Tuesday, October 6, 2009

Why does the doctor always make me wait before my appointments?

1. Because he/she can – Seriously, think back to the last time you waited at the office. Did you cause a stir? Did you complain? And I mean complain to the doctor, not the poor receptionist so frazzled she can’t even remember her own name. Did you say anything? Now, think, if the cable guy was that far outside the “window” – would you have called the cable company in a huff? I bet you would have.

Doctors keep us waiting because we let them. We don’t make “timeliness” a condition of our devotion. In fact, many of us don’t have any conditions for which doctor we see other than 1. Does he/she take my insurance? and sometimes 2. Do I “like” him/her? We don’t take advantage of online tools that compare doctors of hospitals based on performance or numbers of procedures. We go to people our insurance covers and we “like”. We are more picky about choosing a car than a doctor. Yet, we complain when doctors don’t meet our expectations. Before choosing your last doctor, did you ask how often do you run on schedule? How do you communicate with the patients? E-mails? Phones? Do you call with test results even if there is nothing wrong? What are the chances I can get a same-day appointment if I am really sick? Well, if you didn’t ask, you may think twice about complaining about your doctor running two hours late after you waited 3 weeks for the appointment just to find out your test results.

But it’s not all the doctor’s fault. There is a systemic problem to blame as well:

2. Because she/he has to – The cost of a medical education in this country is insane. Yes, clinically insane. In order to clear themselves out of debt, doctors have to see patients. Reimbursement rates are by patient, not per hour, so the incentive is for doctors to see as many patients as they can in the shortest amount of time that they can. That standard has moved from 2 patients/ hour to 4 patients/ hour to one doctor that I had to break up with that scheduled people every 10 minutes. Now, it’s no wonder they are always running late. Imagine what happens if a patient has an actual condition that requires explanations of treatments and side effects and a weighing of options. Now, the doctor has spent 2 time slots on one patient and pushed off the whole day. Some doctors manage this better than others. They work with their staff and rely on their nurses for the bulk of the exam so the 15 minutes with the doctor are efficiently used.

Here’s a good example: A few months ago, I went to the doctor with several issues I wanted to discuss. None of them were serious, but I still had some concerns and questions. The doctor informed me that we could only discuss one or two issues and that I would have to schedule another appointment to go over the rest – in one to two issue increments. So it would take me at least 3 appointments over probably 5-6 weeks to figure out if the 5 issues were related. In the meantime, I would have started treatment on each issue as if it was an isolated problem. This does not make sense. I quickly switched to the University Faculty Group of the local Medical School where the Medical Student was more than happy to hear all my issues and try to piece them all together and present a diagnosis to the doctor. Then the doctor was more than happy to explain why the Med Student was not quite right and come up with a plan that addressed all the 5 issues. Time with Medical Student: 45 minutes. Time with the physician: 12 minutes. Time in the Waiting Room: Zero. Now we are talking! This was partially possible because the physician’s salary was supplemented by being part of the faculty and she had access to medical students.

In my opinion, solutions to the doctor waiting problem go from:
Schedule the first appointment of the morning and bring a list of issues you want to discuss TO
Nationalize physician education so that doctors don’t leave school with so much debt and reform the reimbursement system to value diagnosis/treatment/outcome over volume.

Just depends how much effort you want to put in.

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