Ad­vice to a young doc­tor from a cus­tomer

There are surely ways to make ap­point­ment times ef­fi­cient to ev­ery­one’s sat­is­fac­tion

The Hamilton Spectator - - COMMENT - DAVID BIR­KETT David Bir­kett is the for­mer di­rec­tor of bud­gets and fi­nance for Hal­ton Re­gion, and cur­rently teaches cor­po­rate fi­nance at the Uni­ver­sity of Guelph Hum­ber.

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.

DREAMSTIME

Overly long waits for med­i­cal ap­point­ments should not be nec­es­sary, ar­gues David Bir­kett, who also sug­gests so­lu­tions.

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