Medical appointment peeve

[Bernie Kopfer]

My doctor, like most of them in the area, works for a large corporate medical company. Most of the private practices have been bought out a long time ago. I was told by some staff that the corporation expects the doctor to spend no more than 15 minutes per patient visit actually with the patient. If they exceed that, they have to account for it to a supervisor. So if there is a patient that needs more time, then the next patient gets delayed. I dont know how any doctor can keep to a schedule under those conditions, without pissing someone off. My appointments are always rushed if they are routine.

You hit the nail on the head! Physicians are not their own bosses anymore. They (particularly if they practice in a large system) are employees governed by whoever runs/owns the system.

[Alan Lightstone]

So happy to be retired from medicine. Times in the OR are "relative". Surgeons give fake shorter times for surgeries when they book them, so that they can schedule more cases in a day. OR staff knows this, and even have computer readouts of their actual times, but they don't dare confront the surgeons with this, as they don't want to lose the business. Ah, medicine in the 2020s.

I always felt bad for receptionists in surgeons offices. They are usually late for their appointments, and often have to cancel large numbers of appointments with the patients waiting for them in their waiting rooms. Must not be a fun job.

And, yeah, I get the e-mails asking me to be 15 minutes early, but giving me the web address for the portal to fill out all the forms. Which, I can assure you, with my background are completed fully and accurately. So that 15 minutes involves me saying hi to the receptionist and saying, no, my insurance hasn't changed.

[Doug Garson]

I don't think that the wait is the issue that John is bringing up. There should always be a certain expectation that a doctor/PA/NPA/Nurse is going to be somewhat flexible with time when they are with a patient when they are a patient focused resource. I actually expect that from them when I'm the patient. But I absolutely would be annoyed with what John describes if the expected time of arrival keeps changing because of "paperwork" or whatever. Tell me the time of my appointment and what time I need to physically be there up front and keep the "arrive early" expectation reasonable, too. Nobody's "paperwork" should take a long time and if there are more involved questionnaires, etc., required for the situation, provide them in advance...we live in a connected world.

Good point, I haven't had that experience of changing appointment times to do paperwork. I have had the annoying experience of filling out forms online before the appointment only to be given a different form to fill out while I'm waiting asking many of the same questions.

[Mike Henderson]

When I make an appointment with a new physician, I ask them to send me the paperwork by email so I can fill it out before I go there. Many of the docs here have the "paperwork" on a web site and you fill it out there. This is a big advantage to them, now that they have to do electronic records. Your electronic submission goes right into your record. If you do it by paper, someone has to enter all that data (which usually is not done).

If I go to a doctor for a non crtitical appointment (where if I don't see the doctor, I'll won't die), if I'm kept waiting too long, I go to the desk and tell them I can't wait any longer and I need to reschedule the appointment. Most of the time, that gets me in right away. If that keeps happening, I go to a different doctor.

I don't accept the excuse that the doctor has to spend more time with a patient. That just pushes everyone else back, or the doctor has to "short" some of the later patients, which is unfair to all the patients later in the day. The doctor needs to schedule that patient for a follow-up appointment rather than punishing everyone else on the schedule.

If it's a real emergency, I understand. But doctors often overschedule because they expect a few people will call and cancel. And most doctors hate to have a dead time in their day - they don't make any money if they don't see anyone. They would rather inconvenience you than lose the money for a time slot.

Mike

[John K Jordan]

I don’t mind waiting at all. I know my dr takes as much time with me as I need. If i’m waiting a long time I simply assume he is doing the same for other patients. He’s a fantastic doctor.

Now once I had to wait almost 3 hrs at another doctor's. I used some of the time to calculate the square root of 15 in my head, to 10 significant figures. That was decades ago and I still can’t forget it; it’s taking up space, wasting valuable memory cells. 3.872983346

Another time I waited for hours to get a cast cut off my young son’s arm. This was about 35 years ago when he was small. I finally took him up to the receptionist and told them we’d been waiting there WAY too long, just forget it, I was taking him home now and I would cut off the cast myself. They had the cast off and we were on our way in less than two minutes.

[Alan Rutherford]

I have an appointment at 8 tomorrow morning for dental surgery. They want me there at 7:30. No excuse about paperwork or anything. They just want my body inside their door at 7:30.

[Steve Demuth]

Speaking as the former CTO for a hospital / clinic that saw over 1M patients per year, and who spent a LOT of time trying to measure and improve the patient experience, and simultaneously as the spouse of a person with medical conditions that require medical appointments in aggregate more frequently than once a month - I feel your pain from both sides of the equation.

First, most clinics are primarily scheduling the doctor's time, and using that to inform the patient of the appointment. That is, the primary record, and purpose, of their record of te appointment is as you say, to note when the patient is expected to see the doctor. Their Electronic Heath Records system are wired that way as well, by design. Any clinic that thinks about and tries to optimized patient experience, though, will make an effort at the time of scheduling, and in all subsequent notifications to be clear when they expect you to arrive and begin interaction with the clinic overall.

Patients, however, don't make this easy. If we told patients their "appointment" was at 9:00AM, when in fact we didn't expect the doctor to see them until 9:30, but needed them their early for registration, paperwork and rooming, we were dinged for the doctor being late. If we told them their appointment was at 9:30, but we needed them at registration by 9:00, we heard complaints such as yours. And, often, we'd have to change things a bit in the notifications. If the doctor decided that a pre-visit test was needed, after the initial scheduling, we'd have to notify the patient, as in your case, that we needed to see them even earlier.

I know, of course, that the patient experience team mostly saw the complaints, and heard very little from anyone who was happy with how scheduling went. Still, it was frustrating trying to align to a system that reduced disappointment. We found it particularly hard, because the actual variance in timing, and need for "padding" varied widely from primary care to routine followup in speciality care, to a wide variance between specialties in first-line specialty care.

From the patient's point of view - my (obviously informed) expectation is that I be told at the time of scheduling when I am expected to arrive, AND when I should expect the actual doctor appointment to commence, and that this set of facts be clear in any followup notifications. For primary and routine secondary care, any good scheduler should know these things, and the system should accomodate and communicate them. But I know from experience that many EHR system do not make this easy, stuck as they are on scheduling doctors, not patients. We spent millions refactoring the out of the box scheduling system from our EHR to accomodate our sprawling practice and create a focus on patient experience and scheduling. We may have been better at it than any comparably sized institution. 10-15% of our patients were still unhappy. C'est la vie.

[Alan Rutherford]

I have an appointment at 8 tomorrow morning for dental surgery. They want me there at 7:30. No excuse about paperwork or anything. They just want my body inside their door at 7:30.

Arrived at 7:26. Spent about 2-3 minutes at the desk and 2-3 minutes in the waiting room. Dental assistant did the preliminaries and anesthetist stuck something in my arm and I don't remember anything until about 10. So I can't really say when my "appointment" was but if I was kept waiting too long, I slept through it.

[Ron Citerone]

I think a good secretary/scheduler could eliminate a lot of the confusion and upset patients.

[Bill George]

Ok paper work, I am a computer person. Years ago perhaps 25 I typed up in Word my current and its updated as needed, medical history and on another sheet my RX's. Now I print out those and also have a DOC file on my smartphone that I can send in a email attachment. When asked to fill out this and that I hand them the print outs and ask if they need electronic files I can send if needed. End of discussion, but we need you to fill out OUR paper work.... honey its right there, just scan it in!

[Alan Rutherford]

I'm a computer person too and that wouldn't fly around here. It would be nice, but it wouldn't work. The RX, sometimes, not the rest.

[Doug Garson]

I think a good secretary/scheduler could eliminate a lot of the confusion and upset patients.

I doubt it, if the first appointment is scheduled for 10 min and takes 25, the whole day's schedule is off until/unless several appointments take less than the allotted time to get back on track. Not sure what the best secretary/scheduler can do about that other than advise patients as they arrive how far behind the doctor is. Up here there are many more patients than doctors so doctor's time is more critical so overestimating appointment length would lead to idle doctors and patients waiting an extra day or more to get an appointment. The real solution is more doctors.

[Doug Garson]

Ok paper work, I am a computer person. Years ago perhaps 25 I typed up in Word my current and its updated as needed, medical history and on another sheet my RX's. Now I print out those and also have a DOC file on my smartphone that I can send in a email attachment. When asked to fill out this and that I hand them the print outs and ask if they need electronic files I can send if needed. End of discussion, but we need you to fill out OUR paper work.... honey its right there, just scan it in!

Agree with Alan, imagine the extra time required to review patients history and potential errors if every patient had their medical history in a different format.

[Alan Lightstone]

I do the same thing with the same result. I have to type everything in again.

[Bill George]

I do the same thing with the same result. I have to type everything in again.

Never ever had an issue, I just say here it is and just scan it in. Handwritten Why? They never have an answer. BTW it all has to be entered into the system anyway, what magic is there in handwritten on their form? Zero and there is zero interest by the doctor he never looks at it, just looks at you and asks what's wrong?

Oh my medical history is in chorological order, what could be an issue?