I am tempted to give a cynical, one word answer – “avarice.” There is no more universal complaint than that the doctor is always running late. Why should that be? Can’t they organize their schedules better? There is no question; the life of a doctor is unpredictable. All those things that screw up their carefully made timetables:
• Patients with urgent problems have to be fitted in.
• What appears to be a simple problem escalates.
• Patients have long-winded or multiple problems they want addressed – and reining them in (but still making them feel like they’ve been heard) is one of the fine arts of being a doctor (if you’ve kept them waiting you feel like you have to accommodate them, then it’s a downward spiral).
• One of your patients in the hospital is crumping and you have to take multiple phone calls from the nurse on the floor.
• If your doctor attends at the hospital as well, he or she will probably have to make rounds before coming to the office – which also can be an unpredictable business.
Then there’s the more predictable stuff, like: having to wrangle with insurance companies over why Mrs. T. should have Lamasil for her toenail fungus; calls/texts/e-mails from patients about side effects of their medicines, their lack of progress, their blood pressure readings, their reaction to the flu shot (you insisted they get), or possibly their grandmother who is in the hospital in Nova Scotia; forms to be filled out for Workers Comp/disability/DMV/lawyers; and a million other things.
In this day and age, this is all compounded by the “advance” of having computerized medical records – and having to record stuff like “meaningful use” where your doctor is mandated to take note of all sorts of demographics.
And, of course, if those drug-peddling sirens come by with coffee and donuts, they need the quid-pro-quo of a few minutes of your time to bend your ear about their company’s newest medication.
“Why can’t doctors just allow enough extra time in their schedule to accommodate all these eventualities?” you might ask. And this is where the avarice comes in.
There is nothing burns a doctor more than sitting around twiddling his or her thumbs when he or she could be seeing patients and making money. If you happen to have a light day with no drug reps, no emergencies, no calls, and only straightforward patients, it can happen.
So doctors book themselves schedules based on light days like this, and when reality hits – they run late.
What Can You, as the Patient, Do About It?
If doctors were paid to get their patients better, or keep them well, instead of being paid fee-for-service (“medicine by the yard” as the wags call it), which incentivizes them to bang through as many patients as possible, and, if you take the really cynical view, provides a disincentive to get their patients better, but rather keep them coming back, things might be different.
If we could accelerate the baby steps that are being taken to change to pay-for-performance and change the trend of practices being taken over by hospitals/medical corporations, who then run them like a widget factory, with only the bottom line that matters … again, things might be different.
But while you’re waiting, one solution is to seek out the right doctor.
There have been doctors in the history of medicine who have run on time (there was one pulmonologist in our group who reputedly used an egg timer). There are some who somehow manage to run fairly much on time even without such draconian methods.
If punctuality matters a lot to you, find one of these doctors – though it might be a trade off. There was one cardiologist in our group who regularly kept people waiting 2 or 3 hours, but patients found him such a wonderful doctor, they were willing to wait.
Your doctor is much more likely to be on time for the first appointment or two in the session – so ask for an early morning or afternoon appointment.
Inform the front office staff, or better still the doctor’s nurse if possible, if you have a tight time schedule.
Making a prioritized list is likely to make the best use of the time you do have with the doctor.
It may sound unfair, but you being punctual is important. Murphy’s Law being what it is, the day you are late is the one-day your doctor will be running on time – but even if this is not the case you can at least take the moral high ground when complaining about the doctor being late.
And one thing that placates patients of doctors who run late is if the front office staff informs them and can give some idea of how late. Some people advocate calling ahead to see. But at least ask when you get there.
As noted, the doctor running late seems to be a universal phenomenon. I truly believe if they weren’t trying to cram a quart into a pint pot, they could do a much better job of running on time.
Patrick Neustatter, M.D. practiced primary care for more than 40 years. Developing an interest in coaching patients to help themselves and throw off the ingrained notion that “the doctor knows best, ” he recently published Managing Your Doctor: The Smart Patient’s Guide to Getting Effective, Affordable Healthcare