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An appointment ... to wait?

Patients have long griped about delays at the doctor's office. But solutions do exist.

December 27, 2004|Daniel Costello | Times Staff Writer

Before leaving for a checkup with her doctor last month, Suzi Finer called ahead to ask if the doctor was on schedule; the nurse assured that he was. A stickler for time, Finer arrived 10 minutes early for her 10:20 a.m. appointment.

The preparation didn't help. After checking in, Finer sat in the waiting room for 40 minutes. She then spent 20 more minutes "staring at four blank walls" in an exam room, twice poking her head into the hall hoping to grab someone's attention.

"When the doctor showed up, he was nice and very helpful," says Finer, 41, of Beverly Hills. But "no one even apologized." Making matters worse, she says: "They don't validate for parking. I had to pay $9. Cash."

Each day, countless patients like Finer, many of whom are sick, visit their doctors and confront seemingly endless waits. Most view the ritual as a fact of life they can do little about, such as rush hour traffic or holiday shopping. But in an age when a microchip from China can be shipped to Kansas overnight, it's hard not to wonder why people still need to wait so long to see their doctor.

In recent years, the fast-food and retail industries -- and even time-honored dawdlers such as post offices and departments of motor vehicles -- have reduced wait times by spending considerable time, money and energy to speed customers along. Most are seeing the fruits of their labor in higher customer satisfaction, lower costs and often a rise in profits.

Waits in doctors' offices, meanwhile, are getting longer. According to the Agency for Healthcare Research and Quality, the proportion of patients who wait more than 30 minutes in their doctor's office rose slightly from 16% in 1999 to 17% in 2001, the last year that information was available.

To be fair, some doctors are trying to alleviate the problem. An estimated 5% of physicians have switched to an increasingly popular scheduling system known as "same day access" that minimizes scheduled appointments and leaves most of their day open for walk-in patients. Some are doing group appointments for up to a dozen people with similar chronic conditions or are allowing patients to set up appointments and view their medical records online, hoping it can reduce phone calls and unplanned office visits. Others are taking the "make them think of something else" approach by adding comfortable chairs, relaxing music and lighting, even coffee and juice bars in their lobbies.

Still, many doctors pay little attention to punctuality. "The issue in medicine is that most people have always believed they can't do anything about things like waiting times, so they never tried," says Mark Murray, a Sacramento healthcare consultant who works with medical practices and hospitals to improve office efficiency.

Long waits aren't just a temporary annoyance. They're a primary factor in how satisfied patients are with their visit. And they are one of the main reasons up to 40% of all patients skip their appointments, making scheduling and staffing levels unpredictable and raising costs across the industry.

What is more, purgatory-like office waits can determine how often some patients seek care. According to a study released last year in the American Journal of Public Health, waiting times of 30 minutes or longer sharply reduced the likelihood that men would visit a doctor again. A woman's decision to return to a doctor is much more affected by the cost of the visit, the study also found. Only 5% of women left waiting stay away.

So what's keeping doctors from being on time year after year? Some simply expect patients to wait for them. But experts say the larger problem is that healthcare has mostly ignored lessons other industries have used to make customer service improvements, partially because few doctors have tried but also because many believe wait-inducing factors can't be changed.

For starters, they say, too few physicians have embraced technology, such as electronic medical records or computer systems to automate and track patient visits. Instead, many offices still use paper forms to record patient visits and insurance information, rely on outdated filing systems, and have inefficient procedures to track patients once they leave the office. Supporters of the new technology say that by standardizing, doctors could considerably speed up appointments.

Eugene Litvak, director of Boston University's Program for Management of Variability in Health Care Delivery, says doctors also put too much faith in the idea that they can't predict surprises. That, Litvak says, isn't true. If doctors looked for natural patterns -- how many patients arrive before noon on Monday, how many show up with back problems in December -- they could readjust their staff accordingly and better deal with patients' ebbs and flows.

"Doctors shouldn't assume patients demand is given by God," he says. "No one else does."


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