Must Waiting Be Inherent To Medical Care?

October 19, 2011 at 8:22 am 38 comments

“By the time you see the doctor, you’re either dead or you’re better,” my mother-in-law told me. She had to have multiple tests, all with long waits to get the appointments and the results, before her health insurer would allow her to make an appointment with a specialist.

“Waiting is the bane of the medical system,” a former student, an R.N., concurred. Advances in medicine and technology have improved medical outcomes, but have often resulted in more waiting at a time when every other aspect of life is speeding up. Waiting is a systemic problem exacerbated by advances in medicine and by health care reform.

Some of the ways we wait:

  1. Wait to see if the symptoms go away or get worse. We all struggle with these decisions: do we need to be seen about the fever, back pain, or rash? Sometimes we wait because of denial or hopelessness; sometimes because of the cost or availability of medical care. I make decisions about when I need to see the doctor by asking myself if, under the same circumstances, I would take one of my children to the doctor.
  2. Wait to get an appointment scheduled. I’ve made appointments for a sick child by channeling an old friend who could be relentless: “That is not acceptable. I need an appointment today.” Obnoxious but it sometimes worked. The rest of the time, though, the period between making and having an appointment can feel very long.
  3. Wait to get to the appointment. Doctors and hospitals are more abundant in Greater Boston, where I live, than in other places, although traffic and parking can be problematic. Melody Smith Jones described a man’s six hour commute to see a doctor.
  4. Wait to be seen by the doctor. It isn’t called the waiting room for nothing. Dr. Atul Gawande wrote in The Checklist Manifesto about people in the waiting room getting irate when he was running two hours behind on a hectic day. Being irate – or anxious or bored – is unlikely to increase the quality of physician-patient communication.
  5. Wait in the examining room. At least in a waiting room you are dressed. If it is cold and you are wearing a paper or cloth johnny, distractions don’t work as well and examining rooms have fewer than waiting rooms.
  6. See the doctor. Nowadays, as my mother-in-law recounted, you have to wait for the doctor to review your records before even looking at you. I find it surprising that physician rating systems give equal weight to wait times as they do to “communicates” and “listens”, when the latter are so much more important.
  7. Wait in the lab. The selection of magazines is skimpier. You may be reviewing what you were told not to eat or drink: will that cup of black coffee skew the results?
  8. Wait for lab results. If there are any non-routine reasons for testing, this can be interminable. I leave a lab asking when results will be ready and then I call. A former student told me about using Harvard Vanguard’s MyHealth Online. She said, “I love getting the lab results immediately online but I can see how those without clinical training could be overwhelmed or confused by the data and how to interpret them.”
  9. Wait for the doctor’s interpretation of lab results. Lab results can be hard to decipher without clinical training, as my student said above. Even when I know results are available and the doctor has seen them, it can take many phone calls to obtain the doctor’s message via the secretary. Asking the doctor follow-up questions takes even longer. These are waits with a cell phone never turned off so you don’t miss the call.
  10. Loop. You think you’re done but you may need to see a specialist, get a second opinion, or have more tests. As my mother-in-law pointed out, this process can be controlled more by insurance companies than by doctors’ availability. Another type of waiting also takes place now: waiting to get better. A friend bemoaned how she “couldn’t wait” for her black eye resulting from a fall to clear up because she was tired of people staring at her.

Waiting Reduction

We all have to wait. Waiting is an inherent part of being ill. But here are some ways to reduce wait time or lessen the impact:

  1. Schedule tests and doctor’s appointments together. My exercise teacher told me about her husband’s hospital visit that started with a CT scan and ended with a doctor’s appointment to discuss the results. With no problems detected and a year until they next visit, they both said what a relief it was to get it over with quickly. Scheduling appointments together reduced both waiting time and anxiety, although not all tests results can be interpreted this quickly. Personally I find it is much easier to deal with a diagnosis than fear of what a symptom could mean.
  2. Avoid unnecessary appointments through email or phone. A Dutch friend, whose sister and aunt are doctors, recounted instances when she was able to get quick answers by email or phone to questions, be reassured, and save a lot of time and effort. One instance: “Once I was on holiday in Greece and sent my sister a picture when my eye was infected. She told me to buy drops and that it would go away.” Since most people do not have convenient relatives with medical degrees to talk to, being able to easily reach a doctor or nurse by email could provide a way to get a quick answer. Dr. Danny Sands has long been a proponent of physician-patient email, but most practices do not support it. I can easily see the benefits because email forces you to describe a situation concisely and images can be attached as appropriate.
  3. Meet Dr. Skype. Melody Smith Jones posed the question, “Can telehealth be used to end this man’s 6 hour commute by providing him access to the specialists he requires? What barriers and challenges still lay before us to make this a reality?” Dr. Joseph Kvedar answers this, saying “We have to move beyond the antiquated notion that you must visit a physical space and talk real-time with your health care provider to fulfill the process of care.  Seamless communication between you the patient and the system (including your provider but also your health information) will allow us to cut through what is a falsely complex and inefficient system to achieve more efficiency, less waiting and less anxiety.”
  4. Ask the expert. Self-proclaimed experts and community-verified experts provide advice in many sites like Yahoo! Answers. Recently there has been a proliferation of sites supporting health Q&A. A new entry, HealthTap, promotes that it has “Answers from 5,000 U.S. licensed physicians. No waiting room.” I tried it and questioned why I needed to answer so many personal questions during the registration process. Once registered, I started to ask a question but was stumped by how much context to provide. In general one of the things I like about Ask the Expert is the ability to browse other people’s questions – sometimes you learn more from questions you never would have thought to ask – and answers.
  5. Use clinics for non-urgent care. I had a friend who believed that it was important to see the same doctor because he or she could notice changes that might not otherwise be detected. While I agree, the Minute Clinic (note the name) model can potentially reduce some of the use of doctors for non-urgent care.
  6. Enhance health literacy skills. With 80% of US internet users looking online for health information, better health literacy skills are needed to guide the strategies used to seek, select, and use online health information. This is rarely taught in schools or by doctors, and is increasingly necessary because of the lower barriers with social media: it is easier than ever to promote herbal supplements and bad advice.
  7. Make waiting fun – or at least less stressful. Deirdre Walsh, a health coach and a former student, said, “The pain and frustration of endless waiting seems needlessly cruel. But it’s often the emotional toll of fear and uncertainty that does the most damage from the negative effects of stress chemicals on energy, sleep and mood.  If waiting is inevitable, there are self-awareness exercises that restore calm, power, and the sense of control. ” Games and gamification have potential as well: a version of “Wait, wait… don’t tell me!” for the waiting room?
  8. Is there an app for that? Not that I know of, but social media is being used by public health departments to post flu clinic waits and by emergency rooms to post wait times. What about for doctor’s visits? Dr. Richard Besser said, “You shouldn’t have to wait more than 15 minutes unless there’s an emergency.  Social media might be a great place for people to share waiting times.” Along those lines, I read about, but have not tried, WaitChecker, a web-based service to alert patients to appointment delays.
  9. Set expectations. The metaphor Trisha Torrey uses is “when you arrive at a busy restaurant on a Friday night, what’s your question to the host?  How long is the wait?  It’s only fair that providers manage our expectations about wait times, too.” It is easier to be patient with expectations set, not just for the length of a wait but the course of a disease.
  10. Use waiting time on task. A student once told me that she had a rash when pregnant and assumed it was unrelated to her pregnancy. She searched for information on her iPhone while in the waiting room, decided it might be related after all, and asked her doctor, who treated it. She saved another doctor’s appointment. What if all waiting rooms provided mobile devices? Or promoted prevention with education, exercises, and healthy snacks. Talk about captive audiences.

Quality of Health Care Is Paramount

It is important to maintain perspective: quality of health care is paramount. Everyone wants the best care possible and sometimes waiting is unavoidable. With no health advantages to waiting, put , as Dr. Ted Eytan said, “the patients’ cost of care, which includes the time they spend waiting, into the equation. Everything follows from that.” There is no reason to accept that it’s part of our health system, but, instead to work to reduce waiting, and to reduce the impact of waiting.

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38 Comments Add your own

  • 1. text the romance back by michael fiore pdf  |  February 15, 2014 at 8:09 pm

    One promising concept is called open access scheduling. Open access means seeing today’s patients today rather than forcing them into a slot far in the future or trying to squeeze them in to a crammed schedule.

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  • 5. Jak Down  |  December 4, 2013 at 10:26 pm

    I think it does improve care, and it certainly helps me keep my blood pressure down.

    Reply
  • 6. lkafle  |  May 16, 2012 at 11:38 am

    Reblogged this on lava kafle kathmandu nepal.

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  • 7. Sophie Parker  |  April 23, 2012 at 9:31 pm

    What a beautiful piece of writing. It reminded me of your “voice,” which I haven’t heard for a while. What you say is so clear, makes so much sense, and helps me organize how I think about the topic. In this case, waiting. I have recently decided that waiting is an opportunity for me to practice patience, which I think in our society (and in me), is underutilized and underdeveloped. Waiting at the doctor’s, waiting at the post office, waiting to be served food or drink, all of that is somehow more fraught that I think it should be. Did we just get this way, since everything became instant? Impatient, judgmental, entitled? I can’t remember if it was harder to wait or easier when I was younger. Compassion and patience, is this something that we come to once we get older, whereas before we just never thought about that as an option? On my best days I can track myself going between being assertive and patient; just to make sure I don’t go from being enlightened to being a sheep.

    This does not in any way take from the notion that doctor’s offices are places where we have to wait, often unnecessarily. The power dynamic is certainly one issue; another is that these systems, doctor’s offices, have become broken by health care policies. Doctors have too much to do crammed into a 10 minute slot; it would be impossible if they didn’t go over time. I find the doctors I return to make up the stress of waiting by being more than usually attentive, listening to my concerns and asking questions (then waiting for answers!). I practice compassion for everyone I come in contact with: the doctor, the receptionist and the nurse practitioners, everyone. I am not perfect, I can’t do this every time; I am practicing patience. I think it does improve care, and it certainly helps me keep my blood pressure down.

    Reply
  • 8. C. Onyeije, M.D. MFM (@chukwumaonyeije)  |  December 1, 2011 at 4:51 am

    When I re-read this post earlier today it was something of an epiphany.

    As a physician I struggle to be on time, to provide each patient with individualized care and to truly improve outcomes. Unfortunately, it seems as though much of the time these three goals lead to either frustrated patients or 16 hour days. It seems clear to me, that the key to changing the dynamic that results in my patients waiting long hours to see me is going to HAVE to be a complete re-thinking of the idea of an office visit or a hospital consultation.

    I like +Carmen Gonzalez ‘s idea of Google plus of an express lane for patient’s who require a 10 minute visit as well as protected time for visits that will need to be longer.

    (https://plus.google.com/102255706014869428654/posts/F6Shd31NgrM )

    Ultimately, we will all have to be open to the possibility that everything can and should change (if necessary) to optimize the patient’s experience. No more excuses or sacred cows…

    My first question (for myself) is “Why have a ‘waiting room’ in the first place?”

    I think that’s a great place to start.

    Reply
  • 9. Pete  |  November 29, 2011 at 7:10 pm

    There are a couple of issues here. First off, waiting for an appointment reduces costs. Many issues resolve in a couple of days, and even if you keep your appointment, it will cut the costs of tests and drugs that you might have been given. This is proven in other national systems. I don’t think that there is a way to cut the time between requesting and receiving a face-to-face medical appointment.

    The biggest issue, and the biggest cost driver, is our management of chronic disease in an acute care model. It results in poor use of healthcare resources. A friend of mine who is an academic expert in health quality described the follow-up interval as “the revenue throttle.” Routine follow-up wastes physician time with algorithmic interactions (you come in for a routine interaction and they review 10 systems to get up to a 99214 or 99215 — complex follow-up visit). The genesis of this problem is complex, but is only addressable with health system reform.

    In-office queuing results from optimizing the system to best utilize the physician’s time — the longer the queue, the less likely the physician will have to wait for a patient. This is a consequence of economics. In Canada, the government reimburses patients for travel costs to see a physician and because of this physicians get higher reimbursement for telemedicine consults than in-office ones — the offsetting lower travel costs more than compensates. What if moderately wealthy people — the 2% maybe — were to get an insurance company to pay a $10 premium if their patients were seen by the physician within 5 minutes of the scheduled appointment time?

    Reply
  • 10. AfternoonNapper  |  November 5, 2011 at 1:48 pm

    I spent an hour today in an ugly waiting room listening to country music. I was the VERY last patient to be seen and didn’t even get back to see the surgeon until 5 p.m. The good thing? The nurse said, “I’m sorry to keep you waiting. Thank you for being patient.” Just an acknowledgment goes a long way.

    Reply
  • 11. Kathy Kastner  |  November 1, 2011 at 5:50 am

    Stephen Wilkins and Danny Sands comments remind me of Journal of Family Meds Life in 55 words (author: William R Phillips MD MPH University of Washington, Seattle)
    Running late in clinic, I apologized. Someone that morning needed more time than scheduled. I didn’t say if it was depression, a
    miscarriage or a beating, or all three. The patient touched me with understanding;’Someday I will come in with a special problem and I know that you will make extra time for me.’

    Reply
  • 12. Stephen Wilkins  |  October 29, 2011 at 9:51 pm

    I am 4 days post op from having my 2nd Vitrectomy – where they gut you eyeball in order to repair a detached retina. I had the same surgery (with a different surgeon) on my other eye back in February.

    The wait time for my current surgeon is 1 1nd1/2 hours on average. Initially I thought the long wait time was because the surgeon was just insensitive to his patients. I came to realize that it was because of something very different. This retinal surgeon was the best in town. Once in the exam room he acknowledged and apologized for the delay, was incredible thorough, answered my questions and “cared” about my vision and took the time to understand my bad experience with my other eye.

    The point here is that sometimes waiting is simply inevitable, particularly when “getting it right” really counts. There are only so many experts around and who can blame people for preferring an expert over an “also ran.” Bottom line Lisa, in your examination of wait time I suspect you will find a direct correlation between a person’s tolerance for waiting, the seriousness of their condition and the reputation of the doctor. No amount of queuing theory can predict or address that.

    Steve Wilkins

    Reply
  • […] O’MalleyThis guest post by Lisa Gualtieri originally appeared in the author’s health blog.“By the time you see the doctor,you’re either dead or you’re better,” my mother-in-law told […]

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  • […] This guest post by Lisa Gualtieri originally appeared in the author’s health blog. […]

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  • 15. Danny Sands  |  October 28, 2011 at 7:29 am

    Lisa, this was a nicely written post. I wish to comment, from my perspective as a primary care physician, as well as president and a co-founder of the Society for Participatory Medicine and sometimes a patient. But since my comments got to be so long I decided to write a bit here and put the rest in a blog post on the SPM blog e-Patients.net. But in brief:

    It’s difficult to get appointments because there are not enough physicians relative to the number of patients who need care. Arguably, some of the patients getting care in the office today would be better off getting care online or providing self-care, but our current system provides little disincentive for patients to seek face-to-face care and a significant incentive for physicians to encourage it. But with our current system we have a supply and demand mismatch.

    Physicians don’t often make patients wait because of habit, laziness, or disrespect. There are a great many things that may cause your physician to be delayed, including phone calls, emergencies, and other patients who require more care than their scheduled appointment permits.

    Which leads to the next point. Unless your physician is taking care of standardized patients and performing uniform evaluations and treatment for each (like a factory), chances are that some patients will take more time than they are allotted. If a physician knew ahead of time all the issues that would arise, he could possibly change the scheduled appointment time accordingly. But scheduling systems won’t accommodate more than a few different sizes of visit and, even if they did know how long a given patient would take, there would not be capacity to extend a visit if, a few days beforehand, he determines that more time will be needed.

    Moreover, situations can’t be anticipated. Will a patient’s blood pressure be dangerously high? Will the patient start crying because her husband left her? Will a patient be developing a serious new condition? All of these result in visits being longer than scheduled and the physician being delayed.

    And if the patient starts crying, should I hand them a tissue and send them out ASAP so I won’t be delayed? If a patient requires a new prescription, should I not engage the patient in a discussion of the treatment options? If a new potentially serious symptom arises should I call an ambulance and send the patient to an emergency department without any evaluation? And even if I did, who would write up the note for the receiving care team? If an elderly patient needs a bit more time getting on and off of the examination table, should I not be kind?

    In the past, the reimbursement system made it possible to schedule longer visits. Then, on average, things were more likely to even out over the course of the day. Now with 10 or 15 minute visits being the norm, it’s much more likely that you’ll be waiting longer than you’d like.

    So I suggest you do as I do when I visit my doctor. Bring a book, laptop, or iPad and do work, amuse yourself, or read about your heath. Or you could even use the time to listen to music and relax.

    Reply
  • 16. Mark Notess  |  October 27, 2011 at 7:48 pm

    Medical practice needs to become event-driven. Today when something happens (test results, symptom change, prescription runs out), it gets put in a queue that fills up until the next appointment or until someone has time to write a letter, call in a prescription, or make a phone call at the end of the day. If you look instead at how modern workflow systems operate, they are event-based. With event-based systems, people can handle needed interactions or transactions as they arise. Current systems require too much synchronization whereas workflow systems optimize asynchronous coordination. This will of course mean big changes for how offices operate, how insurance companies characterize services, and so on. But the efficiencies, if designed well, should reduce costs while improving health outcomes–even saving lives.

    Reply
  • 17. MUST Health Care Be A Waiting Bane? « Healthcare 311 News  |  October 25, 2011 at 6:43 pm

    […] the title of Lisa’s original posting, on her own blog: Must Waiting Be Inherent to Medical Care? (Lisa Gualtieri PhD, Lisa Gualtieri’s Blog on Health, […]

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  • 18. Ellen Hoenig  |  October 25, 2011 at 3:52 am

    Lisa,
    With the exception of one doctor, I have found that waits have generally improved over the last few years and are pretty reasonable. At my kids pediatricians, for example, I can honestly count the number of long waits on one hand over a 14 year period x 3 boys! And my dentist is more timely than i am! But, just in case, I always bring my BB and now iPad to make good use of any down time…:-)

    But the three hardest waits for me:

    1) trying to get into a good specialist. Having to wait months to see a new specialist is a crime since if you have to see a specialist it is because of something potentially important, painful etc. or worse yet to be told that the specialist is not taking any new patients….I have experienced this on multiple levels with my children…and find it totally frustrating…If your child is not feeling well to a point that you have to act, how can you really wait another 2-3 months to see a good specialist?

    2) waiting for results and analysis; waiting for specialists to send their results in writing to Pediatrician and parent so we can also send to school who requires…it seems like a pretty easy administrative function to get on top of…

    3) deciding when to wait and when to go to the doctor…always a tough one. You just can’t take a child into the doctor with every complaint and sniffle…but one has to be careful or you end up like Susannah, and it knocks you out for a few weeks vs a few days had you acted right away…We just dealt with something like this…when the boys grew 5 inches over the summer and their knees began to hurt more and more…[yes osgood schlatter]…and then when we really needed a doctor, it was over a month to get into a great doctor with a great reputation for managing sports injuries…

    Lisa, thanks for an interesting post!
    Ellen

    Reply
  • 19. Perficient Health IT (@Perficient_HC)  |  October 24, 2011 at 6:55 pm

    This is a very important post. You have acknowledged the enormous number of barriers in the way for patients in their path towards better health. Thank you for providing increased visibility around the gentleman that I met that commutes six hours one way in order to see his doctor. It is my opinion that the smart application of technology to healthcare exists to tear down these barriers, but we must transcend the mental gap that would make care more accessible.

    Reply
  • 20. Matthew Katz, MD  |  October 24, 2011 at 7:15 am

    Great post, Lisa. I agree with much that has been discussed. One other simple point is doctors can acknowledge when we have to wait. Even if we can’t avoid it, recognizing the incovenience and anxiety is important. This doesn’t reduce wait time but may lessen the cost emotionally and reassures us that someone cares.

    Reply
  • 21. Lisa Gualtieri  |  October 23, 2011 at 3:42 am

    Pat Rich (@cmaer), at the Canadian Medical Association, told me about “Wait Time Alliance for Timely Access to Health Care”, http://www.waittimealliance.ca/, which “was formed out of concern among Canada’s doctors over delayed access to care for their patients, and an interest in working collaboratively with stakeholders to improve wait times. The WTA is comprised of several national medical specialty societies whose members are directly involved in providing care to patients.” They produce an annual Report Card on Wait Times in Canada which includes a patient-centric perspective.

    Reply
  • 22. Simon Sikorski, M.D. Twitter @SimonSikorskiMD  |  October 22, 2011 at 8:31 pm

    5 years ago, I put a clause into my contracts for all medical practice marketing / management projects http://www.healthcaremarketingcoe.com/medical-practice-marketing/ – All physicians have to adhere and sign contracts with the following promises:

    1) To schedule appointments for new patients within 2 days
    2) To keep waiting times to less than 10 minutes
    3) To offer patient engagement materials in the waiting room and to take home – specific to the patient’s reason for visit (5 years ago it was in form of brochures and articles on paper… in 2011 it comes in form of Tablet PCs .. and hopefully soon, more phone-based connectivity)
    4) To become more focused on their TOP area of expertise with each new patient. (To stop being generalists)
    5) To offer instructions on how patients can stay connected. Critical in this aspect is PRESCRIBING of patient education resources, online patient communities, secure email / PHR access, and with much anticipation and excitement … mobile devices to track adherence to treatment algorithms. Why? So that the patients can not only learn the information the doctor already approved, but also so that they can feel they are connected with their doctor on a much deeper level.
    6) To hire full-time staff members who will help adhere to these guidelines – practice-based patient advocates. FYI, assigning this duty to the receptionist is not the same.

    Doctors call to join my program when their practices are failing, when they’re not seeing enough patients. But to this day, physicians are dropped from my program at a rate of 20% within the first 3 months. When does this usually happen? – When they get so many patients that they overbook… and forget their manners. It also happens when doctors don’t adhere to their expertise and continue to see patients who are much better off going to see true experts. (This is especially true in surgery-based specialties) Most of the drop-outs wake up within the next two months when their patient volumes decrease again, but it’s too late for them to come back into my program.

    I love all the suggestions for patients’ behavior changes, but I have to agree most with Dave – we need to start screening out doctors who just don’t care about patient experience. We need to modify physician behaviors.

    How can we do that best? Stop going to see doctors where you continue having a bad experience. I hope to see more medical school and residency programs provide business courses for health care professionals on how to manage a practice and that they stress the importance of the patient’s experience. Why are doctors still graduating with no knowledge of how to run a medical practice. This behavior modification needs to be implemented at graduation time.

    Reply
  • 23. Janice McCallum (@janicemccallum)  |  October 22, 2011 at 2:05 am

    Lisa,
    You offer a comprehensive list of solutions & I expecially like 2-7. I think we have to do more than just make the current processes more efficient. I favor solutions that change both supply and demand through transparency, technology and knowledge. Email and phone communication with doctors, nurses, etc. make so much sense to me, for instance.

    One hot button for me: why don’t medical offices have better patient education information available to read during the wait times?! 99% of the materials I’ve seen have been consumer magazines or pharma-sponsored promotional junk.

    Reply
  • 24. Kathy kastner  |  October 21, 2011 at 6:12 pm

    Great post indeed-to one of your points: I’ve learned lots from everyone’s comments🙂
    Kathy

    Reply
  • 25. David Williams (@HealthBizBlog)  |  October 21, 2011 at 6:41 am

    An informative and comprehensive post. However, all 10 of your waiting reduction strategies involve having the patient modify his or her routine. There is an alternative: find a physician whose practice is organized to reduce waiting.

    One promising concept is called open access scheduling. Open access means seeing today’s patients today rather than forcing them into a slot far in the future or trying to squeeze them in to a crammed schedule.

    What’s required to make open access work?

    – Working overtime to chip away at the existing backlog (otherwise there’s not free time to offer up)
    – Varying the number of hours worked per day to accommodate fluctuating demand
    – Having the right sized patient panel –something that’s hard to assess in advance, since the true demand is unknown (offices usually just know how far out they are scheduling)

    Admittedly finding an open access doc won’t solve all your problems if you have to interact with other parts of the health care system. Still, it’s a start.

    Reply
  • 26. Simon Lee  |  October 20, 2011 at 11:53 pm

    Love this post and the ideas for improving the situation. One issue for doctors for the “waiting game” is that an app exist to check out of the waiting room and find another doctor. It’s called Facebook. That’s what my wife did, from the waiting room, to find a new doctor last year after one of her MANY 2+hour long waits for regular exam.

    Reply
  • 27. Erin  |  October 20, 2011 at 9:51 pm

    I have worked in a major hospital for the bulk of my short career. Five years in an emergency room that was a level 1 trauma unit and saw upwards of 300 patients a day. When I first started there it was normal for patients to experience 4-8 hour waits and in extreme cases 12 hours. This wasn’t because anyone wanted patients to wait. It was a mixture of factors that included limited staffing and people coming to us instead of their pcp. Over the last few years wait times have been on the agenda to fix. A typical long wait time went from 4 hours to 2 because staffing and rooms were increased and the processes were tweaked.

    The experiences that I have had have made me more aware of waiting. I go to the doctors expecting to wait. I avoid the emergency department at all costs so I don’t have to wait.

    While there are processes that are causing wait times to be attrocious, I truly believe that over the next few years an increase in focus on wait times may force some of these processes to be tweaked. Only time will tell.

    Reply
  • 28. Aurelia  |  October 20, 2011 at 9:01 pm

    So interesting, Canadians are convinced that no American has ever waited for health care, and it’s all instantaneous, even for poor, or public ERs. heh. So much for TV.🙂

    Anyway, because of the reputation Canada had, I find that my doctors are now extremely skilled in triage. I can get an appointment or speak to a Doctor or nurse, same day, for an urgent appt, but the deal is that I have to book annual check-ups far ahead, and follow-ups or non-urgent appts a few days or weeks ahead. (They block off chunks of time for each type of appt in every day.) My GP’s practice provides a walk-in clinic and supposedly they now have access to my electronic records, good and bad…since I am an extremely complicated patient and even with records, it gets confusing for a new Doc. but still–I get to see one.

    The weird thing about triaging everything though, is that I now know that the faster I see a specialist or get a test result, the sicker I must be, or the more concerned someone is. When I see the radiologist walk in after a scan, and talk to me, I know I’m i trouble. If I keep getting rescheduled for my test further and further down the line, I know that’s a Canadian Doc’s polite way of saying, you don’t really need this lady, you are paranoid, and have no symptoms. There are no insurance companies saying we aren’t allowed to have something because of zero medical need or because we are poor candidates for procedure X, just waiting….

    (Exceptions to this–many extreme rural or far north areas with doctors who fly in,etc)

    Reply
  • 29. Bridgette Collado (@BCollado)  |  October 20, 2011 at 8:13 pm

    Thanks for your post, Lisa! You illustrate the need for attention on waiting from all vantage points.

    I have a recent anecdote to contribute: Just this week, I had an appointment with an eye doctor, who was about 30 minutes late for our appointment. She did apologize and explained that the two cases before me were not straight-forward and she ended up needing more time to complete the visit. I understood, especially as a clinician, AND I still felt frustrated as a patient.

    Some questions you raised for me are:
    – Would some of the waiting on the visit side be reduced if we more people didn’t wait as long to see a health care professional? Would there be more “straight-forward” cases?
    – Would we wait less to see a practitioner if we didn’t have to wait for approvals and such from insurance companies? Or if we had better access? Or better communication about when to see a provider and when to wait?
    – Would health care providers work to reduce wait times if we demanded it?
    – Would quality of health care improve if wait times improve? (wonder if there is any literature exploring this???)

    We have work to do.🙂

    Reply
    • 30. Drake Hosting  |  February 4, 2014 at 11:20 am

      work to reduce wait times if we demanded it?
      – Would quality of health care improve if wait times improve? (wonder if there is any literature exploring this???)

      Reply
  • 31. Lisa Gualtieri  |  October 20, 2011 at 6:52 am

    Thank you for the great insights and ideas, Dave, Paulo, Susannah, and Pam. I just heard one of the ideas above reiterated by Herman Cain, who, in an interview, said that when was treated for cancer, he couldn’t see the results of the CT scan of his tumors until his doctor saw it and reported on the results to him.

    Reply
    • 32. Alex Albin (@msaxolotl)  |  October 22, 2011 at 2:39 am

      I always get a CD of any diagnostic procedure (ultrasound, CT scan, MRI, Fluoroscopic injection, EKG, Echo ) at the time of service and sign paperwork to receive reports. Usually Dr and I are talking about outcomes from his review and my notes/questions on the report. (in that way I prefer paper). Sometimes I can receive them via email.

      Asking upfront is saves $$ too. When you request them later, you are usually are charged to receive them, because they have essentially been “archived” in medical records, even if this is within days. (that gets my goat)

      I run into so many people that simply do not want to know, young or old; technically oriented or not, A types. There are few that are so proactive to do so. And, interestingly I have found among the Drs I know whom when they have diagnostic procedures do not want the information either. Funny how us humans are

      Reply
  • 33. Pam Ressler (@pamressler)  |  October 20, 2011 at 6:14 am

    Great post, Lisa. You have highlighted a very important issue in healthcare delivery…waiting! I believe much of the waiting is not rational and ingrained in the ritual of healthcare. As patients become partners in their healthcare instead of passive recipients of care, we may begin to see a shift in valuing the time and expertise of both the providers and patients. Until then, I will bring my book and Sudoku puzzles!

    Reply
  • 34. Susannah Fox  |  October 20, 2011 at 3:32 am

    Great post, Lisa!

    My recent bout with pneumonia was definitely because of my propensity to wait. I was sure my cough would get better…tomorrow. So of course I waited too long to see a doctor and that cough developed into something that knocked me out for weeks.

    Have you seen The Waiting Room Project, by any chance?

    http://waitingroomproject.org/

    It’s Alexandra Albin’s response to her own experience as a patient.

    As she writes:

    “At some point in our lives, for some more and others less, we will be in a doctors office or hospital waiting room. either waiting for ourselves or someone we love. Sometimes visits are short and sometimes they are long, and other times very very long. Some people go to the same room day after day, week after week, year after.

    The waiting room is where at the end of the experience there is relief, and others times it is a place to receive painful news. They can be a place where you spend a long time or a very very short. They can be the places where family members see each other for the first time in ages. It is a place where one can have and experience a range of emotions. Waiting rooms have a subtle and not so subtle impact on our medical experience.”

    I wrote a comment there last year about my own trick to make the minutes fly by: imagine Anne Hathaway & Jake Gyllenhaal sauntering in. If you’ve seen the movie “Love and Other Drugs” you might remember how some of the biggest drama happens in the most boring-looking waiting rooms!

    Reply
    • 35. Alex Albin (@msaxolotl)  |  October 21, 2011 at 9:28 pm

      Love that Movie and Great Post….so much to talk about. I will address the specifics of waiting rooms. Yes bring an IPad, iphone, or whatever that brings you anxiety relief. Nail filing for instance🙂 for sitting in a waiting room. I have started using https://foursquare.com/ for fun.

      I hate waiting and mostly have found and work with Drs that are respectful of my time. I do sometimes wait for Drs that are really good, especially those that will spend the “time” with me I need to make a plan for next steps. Some have those monitors that set your expectations of how long the wait is. Although that does not make a good Dr, in fact when they are not a good Dr (for me) those monitors make me even more irritated. One group I really like uses those blinking coasters (a paging blinker system) like they use in restaurants, and some will even take down your cell phone to call you, so you have some flexibility in movement. Those are all mechanisms that make the “waiting time” more tolerable. Oh, I almost forgot some groups have cofffee, tea, juices, and snacks to keep up your blood sugar while you are waiting…those teams know they are running behind. I have been luckily to finally have found a group that the Drs will squeeze me in between their surgeries (when there is a high priority issue). I email my concerns, I prioritize them, and they get back to me toot suite. Those are offices with good workflow practices. When waiting times are long I try to use the mantra … I am a patient practicing patience…a little meditation…. I use waiting times as one piece of assessing the value proposition of the Dr. I balance the soft skills (e.g. respect for your time) and hard skills.

      Thanks for the great post.

      Reply
    • 36. services d'entretien ménager  |  February 5, 2014 at 6:32 pm

      see the same doctor because he or she could notice changes that might not otherwise be detected. While I agree, the Minute Clinic (note the name) model can potentially reduce some of the use of doctors for non-urgent care. services d’entretien ménager

      Reply
  • 37. Paulo  |  October 19, 2011 at 6:01 pm

    Great piece Lisa!
    After all time is of the essence when it comes to your health.
    Since customers have never really pushed the current healthcare delivery model to be ON TIME – the ‘system’ has responded accordingly. The digitization of life is rapidly changing consumer expectations when it comes to time – 24/7, instant gratification, DIY, transparency, etc. These expectations are just starting to have an impact on how healthcare is delivered. Strap in! The big changes are yet to come!
    Paulo

    Reply
  • 38. e-Patient Dave  |  October 19, 2011 at 5:57 pm

    The relevant discipline here is queuing theory – how many of something you need to have, given various patterns of incoming “customers,” to keep wait time within a certain acceptable level. It’s valid for cashiers at grocery stores, gasoline pumps, airport check-in counters (or kiosks), anything.

    But in healthcare this is often confounded by one essential problem that doesn’t exist in hardly ANY other industry: too often, to the provider there’s NO SUCH THING as an unacceptable wait time. For whatever reason, too many of them just don’t give a rat’s patoot how long we wait. You can tell because they don’t do a single thing to prevent it.

    Some providers will let you know they’re running late, so you can show up late. Very few do.

    In my personal experience, some even seem to make a point of making us wait. 15 years ago I had a dermatologist who was always at least an hour late, and the desk staff clearly wasn’t concerned – one woman seemed to completely agree that this dermatologist was a god, and I was lucky to even have an appointment. (This was in frickin’ Derry N.H., not Mass. General or something.) So one time I made a point of picking the first appointment of the day – and the guy was STILL 45 minutes late.

    I stopped going to him. And as we become more able to ditch providers who really don’t care, shops like his will finally get to experience what every other industry experiences: the consequences of bad service.

    I know there are a hundred reasons why good caring docs can run late. I say, don’t give me that discussion until the shop has really worked at staying on time and letting patients know when a day has gotten out of control. Physician practices have no business exhibiting “learned helplessness,” i.e. giving up on ever having a life that works.

    So there.🙂

    Reply

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Lisa Gualtieri, PhD, ScM

Lisa GualtieriLisa Gualtieri is Assistant Professor at Tufts University School of Medicine in the Department of Public Health and Community Medicine. She is Director of the Certificate Program in Digital Health Communication. Lisa teaches Designing Health Campaigns using Social Media, Social Media and Health, Mobile Health Design, and Digital Strategies for Health Communication. Contact Lisa: lisa.gualtieri@tufts.edu

@lisagualtieri


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