Tuesday, August 14, 2007

Why we wait so long in the waiting room...

The biggest complaint that most people have is the never-ending wait in the waiting room. What exactly is going on behind those closed doors? It's an aggravating situation that is exacerbated by the demands of a bottom-line (many practices run on productivity and have to double-book to account for no-shows) and also the (sometimes unrealistic) expectations of patients themselves. It's not uncommon for a patient to want a full hour of attention when only fifteen minutes is scheduled for an appointment. Do the math, and you'll see why doctors run so far behind. Good doctors will always try to address all your issues, but sometimes it's to the detriment of a short wait.

The biggest complaint of doctors is what I describe as the "kitchen sink phenomenon." This is when patients bring EVERY complaint to a visit, usually the annual exam. Many patients "save up" their health concerns for a once-a-year visit. One of my best friends, who is an internist, regularly has patients who "kitchen sink" her. An example would be when a patient arrives for a half-hour annual exam appointment, and then comes in with a list of complaints that include high blood pressure, high cholesterol, chronic headaches, diabetes, sciatica, fibromyalgia, psoriasis, allergies, bacterial vaginosis, chest pain, depression and edema. Then there are the social issues that may be added in like domestic violence or lack of money for medications. This visit then becomes a two-hour visit because of the number of issues that need to be addressed. The kicker for my friend is when the patient will complain that not enough time was spent on her problems. And then there's the waiting room full of patients, who are angry that their appointment doesn't start on time. You can imagine it becomes a very bad day for both doctor and patient.

But there are ways to reduce the frustration. Here's how:

-If you absolutely can, ALWAYS try to schedule the first appointment in the morning. The later you schedule in the day, the more likely you will have to wait for an extended period of time.
-The average time scheduled for an appointment is fifteen minutes. Come in with a concise description of your issue. If you have a large number of health issues, the maximum number that you can probably talk about is TWO in that time slot. Again, a good doctor will never rush you out, but you may be happier about the attention to your problems if you actually devote dedicated time for each issue, especially if your health issues are chronic ones like high blood pressure or diabetes.
-If your medical practice has a website, check to see if you can download forms online. Filling out those forms ahead of time speeds up your check-in process. After all, the front desk won't kick your file back to the nurse until the paperwork is done.
-Many practices double-book appointments because of chronic no-shows as well as because of acute same-day emergencies. Double-booked appointments tend to be more egregious in the afternoon, so again, try to have a morning appointment or barring the morning, try to book the FIRST appointment for the afternoon.
-If you only have time for one appointment (or have money issues--it's true that you have to do a co-pay with each visit) but have a number of health issues, ask to speak to the doctor's nurse/medical assistant to explain the situation. The assistant may be able to talk the doctor about extending your appointment time in her books, and you may also be able to receive some feedback for less serious problems. I have yet to meet a doctor who refuses a conscientious patient's request for extra time if it's merited.

It may be that despite your best effort, you'll still have to wait. Just keep in mind that a number of things could be happening that are true emergencies. My husband had one patient whose husband was threatening to kill her because she was pregnant. She was the first patient of the day, and it basically eliminated the rest of his morning appointments. Sometimes the issues that your doctor is dealing with may be truly life or death.


Spires / Zimmerman Wedding said...

I'm sorry, there's no excuse. Every time I go to the gynecologist it's a 1-2 hour wait. What gives?! I, too, am in a profession where I schedule (and keep) appointments. If I made my clients wait more than 15 minutes I would lose my job. Why is the doctor's job more important than mine? What's the point of making appointments?

Also, what is wrong with the front office people in a doc's office? I walked in to my appointment today (which I walked out of after waiting 90 minutes--I had to keep an appointment I made with a client)and the 2 young ladies at the desk did not even make eye contact but said "take a seat".

I refused to move until one of them actually greeted me (whatever happened to "hello, how are you?" or "hello, may I have your name"? or just a simple "hello" and eye contact??) and I said, "I'm a new patient, do you have some paper-work for me to complete?". She reluctanly gave me the forms. Looking back on it, she must have been thinking "What's the rush?".

Glenn said...

The problem I see is double and tripple booking for a time slot because of the high rate of no-shows, late cancelations, or late arrivals. If more patients showed the same consideration for their medical providers and each other as they expect to be shown to them, then we would all be on-time.

Beth said...

I don't buy it. In my own professional life, my clients also are occasional no-shows. I would never dream of double-booking (not to mention triple-booking!) because most people keep their appointments!

I believe it's simply sloppy business practice on the part of physicians. The docs could - at the very least - install wireless Internet capability so that we could work while waiting the 1-2-plus hours for our appointments. Instead, they have TVs blaring "The View" or some other obnoxious programming. Why do they treat us - the patients - as idiots who will just lie down (no pun intended) and take it? It's infuriating!

Lobby Manager said...

Your article "Why we wait so long in the waiting room"...great article...so true.

It is very frustrating waiting and thinking you have been forgoten...as a solution architect...I felt I had to come up with a solution...so I designed a product called Lobby Manager...it basically tracks patients waiting and visually displays them across monitors so the staff - doctors, office management can see the patients and know how long they are waiting

It also helps management - staff to work together nmore efficiently by helping each other.
Thanks...Lobby Manager

Beth said...

There are so many obvous solutions to scheduling and tracking patients appts. and wait times. The question is: why aren't effective solutions being implemented? This is 2007! WHAT IS THE PROBLEM?

Are docs saying, poor us, we don't have time to figure out a modern scheduling system? We're just so darn busy, we must make our patients wait 2 hours for an appt? THAT'S RETARDED! AND BAD FOR BUSINESS-THEIRS AND MINE.

This is my last thought on this: get with the program, Docs. Adopt an attitude of respect for your patients' time, and develop a scheduling program that honors and respects the patients - YOUR CUSTOMERS.

Danielle said...

I would love for anyone of you to work as a medical receptionist for one day! Your head would be spinning. I was a medical receptionist for 5 years and I can assure you WE DO NOT DOUBLE BOOK PATIENTS AND SNICKER ABOUT YOU HAVING TO WAIT.

Let me give you a brief description of things that throw wrenches into your obvious solutions.

-99% of the time doctors are making rounds at local hospitals
before they're scheduled to come into the office
so there's ALWAYS the possibility he could get stuck there.
*I'm open to solutions for this one. Perhaps drive to the hospital and yank him out of the OR?*

-patients who show up on the wrong day and insist they have an appointment.
*Would you tell the elderly man who took the bus to the office that you're very sorry but he doesnt have an appointment and he'll have to come back another time???

- patients who will come in early. hoping to be seen early.

-patients who walk in with emergencies
**Would you whip out your appointment book and suggest the person with chest pains come back next week because we don't want to double book?

-patients who walk in asking for prescriptions.

-post operative follow ups. as well as patients who need to be seen immediately for pre-operative clearence
*Would you explain that you're alreday booked and theyll just have to leave those stitches in for a few more days?
*Would you suggest to the patient that they postpone their surgery because you dont want the natives in the waiting room to get restless?

Now onto the phone calls.

-patients who call and give you the whole song & dance about how they missed their appointment and are out of medication and they need to come in asap

-other doctor's callling to discuss patients

-pharmacies calling to speak with the doctor

-patients who call 5+ times a day asking to speak to the doctor.

If I gave you the above responses, you would be outraged.
With that said,think twice before you go and blame the staff for you having to wait.

neville said...

Thank you Danielle. As a surgical center administrator we face this problem constantly. The average time of our procedures varies tremendously. We tell our patients that there can be a two to three hour wait in advance. A simple procedure can take anywhere from 5 to 50minutes. Our average time is 15minutes. If we schedule one patient every 30minutes, we will not cover our overheads for the day. We can not down size or lower our expenses since we are required to have a certain amount of staff, a certain amount of lights, a certain amount of air circulation and all kinds of other requirments by law. Sometimes one patient who has the same exact symptoms and characteristics as another patient can take tripple the amount of time then the other. When things get backed up , we start calling our patients and letting them know...but that doesnt help the situation. And like Danielle said... there are more than a million other factors involved and it keeps growing and is 100% unpredictable.

gopher said...

I had a situation today where I was in the waiting room a short amount of time, maybe 10 minutes - then the nurse showed me into the doctor's office and said "He has one more patient, he will be here shortly." I had to sit there an hour and 10 minutes before I got fed up and walked out. But it wasnt the waiting, it was the disrespect and lack of common courtesy. I expected to wait - **in the waiting room** - there is tv, there are magazines - they showed me into a little room with nothing to do and expected me to sit there for an hour? She said he had one other patient. That takes an hour? It is a matter of courtesy - if he was delayed, then she needed to come in and say, "sorry it is taking so long, here is why..." but nobody said anything to me until more than an hour of waiting in a small room - nobody would be complaining as much about this stuff if people just used a little common courtesy. You should give people an idea how long they are going to have to wait. You should let them know if you are delayed and you should apologize or explain - just show a little humility. None of this costs a dime. Not a dime. But the people in the office all were rude and disrespectful. I saw the doctor in the hall because I went outside to look at the clock, and he gave no indication that he was sorry about making me wait an hour. So I am thinking -- "This guy is a jerk. He doesn't even have any common decency. How am I going to expect him to care about me or my problem? I don't even feel like talking to this jerk about my problem." These people are rude jerks for one reason: because they can get away with it. People being what they are, that will never change.

Jeff said...

To Gopher: Your Doctor doesn't sound like a jerk. Sounds like he would have had no way of knowing you'd been waiting that long. Sounds like it's the staff that was very disrespectful. The Doctor's job is to take care of your medical problems and to hire people to run his office in an efficient matter. It would be too much to expect him to do both. Sounds like he did a poor job of hiring a staff. Then again, I don't think the staff in a medical office are pulling in the big bucks, yet as Danielle pointed out it's not an easy job.

I basically don't go to the doctor unless I absolutely need to and I get frustrated anytime I go. In fact, the last 4 times I've needed to go I just went to the Urgent Care Center instead and have had to wait between 20 minutes and an hour. It's much more efficient and a better use of my time.

Unknown said...

just linked this article on my facebook account. it’s a very interesting article for all.

Patient Appointment Scheduling