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Why your doctor is running late.

I read an article about a guy who sued his doctor for waiting for 3 hours. It got me to thinking. The usual appointment length is 15 minutes. This includes time for the nurse or MA to bring you back, get your weight, do your vital signs and let the provider know you're all set and ready to go, all of which can take 5-7 minutes or more depending on how talkative you are and what the appointment is for (and therefore what the nurse or MA needs to do with you before the provider comes in). Want to know the real reason why your provider is running late?

It's usually for one of 5 reasons:

1. An urgent or emergency situation.

2. He or she keeps getting interrupted by others.

3. Double booking two patients in the same time slot.

4. Late patients.

5. Patients come in for one reason but bring up other issues, too.

1. An urgent or emergency situation sometimes comes up in health care. Sometimes it's a patient who is in the office and casually mentions that they've been having this nagging chest pain. And they happen to be a diabetic. With high blood pressure, high cholesterol and a family history of cardiac problems. Sometimes it's the same situation, only it's a patient who is on the phone rather than in the office. Or sometimes it's a patient who walks into the office rather than going to the ER. Doctors are responsible for caring for their patients in emergency situations such as these, even if it means dropping everything else in order to take care of it. Most people understand this.

2. Doctors can get interrupted constantly, whether it's by other providers in the office looking for help or a second opinion, or other providers in the area. ER docs call with a question about another of your doctor's patients who is in the ER right now, specialists call in order to give your doctor an important update on someone else. Sometimes the doctors who call are calling your doctor back in order to answer a question they had about another patient. Even if each phone call and interaction only takes 5 minutes, when you add them all up it can cause long delays, especially if the interruptions are related to an urgent situation, such as trying to get a patient admitted to the hospital. A lot of people understand this, but not all.

3. Doctors get pressure from the hospital they're affiliated with to see as many patients as possible in one day, yet many practices don't charge patients for no-shows, which doesn't make sense to me. As a result, they have pressure to both overbook (add patients at the end of the day) and double book (schedule two patients in the same time slot with the same provider). Sometimes patients feel they're entitled to be seen today regardless of the reason and throw their weight around in order to get what they want, resulting in their being booked for an appointment with your doctor at the same time as you. How are we supposed to explain this to you? The hospital likely wouldn't tolerate that, nor would the office manager. So instead, the provider looks bad and we're helpless to explain why.

4. Late patients. You'd be surprised how many patients either simply don't show up for their appointments (meanwhile we're denying appointments to people who need them, thinking this person is going to be there!) or show up late. What is your doctor, nurse or office staff supposed to do, tell you that an earlier patient--or two, or three--showed up 7 or 10 minutes late for their 15 minute appointment and that's why your doctor is late? Would you believe them? Would it be professional? No, most people won't tell you that that's why your doctor is running late, although it happens at least once or twice every single day to every single provider. Again, making the provider look bad while we're unable to explain why.

5. However, one of the most common reasons that your doctor is late is because patients who are scheduled to come in for one issue bring up one or more other issues. The provider doesn't want to turn someone away and make them come back another time (especially in this economy), so they cram everything into the 15 minute appointment. Which means that their 15 minute appointment actually takes 25 or 30 minutes, sometimes even longer! Sometimes the unrelated issue is something like chest pain or abdominal pain, things that can be very serious. We can't just let that person go without making sure it's safe for them to leave! Not only is it important to the patient that we address it in case it's a heart attack or appendicitis, but imagine the liability if a provider let that person leave the office without checking it out and it turned out to be the worst case scenario! Other times it's not quite that serious, but is something that requires a more lengthy assessment than simply asking "what happened?"

In other words, it's pretty unusual that the reason your doctor is late is because they've been sitting around chatting with coworkers and making jokes about how long they're making you suckers wait. Trust me, we want to go home on time (or as close to it as possible) just as much as you do!

Full post as published by Random Ramblings About Life and Law School on October 30, 2008 (boomark / email).