Science / Medicine : ON MEDICINE DANIEL S. GREENBERG : Irate Patients Go From Waiting Room to Courtroom

As litigation champ of the world, the United States rarely lags in inventive breakthroughs in jurisprudence, but now there’s a challenge: A judge in Germany has cut the bill of a patient who spent 2 1/2 hours of involuntary waiting-room time during three scheduled visits to the doctor. If not one of the great moments in medico-legal affairs, the decision surely merits note as a counter to the teeth-clenching delays so often experienced in doctors’ waiting rooms.

The German patient, identified only as a management-level executive, toted up his hourly pay and concluded that his wasted time equaled the bill, which was the equivalent of $247. According to American Medical News, published by the American Medical Assn., when he refused to pay, the doctor sued. The judge ruled that waiting time beyond 30 minutes is unacceptable, the paper reported, but that the doctor was entitled to some remuneration, for which the judge allowed half the original amount billed.

The medical newspaper said no similar precedent has been established by American courts, though some irate patients have scored victories by bringing suits in small claims courts. Among them, it was reported, was a professor who was given the standard story about an emergency putting his doctor behind schedule. After cooling his heels for about an hour, the irate professor discovered that the emergency was a game of golf. Figuring his time at $200 an hour, the professor sued in small claims court and won a judgment.

The German Medical Assn., understandably shaken by the court ruling, warned that it poses the risk of “three-minute medicine.” The danger may be there, but the greater likelihood is that wide application of the ruling might also be an inducement to punctuality, a trait that doctors insist on in patients but often take lightly themselves.

The “emergency” excuse is no doubt valid on some occasions. But an odd fact of the doctor business is that many physicians are routinely punctual, with occasional exceptions, while many others regularly over-stack their appointment books to assure maximum use of their time. According to surveys conducted by the AMA, prolonged waiting time is a major grievance among patients, and dissatisfaction is on the rise.

When doctors go to the doctor, “professional courtesy” usually spares them from waiting-room ordeals. But sometimes they, too, must wait far beyond the appointed hour. A physician who experienced irritation and inconvenience when his doctor kept him waiting suggested a simple remedy in a recent article in the New England Journal of Medicine.

A slight cutback in bookings, he calculated, would provide a time cushion for emergencies and other schedule disruptions. The spare time that might ensue, he said, could be usefully applied to paperwork, study, rest and reflection--to the benefit of patients and physicians, he suggested.

The response from fellow physicians was fascinating. One wrote that reducing appointment slots from 25 to 20 per day would mean that “some patients won’t be able to see the doctor at all that day.” The poor doc apparently missed the point: If 25 patients cannot be properly seen in the available time, the schedule should be reduced.

Another doctor responded to the scheduling proposal by suggesting that patients come prepared for delays. “Most people have a good book that they are partway through, and passing time in the waiting room that way is absolutely painless,” he wrote. To which he added, “I find professional people tend to bring a briefcase full of work, which they do in the waiting room almost as easily as they might do it on the train or in their own office.”

From the doctor’s point of view, that’s no doubt a reasonable antidote to the problems that arise from an appointment book loaded to favor the doctor. But a doctor’s waiting room, which often resounds with respiratory distress and squalling children, is not everyone’s idea of a proper reading room or workplace.

For frustration in the waiting room, there may be a better solution--a fast trip to the courtroom.