The Doctor Will See You Later

I had to wait an hour and a half past my scheduled appointment to see a dermatologist the other day, and by the time I got to him, I was ready to mar his perfect complexion.

Under normal circumstances, being small and afraid, I am not the kind of person who tempts confrontation. But waiting stimulates a primal rage that I find difficult to control.

The doctor in question sensed my anger but wasn’t particularly disturbed. He mumbled an apology and explained in a somewhat offhanded manner that he’d been delayed by a medical emergency. Then he aimed a long needle at me.

I decided that silence in this instance was the better part of annoyance, so I ceased to express my dismay at being kept waiting for so long. I don’t confront people who are armed with either cutting or puncturing devices.

I learned later that the medical-emergency explanation is considered among the oldest excuses in existence to cover overbooking, a procedure that allows doctors to build fat practices and move from places like Tarzana into large, ugly houses in Beverly Hills.

As far as I could determine there are no constraints to prevent our, well, caregivers from jamming more patients into a day than anyone can properly handle. Not even Hippocrates, who established the oath of medical conduct 2,500 years ago, broached the subject. He warned against such diverse evils as bad drugs and having sex with one’s patients, but failed to foresee the torture of long waits in a doctor’s office.

After an hour had passed, I complained to the receptionist. She indicated that her boss, the dermatologist, was a serial overbooker, despite her best efforts to have him ease up a bit. As far as I was concerned, that put his medical-emergency excuse on the level of “a dog ate my homework.”

*

I had gone to him in the first place not for cosmetic enhancement but to have a small growth removed, which is why he came at me with the needle. It was to deaden the pain, but it also had the effect of shutting me up.

Conditioned by decades of deadlines and an obsessive need for punctuality, I arrived at his office exactly on time, whereupon I estimated it would be about a 20-minute wait to see him. I should have known better.

The waiting room was packed when I got there and, in fact, three people were standing and two sitting on the floor. Salesmen with their medical samples and their jovial ways contributed to an overwhelming sense of being in a large elevator stuck between floors in hell.

Grumbles aimed at the long wait were heard periodically, like bursts of flak in the stale air. It was the kind of seething discontentment that overthrows kings.

Adding to the indignity of waiting in a crowded room, there was nothing to read, unless one was attracted to articles in Keyboard Inc., Arts & Antiques and other journals of similarly limited appeal.

I actually complained several times to the receptionist, but the poor woman could only shrug. A shrug is also what I pretty much received later from a spokesman for the American Medical Assn., who said more or less that it’s not the doctor’s fault.

Physicians, he explained in a tone of sincerity that Hippocrates might have envied, must spend as much time with a patient as necessary to tend to his needs, thereby causing occasional backups. The implication here was either we endure the waiting in silence or end up with Jack-in-the-Box drive-through medical care in America. It’s a warning physicians like to refer to as the danger of three-minute medicine.

*

Some years ago in Germany a patient who had spent 21/2 hours of involuntary waiting-room time during three scheduled visits refused to pay his bill, claiming that his wasted time equaled what the doctor wanted to charge. The physician sued, but the court ruled that a wait beyond 30 minutes was unacceptable and cut the bill in half.

In the U.S., a man forced to wait an hour because of the doctor’s “medical emergency” discovered later that the physician’s delay was caused not by the necessity to save a life but by the fact that he’d been playing golf.

The man sued for his wasted time and collected $200.

Karen Koss, who’s the media rep for the L.A. County Medical Assn., informed me in a surprising display of candor that dermatologists are the worst when it comes to making patients wait.

“They’ll make you crazy,” she said. “I had to wait two hours for a dermatologist once and I’ve never waited for less than an hour. They’re terrible because they do the work right there, and it takes time. That’s great for patients but not good for waiters.”

In a study 10 years ago, the AMA concluded that prolonged waiting is a major grievance among patients and that dissatisfaction was on the rise. Judging from the grumbling I heard in my dermatologist’s office, it’s still on the rise.

By the time I left, I had spent two hours there for a procedure that took less than 15 minutes. The waiting room was still full. It wouldn’t surprise me to hear that one or two patients remain there days later, thumbing through old copies of Architectural Digest as they wearily await their 15 minutes of treatment.

*

Al Martinez’s column appears Mondays and Thursdays. He’s at al.martinez@latimes.com.