As an oncologist, I hate running late

Yesterday I had office hours: 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late.

Now, I have to admit this is a unique complaint.  Google yields 52 million hits for “why is my doctor always late?,” none for “why are my patients always late?” Apparently, doctors have not yet begun a postponed patient protest.  There are voluminous excuses posted on line for late doctors, but even more patient anger and frustration.

As an oncologist, I detest running late, because it means leaving people with cancer on their minds, stewing in my waiting room.  Personally, I worry when I am waiting at the dentist for a cleaning.  What goes on in the mind of someone waiting to see me? Given the skyrocketing blood pressures of the average visitor to our office, I do not wish to add to that anxiety by leaving patients to stare at our fireplace or leaf blankly through a popular magazine.

Making another person wait seems disrespectful.  It says, “I am more important than you.”  Now of course one can read too much into the everyday necessities that cause delay, so I try not to be offended when they take too long to de-ice my plane before a winter flight.  Still, as part of the patient-doctor relationship, our obligation is to prepare to meet at a particular moment, and when you add the anxiety and complexity of medical care, that moment is very important.  If I was a cancer patient trying to understand disease, treatment and side effects, worrying about picking up the kids after school, and at the same time keep my nerves under control, it would not help to watch an hour or two of the chaotic dance of an oncologist’s office, before finally being allowed into chambers.

I try to be on time to see my patients.  Even, if there is a heavy schedule, I extend rather than double book, because by definition double booking means being already late.   I try to anticipate emergencies and distractions and adjust to maintain a reasonable flow.  In a busy office that can be a challenge, so I get anxious when patients add stress by being late.

When patients are late, there are several solutions.  As a kid when I was tardy for dinner, my Mom would start the meal without me.  If they finished eating before I showed up, it was going to be a hungry night.  Therefore, I tried starting the appointment before the patient arrived.  My staff was not encouraged to hear me talking in exam room #1, by myself.

Therefore, the obvious answer is that if a patient shows up 20 minutes late, without calling, make them reschedule.  Did I say these are cancer patients?  I would have to be a pretty cold fish to tell someone that a few minutes of my day is more precious than their fight for survival.  Therefore, yes, I always see them.  I take a deep breath and do not even mention that their tardiness has caused me angst.  I know, not very good patient parenting skills, but then my wife was always the disciplinarian.  The sentence, “well it looks like you need more chemo because the tumor is growing, but I am upset you were late,” is just not in my vocabulary.

So, let’s make a deal.  I will beat up on my colleagues about their lateness: explain time management, office organization, communication and mutual respect. Tell them to have staff inform patients when the doc is running late and build reasonable, achievable schedules.  In return, I only request that patients show up, more or less, on time.   Patients are not the only one anxious for each appointment.  I am anxious.  Anxious to see that each person gets the absolute best care possible and it seems to me that we start by doing the first thing we agreed, which is begin on time.

James C. Salwitz is an oncologist who blogs at Sunrise Rounds.

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  • http://www.facebook.com/karenjrinehart Karen Rinehart

    Fabulous POV. This, from a gal who was the cause of OB/GYN patients’ appointments being delayed or canceled one summer day 21 years ago. Why? Because the Dr. had to literally run out of the office building to the hospital next door to save my life. Whenever I schedule a Dr’s appointment, I take a book, my phone charger and a grateful attitude. YOU just might be the next patient that makes the doctor late for the rest of the day.

    • Guest

      A doctor running late once in a while is one thing, but I finally had to leave my last doc because for whatever reason he was incapable of keeping to anything close to a schedule. I work too! I have a family too! I have a life too! My schedule is important too! Whether he had life-saving emergencies to attend to every single day (really?) which set him back, or whether it was because every single day he let other patients wander in whenever they felt like it and didn’t see a problem with messing up his punctual patients’ days to accommodate them (really?), I don’t know and in the end I don’t care. There was never any explanation, let alone apology, for not getting around to see a 10am appointment till nearly lunchtime or a 1pm appointment until 3:15, that was just the way it was. Every appointment.

      I am lucky to live in an urban area with lots of choice as to doctors and specialists, and was lucky enough to find another one just as skilled and qualified but who only left me hanging maybe one out of every four appointments.

  • Suzi Q 38

    I have been fairly lucky with doctor’s appointments.
    I usually make them the first appointment in the morning, or the first after lunch. My average wait is about 20 minutes.

    I have been late for doctor’s appointments due to work schedule, traffic, or lack of parking. Bad excuses, i know.
    I try to tell the nurse not to give me that appointment, as I can’t get there that early, but she gives it to me anyway. If there is a car accident, the traffic is unavoidable. Sometimes the parking lots at teaching hospitals are just full. After awhile, I give up and go to the valet. It costs me, but does the job.
    Sorry for being late, doctor. I realize that your time is valuable. thank goodness that I am only late about once a year.

  • http://www.facebook.com/shirie.leng Shirie Leng

    People don’t remember that medicine is not an exact science. Emergencies occur. People get sick. It happens. You want your doctor to spend as much time with you as you need. Everyone else expects that too. Be patient.

    • Guest

      If I was continually late to every appointment with a doctor, with no forewarning or explanation, after a while I imagine he or she would start to feel like I did not respect his or her time. Unexpected delays crop up from time to time for everyone, patients and doctors alike, and do call for patience. It’s when they become the norm that the people being inconvenienced by habitual tardiness start to wonder what else is going on.

  • tu71586

    Nice post, I feel your pain. This is absolutely the number one reason when I run late. Sure, phone calls and emergencies happen but not nearly at the rate of patients being late. Patients may not feel like being 5-10 minutes late is any big deal, but many times, these same patients bring up issues that take longer than than the average patient to address. Aargh!

    • Trey

      “Patients may not feel like being 5-10 minutes late is any big deal”

      Maybe doctors who routinely keep their patients waiting half an hour or more inculcate in them a lack of respect for punctuality. After all, if your doctor reckons being 30 or minutes late in seeing YOU every time is no big deal, then you may well start to be of the mind, “so appointment times aren’t ever kept anyway, what’s wrong with ME being 5-10 minutes late”. Goose, gander. Vicious cycle.

      • WW

        This is an interesting point. Even without meaning to, we teach others how to treat us. If we teach that being tardy is defensible, we can hardly be surprised if that’s what our patients learn.

  • http://www.facebook.com/scott.weir.100 Scott Weir

    As an outsider, it seems that this is a cultural situation that has gone on since time began. So how do both Patients and Providers rebuild the trust that has been lost when it comes to scheduling? Well it’s probably going to be more effective to use the carrot and not the stick.
    One brainstorming idea; provide two way information (texts, tweets, email, phone) that lets either side know if the other is late and what options – if any – exist to accomodate the situation; including rescheduling.
    Also doesn’t hurt to educate people on how the scheduling works, and what the impact is to other patients. And the best carrot is that if you’re on-time, you don’t wait or have a minimal wait. And be able to consistently deliver on that.
    Going further, you could also have blocks of time that are first come, first serve for those who missed appointments. And then have a 3 strikes and you’re out policy that if you miss or are late for 3 appointments, then you can’t schedule for some amount of time and have to come during the first come first served slots?
    You can then go recruit people from the airlines who are adept at dynamically rescheduling things!

  • disqus_XpaeflETHK

    Dr Salwitz, You are an intelligent person, not a wallflower. I would like to know how you could allow a schedule comprising 30+ cancer patients in a day ???? This is obvious poor patient care when visits are less than 15 mins (after computer time}. Are you permitting this type of absurd schedule to make more money?? Another clinician.

  • disqus_XpaeflETHK

    I dont understand how a Physician would agree to a daily schedule of over 30 cancer patients? This is not good medicine. You are in control… dont blame the practice administrator.

  • http://www.facebook.com/people/Roberta-Ghahremani/100000919815524 Roberta Ghahremani

    As a

  • Jan Corbin

    This is my biggest irritation with an otherwise very competent, seemingly caring and engaged physician in a local cancer center. As a followup patient, I know my visit is only going to take a couple of minutes, just to go over bloodwork and a brief exam. It really irks me to wait over an hour for this; and I have discussed this several times with the office staff and my physician. I was surprised to hear that he was under a directive to TRIPLE BOOK his patients. I pointed out that most of the other patients looked to be feeling ill and it was not nice to make them wait without informing them of the expected wait time so they could make other arrangements–get a snack, reschedule, whatever. He does not set policy, though; I suspect the driving force is the CFO! And BTW, I have seen close to 30 people (probably not all patients) in his waiting room at one time!