You know what’s worse than spending only five minutes with the doctor responsible for treating your complex, chronic illness? Waiting two hours for the opportunity to spend those five minutes with that doctor.
Today I sat in a cramped room with four other patients. We were sequestered from everyone else, the losers who were still waiting out front, who’d yet to be taken back to this second area, the pre-exam room holding zone.
But it was no prize to have been set apart from the rest. From our vantage point, we could catch a glimpse of the doctor but each doctor knows to move quickly enough to be plausibly just out of earshot of our questions about why we’re all still waiting. For the same doctor.
It was 12:20 p.m. My appointment was at 11:40 a.m.
One brave soul asked the nurse who’d led us back to this second waiting room what the hell was taking so long.
“The doctor has six new patients today, you see,” the nurse explained.
Interesting. Yes, my old doctor had recently retired and I’d been transferred to this new doctor. But that “transfer” had occurred two weeks ago. In the interim, no one had figured out how to arrange the new doctor’s schedule?
My car gets better treatment.
I went to Valvoline a few days ago. I’d just driven from Louisiana to California and the menacingly orange “Maintenance Required” light had been on since New Mexico. I was worried that this new car of mine had something wrong with it, something expensive and time consuming. I know nothing about cars and this fact becomes pretty obvious within seconds of talking to me. I was bracing for a ridiculous estimate to fix a problem I would never be sure had existed in the first place.
I was pleasantly surprised. The mechanic assigned to my car quickly figured out that all I needed was an oil change, but promised to check everything else out too. He gave me an estimate of how much time the entire process would take. He insisted that the mechanics working with him shouted out verbal assurances that each step had been completed to his satisfaction. He gave me clear, specific instructions about what he needed me to do from inside the car while the Valvoline guys worked underneath it. He did not laugh when I couldn’t figure out how to pop the hood (terrible, I know). He made eye contact each time he addressed me. He was patient when he could have been condescending. And his team finished up its job in fifteen minutes, five minutes less than the estimate. I’m going back to that Valvoline. My entire experience seemed designed to make me a repeat customer.
Since I’ve returned to California, in addition to changing the oil in my car, I’ve also visited my usual array of specialists: rheumatologist, ophthalmologist, on and on . . . and man, their offices could stand to learn something from Valvoline.
But while I could shop around for another oil change, I’m stuck with the doctor that’s covered by my insurance, the one whose office is within a reasonable distance of my home. And I’m stuck with all of that doctor’s oversights, including his or her inability to actually see me at the time I was promised.
If my time is considered valuable during a Sunday morning oil change, shouldn’t it also be respected on Tuesday morning at 10 a.m., an appointment time that will force me to recalibrate the rest of my week to make up for the time I spend sitting and waiting and finally, at some point, hours later, actually being seen? Or maybe just spoken to; eye contact at a doctor’s appointment is not something I take for granted.
Most of my doctors see me at least an hour after my scheduled appointment time. The dead time—the time between when I’m supposed to be seen and when I’m actually seen—makes me want to rip my hair out.
This time gets spent in different ways. Sometimes a nurse pulls me from the waiting room to an examination room she uses to confirm exactly what I’m there for. The doctor will repeat her questions verbatim when he finally shows up.
I know it’s easier to get some stuff out of the way before the doctor comes in. Fine. But I often wonder if this extra step is used to cover up the doctor’s tardiness. Especially when the doctor comes in ten minutes later smelling like cigarette smoke. Or pulling on his lab coat because he just arrived. Late.
Often I don’t even get in to see a nurse at my appointment time. Usually I’m stuck in the practice’s windowless waiting room. The waiting room chairs are covered in blue or red plastic that sticks to my skin. The chairs haven’t been cleaned since they were first installed, circa 1975. The patient bathroom is as far away from the doctors as possible, but really close to everyone in the waiting room. The lock on the bathroom door is usually broken. Some older man who can’t see well enough to read the big sign instructing everyone to “KNOCK BEFORE YOU ENTER!!!!” is walking in on an older woman who thought she was behind a secure bathroom door. Everyone else in the waiting room pretends not to hear them swearing at each other.
I often bring my laptop so I can work on my lesson plans or my writing (I wrote some of this essay, you guessed it, in a waiting room) while I wait. This works really well until my eyes get dilated. Which happens pretty often.
If I can’t use my laptop, I’ll search in vain for a magazine that’s (a) not grimy, (b) was published before 2008, and (c) includes articles about something other than vitamin supplements and Viagra ads.
I don’t dare go to the bathroom. Last time I did that they called my name, assumed I’d disappeared, and moved on to ten people who were originally behind me. When I finally asked someone what was going on, she laughed.
“Oh, you were in the bathroom! Hah hah hah hah. How funny.”
I will forgive almost anything if a doctor cares about sticking to a schedule. You’re actually running on time? Well, you’re communicating to me that you care enough about your word (i.e., the time you assigned me to come see you) to try to keep it. An office that’s trying to stay on top of its appointments is telling me that efficiency is valued. This m.o. often trickles down—a punctual office fills my prescriptions in a reasonable time and returns my calls within a business day.
Granted, an on time doctor’s office generally is not motivated by the concern a doctor has about his patients. The most punctual offices are often those run by fascists who scare their staff into submission. Honestly, I don’t care. Whatever it takes. Fear, negative reinforcement, corporal punishment. Just see me on time.
Here’s why. I actually believe you when you tell me that my appointment is going to happen at 9:30 a.m. I show up at 9:20 in an attempt to beat the other ten people you also scheduled for 9:30. Most people who work are generally at or on their way to work at 9:30. So I’m missing work for this. When you schedule me for 9:30 and don’t see me until 11, you’ve just rendered the time I spent driving through rush hour traffic to your 9:30 appointment meaningless. And you’ve ensured that the time I told my boss that I’d be back into work by is a terrible estimate, and that when I roll in hours later, I’ll be looked down upon.
If your office is constantly running behind schedule, ask yourself, do you have too many patients? The answer to this is usually that you’re seeing as many patients as you need to see to make enough money to keep your office profitable.
Which is infuriating. Should you really be in a business that forces you to shortchange care in order to break even? Is that what you meant when you promised to do no harm? If you can’t even stick to a daily schedule, why should I trust you with my health?
If you still want to practice medicine in this way, resigned to abandoning any effort to stick to your appointment times, you at least need to tell me.
The first time I schedule an appointment, I need to know that your office runs, on average, two hours late. Don’t know the average? Open up an Excel spreadsheet and figure it out.
If I know you’re prone to being that late, I’ll try to bring enough work to fill that time. Or I’ll go elsewhere.
Consider this mindblowing idea: communicate to patients in real time that you’re running late. Send a text. Set up some sort of automated system that does this for you.
Don’t think this is feasible? Somehow my hairdresser manages to keep me up to date on this kind of data. Are you really less efficient, less technologically adept, than my hairdresser?
Know this: the sooner I get out of your office the sooner I can get back to work. The less sick time I have to take. The earlier I can go home to see my kids or cook dinner or, God forbid, rest. And then multiply the hours I waste at your office by the number of doctors I see. Do you now see what an impact your failure to adhere to a schedule has on my life? The stress makes me sicker. And it makes me sick of you.