Science / Medicine : Waiting Room Blues: Doctors Could Do Better : A Weekly Roundup of News, Features and Commentary
Waiting for the doctor, a statistician observes, is “among the richest of our queuing experiences,” one with “all the requirements for congestion--random customer arrivals (emergencies), variable lengths of treatment, often too many patients per doctor.”
So explains Robert Hooke in “How to Tell the Liars from the Statisticians” (Marcel Dekker, 1983).
Most doctors deal with the problem “by muddling through,” he contends.
That need not be. Most of us have experienced both extremes, the office where everyone w-a-i-t-s and the offices, often offices of busy physicians, where waiting is usually brief.
There are many things physicians and health centers can do or avoid doing. We patients should know that there are measures--better ways of office management--we can encourage them to institute. The ideas here come from practice consultants Diane Palmer (in Montgomery Medicine, a publication of the Montgomery County (Md.) Medical Society) the Bala Cynwyd, Pa., Health Care Group (in the District of Columbia Medical Society’s MSDC News), Stevan Olian (in Medical Economics) and others quoted in the American Medical Assn.’s American Medical News, as well as Dr. Eugene Guazzo of Chaptico, Md., and other physicians.
Much inordinate waiting is caused by “inept scheduling,” we’re told.
The experts’ suggestions for busy physicians and/or staffs: Both you and your staff should be in the office 15 minutes before the first appointment to get ready for patients. Above all, “think through” your schedule--to decide how many patients you really should see, as well as what kinds of patients on which days and times of day.
Avoid booking complicated visits all in a row. Leave a few slots open for patients who must be seen on short notice.
Have a set of rules--clear to everyone in the office--on when sick or troubled patients should be seen either immediately, by day’s end or by future appointment.
Don’t make scheduled patients wait while you see walk-ins, except in a true emergency.
If a patient needs more time for a complete investigation, reschedule rather than make everyone else wait.
Don’t tell patients without urgent problems to “drop by.” If they insist, make it clear that they may sit for some time.
Phone patients a day or even two days in advance to remind them of appointments. Say--warmly--”The doctor and staff are looking forward to seeing you.”
Phone or write patients who need follow-ups for their own good. Ask how they’re doing. Make it clear you’re concerned about them, not your fees.
“My priority is the patient I’m with at the moment,” Guazzo says. “Even if President Reagan calls, I’ve told my receptionist to ask what his problem is, evaluate its urgency and then decide whether I should talk with him,” then or later.
Fair enough. We can’t ask for better treatment than the President would get.
We can ask for courtesy.
The most conscientious doctors run late sometimes. Never keep a patient in the dark, says one consultant to American Medical News.
Why can’t a staff member announce--or tell us when we come in--”We’re sorry, but Dr. Band-Aid is running late today because ------. You shouldn’t have to wait longer than ------.” And, if the wait would be onerous, “Would you prefer to come back later? Or on another day?”
In a clinic or large very practice, says Dr. William Anlyan, Duke University medical chancellor, there should be someone “circulating periodically as a caring ombudsman for the patient. Coffee and refreshments should be available.”
“If I’ve kept a patient waiting longer than 20 or 30 minutes, I make a point of apologizing,” Guazzo reports. “An amazing number of patients have told me that they’ve never before heard a doctor say, ‘I’m sorry you had to wait.’ ”
Small-town family practitioner Guazzo tries to see every patient with no longer than a 10- to 15-minute wait. But he once wrote: “If a doctor’s patients consistently wait too long to be seen, then that doctor’s office is consistently incompetent when it comes to scheduling. . . . If every patient is seen consistently right on time, I would wonder what the doctor is treating; certainly it can’t be people.”
A patient who requests anonymity writes of visiting a gynecologist:
“My annual appointment was scheduled for 2:15 p.m. I arrived at 1:45. At 2:25 I asked the nurse how long it would be before I was called. She said I was next and escorted me to a room.
“I put on a gown and waited nearly one hour, during which time no one had the courtesy to explain the delay. . . . I opened the door and asked a nurse how much longer I’d have to wait. She said she didn’t know. Not satisfied, I asked if she could find out, and she replied, ‘No.’ I proceeded to get dressed. I then rescheduled my appointment and left.”
She wrote the above to the doctor, adding, “It’s situations (like this) that make patients feel like billing their doctors, rather than vice versa.”
Her doctor wrote back, explained that “that was the day I was handling a number of problem patients, several of whom are miscarrying” and apologized.
“What really gripes me,” she writes, “is that the doctor defended his office instead of acknowledging that they were rude. Yes, I still see him because he’s a good doctor. I still find his office staff to be cold, if not downright rude.”
A doctor-patient relationship, certainly, but certainly not the best.
