Why Doctors Run Behind Schedule
What is the number one complaint of patients about their doctors? Their miserably long wait time. “Why can’t you doctors stay on schedule?” an angry patient once hurled at me. Why, indeed! Yes, in a perfect world, I would see patients in a timely manner. But here’s a typical Monday morning:
8:00 AM: The first patient no-shows.
8:15 AM: The second patient no-shows.
8:25 AM: I glance at my watch and scowl. Where is everybody? “Did you forget to call and remind the patients?” I ask my receptionist. That goes over big! Tanya slams a chart on her desk and informs me with clipped tones that yes, all the patients were notified! I apologize for even asking such a ridiculous question and slither back to my office.
8:30 AM: Madeline Sorenson, the 8 AM patient, waddles in thirty minutes late, dripping with sweat, gasping for breath, and sputtering about the terrible rush-hour traffic. Instead of apologizing for her tardiness, however, she glares at Tanya as though it’s her fault I-40 is a nightmare every morning! Tanya politely asks Madeline to pay her $25 co-pay. Madeline slaps her forehead and says she accidentally left her pocketbook in the car. Interpretation? No $25 co-pay! Not unless we make her waddle back to the parking garage, thereby putting us further behind schedule. Since Madeline is 400-pounds, arthritic, and looking like she's one step from a stroke after her hundred-yard hike from the parking garage, Tanya takes pity on her and hands her an envelope stamped with our address. “Just mail us your co-pay.” (We won’t hold our breaths, however, as Madeline is notorious for “accidentally” forgetting her pocketbook and “accidentally” losing the envelope she is handed.)
8:30 AM: Josephine Smith, a sweetheart from Kentucky, arrives thirty minutes EARLY for her 9:00 o’clock appointment because she allotted extra time. “I know how bad the interstates into Nashville get this time of day, so I planned ahead.” She hands Tanya a check to cover her co-pay without even being asked! She then offers up a bag of homemade blueberry muffins for the entire staff saying, “You all do such a marvelous job I wanted to do something nice for you.” We love Josephine!
8:30 AM: The 8:15 AM patient barrels in complaining about rush hour traffic AND the 95-year-old man in front of her in the parking garage. “That old geezer took forever to meander the garage corridors. I thought he’d never find a spot.”
8:30 AM: The 8:30 patient arrives on-time and with her checkbook, but then insists she has to be out by “nine at the latest” so she won’t miss her 9:15 Mammogram.
8:30 AM: An unscheduled patient shows up wheezing, coughing, and gasping for breath. She’s endured a severe asthma flare all weekend and from past experience knows she needs an aerosol treatment and cortisone shot ASAP, or she'll wind up in the ER.
I groan. I now have five patients waiting for three exam rooms after twiddling my thumbs for thirty minutes!
Who do I see first? The 8 a.m., since she’s first on the schedule? The 8:15 because she’s the first to show up with her copay? Sweet Josephine Smith who is never late, always pays her co-pay, and comes bearing goodies? (Shouldn’t we reward good behavior?) Or, should I see the 8:30, who has to be out by nine or she'll miss her Mammogram? And what about the patient who can’t breathe and is so wheezy she’s scaring the other patients in the waiting room?
I tell my nurse to bring back the asthmatic patient first (severity of illness takes precedence over schedules) and to prepare an aerosol breathing treatment and cortisone injection while I bring back the 8:30 patient so she can make it to her Mammogram. I will then see the patients in order of the schedule (which means sweet Josephine gets seen last, and late, irritable, co-payless Madeline gets seen first! No body said life is fair!)
10 AM: I’m now one hour behind schedule--in part because of my late start, in part because of the asthmatic emergency, and in part because Dorinda Cassidy, who was scheduled for a simple “Well-Woman check”, comes in brandishing a list with no fewer than ten problems to address. Well-woman, my eye!
11 AM: A pharmaceutical rep walks in. On hectic days like this, I normally would just sign for the drug samples, and the rep would leave them in the drug closet. As luck would have it, today she is escorted by her manager. Her eyes plead with me not to blow her off and say I’m too busy to hear about bladder control drugs. While I scribble my signature on the sample request sheet, I tell the boss what a fabulous rep Cassie is, and how I prescribe her drug all the time. "There’s no need to review the merits of Vesicare today," I inform him, "because Cassie has done such a splendid job selling me on the drug at a previous visit." She beams an appreciative smile, while I pat myself on the back for coming up with a way to avoid a mind-numbing, time-robbing dissertation about incontinence drugs.
11:30 AM: Jessica, a harried mother of three, is here for her yearly physical. As always, her cell phone is glued to her ear when I walk in the room. She acknowledges me with a smile and a nod but continues to blather away with her twelve-year old. She informs him, “I need to go. The doctor just walked in. Bye!…No, I won’t forget to pick you up after soccer….Wait! You need me to bring your sneakers to the practice? Did you forget to pack them in your backpack again? Nolan Fairchild, how many times have I told you to bring your sneakers on Mondays?” She sees me squirming in my chair and says, “Listen, I’ve got to go. The doctor is waiting.” She listens to another thirty-second pediatric monolog before adding, “Yes, I can bring you a snack…..I'll bring you an apple.” More listening. “No, I won’t bring you Cheetos. How about a yogurt?”
I want to clap my hands and exclaim, “Yogurt it is! Now get off the phone!”
But no! They now discuss which flavor of yogurt! Raspberry or lemon swirl.
I’m an hour behind schedule, and I’m wasting time listening to the snack choices of a twelve-year old?
I stand up and head toward the door mouthing, “I’ll be back when you’re done.”
Jessica eyes my hand on the doorknob and holds up a hand in protest. “Dr. Burbank, wait! I’m done! I promise.”
Except she’s not!
She continues her phone call, only this time with more insistence. “I really do have to go, Nolan. The doctor is literally standing here and is about to walk out if I don’t get off the phone.” She listens to Nolan before adding, ”I won’t forget your sneakers and snacks, I promise.” She moves the phone to her other ear, listens a few seconds then shouts, “You got a D on your Social Studies test?”
Swell! That’ll be good for another ten minutes! I wave at her and whisper, “I’ll be back!” Outside the door I hear her shouting, “I told you to study those Civil War battle sites! I knew you weren't ready for that test.”
Yup! It was one of those days.
11:40 AM: While I wait for Jessica to end her phone call, I’ll run see Alisha, a healthy college student, who is hopefully just here for a quick refill on her migraine medication. Maybe I can make up a little time. I walk in, but she doesn’t even acknowledge me. Her eyes stare like a zombie at her cell phone, and her thumbs text frantically. I say hello and ask how she’s doing, but she only grunts, and her thumbs continue to fly across her screen. I ask how the Imitrex is working for her headaches, but she’s too distracted to answer.
How rude, I fume. At least Jessica acknowledged I was in the room!
Finally, Alisha glances up glassy eyed and mumbles, “Oh, sorry! Did you ask me something?”
I repeat my question, but instead of putting her phone away, Alisha attempts to text and answer my questions. After every other question she mutters, “Sorry! Can you repeat that?”
Exasperated, I suggest, “How about you put that phone down for five minutes so we can complete your evaluation without distraction?”
Thumbs flying, eyes pasted to her phone she responds, “I can't. This is really important. My niece just graduated from pre-K, and my sister needs to know today what I’m bringing to the picnic tomorrow.”
Right! And this momentous decision can’t wait five minutes?
I grit my teeth and make a mental note to tell my own college-aged kids to NEVER treat a doctor this way! Or anyone else, for that matter! I inform Alisha I’ll be back in ten minutes, once she’s done her can’t-wait text message.
I listen outside Jessica’s exam room and almost tap on the door when I overhear her still raking Nolan over the coals: “I told you to review those Civil war Generals, but you blew me off and wasted your night playing Minecraft. I am so taking that stupid video game away from you!”
Maybe I should examine the last patient of the morning while Alisha finished her text message and Jessica finished her tongue lashing!
At least Agnes wouldn't be on a cell phone!
How do I know? Agnes was born when Woodrow Wilson was President, and she has the hearing of a tombstone! She owns expensive hearing aids but refuses to wear them because they squawk like territorial geese in a barnyard tiff.
12:45: While devoid of cell phones, my visit with Agnes is exhausting; I have to holler each question in a volume loud enough to make me deaf as a tombstone before she can hear me. Even then, her comprehension leaves a lot to be desired:
Me: “HOW ARE YOUR KNEES FEELING?”
Agnes: “My niece is doing well! In fact, she just graduated from nursing school.”
Me: “No, I said, how are your kneeeeees.” I point to my knees for emphasis.
Agnes: “Gloria doesn’t have knee problems! She’s fit as a fiddle.”
I inhale deeply and count to ten. Is Alisha done with that text message yet?
People wonder why doctors run behind? Now you know!
***All names have been changed to preserve patient confidentiality.