Why doctors run late

Why doctors run late

Image: pixabay.com

Doctors running late is a common problem. It’s the number-one complaint on the Facebook page of our practice.

The other day I read an interesting article about the waiting time at the doctor’s. The author wrote:

What other profession keeps you waiting an hour for a scheduled appointment. Working in newspapers I have lined up hundreds of interviews and never ran that late.

I can understand her frustration. I don’t know how to fix it. This is why I am often running late:

  • People have difficult, e.g. emotional issues that take more time than expected.
  • A patient presents with a problem that requires extra treatment like a biopsy, sutures, ECG.
  • Elderly people may need more time than the appointment time they booked. It does take a while before my 89-year old patient is on the examination couch.
  • Patients sometimes have a list of problems they want to discuss.
  • I am waiting for the Medicare script authority hotline while my patients are waiting for me. Watch this video.
  • I am getting flooded with requests for reports, workers compensation forms, centre link documents, certificates, insurance requests, closing the gap documents, travel cost reimbursement documents, DVA websterpack authority requests etc.
  • Some days can be hectic with phone calls from hospitals, pharmacies, community nurses, faxes with urgent requests for information, reports and scripts. And occasionally I am called away for emergencies.

Getting back to the article. The author also said:

I know they are dealing with health issues which can mean life and death, but surely they could make the appointments a bit of a closer fit with the reality.

Some of my patients always need a double appointment and we’ve agreed that our receptionists give them that extra time when they ring up. But this is also more expensive, so most people would naturally try to fit as much as possible in a single appointment.

If we would give everybody a long appointment, we could only see half of our patients, which would increase the waiting time for an appointment. This would also reduce the practice revenue, which would mean that we can’t employ all our invaluable nurses and receptionists, which would further increase the waiting time and decrease the quality of the service we can offer.

Occasionally, when the nature of a health problem allows it, I might say something along these lines: “I’m very sorry Mrs Jones, but we’ve talked for almost 20 minutes now and there are other patients waiting. I know it is important and I would like to ask you to book another appointment so I have enough time to help you.” Not easy to say, but sometimes it’s necessary. Most people understand. A few get cranky with me, especially if they’ve had to wait for half an hour.

11 thoughts on “Why doctors run late

  1. I have been a GP for 20 yrs, most of it spent in Rural practice. I have only ever once run late and that was 3 hours while I pulled a stuck calf from a cow in the Kalahari as I was the closest thing to a Vet they had. I had to drive 200km back to my practice and went straight there as I knew I had patients waiting. I got asked very politely by my receptionist to go home and shower first as I apparently had an “air” around me.

    Point is that we don’t need to run late with good time management skills. I have kept to my appointments even with a full day of 60 patients and I invite any of those patients to comment on the fact if they were ever rushed or felt that they did not have enough time with me or for that matter if I was ever late.

    The important thing is communication and mutual understanding. If your patient feels they need a longer appointment, then have them make one. I do not think it is fair to book a single 15min slot and then come with a “shopping list” of things to get through. Spare a moment for the guy sitting in the corner, he may be a lawyer/businessman/accountant with an important client booked in at 10. Is it fair to make him late and potentially loose a client just because we can not time -manage?

    If one of my patients start rambling, I respectfully ask them to make another (longer) appointment to give us both the time we need.

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    • I agree. These things can always be solved by being respectful but firm with boundaries. After a genuine emergency there is always the option of letting people know and asking if they would prefer to reschedule etcetera. I very rarely run late. I also refuse to see people who arrive late, explaining that I will then be late for the next patient, who has arrived on time.

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  2. Edwin, this is a hot topic of debate in my house. Last week my daughter was scheduled to see a specialist. Before taking her out of school, she rang to check whether there was a hold up. No it was fine.

    So 30 minutes later when my wife arrived, having interrupted my daughter’s learning, she arrived to find a room full of people. Clearly they were not running to schedule. In fact, there was an 1:45 wait.

    In the end, they rescheduled the appointment and my daughter missed the whole afternoon of classes. Surely another appointment could have been offered earlier. Or even a simple text message to the patients advising them of delays.

    We know doctors are busy and in demand. But these simple courtesies can make everyone’s life easier.

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  3. Whenever I see them bringing in LISTs, I would go through each of them to see what I could sort out on the day or at a later day. I always tell them it’s not fair to make others in the waiting room waiting as their time is just as important.

    I ran 1 hour late was when a patient came in after a stroke over night?! He should have gone to the hospital immediately but he decided to wait till the morning. He was hemiplegic and aphasic when he tried walking through the door. We had to arrange for an ambulance. The next patient after him came in post concussion and was going in and out of consciousness. Another ambulance was called straight after. I was working in outer metro region at that time.

    Another time when someone booked a 15 mins consultation for implanon removal and insertion, she forgot to mention to reception it was for a procedure. Rather than making the rest of my patients running late, I got her to come back later during my lunch break, that way, everyone was happy. Except for my stomach.

    Baby sitting a patient of my colleague whilst my colleague was on holidays. I had to break the bad news to her that she had pancreatic cancer. This could not be done under 15 mins.

    I agree with Edwin, sometimes running late is unavoidable. We are human, not machines. SMS system will be good to notify patients if we are running late then we can at least give them the option to wait or rebook first thing in the morning or first one after lunch.

    I got given a coffee voucher the other day at the dentist when she was running 30 mins late. I was happy to wait because I brought work to entertain myself in case she was late. I was happy to have a coffee too.

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  4. Great topic Edwin, agree with the points you make! Too much to say for a comment, so I might write a blog post about it over the next week or so. For now better run, I’m only 5 mins behind!!

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  5. Excellent topic….thank you Edwin

    I agree with everything said before. We are humans and the unexpected IS part of our daily routine.

    However with a bit of skill and the correct use of delegation and technology the waiting time can be reduced significantly. ( average of 4 min in my case)

    Some suggestions from our experience.

    – educate your patients so they understand THEIR responsibilities . They need to understand what a 15 min appointments is for and learn to respect your and the other patients time. If they come with a list I chose the items that I consider a priority , deal with them and ask them to make another appointment for the rest. In many cases some of the issues can be dealt with in the context of EPCs that allow me to involve the allied health professionals.

    – delegate as many practice tasks as possible to your nurses. It does take time for a 89 year old to get on the couch ,to draw up the vaccines for a 6 months old ,to do an ECG or a dressing but I do not have to be in the room when it happens. I talk to the patient, take them in the treatment room where the nurse gets them on the couch, does the ECG or sets up the procedure tray and messages me when everything is ready. I can see another patient in that time and just walk in to do what I have to do.

    – charge a decent fee for reports, workers compensation forms, travel letters and insurance company forms. I charge a professional fee of 250$/hour which allows me to schedule time for doing the paperwork. That way it does not intrude on my clinical time. I also instructed my receptionists that when I am with patients I only take calls from other doctors. All other calls from patients, nurses or hospitals are screen by the nurse who then determines the urgency and clinical relevance of the call. By the way, I DICTATE my notes , letters and reports which allows me to spend less time on the computer and more time interacting with the patients.

    – free your receptionists time by using online appointments. We diverted over 38% of our appointments ( which represents half of the normal 15 min appointments and virtually all workers compensation app) to our AUTOMATIC online appointment system. Instead of rushing to answer the phones the receptionists have more time to engage with the patients in the practice , to screen the patients on the phone and give them the appropriate type of appointment. It comes down again to patient education. All our patients know now that the easiest way to make a ROUTINE 15 min appointment with the doctor of their choice , at a time convenient to them is to make it online on their computers or on the mobile phone apps. If they need ANYTHING ELSE they ring the receptionists to discuss the appropriate appointment. Patients and receptionists love it and we have much better organised days with shorter waiting times.

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  6. Really good discussion and, as usual, I think “I must try harder!!”.

    However, the fact remains that, when trying to attend to patients in an integrated, holistic way, it can be difficult to attend to one problem in isolation from the others. Particularly as rural GPs, we have additional problems of dealing with the unexpected and trying to accommodate patients who travel long distances and are always struggling for adequate staff resources so, for us, team work means that ‘assuming that they have the right skills, the person who is in the best position at that time to do a task gets on with it.’

    There is also an increasing issue of how much it is acceptable for a receptionist to enquire about the nature of a person’s problem/s at the time of making an appointment and now, with computer screens that can be overlooked, they are restrained from putting clues (e.g. “1st ante-natal” or “procedure”) for me to see and adjust the length of appointments.

    In the end, we just do our best, using all the great techniques mentioned above including encouraging patients to phone in and find out “how he’s going?”.

    Ideally, as far as is practical and humane, everyone get’s the time they need and I warn the medical students and sometimes warn patients to “Beware the doctor who always runs on time!”

    I was locuming in Oxford UK and, when I was running about 3/4 hour behind, my last patient came in complaining about how long she’d had to wait. I apologised and we got on with the consultation – quite complex with some social issues as well. When we’d finished she left with the warm words: “Thank you doctor. Now I know why you run late.” This is actually one of the most treasured events of my career!

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