Are doctors to blame for long waiting room times?

As a physician, I was inspired by the Lesley Alderman article –”The Doctor Will See You … Eventually” – that appeared in the New York Times recently.

There is a great deal of emotion in this country surrounding the debate over waiting-room delays in physicians’ offices. Doctors feel as though they are being unjustly blamed for making patients wait when physicians are now forced to see more patients in less time, and with ever-increasing amounts of paperwork and administrative tasks attached to patient care. Patients feel as though doctors don’t care if they have to wait, and don’t value their time at all. The fact is there is truth to both positions on this issue.

I am a practicing orthopedic surgeon who has found it necessary at times to make patients wait for up to 1.5 hours. But I understand the other side all too well; as the father of a child who spent the first three months of her life in the neonatal intensive care unit followed by countless doctors’ visits, I have – as the parent of a young patient – myself had to wait at times for 1.5 hours.

As a doctor, I would ideally love to be able to see fifteen patients each day, and have the luxury of being able to spend thirty minutes with each one. This would make me happy. However, if I chose to practice this way, I would end up having to declare bankruptcy. As a result of declining reimbursements, I have to see more patients in less time than ever before. The result is tighter timelines, so there is no time during the day to catch up. If I get behind, I will stay behind and likely get further behind throughout the day.

My patients are understanding; after all, the doctor-patient relationship is a relationship just like any other, so they – like my family and friends – understand that I run behind. I don’t want to make them wait, and I am working my tail off. They know this. But just as in my relationships with my friends and family, if I kept them waiting for an 1.5 hours without letting them know, this would just be plain rude and unacceptable.

I usually do know when I am getting behind, and I communicate this delay and the reason for the delay electronically to them. If I am running substantially behind, they are able to adjust their schedule or run an errand on the way to see me. When I was taking my daughter to her doctors, there was nothing more annoying than carving out two hours of my day, rushing and running yellow lights to get to the appointment in time, only to end up waiting for over an hour.

There is no way that doctors will ever be able to always run on time. Healthcare is not predictable, and doctors are only getting busier. Patients need to get over this and have realistic expectations. We (doctors) don’t like running over either, and derive no joy out of making patients wait. However, there is no excuse for doctors who fail to communicate delays to their patients as they become aware of them.

The doctor-patient relationship is just that: a relationship. We always say we don’t want the government or anyone else to interfere in the sacred trust between a doctor and a patient. Well, with this in mind, let me state that we (doctors) are often the ones interfering in this trust. Communication goes a long way. Respect your patients and they will respect you. Let’s get this relationship back on track and focus on our goal: making people better.

Vishal Mehta is an orthopedic surgeon.

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  • http://twitter.com/kmktg Kelley Hunton

    It’s refreshing to hear a surgeon understand how important wait times are to their clinics. I’m Director of Marketing for a group of orthopaedic surgeons and in my experiece, that you actually communicate with your patients is a complete rarity! I beg our surgeons to have their staff keep our front desk informed of issues.  You hit the nail on the head on all points.  Patients aren’t coming to see orthopods for a wellness visit, they are in pain and making them wait only increases their anxiety which makes for an awful visit for them, the staff & surgeon. We all want to feel in control of our lives.  The nature of medicine make patients feel out of control and by communicating with them you give them a little back.  Believe me, I will be forwarding your article to our group.

    • http://twitter.com/Vishal_Mehta_MD Vishal Mehta

      Thanks Kelley for the nice comments.  It is not only the right thing to do but is also good for the practice.  Our patient satisfaction scores are very high and many patients do switch surgeons because they feel as if their time was not being respected.

  • http://www.facebook.com/jonathan.marcus.ca Jonathan Marcus

    I’m a family doctor.  I see about thirty patients per day and I manage to run on time…. plus or minus fifteen minutes.  Yes, this means that sometimes I’m actually early.  If a doctor routinely runs late, then I think they should accept the fact that the average visit takes longer than they planned.  They should book longer appointments.  In the end they will make the same income, but stay later in the day and patients will be able to be seen without long waits.

    • http://www.cadencemed.com CadenceMed

      Jonathan, I couldn’t agree more. If it is common (occurs daily or most days out of the week) that anyone runs significantly late (more than 30 minutes), then I would recommend taking a look at your practice’s appointment scheduling habits. What you might sacrifice in number of patients seen in a day by rather small amounts, you will likely gain in improved patient satisfaction, which will result in improved patient loyalty and referrals down the road.

      • http://twitter.com/Vishal_Mehta_MD Vishal Mehta

        Agree with both of these comments completely.  It may seem like I always run late but actually most days I am right on time or 15 minutes late.  As an orthopod, one of the issues is that some problems cannot wait very long.  Lets say I plan on seeing 30 patients a day.  I might leave 5 spots open for add-ons.  Most of the time things will go smoothly and I will add on the 5 and absorb them into my schedule without any significant delays.  Sometimes I may get 15 add-ons.  This might happen 10% of the time.  I am often times obilgated to see these patients and cannot say “sorry we are just too booked”.  They also often times have injuries that require them to be seen within a day or two.  This makes for significant delays.  I cannot plan for this situtation or I would have a very inefficient practice most of the time.  In other industries this problem takes care of itself.  For example, if you run a sandwhich shop and have more demand than you can handle, you have long waits and people go elsewhere.  For us, our group might be on call at 2 hospitals and all the patients that were seen at those hospitals need to get absorbed and don’t really go elsewhere.  They go where the ER directs them.  So the problem does not sort itself out and just leads to long delays in these instances.  Totally agree that you need to optimize your scheduling first but in my experience, even with optimization, delays happen.

  • http://AleMarcMD.tumblr.com AleMarc

    Vishal – I admire your dedication to preserve the doctor-patient relationship when communicating your delay. Also, it is impressive that you’ve adopted new technologies to enhance and facilitate this relationship (I’m talking about the electronic notification of your delay). I believe that new technologies can help us with many problems that hurt us these days, but to what extent should physicians (and consequently patients) pay for the obstacles set up by insurance companies and nonsense healthcare policies?

    • http://www.cadencemed.com/blog Matt Langan

      Agreed. I would really like to hear more from Dr. Mehta about the technologies he’s utilizing and how they’ve improved operations (assuming they have).

      In response to “what extent should physicians pay for the obstacles set up by insurance companies,” I think they should at least have to pay whatever it takes to ensure that their patients are satisfied. If that means investing in a bit of technology to drop waiting times down or improve the patients’ demeanor while they wait, then I suppose it’s necessary. You have to be patient-centric if you want to operate effectively.

      • http://twitter.com/Vishal_Mehta_MD Vishal Mehta

        Thanks for your comments.  Regarding AleMarc’s comment about to what extent we should pay for the obstacles set up by insurance companies…Ideally we wouldn’t.  I would love to remove the inefficiencies and increase the doctor to patient face time in my practice.  Realistically, I can’t.  This is something that we may be able to improve as an organized group or a nation but as an individual physician it is much more fruitful for me to focus on things that are direclty in my control.  Regarding Matt Langan’s comments about technologies…I use a system that allows me to broadcast delays either in actual minutes or in green/yellow/red format.  Can be checked on-line, via iphone app or via text messaging (can text vmehta to 41411 to try).  If I am running an hour late, I typically let patients know, also tell them the reason and then allow them to come in 30-45 minutes late.  Turning an uninformed wait into an informed wait goes a long way.  Also, I keep a little buffer in case I catch up.  If patients know I am behind due to a surgery running late or seeing multiple complex cases in clinic, it personalizes the experience and they are very understanding as they know that it could be them that needs the extra time.  I am the developer of the system I am discussing and want to respect this forum and not turn it into an advertisment but I would be happy to discuss via email at vmehta@fvortho.com.  Thanks again for the comments.

        • http://www.cadencemed.com/blog Matt Langan

          Thanks for the thorough reply, Dr. Mehta. The text system sounds very interesting and potentially very useful. Communication certainly is everything when it comes to allaying patient frustration.