Anonymous said: Why when you go to see the doctor do you have to wait so long, either in the waiting room or in the examination room even if you have an appointment? And this isn't in the hospital. It is just a general doctor's office. There always seems to be at least an hours wait.
What an excellent question, Saint Patience! Let me answer it by giving you a rough outline of what happens "behind the scenes" for a typical doctor’s office visit. Each of these steps contains factors which lead to YOU, the patient, sitting around longer than you expected. (Note: This is based on my experience working in the American healthcare system — your other-country results may vary. ALSO note: For sake of grammatical clarity, this theoretical doctor is a male.)
- You call for an appointment. The front desk staff look at the schedule for that day, think about the “Visit Type” that they think you need (based on some mystical combination of your symptoms, the amount of time since your last visit with the doctor, and possibly the phases of the moon), and give you an appointment time — without asking your doctor about it. Your “Visit Type” determines how much of the doctor’s clinic time is allotted for your visit — typically between 5-15 minutes, with 30-minute visits reserved for physical exams or complicated visits. [EDIT: As jumbled-perusings pointed out, the reason that the doctor’s schedule is broken down into such tiny slots is because of reimbursement. The insurance companies (especially the state insurances, shudder) do NOT cover the costs of the patient’s visit, so if the doctor’s office wants to still be able to pay for rent, staff, advertising, electricity, etc., the doctor has to schedule way more patients than the patients themselves (or the doctor!) would prefer to be seen in that time frame!]
- The day of your appointment, the doctor’s patient list is a mix of various Visit Types, with a few “unassigned” visit slots kept open until that morning in order to accommodate people who need an urgent “same-day” visit. Those “suddenly sick” people start calling in, snatching up the open slots. Once those open slots are full, another patient will only be able to still be “squeezed in” if the doctor mercifully gives permission on a case-by-case basis.
- The doctor starts seeing patients — HOPEFULLY on time. That “on time” goal will likely be derailed if: the doctor had patients to “round on” in the hospital first; if he is keeping track of a laboring woman or a crumping ICU case with frequent interrupting pages or phone calls from other staff; if he is a surgeon who had a few early-morning operations before clinic was scheduled to start; if he was away from clinic for the previous day or more, and is now trying to get caught up on all the charts, med refills, lab results, and assorted detritus that constantly accumulates in his inbox; if he was on-call last night and is running on fumes trying to stay awake for clinic today; if a patient was late for their appointment and showed up later asking to be “squeezed in” — you get the idea.
- Before/after each patient visit in clinic, the doctor has to deal with many issues (some related to that patient’s visit, some not): filling out lab/radiology order forms and prescriptions and referral forms, documenting what happened during the visit (unless he decides to let all the charting pile up until the end of the workday, which means that even though the clinic “closes” at 5, he may be there until 6 or 7 taking care of the paperwork), contacting other doctors about patient issues that need urgent consulting/follow-up, reviewing the results from prior tests, filling out the billing sheet for the visit, and checking in on those hypothetical hospital patients that might be still in labor or doing poorly in the ICU.
- During a visit, the doctor may run into situations that are going to take up more time than the 15 alloted minutes! FOR EXAMPLE: The patient might have said the visit was to “discuss birth control” to the scheduler, but then when she arrives to the visit, she admits to the doctor that “actually, she’s worried that her husband might be having an affair, and she wants to be checked for infections” — BOOM, that 15-minute visit just turned into a longer case, since she will need to have a pelvic exam (which takes time to prepare for as she undresses, the nurse sets up the proper equipment, the doctor performs the exam and associated swab tests, the lab slips are filled out, the patient gets dressed, the doc comes back into the room to discuss “what will happen next”, the patient possibly has a melt-down and the compassionate doctor sits and listens while she sobs…. etc). Sure, the doctor can “move ahead” and start seeing another patient or 2 during the undressing/dressing stages of that example, but his “contact time” with that patient is still gonna be over 15 minutes now. (Does that mean that his schedule is now “shifted back” and all the upcoming patients are rescheduled into later time slots? NOPE — the patients still expect THEIR visit to be on time, and they expect the getting-further-behind doctor to be equally compassionate and willing to spend extra time on THEM.)
- Now, YOUR appointment is scheduled for 10 am. In your head, you have assumed that this means the doctor will walk into your exam room at 10 am. But all-too-often, what time do you actually show up for your appointment? Yeah, about 9:58 am, if the parking lot wasn’t too crowded. Then you still have to get signed in at the front desk, your insurance coverage is double-checked, and the nurse (who is also busy taking care of that unexpected pelvic exam) needs to see you first to take your vital signs and “set the stage” for your visit. (And even if YOU were considerate, and showed up 15 minutes early, all it takes is one prior patient to be time-dumb, and huzzah everyone else is affected.)
- If you’re lucky, the nurse is experienced and will zip through your vital signs while getting a one-sentence description of your visit reason. If you’re unlucky, the nurse will putter with the BP cuff, take 3 minutes to one-finger-type your vital signs into the computer (while still writing them down on a paper chart too, if your doctor’s office is still figuring out just how to blend Electronic and Paper charting together), and want to chat about the weather.
- So the nurse has taken your vital signs, then finally moved you into an exam room (she had to wait for the unexpected pelvic-exam patient to leave, in order to open up room for YOU, in this example). You sit there, flipping through outdated copies of Reader’s Digest (Haha, that article on Saddam Hussein sure is funny!), and checking your watch. 10:45? What the hell? Is the doctor back in his office somewhere, getting a foot massage? Your temper rises, and when the doc finally enters your room, you feel entitled to give him a piece of your mind. Guess what? Your passive-aggressive complaints about “Well it’s about time, I thought you forgot about me in here!” and the doctor’s reply (a polite series of excuses/apologies, if you have a good doctor) just took up MORE TIME that should’ve been spent on providing healthcare. [I know, this sounds like a stupid thing to point out, but do the math: 20 patients who each need 30 seconds of soothing apologies by the “tardy” doctor = 10 minutes of polite but wasted time.]
- And to top it all off, you said your reason for the visit was “sore throat”, but then as the doctor is skipping back out the door (3 minutes AHEAD of schedule with this visit, hooray!), you toss in the “By the Way” phrase which makes any doctor cringe inside — “By the way, doc, I’ve been having really bad headaches that make me throw up and see stars…” Either the doctor kicks his clinic schedule in the nads and starts discussing this much-more-serious-why-didn’t-you-mention-this-sooner symptom with you NOW, or he takes the time to come up with some kind of follow-up plan for you (which will still eat up valuable clinic minutes).
- Finally, you’re done! You leave the clinic at 11:30, the doctor still has 8 patients to see before his “noon lunch break” (which he may just skip, cuz otherwise his 1pm patient will be even MORE pissed), and as you exit the parking lot, you see the doctor running for his car — the baby is finally ready to deliver! And there goes the day…
In short, Saint Patience, a delay in the doctor’s office is never one person’s fault. It’s a mishmash of various reasons, some of which can be avoided/prevented by careful systems-analysis and efficiency, some of which are gonna happen no matter what, because after all, we are ALL human.
***Pending Cranquis-Mails: 5; Ask Box: Closed***
AKA “The real reason I work in an Urgent Care”…
Yes. Everything about this yes.
Dr. Cranquis' Mumbled Gripes: Behind the Medic: You can't hiiiiide your lying eyes!
Ways I will figure out that you are lying to me when you show up asking for Vicodin (or other similar oft-abused medications):
- Look at your chart in the computer and see that you got a prescription for 120 Vicodin from your primary-care doctor… 2 days ago.
- Get a phone call…
Glad I’m in pediatrics. Just gotta watch for parents diverting their kids meds.
It is thought that there will be no more official sightings of Prince George until 2014. What a relief, because I really couldn’t handle much more of this.
one of the best fam pics ever. just look at how happy they all look!
At Restaurant, Delay Is Help on Health Law
Restaurant owners like Eric King have been highly critical of the employer health insurance mandate, and he said the rule’s delay “gives us another year to plan.”
Mr. King thinks his current system is fair — he offers insurance to his most valuable employees, who are also the most likely to stick around — and points to low turnover as evidence that his uninsured servers, busboys, dishwashers, line cooks and hosts are content. Most are young and in good health.
He said “not a soul” among the employees at Shanty Grille had asked him to comply with the mandate.
“Most of my servers are 25 to 30 years old,” he said. “They’d rather take the $200 a month and put it in a bar bill as opposed to insurance.”
Oh my god sir, please fuck off and die.
This drives me nuts. As a “young and healthy” 20-something, I can certainly point to the value of insurance. I just broke my thumb, which was clearly not planned, and a pretty minor injury in the grand scheme of things. The first of many bills for the surgical repair arrived and I am VERY glad I have insurance. JUST the hospital fees added up to more than $10,000.
If one of his employees broke their thumb, I’m sure they would be regretting that $200 at the bar each month.
Not to mention if everyone had insurance, the bill for my surgical repair wouldn’t be so pricey.