A Tryst with the Waiting Room

One of the most common complaints patients have is that they wait too long in the office or for scheduled procedures. I will have to respond with a “mea culpa!”. I must also acknowledge that the overwhelming majority of our patients have been incredibly indulgent, forgiving unpredictable prolonged waits.

I have for long contemplated giving you – the patient – a sense of how you end up waiting varying lengths of time. Firstly, we do not double book. Secondly, if we were able to space patients out far more than we are doing now, we would probably not make many people wait. Based on the number of patients we have to see and the time frame we have to see them in, this is not a practical option for us. Third is the problem with my not starting on time. This is something that I am trying to reduce as much as I can. Fourth, I would like it known that I do not play golf AT ALL. I felt constrained to make this assertion with much vigor when a silver-haired grandmotherly patient of mine waiting patiently in a packed office said in a quiet voice – as I walked in late - “Golf, doctor?”. I also have hospital obligations and calls from other doctors that affect our schedule. I end up trying to assure patients that I will do the best I can when I get to them and will spend all the time with them I feel is optimal, though this seems insipid and doesn’t provide much solace when you have other things planned. There have even been times when patients new to our office have left in exasperation asking to reschedule appointments, though what anguishes me most is the wait many elderly patients very dear to me have so generously endured.

We have tried several approaches to decrease the wait time. We have left time slots intentionally open - for example 12:30-1, but Murphy’s Law kicks in and we will be going like clockwork till 12:30 and then I will end up spending an hour and a half with the 1 PM patient! The only way I can definitively solve the wait problem is to keep each visit restricted to the “allowed” time. So, if we have assigned a patient 15 minutes, I WILL have to wrap things up in that time period. The problem with “watching the clock” is that patients’ medical situations come in so many forms that I might spend half an hour tracking down a piece of information that I think helps me look at a particular patient’s condition more effectively and this throws the whole schedule off. Our staff do attempt to get some of this information - often before a patient is seen, but we are not able to do this on all such patients for a variety of reasons and what is more, often I have to personally work on it.

My chief motivation for this long letter is the hope that patients who give me the privilege of caring for them understand the need for differing amounts of time to talk to, examine and think about each patient’s problem even as we assign appointments based on “averages”. I often review the record ahead of time and some visits may take only a few minutes, but others not so. For me to rush is not the best thing for the patient I am with, though I do feel the stress and the guilt of keeping you waiting. This is especially true when I am doing procedures and we find ten polyps in one patient and it takes a long time to find and remove each of these - anyone of which might become a cancer in the future. I know the next patient is waiting and probably “hangry” and eager to go home but rushing through any patient would be a betrayal of trust. I ignore the worry that someone is waiting and keep going. What is worse is that when I spend an extended period with one patient, I can’t “catch up” because it is unconscionable to rush through anyone else down the line. Very unpredictable emergencies - even when they don’t involve my patients directly - add to delays.

Patients sometimes ask – tongue in cheek - if they can come half an hour after the appointment time, the problem - as another patient noted was that I had seen him within five or ten minutes of the scheduled time 75% of the time, but kept him waiting more than half an hour 10% of the time! We can sometimes call patients to alert them of delays and it helps if we have three contact numbers for you. Unfortunately, the staff may get very busy and may not be able to call you to appraise you of the delay. One consequence of “Telehealth” - which we are rapidly adopting – may be that we can do consultations at times more convenient to you without a wait. Even prior to Telehealth, we seemed to have vastly improved wait times in the recent past. A few weeks ago, I was basking in this sea of self-congratulation when we had a problem with the Electronic Health Record servers for a few hours in the morning and this caused many patients to wait over an hour. We had no idea whether it would start working the next minute or not at all and we waited several hours before calling patients to move them back. What is worse, because of the way the system works, when I saw those patients for a follow-up, the format we had to input data the day the servers froze caused delays when we saw them again. I realize most of the above are excuses that are largely for my benefit - a catharsis for my conscience, but I thank you for reading. As I said, hopefully the waits will decrease with Telehealth and Social Distancing but in the meanwhile, I am afraid you may just have to use the method I have suggested to some - make a wax idol of me and stick needles into it!

Thank you

Ravi Thiruvengadam, MD