Advice to a young doctor from a customer
There are surely ways to make appointment times efficient to everyone’s satisfaction
The Spec has from time to time featured stories concerning advice given to new medical students by their mentors. The tone of the advice is always to remain humble and to keep the interest of the patient paramount. I am not a medical professional but rather a “customer” with a vested interest and so feel qualified to add my own advice.
Recently on one of my visits to a specialist for a routine checkup, I arrived on time to a waiting room that was completely filled — there was standing room only. Over the next hour, patients were called in but the waiting room remained in the same state as when I arrived. New patients, no doubt arriving on time, joined the queue. In my experience this was neither an exceptional occurrence nor a pattern unique to this physician. With a few notable exceptions, this seems to be a pattern of behaviour accepted as the norm in the medical community and, in the true spirit of what Canadians are known to be, politely accepted by their patients. Based on the body language of my fellow waiting room colleagues, what I am setting out here might resonate.
I do accept that providing the type of care we expect from our doctors will require that some appointments will extend beyond the allotted time and will therefore push remaining appointments back. However, it seems to me that this is a scheduling issue since the waiting room backup is most often the rule than the exception. I have spent most of my working career in senior management positions in both the private and public sector. I can absolutely guarantee the response I would get were invitees to a scheduled meeting left to wait outside my office for an extended period without a reasonable explanation. I appreciate that the rules are not absolutely transferable to a doctor’s office, but it seems that simple improvements could be made that would not affect the efficiency of the practitioner.
My suggestion to the young med students would be to develop a rational basis for scheduling appointments:
1. Begin by creating an appointment schedule based on an estimate of the average time needed to examine each patient
2. Over a reasonable test period, say one month, track the time that each appointment starts and ends.
3. At the end of the test period, use the “real time” experience to adjust, if necessary, the average duration of appointments.
4. Schedule to repeat this every six to eight months to keep the schedule current.
This should reduce patient waiting time to a minimum, as it will only occur if the doctor must spend an unexpectedly long time with one or two appointments. However, this may not even occur given that some appointments during the day will require less than the full time allocated. Also, if patients are to be “fit in” because of urgency, have them scheduled at the end of the day so as not to distort the flow for scheduled patients.
One final personal anecdote regarding a doctor with a notorious overbooking problem. Given that my appointments were usually during a predictably busy day and given that the travel time to his office was approximately 20 minutes, 30 minutes before my scheduled appointment, I contacted the receptionist to see how far behind the doctor was. On this occasion the answer was about 45 minutes, so I indicated that I would arrive no less than 40 minutes after my scheduled appointment time. True to form, upon arrival the waiting room was full and I had to wait an additional 45 minutes (now a total of nearly an hour and a half ) to see the doctor. His perfunctory “How are you today” was followed by my polite but far from perfunctory response — “I’m not really that good but the issue is not medical.” His immediate bewildered reaction when explaining my issue resembled what I would have expected if my question had been: “How’s your sex life?” — a combination of outrage (“How dare you ask this question”) and bewilderment (“How do I answer this?”). I would much rather keep my visits to the doctor as pleasant and professional as possible, untainted by my having to mask the annoyance of a long unnecessary period in the waiting room.
… it seems that simple improvements could be made that would not affect the efficiency of the practitioner.