Is This Frigging Unconscionable, or, Am I An Impatient Hotheaded Crank?
June 25, 2018 1:22 PM   Subscribe

I walked out of a cardiologists office an hour and a half after my scheduled appointment time.  The physician still had not shown his face.   At the time, this seemed like the obvious thing to do, but I have been getting differing opinions from friends and family.   So I am curious... how much of this type of treatment will you accept from a physician?

Some additional color:
I was told by one of the assistants that this is not atypical, that this doctor runs behind a lot.  
   - My thought was, that's bad, because if it was a one time occurrence, ok, stuff happens.  But if it happens regularly, that should be fixable; appointments can be staggered more realistically.  Therefore no excuse.    
   - Some friends of mine weighed in that this means that the doctor gives all the time that's needed to each patient.  So it is a doctor worth waiting for.  

As I was leaving, my departure barely merited a second glance from the staff.  One person asked "you leaving?"  Uh, yes.  "Do you want to make another appointment?"   Uh, no thank you. "OK, take care."  That the staff took this so matter of fact-ly added to my impression that this is not an atypcial occurrence.

Some have told me that this is relatively normal for American Medicine these days. The physican's time matters and the patient's time does not. That I should learn to suck it up. I should "get smart" and set another appointment first thing when they open, so the doctor won't be running so far behind.  I understand that they feel they are being pragmatic.  

My questions are:   How normal / usual do you find these types of occurrences to be at medical offices?   If you have encountered it do you roll with it?  Should I learn to suck it up?    Do you suck it up? (Don't mean that the way it sounds!)
posted by elf27 to Health & Fitness (46 answers total)
 
Find a new cardiologist.

I haven't been to a specialist other than my OB/GYN, but I do find that whether it's our family physician, my OB/GYN, our pediatrician, or the dentist, there is a wait time of anywhere from 15 minutes to 45 minutes (a rare extreme.) I consider all my medical service providers excellent at what they do, and do not think I've been short-changed in my interactions with them, no matter the duration of my visit. When I chose my practices, I looked at reviews from reputable sources on patient wait times, among other things. Doctors who were overly busy were not options for me or my family.

That said, I believe that not being seen 1.5 hours after your scheduled time is excessive, and if this happens frequently, probably behooves you to find a new cardiologist. There are many great specialists who take wonderful care of their patients without being excessively behind on their appointments. If you're in an emergency, access to your doctor is extremely important.
posted by Everydayville at 1:28 PM on June 25, 2018 [6 favorites]


In my experience this is fairly normal for high-level specialists like a cardiologist. My mother routinely waits 5-6 hours or more (sometimes until 9pm!) for her retina specialist as he is the only such provider in her small town and has to overbook to treat all the patients who need his services. Another of my mother's doctors (endocrinologist) advises patients to come in an hour after their scheduled appointment time to avoid a long wait.
posted by miaou at 1:28 PM on June 25, 2018 [5 favorites]


An hour and a half, with no explanation about what is happening, is unacceptable. You are not overreacting. I would have been in the car after 20 minutes.

Gunning for the first appointment is indeed a common strategy to getting seen quicker, but the staff definitely owes it to you to communicate and offer you alternatives if the doctor is running too long.

That the staff took this so matter of fact-ly added to my impression that this is not an atypical occurrence.

Just be careful that they don't bill your insurance for the visit. I've heard of this happening. I've seen some suggest that you get it writing that you left without being seen.
posted by JoeZydeco at 1:28 PM on June 25, 2018 [17 favorites]


A couple years ago I left a specialist's office about an hour after having arrived on time for an appointment. It was in the middle of the day and I had to get back to work. They apologized and a couple of days later they sent me a couple of movie theater gift cards in the mail, which I thought was nice of them.

I don't assume bad faith on anyone's part - on the contrary - I appreciate that if I have questions the doctor will answer them rather than hurrying me out. And they're doing that for everyone. So yeah, it snowballs. I've learned that if I don't have time to wait around, I need to schedule for first thing in the morning, or first appointment after lunch.
posted by fingersandtoes at 1:28 PM on June 25, 2018 [5 favorites]


I would have done the same thing you did, assuming my medical needs weren’t urgent and I lived in a place where I was confident I could find another provider. Maybe things are different in the cardiology field, but this kind of wait is not typical in my experience with general outpatient/preventative medical care in the US. I expect to wait, but 45 minutes is about as long as I’d find acceptable without some kind of explanation/apology/promise of attention ASAP.
posted by exutima at 1:29 PM on June 25, 2018 [1 favorite]


I live in the UK and use the National Health Service. At the outpatient clinics I have experience of, yes they run late sometimes (not always!) but there is usually some kind of expectation management in the form of a notice on a whiteboard "Dr X is running XX minutes late" or even a pager system so patients can go and get something to eat or run an errand or two.

An hour and a half I would definitely consider excessive - what I'd do about it would depend on how ill I was feeling (i.e. how urgently I needed the appointment), and what, if any, explanation/help I got from the staff.
posted by altolinguistic at 1:34 PM on June 25, 2018 [1 favorite]


I have found this varies by location. I lived in one city where this would have been totally normal for any doctor. When I relocated, I was shocked to discover that doctors ran mostly on time. So this may not be unreasonable (or at least unusual) for where you live.

However, in my city where doctors run on time, my oncologist sometimes runs very late, and I know this is because she takes as much time to answer questions as each patient needs, so I am willing to put up with it. It doesn't happen every single time though.

Maybe call around to different cardiologists to ask about wait times? This seems not good, but depending on where you live, you might not have much of a choice.
posted by FencingGal at 1:35 PM on June 25, 2018 [1 favorite]


I saw specialists in neurology multiple times a year for 25 years at major medical centers in the US. It was rare to be seen within an hour of an appointment time and waiting 6 hours was not terribly unusual. It is horrible and exhausting and disrespectful, but I didn't really have other options.
posted by congen at 1:35 PM on June 25, 2018 [1 favorite]


My former gastro doc used to regularly keep people waiting upwards of 2h, coasting on his reputation as an excellent doctor; the waiting room was always, always full of angry, frustrated people. After one 3h hour wait, 2h of which was in the waiting room and the final hour of which was in an exam room, I decided it just wasn't worth the headache. My current gastro doc, who also has a reputation as an excellent and lifesaving doctor, has never made me wait more than 20 minutes, no matter what time of day my appointment was scheduled, and it's a huge weight off my mind, since I'm there for the monitoring of a scary condition.

Anyway find a new doctor, it will be better for you in both the short and long term.
posted by poffin boffin at 1:35 PM on June 25, 2018 [20 favorites]


If there was no compelling reason provided (e.g. some kind of emergency) I’d wait a maximum of 45 minutes or so - 1.5 hrs is far too long.
posted by Sakura3210 at 1:39 PM on June 25, 2018 [2 favorites]


I find it depends in part on the doctor's specialty. For example, OB/GYNs are going to have emergencies all the time.

With my primary care doctor, I find that I sometimes have to wait as much as a half hour beyond my scheduled appointment time. Other times, though, I wait hardly at all. I roll with it by always having something to read while I wait.

My husband deals with it by always taking the first appointment of the day.

I would say, if it happens often and the wait is excessive, consider switching doctors. But I do think cutting a doctor some slack in this area is appropriate, given the nature of what they do. Patients are unpredictable. Especially with the number and nature of questions they may have. I try not to overload my doctor with questions, and I try to make fair use of her time by, for example, writing my questions down in advance so I remember tham and don't waste time hemming and hawing. But I do appreciate that my doctor is willing to answer my questions, and I assume she does the same for her other patients. Which might, yes, make her late for the next patient.

Also, consider that it might not be the doctor's fault. If her first patient of the day is late, that could throw things off for the rest of the day.
posted by merejane at 1:40 PM on June 25, 2018 [1 favorite]


This isn't atypical and is one of many reasons why I don't do clinic-based outpatient medicine. If you look at it from the physician's standpoint, his clinic is probably very overbooked (for a multiplicity of reasons, many of which may not be his fault) and he simply cannot do justice to each patient without falling behind. I worked with one ortho doc when I was in training who saw 60 patients each clinic day. It was completely unmanageable, there was no time for food or bathroom breaks and it was all he (and we) could do just to get through it.
posted by killdevil at 1:44 PM on June 25, 2018 [1 favorite]


I always call before my appointment to ask if the doctor is running on time. Sitting in a waiting room for me then 15 minutes is unacceptable to me unless there was a Big Emergency that caused the delay.

I wish the offices would just text me so I didn't have to call, but it seems everyone's time is more important than the time of the patient.

I have also sought out doctors who don't leave patients waiting.
posted by parakeetdog at 1:49 PM on June 25, 2018


I used to work for a doctor who always ran behind like this and it truly was because he took too much time with each patient but insisted upon trying to keep to a packed schedule anyway. He wanted to help as many people as he could, genuinely. Also, office-based physicians don't actually make that much money; he had to keep a busy schedule to pay our salaries and his insurance and rent and all that. We, as his office staff, were constantly apologizing to annoyed patients. He was a really good doctor, though, and his long-time patients loved him, but also knew what to expect: he just wasn't that great logistically.

So, should you tolerate it? You don't have to - someone should have offered some explanation or apology or something - and I know it's frustrating, but it sounds like you are especially angry as if this behavior has been targeted at you specifically, which is not the case. Specialists often have emergencies, or work in long-time patients in addition to their regular schedule because of a time-sensitive concern. I waited for an hour in my oncologist's office last month, which is unusual for her, but I'd requested a special appointment the day before and I knew she was working me in as a special favor - and I also knew her schedule after me would be messed up as a result. Waiting around is just sort of an unavoidable cost of doing business in modern American medicine. In general, oncology is the only kind of specialty where I almost never have to wait; I guess they feel bad enough for you as a cancer patient that they really try to be efficient with your time.

You can avoid this by always making an appointment first thing in the morning.
posted by something something at 1:52 PM on June 25, 2018 [6 favorites]


I usually wait 1.5 hrs for my primary doc. It's not ideal, but he never pushes me out of his office, and I feel like I have enough time to discuss everything I need to discuss. And he gives excellent referrals to other docs. It's not ideal, but no, I would never get up and leave. I think I've waited about 2.5 hours at times, and it's never felt like the end of the world. No one says anything while I'm waiting, but he always apologizes once I'm face-to-face with him. These are human patients with unpredictable things to discuss, and unpredictable timing to a degree. Ultimately, I blame capitalism and the US medical industry and the insane costs of real estate in my city, and therefore the need for doctors to fit more people into the day than is ideal.
posted by thegreatfleecircus at 1:53 PM on June 25, 2018


This speaks to some combination of poor time management by the doctor, poor expectation management by the office staff and poor workload balancing by the care network, if one is involved. It is hard to say how much each is at fault. Unless this particular doctor is the only one or by far the best local one for your condition, you should try other clinics to see if they all operate this way. I tend to stay within the same care network as my primary doctor, but I will go outside of the network if I don't like a particular clinic. (This is not out-of-network for my insurance - just a clinic that is not affiliated with my own.)

I think I would wait up to an hour for a doctor before going out and asking the staff how much longer it would be. I've already taken the time off of work, so I'd rather not have to take more. Other things include if this is one I regularly see and if this is a checkup or an acute issue. I like all of my regular/checkup doctors enough and they are timely enough that I would let it slide one time. Even it became chronic, I'd allocate more time for the appointment since they are all that good.
posted by soelo at 1:59 PM on June 25, 2018


Chiming again here that this is the sad state of American health care. I have a family member who is a doctor, and the bean counters are not allowing enough time for the doctors to see patients. Its unfair to the doctor and the patients.
On top of that, this is a cardiologist, so they probably had procedures earlier in the day, also, which may have contributed to the long wait time. Not an excuse, but explains what's going on.
What I'm most surprised about was the lack of communication from the office staff. That shouldn't have happened, and you have every right to be upset. I don't know your situation, but if there is another cardiologist you can see, it might be worth it. Having said that, (usually) doctors who are in demand are in demand because they are good.
Finally, if you were going to see a cardiologist, I hope you are taking good care of your stress levels/blood pressure. Stay well!
posted by honey badger at 2:02 PM on June 25, 2018


I'm a doctor though not in the US and I seem to almost always run late. I see a lot of new patients who need a one off specialist consultation.
I schedule patients every 30 minutes and still some visits take up to an hour, usually for elderly patients, patients with cognitive difficulties, anxious patients who sometimes bring pages of notes and long lists of questions.
When I run late I try to periodically peek into the waiting room and update people on the wait. Some people go to the cafe next door and wait there and we may call them when it's their turn.
My biggest delay was 75 minutes but I offered to reschedule and they said they'd wait. In such extreme cases I usually offer a discount. Unless the visit then takes another hour, which has happened. Time seems to flow differently depending on which side of the door you are.

That said, I'd be really annoyed at your doctor's staff. They should be warning you upfront at the time of scheduling and offering you options.
That they seemed so cavalier about the situation would annoy me more than the actual wait.
posted by M. at 2:05 PM on June 25, 2018 [3 favorites]


I worked for an ambulance transport company for 6 months and took a lot of people to a lot of doctor's appointments. It's not unusual (I once waited for 4 hours with a patient for a follow-up ophthalmologist appointment), but it's also completely unacceptable, in my opinion.
posted by coppermoss at 2:10 PM on June 25, 2018


If you are an impatient hotheaded crank, then I am one too. Solidarity!
posted by sheldman at 2:20 PM on June 25, 2018 [2 favorites]


If I'm seen within 20 minutes I'm pretty happy. 45 minutes is about what I'm willing to wait these days. One time I waited for an hour and a half. The staff told me "about ten more minutes" three times before I decided I'd had enough. It's incredibly frustrating, I don't blame you for leaving. Only suck it up if you feel it's necessary. If you don't need that appointment that day then I wouldn't worry about it.
posted by blackzinfandel at 2:27 PM on June 25, 2018


I am a midwife with a sometimes challenging and complex case load. I will admit I usually run a bit behind but my patients are aware and generally know to plan to just be in clinic for X minutes. The reasons for this are varied: I'm booked a minimum of 24 patients per day (this is in outpatient clinic only--not L&D, and is actually fairly low
Compared to some specialties--cardiologists or PCPs might be expected to see 36+ patients per day!) so patients are allotted just 15 minutes for one appointment, plus being responsible for any triage/emergency/urgent gyn that walks in, plus being available to consult my family practice and pediatrician colleagues, as well as take any urgent calls from lab or radiology (eg, critical blood result, unexpected ultrasound finding, etc.) and then managing that by calling the patient or deleting to the nurses to follow up. This also doesn't include charting time, complex clinical findings (difficult IUD insertion, non-reassuring fetal heart tone, someone with chest pain who needs an EKG, someone who discloses IPV, etc.) So because I know I'm often running late, I also never want to shortchange my patients (who are generally medically and socially underserved), so I give them the space to talk and take a bit more time to get things right.

All that is to say, I think it's a crappy system that doesn't necessarily put patients first, but providers are stuck balancing delivering good care and patient expectations for care with management's decisions re patient loads, appt times, etc. In your shoes, I would have asked for why the delay was so long and whether I might expect to be seen soon. Cardiologists are crazy busy and very much in demand (where I work it can take 6-8 weeks for an URGENT referral), so I don't think it's necessarily a case of the doctor not respecting your time. I imagine it's the opposite and the doc was taking a bit of time with patients, so you ended up with a delay, especially if that's routine for him/her. Tip for the future: if you do reschedule there, ask to be the first patient of the day so you don't get stuck behind a backlog of other patients and emergencies.
posted by stillmoving at 2:31 PM on June 25, 2018


I get that medicine is a service being provided, but it's one of the very few services you're going to get in your life where there are genuinely, at this very moment, not actually enough people providing that service in the United States to actually cover everybody who needs that service adequately. Taking fewer appointments, when you are a cardiologist, does not mean that Joe the Bored Podiatrist down the road who doesn't get enough clients decides to respecialize in cardiology to pick up your slack. Nobody is going to a cardiologist on a lark, right?

You might certainly be able to find one who's less busy in your area, in which case I will say I don't think there's any shame in switching, mind--but I boggle at the people who suggest someone like this just see fewer patients. Go to the least busy person you can get to, but I can't see faulting someone for struggling to provide adequate care while keeping to the incredibly short allotted appointment times in this day and age. This is one of those phenomena that I always put down to "nobody's fault", like the fact that I can't get a psychiatrist near work because they're all overbooked already. I don't want any of them to see fewer patients; I do want them to actually have time to sleep and eat. The system is cruddy but I'm okay with absorbing part of the inconvenience of that for the sake of others, but my chosen inconvenience is more likely to be to drive out of my way to get to an office that's less busy.

I'm sure there's probably one somewhere but I've had a lot of doctors that did that but none of them were goofing around on Facebook while I was waiting.
posted by Sequence at 2:36 PM on June 25, 2018 [4 favorites]


I see a cataract specialist at least once a year and a 1.5 hour wait time is not unusual at all. The difference is, though, right on the front of the receptionist's desk is a sign that reads "Expect to be here at least an hour and a half". So at least it's expected.
posted by aclevername at 2:38 PM on June 25, 2018 [1 favorite]


The ortho wrist specialist I saw was almost always 1-1.5 hours behind, but the staff was very responsive at why he was running late (5 out of 6 times it was emergency surgery ranging from reconstructive work to hand reattachment). They also keep a board behind the desk showing who was running late and by how much. If it wasn't urgent or just a routine follow up, they'd book you with a physician assistant instead and those appointments were pretty much on time.

With the surgeons though, usually you'd be in an exam room within 20 minutes in the waiting room, at which point I'd just lie down and take a nap.
posted by astapasta24 at 2:44 PM on June 25, 2018


I have health conditions that require a decent number medical visits, and these delays are not common, nor are they acceptable to me. It's not wrong to perceive these ongoing regular extended delays as saying that your doctor's time is more valuable than yours. And it's not. The one time I had this happen, I kept the appointment but never returned. The doctor had a reputation for being excellent; and so many people tolerate these 1+hour delays. However, I am unwilling to accept this and fortunately live in a large metro area where there are many excellent doctors. My tolerance may be different if I lived in a rural area with limited providers.
posted by seesom at 2:44 PM on June 25, 2018


If we've learned anything in the last couple of years, it's that just because something has become normal doesn't mean it also isn't unconscionable. I probably would have stayed and been pissed, but I don't blame you for being more of a doer and leaving than a stewer like me. If you want to do something about it, I'd file a complaint (through either private insurance if you've got it or the State's Medicaid/Medicare programs). Even though there are plenty of reasons why it may not be the doctor's or their staff's fault, it's still a reality, and even if it's a "macro problem" (e.g. there aren't enough cardiologists where you're at), nobody's going to do anything about it until it becomes an official "thing."
posted by MCMikeNamara at 2:47 PM on June 25, 2018


I was in an an orthopedics office this afternoon, and was in the hallway after my appointment (on time!) when a woman poked her head out of an exam room and asked rather mildly when her doctor would be in to see her. The nurse said "you're next. I'm so sorry he's running late" The patient said "I've been waiting here for my noon appointment. It's now 2:15" and went back into the exam room.

I'd seen the doc she was waiting for once in the past, and the waits were unbelievably long. He's an in-demand University sub-specialist, many of the patients are elderly with complicated medical histories, and a fair amount of them need translators, lengthening their appointments. He wants more widely-spaced appointments but the administration is very resistant - a common complaint among teaching hospital practices, where they have patients seen first by fellows or residents and then the attending physician, tying up the exam rooms. My issue was more straightforward, I don't have a complicated medical history and don't need a translator, and I suspect the panel of patients my own doc saw today shared that with me.

If you are looking for a general cardiologist, and not someone who specializes in a complaint you share (heart failure or abnormal rhythms, for example) you might do better with a community cardiologist who has fewer very sick referral patients with reams of medical records to go through. I do agree, though, that this was a very lengthy wait, and the staff should have been more open with you about what was going on.
posted by citygirl at 2:47 PM on June 25, 2018


I think it's absolutely fair if you don't want to wait for the doctor, but I think that means you should accept it if the doctor only gives you a few minutes or splits in the middle of your appointment to see the next patient. My feeling is that you can't have it both ways.

I would have waited and tried to understand that patients being treated now are me in an hour and the person pissed in the lobby while I'm being treated is me now. I don't mean to lecture you here. You're perfectly free to feel how you want, and I understand not wanting your time wasted. I just look at it differently.

I do think the staff should communicate if the doctor is behind.
posted by cnc at 2:54 PM on June 25, 2018


You’re not a crank, you should have been communicated with better at the very least. You have things to do too and I think it’s total fair to expect to be able to leave without penalty after that long.
posted by SpaceWarp13 at 3:09 PM on June 25, 2018 [1 favorite]


1.5 hours is absolute bullshit. I have waited longer at my OB/GYN but the staff kept me updated (it turned out to be a labor emergency and they eventually got me in to see a different doctor since I was only there for an annual checkup). My psychiatrist is known for awful visits but they have been making an effort to be better about it. As far as my dentist is concerned--you barely have time to sit down in the waiting room before you're called back. I have NO IDEA what they have managed to figure out that no other medical provider has been able to but they have got their appointments timed perfectly.

My neurologist is also known for very lengthy waits and is part of the reason why I'm looking for another neuro. (Which is unfortunate because her office staff is amazing, the doctor herself just sucks.)
posted by sperose at 3:15 PM on June 25, 2018


I have found that sometimes the doctor might be really good but his/her front office SUCKS. And sometimes the doctor's a bit of a jerk and the front office is really good about smoothing out issues. I'd say that in this case, it is clear that the front office SUCKS. There is no earthly reason why they can't let you know that the doctor is running a little behind, way WAY behind, or whatever. They know exactly what is going on back in the doctor's office behind closed doors and they chose not to tell you. And they don't care one whit about doing a good job, which is why they had that attitude when you left. Find a different doctor who hopefully has a better, more communicative front office. Sometimes it makes all the difference.
posted by molasses at 3:39 PM on June 25, 2018 [4 favorites]


I guess this really does vary per city, as FencingGal notes. Nearly every medical professional I've seen in about the last ten years has been anywhere from 15 minutes to 2 hours late, with little to no apology. This includes family physicians and specialists.
posted by whistle pig at 3:55 PM on June 25, 2018


The wait time seems a bit excessive, but the lack of explanation is what I would find really galling. A cardiologist might have an inpatient emergency to attend to, but the front desk staff should have let you know that. If I were you, I'd go back to your referring physician and tell them what happened, because the cardiologist should be made aware of that.

For what it's worth, I'm a neurology subspecialist and I try really really hard to stay on time in my clinic, because it's not cool to run late, plus it stresses me out. If I'm more than 5-10 minutes late, something's seriously wrong. (As an example, I had a patient the other day tell me they were considering suicide; I'm not going to hustle that person out the door.) I am lucky, though, because my office does not overbook, and as a subspecialist I get 60 minutes for new patients and 30 min for returns.
posted by basalganglia at 4:03 PM on June 25, 2018 [2 favorites]


I belong to an HMO in the United States, Kaiser Permanente, which I chose because it was the cheapest health insurance option my employer offered. I have seen a number of specialists as a one-time thing, including a cardiologist, and one specialist on an ongoing basis. In all of those offices, there was a sign on the wall: "If you have been waiting more than 20 minutes to see the doctor, please notify the receptionist." Once I did have occasion to notify the receptionist, and they sprang into action -- "Really? Oh, I'm so sorry! Wait right here and I'll call her to find out what's going on." And then, "She says she's running late today due to an emergency, but should be available in ten more minutes. Can you wait? Or would you like to reschedule? Sorry about this!" Please note also that that I have never felt rushed by a Kaiser Permanente doctor, even when I had a million questions.

In my experience, there is no trade-off: I both get as much time as I need with the doctor, and am seen roughly on-time. There is no reason you should have to settle for less than this. Find another doctor, or maybe another insurer.
posted by pH Indicating Socks at 4:07 PM on June 25, 2018 [3 favorites]


As the stories above mention, this is obviously totally commonplace. I'd probably just deal with it. I always bring my work with me to physician visits so that the wait time is useful.

I don't think you should accept it. It's really annoying when you think about it. Sometimes it might be in your best interest to accept it, though. Such as if you can't find another provider that will see you more promptly.
posted by grouse at 4:11 PM on June 25, 2018


I am an MD whose office routinely has long wait times. There are a few things I wish I could share with patients.

1) I am so, so sorry. It breaks my heart to make patients wait so long. I know you have work/errands/children/other important things to attend to.

2) The institution I work for controls my schedule, not I. If I were in control, I'd schedule patients much differently and hopefully cut down on wait times. We have tried to get this addressed to no avail.

3) If you must reschedule, that is no problem, and I do not take it personally.

4) Emergencies/unexpected things come up in clinic, ranging from a surprise serious patient complaint that I have to spend time on, random phone calls from whoever (calls from other clinicians, pharmacists, patients), emergencies that require procedures or even a trip to the OR (getting all this organized takes some time), and direct admissions from clinic for patient emergencies (which also take a while). All this pushes my schedule back. I can't schedule fewer patients, because sometimes this stuff doesn't happen.

5) When patients get angry, sometimes I want to remind them that we are at an institution that sees patients with insurance statuses that would be rejected by every other place in town. We provide good care at minimal cost to the many patients who need it, and our clinics are hugely overbooked as a result. One kind and understanding patient once said to me, "Cheap, high-quality, and fast - pick two." Unfortunately, this seems to apply to healthcare.

6) If a patient has pressing time constraints (need to pick up kids, are dependent on transportation services, etc), I recommend that they schedule appointments for the first thing in the morning, before delays build up.

When I have to wait a long time at a doctor's office, I reschedule. I am not angry, and I do not demand an explanation, partly because I know the usual reasons. If I really like the doctor, I don't care at all. The receptionist who rescheduled you could have been more apologetic, but s/he may have had to field this complaint multiple times that day and just wanted to reschedule you as efficiently as possible so as not to waste any more of your time.

What I'm trying to say is, your time IS valuable, and I do not blame you for walking out. However, please try not to be angry with us healthcare providers who have unique demands on our time, and know that an explanation may not be available. I hope you have a better experience in the future.
posted by aquamvidam at 6:00 PM on June 25, 2018 [12 favorites]


I used to have to wait forever at a dermatologist and it turned out they were incompetent in other ways, like overbilling me. Some doctors who are in-demand I will certainly wait for, especially if they are willing to spend a lot of time with patients, but not if it's just general disorganization. I might leave a negative review online if it's real bad. But since you've never met the doctor to make a judgement as to what the delay was, it may not be a totally fair or useful review. It is true that getting the first appointment in the morning should minimize your wait time.
posted by AppleTurnover at 6:38 PM on June 25, 2018


My primary care Doc schedules 6 patients to arrive on the hour every hour and then sees each one for 10 minutes. This of course means I spend at least 30 minutes staring at the walls of an exam room any time I see him. Apparently, this is a recommended practice in the US for physicians who want to maximize revenue.
posted by monotreme at 7:55 PM on June 25, 2018


My psychiatrist runs between 1.5 and 4 hours late, always. She's good enough that I don't mind very much any more. She spends on average 45 minutes with me every visit, and she does that with all of her patients. I appreciate her. I've learned to call and ask how late she running before I head to the office.
posted by kitcat at 8:57 PM on June 25, 2018


As others have said, this is definitely common, but not universal, behavior. In my opinion the problem here is not necessarily with the physician, but with the practice. 90+ minute wait times are unacceptable; the physician and the staff in the practice know when you arrive that the doctor is not going to be able to see you at the scheduled time, and they should tell you right then. In the era of ubiquitous cell phones, a practice should have no difficulty calling before the scheduled appointment to let you know they're running late, and can either reschedule you or give you a call once the doctor is getting close to being able to see you. At the bare minimum they should be able to give you a more accurate idea of when you'll actually be seen while you're in the waiting room.

If you decide to change cardiologists, make sure to choose one in a different practice. Otherwise you're going to have the same problem.

Also, scheduling at the very beginning of the day is no guarantee of avoiding a wait. I've done this and still had an irritatingly long wait.
posted by biogeo at 9:28 PM on June 25, 2018


As far as my dentist is concerned--you barely have time to sit down in the waiting room before you're called back. I have NO IDEA what they have managed to figure out that no other medical provider has been able to but they have got their appointments timed perfectly.

Not sure if that is the reason here but some of this is specialty-related. Dentists visits are procedure-oriented, a neurologist or cardiologist (or a GI like me) spends a lot of time

1. getting the patient's story straight (can take a long time, especially in elderly patients with long case histories and memory problems, and some people have never learned the skill of telling a story / explaining a problem without long digressions)
2. getting through reams of paperwork (patient mentions severe anemia, recent labs are fine, the severe anemia results are buried somewhere in this giant folder)
3. explaining things to patients (who might be hard of hearing, or anxious, so you have to repeat yourself often)
4. coordinating care (where do we go from there?)
5. documenting the shit ton of information we acquired during the visit

I also document in real time and give the patient their visit summary with detailed instructions at the end of the visit, both for their benefit and as a courtesy for their primary physician. That takes a lot of time but at least they'll remember (and I remember).

As a subspecialist, if I had an hour for a new patient and 30 minutes for a known patient, as someone mentioned above, that would be ideal, but I do not think most physicians have that option.
posted by M. at 11:23 PM on June 25, 2018 [2 favorites]


Bravo to you for walking out. If everyone did this, practices wouldn't be able to overbook anymore. What you allow is what will continue. Notice how practices that genuinely want to take care of patients don't do this?

(Yes, I know doctors have emergencies, but routine overbooking is unethical and needs to stop. If you are a doctor in a practice that does this, I get that it may not be your fault, but you need to fix it or get out of this practice.)
posted by Violet Hour at 1:30 AM on June 26, 2018


I know someone who works in a clinic, and how long the patients' waits are (and whether the staff gets out on time) has way more to do with which nurse is running the clinic that day, than anything the doctors do or not do.
posted by Pig Tail Orchestra at 6:17 AM on June 26, 2018


I work in health care and know a little about patient flow and scheduling. Some clinics have solved this problem and some don't have the will to do so. But it is a solvable problem. You're right to be pissed, although it's common. Every provider will be late on occasion but the norm should be on time. Find another cardiologist.
posted by latkes at 7:33 AM on June 26, 2018


(Blaming either doctors or nurses for this problem is not quite right. There are enormous time pressures on doctors as mentioned above, and depending on clinic structure, a nurse manager may lack the power to change anything. Both may lack the specialized skill of how to efficiently book and time clinic appointments- skills not taught in medical or nursing school. I've watched a clinic I work with sllooowwly change some ingrained unspoken workflows and it has been painful and challenging for all involved.)
posted by latkes at 7:45 AM on June 26, 2018 [2 favorites]


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