Reasons why your doctor is running late

It may not be rabbit season or duck season but it definitely seems to be doctor season.

Physicians are lined up squarely in the gun sights of the media,  government agencies and legislators, our health care industry employers and coworkers, not to mention our own dissatisfied patients, all happily acquiring hunting licenses in order to trade off taking aim.   It’s not enough any more to wear a bullet proof white coat.  It’s driving doctors to hang up their stethoscope just to get out of the line of fire. Depending on who is expressing an opinion, doctors are seen as overcompensated, demanding, whiny, too uncommitted, too overcommitted, uncaring, egotistical, close minded,  inflexible, and especially– perpetually late.

One of the most frequent complaints expressed about doctors is their lack of sensitivity to the demands of their patients’ schedule.  Doctors do run late and patients wait.  And wait.  And wait some more.  Patients get angry while waiting and this is reflected in patient (dis)satisfaction surveys which are becoming one of the tools the industry uses to judge the quality of a physician’s work and character.

I admit I’m one of those late doctors.   I don’t share the reasons why I’m late with my patients as I enter the exam room apologizing for my tardiness.  Taking time to explain takes time away from the task at hand–taking care of the person sitting or lying in front of me.   At that moment, that is the most important person in the world to me.  More important than the six waiting to see me, more important than the several dozen emails and calls waiting to be returned, more important than the fact I missed lunch or need to go to the bathroom, more important even than the text message from my daughter from school or the worry I carry about my dying mother.

I’m a salaried doctor, just like more and more of my primary care colleagues these days, providing more patient care with fewer resources.  I don’t earn more by seeing more patients.  There is a work load that I’m expected to carry and my day doesn’t end until that work is done.  Some days are typically a four patient an hour schedule, but most days my colleagues and I must work in extra patients triaged to us by careful nurse screeners, and there are only so many minutes that can be squeezed out of an hour so patients end up feeling the pinch.  I really want to try to go over the list of concerns some patients bring in so they don’t need to return to clinic for another appointment, and I really do try to deal with the inevitable “oh, by the way” question when my hand is on the door knob. Anytime that happens, I run later in my schedule, but I see it as my mission to provide essential caring for the “most important person in the world” at that moment.

The patient who is angry about waiting for me to arrive in the exam room can’t know that three patients before them I saw a woman who found out that her upset stomach was caused by an unplanned and unwanted pregnancy.   Perhaps they might be more understanding if they knew that an earlier patient came in with severe self injury so deep it required repair.   Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection, but is showing signs of a pulmonary embolism caused by oral contraceptives.  Or the man with blood on the toilet paper after a bowel movement finding out he has sexually transmitted anal warts when he’s never disclosed he has sex with other men,  or the woman with bloating whose examination reveals an ominous ovarian mass, or finding incidental needle tracks on arms during an evaluation for itchiness, which leads to suspected undiagnosed chronic hepatitis.

Doctors running late are not being inconsiderate, selfish or insensitive to their patients’ needs.  Quite the opposite.  We strive to make our patients feel respected, listened to and cared for.  Most days it is a challenge to do that well and stay on time.  For those who say we are being greedy, so we need to see fewer patients, I respond that health care reform and salaried employment demands we see more patients in less time, not fewer patients in more time.  The waiting will only get longer as more doctors hang up their stethoscopes rather than become a target of anger and resentment as every day becomes “doctor season.”  Patients need to bring a book, bring knitting, schedule for the first appointment of the day.  They also need to bring along a dose of charitable grace when they see how crowded the waiting room is.  It might help to know you are not alone in your worry and misery.

But your doctor is very alone, scrambling to do the very best healing he or she can in the time allowed.

I’m not hanging my stethoscope up though some days I’m so weary by the end, I’m not sure my brain between the ear tips is still functioning.  I refuse to put on a bullet proof white coat since I refuse to be defensive.  If it really is doctor season, I’ll just continue on apologizing as I walk into each exam room, my focus directed to the needs of the “most important person in the whole world.”

And that human being deserves every minute I can give them.

Emily Gibson is a family physician who blogs at Barnstorming.

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  • Angela Caffaratti, MD

    Dr Gibson,
    I have found that patients respond better to “Thank you for waiting,” than, “I am sorry for being late.” It is a tough job for sure.

    • http://briarcroft.wordpress.com Emily Gibson

      Good point, Dr. Caffaratti. That too is my standard way of acknowledging my lateness by saying “thank you for waiting” or if the patient has been really unhappy about the wait: “I’m sorry for keeping you waiting.”

  • Chrysalis

    Bravo!! I’m glad you posted this. If the patients waiting would only stop and think. You all are just one person, with a full schedule, and bathroom breaks aren’t scheduled into your day. When your doctor is running late, he/she may have just had to tell the patient before you the most horrible news of that patient’s life. Would you want them to drop that bomb, check their watch and say, “Gotta go.”

    Keep in mind the fact, you don’t know what that doctor and the patient before you are dealing with. Take some deep breaths and give them a break. They’ll get to you, and you’ll be extended the same courtesy and care, should you need it.

  • Patience

    Great post! As a patient, I totally agree that we should understand when doctors run late, as long as they’re polite when it’s finally our turn. We never know when we’ll be the one who needs the extra time at our appointment. Most of us can find ways to use our time in the waiting room wisely by planning ahead.

    What’s so frustrating is that we run into many doctors who don’t share the attitude of Dr. Gibson. We’re not the most important person in the world when the doctor walks in, not even close, no matter how serious our problem. It sometimes even feels like the more tolerant we are of doctors’ lateness, the more they feel entitled to rush our visit, or even take out their frustrations on us from the last patient who yelled at them. Patients should remember that their doctors are human. They may get low blood sugar from not having time to eat, or gas pain from missing bathroom breaks, just like us. Doctors need to remember that patients are human and deserve basic courtesy, no matter what. When you’re late to see a patient who doesn’t complain about it, that’s not an opportunity to vent your frustrations or cut corners on health care.

    We can’t all schedule the first appointment of the day. :) However, it’s a good suggestion for people who feel like they’re never on the same page with their doctor, a way to find out if communication problems might be resolved instead of finding another doctor. I recently tried it, and as a result I learned that my doctor is a morning person. He also had extra time for me because of a cancellation, and was much more thorough and open-minded than usual. The testing that followed our discussion led to a new diagnosis, and I’m confident now that I can trust him to help me manage the disease. It’s really an eye-opener to see the difference in how our doctors would prefer to care for us when not so pressed for time. Sometimes doctors just take that time, when they can, to provide that level of care, and then they run behind for the whole day.

  • MH

    I am not a doctor, but I have been a patient.

    I find that many doctors are late, sometimes very late, and very few–almost none–ever apologize. I don’t think you need to explain why you are late, but some acknowledgement that you are sorry the patient has been inconvenienced is appropriate. Otherwise, it appears that you are arrogant and don’t care about your patient’s time.

    • http://pediatricinc.wordpress.com/ Berry

      Why don’t you just assume they are sorry and not just assume they are being arrogant or inconsiderate?

  • Jackie

    The longest wait I’ve had with a doctor happened after the diagnosis of my life-long brain tumor. I think my husband and I must have waited close to three hours before the neurosurgeon showed up.

    But we did not have any complaints against the doctor who saved my life 15 days later when he performed a 23-hour marathon craniotomy.

    You see – Dr. Charles S. C. Chang happened to be an acquaintance of mine. He took my call while in the operation room after I had told the receptionist it was an ‘emergency’. After I informed him that he’s the only one that my neurologist would recommend in the region, he told me to bring the CT-scan to his office.

    It was almost 4 o’clock in the afternoon before he came out of the OR. He quickly reviewed the films and commented that he’s the only one that can do the operation. Hubby recalled later how relieved he was to have heard that comment.

    It’s been 21 years since that long wait. I’ve never complained about any doctor who’s late for my appointment ever since – because I know they are dedicated healers who would not be late without good reasons.

  • Finn

    I’ve never understood the level of ire directed at doctors for being late for appointments. When my internist is late, I know it’s not because she was sitting in her office playing Solitaire; she was with another patient who needed more time. I was that patient once, when she had to tell me I had cancer. I’m not going to begrudge another patient the amount of time they need to explain their problem, understand their diagnosis, or work up a treatment plan. As a subway rider, I always bring a book or magazine to entertain myself anyway; on days I have appointments, I make sure I’m not too close to the end so I don’t run out of reading material.

    The only time I got angry at a doctor for being late was the second time my cardiologist kept me waiting for more than an hour–not because of another patient’s need but because he couldn’t run his own life. The first carpool mix-up is free; the second one really ticks me off.

  • http://www.TheMedicalStrategist.com Barbara Hales, M.D.

    Unfortunately, many patients are only interested in themselves and it is immaterial as to the problems that others preceding them are experiencing.

    When told that she would have to reschedule by my head nurse due to a patient about to give birth, this patient actually said “Well, we all have our problems…but I still expect to be seen!

    If a patient walks in and asks the front desk if the doctor is currently on time, BEWARE! Those are the ones that make the doctor late for the rest of the day while asking ten pages of questions and discussing her meals in great depth.

    • http://warmsocks.wordpress.com/ WarmSocks

      Since figuring out that the reason my doctor is sometimes late is that he gives patients all the time they need, I don’t mind and I don’t get mad about it. I’d just like to be informed and given the option of rescheduling or serving part of my wait-time elsewhere.

      If my appointment is at 3:30, the doctor has had lots of time to get behind schedule. I ask approximately how long it will be because if they know it will be at least another hour, I have a quick errand two blocks away that I’d like to take care of instead of sitting in the waiting room.

      • sktaz

        Yeah – MOST Patients can be be very understanding and appreciative of physicians who take time with their patients – which may make them late for other patients. (I was raised seeing a physician like this – I’m very used to it – he was definitely worth the wait).

        If a patient asks if you’re running on time – it’s probably because he has obligations and if you’re running 2-3 hours behind then maybe he has to reschedule. Sorry if that cuts into your factory productivity.

        What we don’t like is when the doctor thinks that the patient is a widget to be moved down the assembly line at the convenience of the medical staff. If you’re running 2 hours late – well, tell me now – I may have to get back to work or risk losing my job. I may have limited time and find that taking an hour to run an errand and then returning for my appointment is the best use of it.

        I can imagine that stacking patients up – to make sure that they’re all there waiting where it’s easiest to bring them in one after another without the doctor losing any time – is a very efficient way to run a factory. But it’s not very respectful of human beings. It’s actually, really and truly NOT ABOUT YOU, BARBIE.

    • Anne

      Unfortunately, many doctors are only interested in themselves and it is immaterial as to the problems their patients are experiencing.

      When the doctor was told that the patient would have to reschedule her appointment because the patient is unable to take more time off from work or fear losing her job, this doctor actually said “Well, we all have our problems…but I still expect to be paid! Afterall, my time is valuable!”

  • http://Www.drmartinyoung.com Martin Young

    Good post.

    I hate keeping people waiting. I hate being late. But I can’t bring myself to cutting the consultation short when breakthrough is tantalizingly within reach. Or let someone risk dying rather than make my next patient be late for a hair appointment.

    It is the price the public has to pay for seeing a doctor prepared to go the extra mile, and not be a machinated clock watcher!

  • e-patient

    I don’t mind waiting. I schedule enough time just in case. I bring a book or perhaps my knitting.

    I have never had a doctor go that “extra mile” for me. I had one doctor tell me my time was up even though I was in tears and nothing had been resolved.

  • solo fp

    For 10 years I have stayed on time 90% of the time and within 10-15 minutes throughout the day. A lot of docs start the office later than the start time, which makes the rest of the day late. Add on drug reps, PT reps, home health reps, and other people who try to waste your time, and you can easily loose 2 hours a day that could be spent seeing patients. I was amazed in my rotations how many docs wasted 30-60 minutes chit chatting for a $5 free lunch with the pretty drug reps and then started the afternoon schedule 30 minutes late. The office staff also get tired of sitting in the office at 5:30 PM or later. A happy office has an on time doctor.

  • Jackie

    The perception of time and the reaction to ‘doctor being late’ depend on the relationship between the doctor and the patient.

    Father-in-law is a WWII veteran and retired school administrator, he’s puctual all the time (always at his appointment 30 minutes ahead of time) and would not hide his disgust/temper when others are late. The only exceptions are my late Mother-in-law and our family doctor.

    Our family doctor is a young, Mayo trained internist. He’s pleasant (always has a smile), humble (always does everything according to the book), and smart. My In-laws liked him so much they introduced him to their friends/neighbors in the rural town 60 miles from the hospital. He actually attended one of the ‘senior citizen’ functions there. Several of Mother-in-law’s childhood friend and colleague subsequently became the patient of Dr. John Myers. One of them even doesn’t mind the four-hour drive to central Texas from her home near Houston…

  • http://www.butdoctorihatepink.com ButDoctorIHatePink

    I am only 53 and have stage IV breast cancer and have seen more doctors than I ever expected to in my life. And, I do find it incredibly rude to be kept waiting with no explanation. I have decided that an hour is the max time I will wait and if I’m not seen in that time, I get up and leave and find another doctor.

    I completely understand that you are seeing patients with unexpected needs and that your time can’t be managed down to the last second. But, I am living my live with a fatal disease, going to work full time, caring for my family, making dinner, and having twice weekly doctors appointments on top of all that. My time IS valuable too, maybe a bit more than the guy with genital warts, who can live an unhealthy lifestyle for years to come – I won’t get that opportunity.

    But, it isn’t bad doctoring that makes patients wait – it is bad office staff. I will never understand why the minute a doctor starts running 30 minutes behind the office staff doesn’t start making phone calls to cancel and reschedule appointments? Surely, the office manager knows the doctor’s working style and that one late patient will lead to another late patient as a domino effect, etc? Why not give me a call, and give me the chance to determine if I want to reschedule or come in and wait? A decent office manager can plan for these occasions.

    It’s pure arrogance that says you are the physician and We. Must. Wait.

    I won’t.

    • elmo

      I do hear what you are saying and I am sorry that you are going through this. A question I have is if this is your action towards your oncologist who goes from room to room having these gut wrenching conversations one after another. As I am sure you know firsthand, these are conversations that are just not zipped through. They take time and patience. Would you tolerate an oncologist looking at his/her watch and trying to rush you during your visit?

      • http://www.butdoctorihatepink.com ButDoctorIHatePink

        Recently, my onc had two appointments scheduled, one person ahead of me. He said to his nurse, “I’m going to take Pink first. ” He said to me, “the other person is new and will take more time.” I was fine with that; he was just ordering a PET scan for me, and I’m sure the other person was fine too – I was in and out in a few minutes and the newbie got extra time.

        In truth, there is no visit I have had with a doctor that I’ve needed more than 15 minutes, even that initial “you have breast cancer” visit. (Although the surgeon did take double that time explaining things, it was stuff I already knew and I didn’t bother to interrupt). Even being told the cancer had invaded my liver didn’t take that much time. I knew what that meant and my questions were about what chemo I’d do next and whether it could be ablated or not. I imagine if/when it’s time to go on hospice, that will be a longer conversation, but hopefully that can be planned for.

        My oncologist is a good doctor and I like him. But, most of our appointment he is typing notes into his computer because of EMR. I feel that it is incumbent on patients these days to become informed about their own conditions. In today’s era, Doctors are the touchpoint, not the fount of all knowledge. They direct my care, tell me what is going to happen, but I read about it on my own afterwards. I rarely have questions right then because I need to research first, any question can wait until my next appointment.

        I know not all patients are like me but it seems a good practice would be able to accommodate different personalities without just lining folks up and making them wait. And if the wait is happening, start to reshuffle. Doctors shouldn’t cause their patients blood pressure to skyrocket. :) I’m passionate about this because I don’t have as much time as others, and given the choice of making a memory with my son or knitting in a doctor’s office as young drug reps walk by with sandwiches, which one do you think I’ll choose?

        • elmo

          Pink
          I am an oncologist.
          I also don’t see drug reps. Never have.
          I don’t talk baseball, don’t have a clue about the standings. Frankly, I am too busy seeing patients.
          I don’t take lunches. My lunch is a homemade sandwich between patients while looking up patient labs/records,
          When I get a new consult with a new diagnosis I fit in patients
          +- ASAP because I understand the stress it causes a patient and loved ones. As you said yourself this isn’t someone with warts. This includes seeing patients at 7:00 AM and 6:00PM or later if there is no room in my schedule (and that is often the case) before and after my staff is present. That is the reality of practice today.
          Though I have patients like you, the fact is many are not like you and I personally find it inappropriate to move patients with this diagnosis quickly along in an assembly fashion and be a clockwatcher. Most of my patients seem to appreciate it and my undivided attention when I am in front of them. At times I do run late, I don’t like it anymore than you do (I also have children I frankly don’t see that much of). Honestly, though I have my staff try to reschedule patients the reality is the majority of my patients have active cancers are under treatment. Rescheduling is often not an option.
          Lastly, as patients progress and treatment options become more and more difficult, these conversations often take more time. Especially in later stages when out of town family members come in and require repeat of the events/plans in an effort to try to be helpful. End of life conversations are by definition time consuming. I will also get in the neigherborhood of 10-20 calls a day that I have to address personally. That is the reality of an oncologist’s day.
          Food for thought and I wish you well.

        • pcp

          Pink:

          You sound like a great patient.

          Tell your doc next time that the time you are paying for is for evaluation and management, not for completion of secretarial chores.

  • http://myheartsisters.org Carolyn Thomas

    Well said, Dr. Emily. But I suspect that whether punctuality is seen to be important or not is often in the eyes of the person waiting, not in the eyes of the one making us wait. I absolutely agree with SoloFP who says: “A lot of docs start the office later than the start time, which makes the rest of the day late…” That’s just poor office management practice at work. Most patients I know can tell stories of observing their doctors flying through the back door late for work with a waiting room already filled with patients at the very first appointment – and often all booked for that same first appointment slot.

    And it’s hardly doctor-bashing to assume that those of us who make appointments (and thus need to rearrange all other priorities in life to be on time for them) are justifiably frustrated by those who act as if no appointment exists. This goes for doctors as well as dentists, lawyers, accountants, builders, vets or any other professional who owns an appointment book and tells clients what time to arrive for meetings.

    Yes, most of us respect the reality that docs are sometimes late because they’re dealing with unexpected pregnancies/STD/terminal disease diagnoses. But I often wonder whether this respect for time is one-sided?

    • http://www.butdoctorihatepink.com ButDoctorIHatePink

      I have not only seen doctors rush in late, but I have heard them in their offices talking on the phone about trivialities (baseball, not patient care) as I waited in the cold exam room in a paper gown for upwards of 40 minutes.

      I have also seen pretty 25 year old pharmaceutical salespeople walk in and get priority over me.

      It’s hubris to suggest that physicians who are late for appointments are giving excellent medical care to the prior patient. It can be occasionally, I’m certain. But, Dr. Emily, if this is a daily habit for you than I suggest you rethink your practices.

      At the very least, instruct your office staff to let new patients know up front that you have a more walk-in, clinic style practice, and appointments are generalities, and let us choose.

      Perhaps there are two types of patients? Those, like me, who are efficient and well-informed, not there for moral support, who will describe any complaint immediately and answer questions honestly without last-minute surprises. Then there are those take a long time to understand an explanation, need to be drawn out and don’t understand the process.

      As a physician, you might be wonderful for the second kind of patient and not the first.

      If that’s the case, let those of us who do like to keep our lives in order, who are not needy patients and who prefer not to hang out knitting in waiting rooms find an efficient doctor by telling us up front your practice doesn’t run on time. Alternatively, or set aside specific days for us to come in, see you, and get out.

      If you PCPs know your patients like you say you do, you know who will benefit from this kind of visit. Maybe you can set aside “quick patient Tuesdays” and make everybody happy. :)

      • http://myheartsisters.org Carolyn Thomas

        BDIHP – glad you brought up the subject of Big Pharma drug reps waltzing ahead of that queue in the waiting room! When AstraZeneca internal documents (including hundreds of pages of reps’ call notes during their physician ‘detailing’ visits to push their anti-psychotic drug Seroquel) were publicly released during lawsuits against the company, they revealed a disturbing trend. See also: http://ethicalnag.org/2009/09/12/astrazeneca/

        It seems that these internal sales call notes revealed that many busy physician had no problem at all leaving patients to stew in the waiting room while they listened to a pitch from their friendly neighbourhood drug reps. For example:

        “Dr had 3 patients waiting but did sit down with me x 25 minutes.”

      • Family Medicine Doctor

        If that’s the case, let those of us who do like to keep our lives in order, who are not needy patients and who prefer not to hang out knitting in waiting rooms find an efficient doctor by telling us up front your practice doesn’t run on time. Alternatively, or set aside specific days for us to come in, see you, and get out.

        Although I appreciate the concern you have and even the attempt to offer a suggestion to resolve the issue, your suggestion is unfortunately completely impractice and impossible to enact.

        • http://myheartsisters.org Carolyn Thomas

          FMD, why do you think this would this be “impossible”? During the H1N1 flu scare, for example, many family docs here scheduled half-day blocks of mini-appointments to do nothing but flu shots (vials of vaccine held 10 shots apiece that had to be used at once, so it made more sense to bring at least 10 patients in at a time for appointments that took 5 minutes max). We all knew in advance that this was just a special quickie visit – if we had ANYTHING else needing attention, we’d schedule a separate visit. Worked like a well-oiled machine! And many docs do regular small group appointments for diabetes patient education follow-up so they can say the same thing once to five patients at a time rather than needing five separate appointments.

          For decades, I’ve been seeing my family doc every three months for routine prescription renewal and blood pressure checks (a 5-minute task) yet I invariably have to sit in her crowded waiting room for an hour OR MORE for this simple in-and-out visit, and that doesn’t count the additional half hour I wait for her when I finally get into an exam room after that initial wait. It is maddeningly frustrating – and not good for one’s blood pressure, I might add.

          I wonder why a half day of prescription renewal appointments, for example, would be considered “completely impractical”? To me, Pink’s idea sounds eminently practical and, more importantly, respectful of the patients’ time.

          • JustADoc

            Because a good half of simple routine prescription renewal visits turn into into much more than that. And there is no changing people. If you complain of chest pain(or many other things) at your simple routine precription renewal, then the visit time lengthens considerably.

  • MZMD

    I am probably in the minority in that all my appointments are 30 minute slots (versus 15). Unfortunately I do run late, never because I am socializing with drug reps (I have never once been to a drug rep dinner), but usually because one of my patients showed up 10 or 20 or 30 minutes late to a 30 minute appointment or someone else needed more time for an urgent issue (unintended pregnancy or new cancer diagnosis) or a worried well person booked a physical and then wanted 5 or 6 other issues addressed, including nutrition, fatigue, etc.

    Like some of the other respondents, it is unusual for me to take a bathroom break, or a lunch break, and when I finish the seeing patients part of my day (I am one of Dr Karen Sibert’s excoriated “part time” physicians – although I work 12.5 hours a day 5-6 days per week) I am already utterly exhausted and then still have to deal with my EMR notes, Medicare Meaningful Use, and numerous phone calls, result notifications, FMLA papers, prescription refills, consult notes, post-ops at the hospital etc.

    I am not making a fortune, and have 2 young kids at home who frankly don’t get the best parts of me because I am expending it all at work. On top of this, I have had a major medical illness myself this past year which I am just recovering from.

    I do apologize to patients when I am running late, and if I have enough lead time or am running late enough early on I do try to reschedule or shuffle people. But sometimes I am not really behind until I am smack in the middle of it and by then 2 or 3 people are already waiting. I try to get fasting labs drawn and send them for lunch but I definitely have to field a fair amount of attitude despite my generally lauded bedside manner (I get good online reviews!) and my apologies.

    Speaking of attitude, the other day I actually had a person read a magazine throughout their entire physical. The same day I had someone call in saying that a mid-level provider in another healthcare field recommended that the patient go on drug type X. I notified my assistant that starting a new chronic medication requires an office visit. I recieved a message back that an office visit “wasn’t worth the time or money” and why couldn’t I just talk to mid-level provider Y and prescribe the drug?

    ?huh? I didn’t go into primary care or become a doctor for the “prestige factor.” All I really wanted to do was help people. And I am good at it. But between my own health and family issues as well as all the crap I have to take daily at work I just really wonder if it is worth it…

    • http://deleted pcp

      Can’t help wondering why, with such a full day, you’re wasting your time on “Medicare Meaningful Use”?

  • Muddy Waters

    Instead of an exact appointment time, I have always been an advocate for an appointment time “estimate.” No one mentions here that patients also run late on occasion, and some patients arrive early. If you are given a range of time that you will be seen, it allows the patient to better plan their schedule, and allows me to see early patients so I can accommodate late-arriving patients as well. Just an idea.

  • http://myheartsisters.org Carolyn Thomas

    Q: do you think this is why our doctors call us “patients”?

  • imdoc

    Running late seems to build on itself during office hours. I think the only reasonable fix is schedule blocks which occur for 15min every couple of hours. This then is either catch-up time or a chance to get to the prioritized calls or paper work. Concentrating also on keeping the staff efficient helps keep things rolling. Patients appreciate at least making progress through getting necessary labs, scheduled consults, x-rays, etc. rather than just sitting with no clear idea of the time horizon. Also, it is best to avoid having patients sit waiting in a paper gown for any period of time. This makes people feel uncomfortable in many ways.

  • Donna-1

    My PCP is so “efficient” that people can’t stand working for her long. She has a reputation for being hard-nosed and inflexible. Maybe this is good for pushing patients through on time, but every time I see her, there is a new staff. Which means none of them know me, nor do I know them, and I do find it disconcerting. I almost wish she would slow down and be a bit more easygoing and give her new staff time to catch on to her way of doing things before ushering them out the door. But I know “modern medicine” and modern medicine practices, including reimbursement and physician groups demand a certain number of patients per day per doc.

    On the other hand, my psychiatrist is usually running late but always has the same receptionist, who knows me by name. He gives me extra time when I need it and yes, others have to wait their turn (and past their turn most of the time.) But I never feel I am rushed. And if there is an emergency I get in right away or at the least get a phone call from him that day.

    Still, with both doctors “conditions” are never explained, med side effects are never discussed prior to taking the meds, and it is as if I am expected to search online for the info I need. Which I do. I wish they had time for the extra few words of explaination w/o having to be asked. Do they assume I know what the side effects are or exactly which type of anemia I have?

  • Dr. Jon

    I am both a physician and a patient (oncology). I have a dual perspective these days. I fully understand the issues of running late… even more so since my cancer diagnosis. I expect that my physicians would do as I have done for 37 years…
    1. I have my staff inform patients who are waiting that I am running late and give the patients an estimate of the waiting time if that is possible.
    2. I apologize to those patients when I enter the room and thank them for waiting.
    3. Most of my established patients know I will give them as much time as I can as their situation calls for. I also triage in sick patients who must be seen that day. I rarely have to remind my patients of that, but I will if they appear to be upset.
    4. Having had a 3.5 hour wait by a physician who triple books himself the one day a week he is not in surgery is just plain wrong if he doesn’t let his patients know that is the way it is going to be… and he didn’t nor did I have any idea how long the wait would be.
    We are in a profession that requires good public relations. I just cannot think of any good reason to not exhibit kindness, compassion, and consideration of others. It is what we expect when we are patients ourselves. If we cannot give that back to our patients, I think we must really rethink why we became physicians or why we are not doing that.

  • jim jaffe

    let’s stipulate that docs work hard and don’t get the respect they deserve and patients are anxious and self-centered. that said, there are ways to reduce anxiety by keeping folks informed for when they’ll be served, even the NY subway system realizes that folks are calmer when they know what lies ahead. telling a patient at check-in time that the doctor is already running 30 minutes late and that the scheduled appointment will probably slide by at least that much would be helpful. putting something on the website warning that the delays are usual and can best be avoided by being one of the day’s first patients would be helpful as well. such practices aren’t rocket science and might be more fruitful than fussing about how patients don’t understand the pressures doctors face.

    • Anne

      Let’s stipulate that in a patient/doctor interaction the entire purpose of that interaction is the patient – and for the patient not to be “self-centered” in the interaction is for the patient to not be focused on the reason why he is visiting the doctor in the first place. Let us also stipulate that the patient, due to illness, may be anxious.

      • http://www.butdoctorihatepink.com ButDoctorIHatePink

        I’m with you Anne, if you can’t be self-centered at the doctor’s office, when are you supposed to be self-centered?

        I have four doctor’s appointments this week alone. If everybody runs an hour behind, that is a big chunk out of my time and no, to be perfectly honest, I do not care that much about the other lady sitting in the room waiting room. Sorry, guess that makes me a bad person.

        I agree with Jim – Disneyland has made an art of helping people wait. The first thing they ever did was put out signs with wait times. It’s the unknown that is difficult and keeping patients informed would go a long way to calming frustrations. How hard is, “Doctor is running 40 minutes behind, do you want to wait or can I reschedule you?” I bet most would wait.

        The truth is nobody can ever understand the frustrations anybody faces in a situation they haven’t been in. A doctor can’t understand what a teacher goes through every day, a teacher can’t understand what a bus driver goes through. Societal norms help us all cope with all these different viewpoints, and one of those norms has to do with keeping time. How often would you frequent a restaurant where your reservations ran an hour or two past time? Even if the meal was made individually for you as “the most important person in the world”

        One of my (former) doctors had a big red sign, not only in his front office, but in the exam room, saying a patient who cancels within 24 hours of an appointment will be charged $50.00. I saw him just once. He kept me waiting an hour and a half in the waiting room, and then longer in the exam room. I was in serious pain so I stayed but that was the last time I saw him. Why he wanted patients to show up or pay when he wouldn’t give us that same courtesy is beyond me and I was very tempted to bill him for my time.

        I work in school administration and see this with teachers too. They want students to turn in work on time but if I give them a deadline they have a million excuses why the rules don’t apply to them and it can’t be done.

  • http://myheartsisters.org Carolyn Thomas

    This morning, a new survey of 12,000 physicians in Canada was released by The Canadian Medical Association, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada.

    Some interesting findings, including five identified factors that affect patient wait times:

    - Increasing complexity of patient caseload

    - Managing aging Boomers with chronic conditions

    - Increasing administrative work and paperwork

    - Increasing patient expectations

    For more info, including today’s media release with a summary of survey findings, see http://www.nationalphysiciansurvey.ca/nps/home-e.asp

  • http://myheartsisters.org Carolyn Thomas

    Ooops, forgot #5:

    An ageing population!

  • barbara spalding

    Most of my doctors do not run late. The one who does, I’m convinced, is simply and purposely overbooked. I end up spending 3-4 hours in his office for a 10 minute epidural procedure. Other professions don’t get away with this and once my current series are completed, I tend to go elsewhere if needed. I’ve already gotten a referral.

  • niki

    Some doctors may have an excuse that they have an unpredicatable day. But when my daughters dermatologist is consistently late it can only be for one reason. She overbooks. The last time I saw her another woman and her baby arrived at the same time as me with an appointment for the same time. And this is a paediatric dermatologist. I think it is highly inconsiderate to keep parents with children and babies deliberately waiting.
    Also I can’t count how many times I have made the first appointment of the day to avoid the wait to see a doctor start the day 20-30 minutes late.

  • http://www.neilbaum.com Neil Baum

    Doctors can provide a “cushion” for delays by allocating 15-20 minutes each morning and afternoon for urgencies and emergencies or for patients who need additional time. Let’s not forget that the number one complaint patients have about the delivery of health care is waiting for doctors. It is one aspect of our practices that we can change and we don’t have to ask Washington for permission to be an onetime doctor.

  • Rebecca Coelius

    Instead of directing your ire and energy at late doctors, how about considering and working towards more equitable reimbursements for office-based visits? There is a reason doctors in large practices or hospital groups are forced to schedule patients back to back; horrible reimbursements for clinic visits (versus procedures or imaging-which do not show any greater cost benefit, but have been lobbied to death by interest groups). If they do not they cannot cover overhead costs much less be competitive at attracting quality staff. And no I don’t just mean the doctors, I mean the RNs, PAs, janitor, lab techs, etc.

    NONE OF US want to be stuck rushing through our patients, or have patients mad at us. And for the small number who really are just jerks who would rather canoodle with the drug reps, at least if more medical students were going into primary care, you would have the CHOICE to find a new clinic. In the status quo most patients can’t switch physicians without putting in an enormous amount of effort and waiting months to get into a new clinic due to the primary care shortage.

  • http://briarcroft.wordpress.com Emily Gibson

    Thank you to all and it has been most helpful to read patients’ perspectives as well as that of other physicians about the dilemma of running behind in a clinic setting.

    I work in a public funded, not private clinic, and as the director of the clinic, I spend a good deal of my administrative time (what little I have) looking at this issue. We operate on a “same day appointment” scheduling basis for most appointments, in order to “get today’s patients seen today”, avoiding the frustration of waiting several days or weeks to be seen for something that needs attention acutely. We see about 1/3 of those who call or email in with symptoms while the rest are triaged to self-care. Still, another 1/3 simply walk in without calling first, so a goodly share of nursing staff time is spent in assessment and determining the best care option for each individual. In addition we provide care for people who need IV hydration and require care all day long.

    Given all those variables being juggled by the physicians and nurse practitioners, I am hard pressed to come up with a better solution to our running late when we must take care of each person who comes through the door, no matter how ill, and yet be done by a certain time of the evening so as not to incur overtime pay for our classified nursing staff, thus impacting a diminishing budget.

    My best thinking to keep visits more efficient is to provide much of the patient education electronically after the visit, so the patient has time to read, digest and then ask questions directly of the provider on line. This is working well and often does prevent unnecessary repeat clinic visits because it develops a relationship between patient and doctor on line that avoids that frustration of the long wait in the exam room.

    Again, my appreciation for your many responses and I look forward to reading more!

    Emily

    • http://warmsocks.wordpress.com/ WarmSocks

      email can be great, but that’s going to take a lot of your staff’s time, too. There are also people who don’t read – they can, but they don’t. That may be why some doctors are posting educational videos on YouTube.

  • CC

    Well I understand that doctors can run late from appointments, but what about when the patient is the first appointment of the day and has sat in the office from the appointed time (from being the only patient to sitting in a full waiting room) till 40 minutes later when the doctor finally decides to arrive at the clinic.

    I personally find that highly disrespectful of the patient’s time to have them wait for such a long time just for a 5 minutes checkup.

    • http://warmsocks.wordpress.com/ WarmSocks

      I’ve seen that happen, but the doctor’s day doesn’t start at 8:30 with the first clinic appointment. He’s not just walzing in late, having overslept, if he arrives at 9:10. My doctor is at the hospital before 6:30 to see all his patients who are hospitalized; then he drives to his clinic to see people who have appointments there. Occasionally somebody in the hospital needs extra time, so the doctor arrives late at the clinic. Just because you’re the first clinic appointment of the day doesn’t mean you’re the first patient to be seen that day.

      However, if my doctor did that frequently, I’d suspect his time management skills. Someone who’s always late finishing rounds needs to start rounds earlier. I’d either find a different doctor, or take the first clinic appointment after lunch, not the first one of the day.

      • http://myheartsisters.org Carolyn Thomas

        Depends on the doctor, Socks. Here in Canada, according to ‘The Hospitalist’ – http://www.the-hospitalist.org/view/0/index.html – over 80% of family docs have given up their hospital privileges, so do not see their “patients who are hospitalized”. Hospitalists see these folks instead.

        I don’t think any of us are talking about the doctor who is occasionally running behind because of an emergency visit with another patient. We’re talking about the chronically late physician who, as has been pointed out here very well, neglects to inform waiting patients how long the wait will be, or who does not know how to be an efficient time manager in his/her office practice. Which is just downright disrespectful….

        • http://warmsocks.wordpress.com/ WarmSocks

          Good point. My doctor still rounds on his hospitalized patients. I tend to forget that many don’t.

  • http://Www.baird-group.com Kristin Baird

    Emily, you make valid points here and yet, it is important for all providers to understand that, like it or not, your service is being compared to other service industries. Consumers have certain expectations when appointments are made, whether it is for a haircut, legal consult, or with a lender. Research demonstrates that it isn’t the amount of time spent waiting that upsets patients, it is having NO information that causes problems. Assuming that you have good systems in place to manage throughput efficiently, it is vital that the staff support the physician by keeping patients informed about wait times. When I ask patients to tell me what is most important about their relationship with their physicians,they emphasize trust and respect. Trust hinges on listening and doing what you say you will do. Respect hinges on treating them as valuable human beings. In both instances, wait times can influence the patient experience. Set a standard for keeping patients informed beginning @ the time they register, after 15 minutes in the waiting room and at the time that they are roomed. You may be surprised to see how this can influence the overall experience.

    • http://briarcroft.wordpress.com Emily Gibson

      We do have those systems in place and we do inform the patients of the wait time as best we can predict it. It does help because any patient who is more informed is a patient empowered to make a decision about whether to wait or leave. A large percentage of our patients are uninsured so they don’t have other affordable health care access.

  • Dr. D

    I’m a salaried dentist working in a FQHC. This article struck a cord with me as well. Some days are terminally long days, trying my best but my schedule is overwhelmed with patients and I am on salary so I am not receiving monetary compensation for more patients but I do so because I want to provide as much care as possible to those that need it the most; most days I find patients to be impatient, short tempered, and even if an apology is offered it is genuinely regarded as unappreciated. Some days I consider making a move to private practice, but then soon feel guilty wondering if they’re will be a shortage of doctors willing to work in nonprofit organizations. As you mentioned, if pateints were perhaps more understanding to the demands of [health center doctors] I would hope they would be more understanding. We live in an age where people are used to instant gratification…so for now we keep fighting the good fight and provide care to those that have the least amount of access, and hope they understand good care takes time.

    • stitch

      I understand where you are coming from; I worked in an FQHC and the scheduling was impossible. However, as someone who tends to be rather, well, neurotic about time, and who hates to keep people waiting, I found the anxiety it was causing was more than I could handle. And the primary anxiety I had was that in trying to take care of complicated patients on an impossible schedule, I would miss something or make an error that could cause harm. I was not the only provider at this particular FQHC to have those feelings. I had to leave or I would have had to leave medicine entirely.

      Now I get the comments all the time about how ‘unusual’ I am to be on time. I try very hard but it is not always possible, but at least now I have the ability to set a schedule that allows time for the complicated patients.

  • SB

    While I would like to think that the reasons patients have to wait is not the fault of the doctor, I know that is not always true. I used to work in a radiation oncology department. These patients had to come in every day for treatments. One day a week they had to be seen by their doctor. I don’t know how these poor patients of one particular doctor tolerated the waiting. They have cancer, they come in for daily treatments and I’m sure they just want to get out of there for the day. This doctor, with a waiting room full of patients, would sit in his office with his feet on his desk reading the newspaper, shooting bull on the phone, eating a leisurely lunch (that he had one of us go out and get for him), read fishing magazines, etc. He was well aware that people were waiting to be seen. It was so frustrating for all of us who worked there. Then, when he would get up and go see a patient who had been waiting a long time, he would breeze in and ask how they are doing and breeze out with his white coat flying behind him.

    Thankfully, of the four physicians who worked there, he was the ony one like this. But, that was one too many!!! Oh, I forgot to mention that if the patient was a good looking or well dressed female…he spent all the time the patient needed and was not in a rush. It was disgusting.

    • http://myheartsisters.org Carolyn Thomas

      This story makes me *cringe*…. Was there nothing that you or any of this guy’s staff/colleagues could do to address this kind of behaviour?

    • Penny

      I have actually had one doctor like that. A couple of times he walked in well over an hour late when his staff said he was occupied with another case, and then would say that he couldn’t find a sitter for his kids or whatever. Patients can tolerate even an excuse like that, but not when the doctor doesn’t let them know and expects his staff to “lie” for him, pretending he’s there. Doctors like that are ultimate scum. Fortunately those types aren’t common as far as I’ve seen. Doctors like that should be disciplined and finally removed from practice.

      On one occasion he didn’t show up for 2.5 hours so I simply left. He never did apologize. He probably forgot about the appointment entirely. This is why I think a site like Rate MD’s is great. I try to not even go to doctors if they’re not rated on Rate MD’s because I assume that either they are too new and inexperienced to rate or they are so bad that they asked to have their ratings removed.

  • Penny

    I think it’s rude becoming upset with a doctor when he’s late. One of the very best doctors I ever had was always very late, because he didn’t treat patients like time pieces. Even if I were dying I would never expect a doctor to run to me. Many of his patients might be dying.for all I know. So I always “assume” a doctor will be late versus the other way round.

    People should lighten up and take reading material with them when they go for visits and try to understand that

  • http://www.neilbaum.com Neil Baum

    I know there are some very creative colleagues who might work on an iPhone “app” for practices informing patients of the anticipated time of their appointment and if there are delays in the office, the patients don’t have to spend time a prolonged in the reception area. This technology and iPhone app is already available from the airlines and I think it would work well for medical offices as well.

    • http://warmsocks.wordpress.com/ WarmSocks

      Not being the owner of an iPhone, this wouldn’t appeal to me. There are similar options already in use, though. When we check in for my daughter’s appointments at the outpatient clinic at Children’s Hospital, we can go anywhere in the building (even the cafeteria) while waiting our turn because at check-in, we’re given a little gizmo that will let us know when they’re ready for us. When it’s our turn, the thing starts vibrating and flashing lights, and displays a message on the screen telling us which door to go to.

  • http://www.anasexperiences.wordpress.com Anas Wajid

    Good Read.
    What I do not understand is why the patient can’t be informed if the doctors are running late.

  • doctor1991

    A good read. You sound like a very caring and empathetic physician, but here is a difficult question: Do you think you would be forced to be more sensitive to time issues if you were in private practice, and not on salary?
    One observation: Patients often don’t tolerate different personality traits in other patients on the schedule well. One patient will be the type to raise a new issue or present disability papers just as I am set to leave, but be willing to tolerate a long wait, while the next patient will inevitably be the type to have filled out all her papers on line and have scheduled three appointments that afternoon and be unwilling to wait long. It’s challenging.

  • MZMD

    Anas-
    I can’t speak for everyone, but I work in a large multi specialty practice. The front desk and my assistant don’t know I am running late unless I call them from an exam room and tell them specifically. Of course, I find it difficult to do this in the middle of the patient encounter that is making me late. Thus, some people end up waiting unfortunately although I always apologize.