Waiting in the Waiting Room

J. Greene


Q: I would like to know if anything can be done about doctors who can’t keep their appointments. I waited over two hours to see a doctor the other day. None of the staff informed me of anything except that I would be next. How long should a patient wait before saying something?

A: What? You had something else to do during those two hours, like maybe get back to work or pick up the kids from school? It almost sounds like you think your time is as valuable as the doctor’s!

       A shocking thought, but one that more patients are having as they realize they need to look out for themselves when it comes to health care. Going to the doctor isn't like visiting an old, trusted friend and adviser anymore — it's like going to the car mechanic, and if he or she kept us waiting two hours while finishing someone else's brake job, we'd screech out of there without a second thought.
      Just because you're going to see the town's highest-rated cardiac surgeon who just had his picture on the cover of "Time" for performing six heart transplants at once, is no reason to cower before his office staff. You — and, hopefully, your insurance company — pay this physician for his services and you should expect reasonable customer service. That's not a concept that was emphasized in medicine in the past, but it's slowly starting to creep into doctors' practices as they find they must compete for patients with other doctors on a health plan's list.
      The average patient waits 19 minutes for a scheduled appointment with a doctor, according to the American Medical Association's latest figures. That number varies by specialty: You're most likely to be left flipping through the May 1983 "National Geographic" in the waiting room of an orthopedic surgeon than any other kind of doctor; 25 minutes is the average wait. If you want promptness, get a polyp in your throat, since otolaryngologists are the quickest, at 16 minutes, to get you in the door. In general, surgeons and obstetricians are most likely to leave you waiting because they are often called to the hospital for a patient with complications or to deliver a baby.
      Given those averages, you might use this rule of thumb: If you're hanging around more than 15 or 20 minutes past your scheduled appointment time, walk up and bug the receptionist. Be firm, but pleasant; there could be a good reason why you're waiting. Besides, being rude to the office staff won't get you anywhere.

       But it may be even more smart to ask upon your arrival whether the doctor is working on schedule that day. If you have to be some place in an hour, let the staff know. If they have an inkling that you won’t be in and out in that time, it might be better to reschedule the appointment.

      Another strategy is to call ahead before you leave for the doctor's office and find out if a wait is likely. Use this technique if your doctor is chronically late, is a surgeon or if you have an important place to be soon after the doctor's appointment. Maybe you can show up 20 minutes late and use that time to your advantage.
      Meanwhile, some doctors are getting a clue about customer service, according to Deborah Walker, a consultant to the Medical Group Management Association (MGMA). Walker has seen offices that provide telephones and laptop computers to allow busy patients to get some work done while they're there. One even provides beepers to patients so they can walk across the street and shop until the doctor's ready for them. She urges medical practices to change the name of their lobbies from "waiting room" to "reception area," to get away from the idea that it's natural to make patients wait interminably for the busy physician.
      Others are trying out more sophisticated scheduling plans so waits are less likely. It seems simple enough: Why don't doctors just schedule the amount of time they expect to spend with each patient — a few minutes for someone who just needs an explanation of test results, or 30 minutes for an elderly person with a multitude of complex health problems? Because patients aren't very good about telling the scheduler over the phone why they want to see the doctor, says Elizabeth Woodcock, another MGMA consultant. "Maybe a third of patients will tell you one thing, and when they come in they didn't want to tell the scheduler what it really was," Woodcock says. "Some physicians just throw up their hands and say, 'I'll just schedule people every 15 minutes.' "
      And keep in mind, from the doctor's perspective, he or she doesn't get paid based on how long you're seen, but on whatever illness is diagnosed. So, for instance, if he or she spends 15 minutes discussing ways to reduce your high blood pressure, and you want to spend another 10 minutes talking about the pros and cons of liposuction, she gets paid for only the 15-minute office visit for hypertension. The other 10 minutes, from her perspective, are off-the-clock.
      That's not to say you shouldn't ask questions. Just plan ahead — write down your questions, and make them succinct and meaningful.
      There are other ways that, as patients, we can make the process go smoother. For instance:

bulletGive the scheduler a good idea of why you want to see the doctor and all the health problems you're likely to raise during this visit. If that means calling during your lunch hour from a pay phone with some privacy, do it. If you want extra time with the doctor, ask for it.
bulletShow up on time if you can. Think of all the poor shlubs with appointments after yours.
bulletIf your visit is over but you still have more important questions, ask to schedule another visit.

Keep in mind, too, that some physician offices aren't run very well. If they're consistently leaving you lingering in the "reception area" for 30 to 40 minutes or longer, there's something wrong, suggest the MGMA consultants. It might be time to consider changing doctors. But be sure to tell the physician why you're leaving — maybe he has no idea how bad things are out there. They might at least put out this month's "National Geographic."


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