Years ago, I had a gynecologist I really liked, but every time I visited the office I waited a minimum of 45 minutes to be seen. There was never a good explanation and it left me feeling incredibly annoyed. After two or three years, I couldn’t take it anymore and I found another doctor.
When I was a primary care pediatrician, I often ran late. Most times it was due to circumstances beyond my control, but that doesn’t make it any better for the patients and families who were waiting. My entry to each room began with an apology for being late. It was a source of significant frustration for me, and one of the reasons I left primary care to become a hospitalist.
So, why are doctors always late? Well, if you promise not to send me hate mail, I will give you some inside information to help you understand this problem a little better. There are many reasons your doctor may be behind schedule, but here are some of the common ones:
1. She accommodates late patients.
In most office settings appointments are scheduled in 15-30-minute time slots. It is not uncommon for the schedule to be completely booked, which does not allow much flexibility when patients do not arrive on time. There are legitimate reasons for being late. Stuff happens. But one late patient can disrupt the schedule for the rest of the session. Consider the scenario below:
|ARRIVAL TIME||APPOINTMENT TIME|
|PATIENT A||7:55 AM||8:00 AM|
|PATIENT B||8:13 AM||8:15 AM|
|PATIENT C||8:48 AM||8:30 AM|
|PATIENT D||8:42 AM||8:45 AM|
|PATIENT E||8:46 AM||8:50 AM|
Patients C, D, and E all arrive at approximately 8:45 AM. The patients scheduled for the remainder of the morning are not shown, but are scheduled every 15-30 minutes until noon. The doctor in this scenario has several options, each of which will leave someone unhappy. She can refuse to see Patient C who is 18 minutes late. You can imagine that won’t go over well. She can accommodate Patient C, who has a valid excuse for being late and really needs to be seen, but that will cause the remaining patients to be seen after their appointment times. In other words, the doctor is now running late. She could make patient C wait until the end of the session (over 3 hours) and continue to see the other patients who arrived on time. Patient C will not think it’s fair to wait 3 hours as a “penalty” for being 18 minutes late. Keep in mind that in a half-day session, it is very likely that other patients will arrive late, exacerbating the problem. This is a lose-lose situation unless you have a “no-show”, which may allow you to get back on track.
2. Additional patients are added to the schedule.
Most primary care doctors leave a few open slots in their schedules to accommodate same-day appointments. Illness is unpredictable. Physicians don’t want to send every sick patient who doesn’t have an appointment to the Emergency Room. However, the demand for these appointments is almost always greater than the supply. Once the open slots are taken, the scheduler must “double” or “triple” book the doctor, meaning more than one patient is scheduled for they same appointment time. The patient who calls the office complaining of a sore throat and is given an appointment two hours later is thrilled. But the patient who booked his appointment 2 months ago can’t understand why he has to wait 35 minutes to be seen. This problem has a snowball effect. One or two extra patients can completely disrupt the schedule and lead to delays.
3. A patient who is booked for a 15-minute appointment has a 60-minute problem.
There is a running joke among physicians regarding the phrase, “Oh, by the way…”. This phrase is typically exclaimed by a patient being seen for a minor problem, as the physician is preparing to exit the room, just as the doctor’s hand makes contact with the door handle. If the “oh, by the way” problem is not worrisome, the physician may ask the patient to schedule another appointment to ensure the concern is properly addressed. But if the problem is chest pain or severe headache, for example, it cannot be ignored. You get the pattern, right? The doctor is now running late.
4. There is an emergency.
Occasionally, a patient has a medical emergency in the office. When this occurs, everything stops while the doctors and nurses attend to the patient until the paramedics arrive. Even if the ambulance arrives quickly, it can take a few minutes for everyone to regroup, collect their thoughts, and resume normal activities. Due to attempts to preserve patient confidentiality and avoid chaos, patients in the waiting room may have no idea what’s going on in the back of the office until the emergency personnel arrive. Emergencies are unsettling and undoubtedly lead to significant delays. In some cases, patients may need to be rescheduled.
5. The doctor is talkative and/or inefficient.
I love talking to patients. Subsequently, patients love talking to me. Years ago, an older physician advised me to remain standing after entering the room so the visit would go faster. I promptly discarded that advice, but you’ll also recall I admitted to being habitually late when I worked in the outpatient setting. There is a price to pay for engaging with your patients and their families, and that price is efficiency. I’d like to think the time and attention I gave my patients made up for my being late, but I’m sure there were some who would disagree. When you add the complexities of an electronic medical record, efficiency can really suffer.
I know I have presented problems without offering any solutions. My goal is to facilitate mutual understanding. This article is not meant to give doctors a free pass for being late. Rather, it is an attempt to explain some of what occurs behind the scenes. Managing expectations is just one way to promote a healthy doctor-patient relationship.
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