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AN intemperate reader contribution in the Sydney Morning Herald got me thinking about all the hours I’ve spent flicking through ancient magazines (or, more likely, trying to get some work done) in various doctors’ waiting rooms.
It used to be accepted that waiting till well past your appointment time was an inevitable part of seeking medical attention, but today’s vocal consumers seem less willing to toe the line.
Under the heading “GPs can be a right pain”, patient Nicola Sheppard vented her ire at being made to wait for up to one-and-a-half hours each time she went to the doctor.
“I have never suffered from high blood pressure … except in doctors’ waiting rooms,” she wrote. “I discovered what the expression ‘blood boiling’ really meant the day I got wise and booked a doctor’s first appointment of the day ― still to wait over 40 minutes.”
Of course, most patients understand that medicine is an unpredictable business and doctors will never be able to guarantee 100% punctuality.
Emergencies happen, presenting conditions are more complex than anticipated, and we all want our doctor to take the time to be thorough.
But I’m not sure those explanations work if a doctor always runs well behind time.
The not-so-patient occupant of the waiting room might find themselves wondering if this practitioner needs to schedule longer appointments or perhaps take a firmer hand with the patients who expect to deal with half a dozen issues in one short consult.
“The patients don’t mind waiting,” a receptionist once said to me. “They know she’s always late because she’s such a good doctor.”
I didn’t say anything at the time (and the doctor was indeed good), but the truth is I did mind waiting every single time I went to see her.
I suppose I could have turned up half an hour late myself, knowing that I always had to wait at least that long, but somehow I could never quite bring myself to do it.
The thing is running late is not just an inconvenience for patients: it has potential health consequences.
I have often put off seeking medical attention because I just don’t have the time, and an Australia Institute survey suggests that is a common reaction of working people.
It showed 27% of the 1360 people surveyed said they probably needed to see a doctor, but were too busy, while a whopping 44% said they had not sought medical attention in the past for the same reason.
Running more or less on time might seem like an impossible dream but with the frenzied pace of modern living and employment pressures on many people, even the most devoted doctor won’t be able to help patients who stop coming in because they don’t have time to sit in the waiting room.
Jane McCredie is a Sydney-based science and medicine writer. She has worked for Melbourne’s The Age and contributed to publications including the BMJ, The Australian and the Sydney Morning Herald. She is also a former news and features editor with Australian Doctor. Her book, Making girls and boys, on the science of sex and gender, will be published by UNSW Press early next year.
Posted 1 November 2010
I fully understand emergencies and unexpected delays when I am waiting for my GP appointment. But as others have said, when it happens every single time, and when the delay is 60-90 minutes, it reflects poor management and disrespect. And what makes it worse is when receptionists don’t apologise and tell you what is going on, they just expect you to wait with no explanation at all. It shows a total lack of respect on behalf of the GP and the reception staff for the patient’s time, and not just workers and professionals – housewives also have busy lives and responsibilities. I always rearrange my work day to get to my appointment on time, then am treated like my time has no value. I was a long-time loyal patient of an excellent GP, but I waited one too many times with an arrogant receptionist and finally changed doctors. I miss my doctor, especially the continuity of care, but I just had to change as the stress of being treated that way was just not worth it.
I could not agree more with the original article. Whilst sympathising completely with the reasons for delays (I have on more than one occasion been one of those “emergency” patients who has thrown the GP’s schedule out), my irritation is with the lack of communication regarding the delay. Usually I am notified of the situation upon arrival but, even after having rung beforehand and checked upon arrival what the delay was likely to be, I have still been left sitting for more than 90 minutes on occasion without further explanation.
I think the problem lies in the amount of time that medical schools and specialist training spend on (1) business administration and (2) queuing theory, and the other basic metrics that any large business has resources to manage. Namely, 1=none and 2=none.
I read Nicola Sheppard’s article as well and, as an ex-GP, I cringed.
Running late was the single most stressful element of my general practice career and I did it on almost a daily basis. I booked 15-minute appointments and left an occasional blank for emergencies and patients known to require long consultations.
But the nature of general practice is that almost every day will deliver an unexpected urgent consult (or two) or a person who just needs more of your time. It’s not always possible to curtail these situations and stick to the plan. To then rush patients who have waited a long time to see you is also not ideal.
My best idea for streamlining would be for true and adequately funded team care so that GPs’ precious time is saved for clinical issues that they are best placed to solve, but we are nowhere near this yet.
The other thorny issue raised by Nicola’s comment was her dissatisfaction with the GP’s billing practices (charging a full fee for a child “fitted in”).
To me this is part of the same problem: a GP pressed for time, trying to meet everyone’s needs, and not wanting to pay the price for giving everyone the time and attention they want. All proof that GPs need some help to provide timely and affordable care.
As a pharmacist I know that certain doctors in our area make all patients wait 2 hours. They may be very good doctors but “blokes” already hate going to doctors, so it is totally useless recommending these type of doctors to anyone other than “housewives” who are not working.
This issue is going to become even more important with the very recent opening up of Medicare to nurse practitioners. Despite government reassurances that these practitioners would operate in conjunction with a local doctor there are now plans to open at least 60 nurse-only clinics that will have no affiliation or connection to local GP clinics (see multiple news articles on Revive Clinics website). With this “competition” it is going to be important for (mostly city-based) GP clinics to get their scheduling right. A true emergency is a rare occurrence at an inner-city GP clinic and it’s time we as a profession took a more professional attitude to our patients’ time. Yes, there are always exceptions, but the long wait to see a GP should be just that, an exception, not the rule.
Encourage your patients to make a list (I know this may sound crazy) and then ask for the list or at least elicit all their problems before you begin to address any problem in detail. Then let the patient know which problem can be dealt with now and which problems they will have to come back for later. It’s hard to do when you’re busy but your patients need training and so may you.
I think Dr Esslemont has made the correct diagnosis. The general practice I have been attending for nearly a quarter of a century has, for the past couple of years, been so well organised, that I always try to attend early for an appointment – or I risk keeping the doctor waiting. A wonderful change from the regular minimum wait of 30-45 minutes, even if I arrived late. My worst-ever experience? Taking my son to see a surgeon who was delayed at the hospital. His receptionist knew this but chose not to share the information with any of the waiting patients until shortly before he arrived – after a delay of two hours. We didn’t go back.
Regular patients know the difference between occasional unavoidable delays and a scheduling procedure that always inconveniences them.
I once tried to manage the customary 2-hour wait for my gynaecologist by phoning a couple of times to check on the current delay. I still had to wait an hour (that is, saw the doctor nearly 3 hours after the appointed time). Changing doctors solved the problem.
And, Nick, people are not always in control of their own work schedules.
In about 1986, a survey of a number of practices, including mine, was undertaken. One of the items included was the time a patient entered a consulting room and the time he/she left. From this we were able to calculate the average time a patient spent with the doctor and thus we were able to give more realistic appointment times. I discovered that the average time a patient waited to see me was 13 minutes. The practice continued this system and was also useful when the Departments queried billing statistics.
What the unnecessary waits show is a lack of respect for patients and the response from Nick reinforces this impression. Would clinicians tolerate the same sort of haphazard treatment from one of their patients providing them a service? I think not.
What particularly disturbs me is doctors who deliberately create long waits such as ophthalmologists who program multiple patients to arrive at the same time so that they can ensure a steady throughput, but seriously by doing so inconvenience many of their patients. Dentists and audiologists seem to manage their appointments acceptably, so why not eye specialists?
A GP friend of mine lectures colleagues on queueing theory – solutions for how doctors can make best use of their time and not inconvenience those who want to see them. Perhaps with consumers having the option to see Nurse Practitioners for some more of their healthcare services, more doctors will want to attend one of Tony’s lectures?
Yes we do keep our patients waiting. I am sure many of the reasons highlighted in this report do reflect why this is so. To those patients who feel their work schedules are too pressing to fit in time for health care I suggest a walk in their local cemetery. There they will have an opportunity to discuss their woes with all those indispensable people who have gone before them.