.

    At the same time, the medical establishment has to begin to address the opportunity costs of patients making several visits for things that could possibly be covered in one appointment: time off from work on multiple occasions, transportation – often public transportation, childcare, payment either direct or copay, living with a problem for a longer period of time if it has to be covered at a later appointment, etc. Working in public health in other countries, these are considerations in planning programs. How to make sure that patients do complete treatments, for example. If people have to return multiple times, they may stop.

    Usually it is not the doctor who controls this situation, but the clinic in which he/she works.