I hate running late.  I prefer to arrive five minutes early for any meeting.  I was that compulsive student who always turned in papers before they were due.  Now I turn in conference abstracts, grant applications, and even poetry contest submissions, well before their deadlines.  Unfortunately, timing is not always in my control.

I particularly hate running late in clinic.  I want to see all my patients on time.  It is never my intention to keep people waiting.  But all it takes is one patient with more complexity than can fit into their scheduled appointment, and the entire day is thrown off.  It is impossible to catch up again if I am fully booked.

People often complain about having to wait at the doctor’s office and say things like, “The doctor must think his time is more valuable than mine.”  Do they assume that the doctor wants to keep them waiting?  Or that the doctor is wasting time?  Or trying to assert dominance by insisting that the patient be on time and not reciprocating?

No, the doctor is late to see them because he or she was delayed by another patient.  Another patient who needed extra attention to deal with a cancer diagnosis, a spouse’s infidelity, a challenging mental illness, a mysterious pain with no clear answer, an important decision between treatment options, an unexpected procedure, five different serious chronic conditions that all need to be addressed, or any number of other issues that come up.  Many problems do not fit neatly into a 15 minute appointment slot and are going to spill over.

If I had my way, I would have longer appointments.  I would be less rushed and less likely to run behind.  But then I would have fewer appointments available, and patients would have to wait longer to be scheduled.  People already have trouble getting access to primary care.

A family medicine doctor in private practice once told me: “My first twenty patients of the day are overhead.”  He had to see at least twenty patients every day just to break even on the expenses of the practice.  He usually saw about thirty and was always under pressure to do more work in less time.  Every day, he worked through lunch and stayed at the office long after the last patient had left, doing the paperwork and follow-up.

The patients in the waiting room do not see what is going on behind the scenes.  They are not reflecting that our system is designed for acute care and not well suited to managing multiple chronic illnesses or social disasters or the ever increasing demands of preventive care or the burden of unreimbursed work.  They do not see my good intentions to provide excellent care and also run on time.  All they know is that the doctor is late.

Tabor Flickinger is an internal medicine physician who blogs at Tea with Dr. Tabor.

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