What can we do about a specialist doctor who is constantly late?
November 8, 2018 7:44 AM   Subscribe

My father is seeing a neurologist in Toronto for botox injections for dystonia. The specialist was highly recommended by his doctor and we've seen him 3 times so far and he's been consistently over an hour late every time for all the people waiting for him.

Today we were supposed to have an appointment at 9:45, there were two other people waiting when we got there and it is now 10:45 and he still isn't here yet. Aside from changing doctors (which I definitely plan to ask for a referral to someone else) and writing a scathing review on ratemd, is there anything we can do? Is there anyone we can report him to? Most of the people in the waiting room are elderly citizens so they are more patient than I am but I had to take PTO to take my father so I am a little more than a little bit irritated to say the least.
posted by vespertinism to Health & Fitness (28 answers total)
 
Is this doctor in surgery in the mornings? If so, it may be that all you can do is be patient. I have this happen with a specialist I see, and it helps a little bit to remember that there are people worse off that he's helping, and to be prepared with a drink and a snack, etc., to wait.
posted by fiercecupcake at 7:52 AM on November 8 [18 favorites]


And so as not to abuse the edit window: yes, I have to wait at least an hour whenever I see him. But he's worth it. If this specialist is not worth your wait, that may be a consideration. If you could report a doctor for being late, they'd all be reported.
posted by fiercecupcake at 7:53 AM on November 8 [2 favorites]


Many specialists have long wait times, unfortunately. If they’re good, then to me, it’s worth it. YMMV. Just make sure before switching to a new doctor that the new one does not also have long wait times.
posted by amro at 8:07 AM on November 8 [4 favorites]


I see an opthalmologist in a specialty area and due to emergencies that arise (which can't be planned for), his appointments can get pushed back, sometimes by hours. I learned to always get the first appointment of the day when I see him to lessen the degree of waiting. It's worth it for me to see someone who fully understands my atypical eye conditions. It's not a personal fault, he's not being unprofessional, it's just the nature of the beast.
posted by Aranquis at 8:34 AM on November 8 [4 favorites]


If I read a ‘scathing’ review for a neurologist because of an hour wait, I’d assume the writer lacked any real experience with in-demand medical professionals.

This guy is most likely putting out proverbial fires every day, trying to save lives or at least improve their quality. It’s not a fault of scheduling, it’s that he’s prioritizing his very short hours in the day to help the people who need it most.

This will not change, and it doesn’t indicate he’s doing anything wrong. If anything, it indicates he’s very skilled, and so many people want/need to see him that he can barely keep up.

Likely any other good specialist will have similar scheduling compliance (i.e. a lack thereof), so I wouldn’t pin too much on solving this by changing doctors.
posted by SaltySalticid at 8:37 AM on November 8 [31 favorites]


Your situation is pretty frustrating! You care about your dad and want him to be comfortable, and you also have responsibilities outside of this doctor's office. My money is also on this doctor being in surgery in the mornings. I see that being a pretty good thing, but if I were in the dark about what was going on, I'd suspect the doctor was just out having coffee with drug reps in the morning.

He's busy and popular with patients and other doctors because he's good. If you feel comfortable seeing a less popular doctor, do that.

My own preference is if the office staff could greet me in the morning with an indication that he is being held up in surgery and there is no reasonable way to guess when he'll get to the office. It's especially nice when the office staff tells me I probably have time to go across the street for a hot drink. This way I can feel like I'm not wasting the time, and being outside the doc office is less stressful than being cooped up in it.

I'm sorry you're not getting that quality of care from the office staff. Feel free to let your doctor know what's going on, and what you want done about it. Realistically, you're not going to get seen faster, and you don't want him to stop performing surgery. Maybe you want better communication? Maybe you want water available in the waiting area. Maybe you are supremely annoyed because the tv is on Fox and you feel you have no say in that selection. You might be able to request appointments on days the doc doesn't have surgery. That might run into rounds though, which sometimes take longer than they should.

I also suggested bringing edible treats for the office staff. Just a shelf stable box of chocolates or cookies every second or third visit will go a long way toward perhaps getting a phone call if there's a particularly hairy delay that they're aware of and can send an alert before you leave home. With or without treats, the conversations that gently reveal how far you come for the appointment, how much PTO you have to take in order to be there, and how much you appreciate the relief your dad gets from the injections.... those are far more effective than rude and demanding comments. It can be really easy to get snippy with office staff. If it happens, please take a deep breath, look the person in the eye, and apologize sincerely and tell them you know they're not hiding the doctor in a closet for funzies.

Also, if you leave that scathing review, the office staff will let the office staff know when they transfer you. Or whenever they see it. And frankly, as an informed consumer of medical services, if I saw that a neurologist was frequently late for their morning appointments I'd think "great doc, needs to train their office staff to manage time expectations." It would not dissuade me from booking a necessary appointment.
posted by bilabial at 8:38 AM on November 8 [21 favorites]


I see a specialist who used to have long wait times (over an hour to get into an exam room, then sitting in that room waiting for another hour easily) but in the past couple of years he and his staff have really pulled things together and things now move at an entirely reasonable pace. The downside of the new and improved wait times is that I have to take whatever I can get in terms of follow-up appointments. They often literally just call and tell me which slot they've found for me, and I either have to make it work or get back in line for another shot. In some ways, having my preference of date and morning vs afternoon and knowing to bring a drink and a book was better.
posted by teremala at 8:45 AM on November 8 [2 favorites]


I have had specialists with long wait times that I just had to accept, but recently I feel like a lot of specialists/their office staff are realizing that it's not acceptable to have people waiting well past their appointment time with no updates. Most of my specialists now use some kind of visual indicator that shows two pieces of information: (1) Is the doctor in the office? (2) How long is the current wait?
posted by muddgirl at 8:52 AM on November 8 [3 favorites]


OP doesn't say if neuro doc is at a private practice or some other setting.

I have seen all manner of doctors at a university teaching hospital for years and years and have had to deal with various levels of waiting.

The top in-demand doctors who do surgery and then go to the clinic to see patients with students in tow, I have waited all day. Get there in the morning and be there until it is getting dark outside. Nothing like being the last one in the clinic waiting for the doc while watching nurses and office staff pack up and head home.

It is what it is. You just got to plan for it and deal accordingly.
posted by Fukiyama at 8:57 AM on November 8 [2 favorites]


At my primary care practice, they generally start on time in the morning and first thing after lunch, with delays being most common late morning and late afternoon. This office's schedule might not be as predictable, but it can't hurt to ask: "Receptionist, I know Dr. X's schedule is unpredictable and that you can't give us any guarantees, but is there a time of day or day of the week when delays tend to be shorter?"
posted by Mr.Know-it-some at 9:01 AM on November 8 [3 favorites]


OP is in Canada. American waiting times are not the norm anywhere else I've lived and would not be acceptable to most patients. Also doubtful he's doing surgery if he's a neurologist and not a surgeon.

I'd complain to the desk staff and let them know you are taking time off from work. Let them know its a problem and see if they can fix it.
posted by fshgrl at 9:03 AM on November 8 [12 favorites]


Neurologists are not surgeons. They are more diagnose and treat. His or her office needs to make a call in check in proceedure, with 15 minute call back.
posted by Oyéah at 9:16 AM on November 8


Oh, how frustrating. I used to run into this with my grandmother, when I took her to appointments. It would be a half day off work no matter what, even if the appointment was at 8am!

Can you switch appointments from mornings to afternoons, and plan on not returning to work after? That doesn't solve the wait time, which there may be no way to solve, but it does solve the issue of not knowing how much PTO to take off, or of being later to work than expected.
posted by needlegrrl at 9:18 AM on November 8 [1 favorite]


This isn't that uncommon for specialists in Toronto. I don't know how the culture developed and what this particular doctor's issue is (is he on rounds, poor office staff, etc.), but if I were happy with the care, I'd just plan for the wait. If this is at the Toronto General neurology department, yeah, definitely plan for that wait -- we've waited hours and hours -- but my dad's care has been so excellent I would still recommend them hands down.
posted by warriorqueen at 9:22 AM on November 8 [1 favorite]


I am a US neurologist who does botox injections for dystonia, and I want to say this is very much NOT the norm for an injection clinic. I also see people with Parkinson disease and those visits do take a really long time because there is so much to talk about, but dystonia clinic? It's so dang efficient! I've started scattering injection visits among my regular clinic because they let me catch back up and stay reasonably on time.

If the first patient of the day shows up late that does throw the whole schedule off, particularly if the practice does not have a late arrival policy. (One place where I worked required us to see everyone, even if they showed up on a totally different day than their actual appointment; it sucked and was dysfunctional and I don't work there anymore for a reason.)

The practice might be double booking patients (I don't know if that's allowed in Canada, but it is common in private practice here in the States, to counteract the financial hit of no-shows) or the doctor is double booking himself with rounding in the hospital. When you say he's not there, do you mean not in the building?

If he is a movement disorders specialist (the most likely type of neurologist who does injections) he may very well be in surgery with a deep brain stimulation patient. Those surgeries can be very unpredictable; if everything is hunky-dory it's an hour or so of your time, but if something goes wrong you could be there for half a day or longer. I don't do DBS placements because I hate that sort of unpredictability. My colleague who does them blocks out the entire day for the OR, but some people try to keep a clinic open, because our waitlist is 9 months right now.

As to what you can do right now: Speak with the front desk to figure out if this is a practice issue or a doctor issue. If you get a referral to a new specialist, try to get either the first appointment of the day or the first appointment after lunch.
posted by basalganglia at 9:27 AM on November 8 [19 favorites]


Hi everyone,

This is at a private practice. This doctor is definitely not in surgery or rounds at a hospital - I am pretty sure he is coming from home from what I overheard from his receptionist calling him. His first patients are also not late, as we were his first and second patients last time and this time respectively. I'm pretty sure they're not double booking as they are also using the old school paper booking system and I can see their schedule right in front of them. The appointments themselves are about 10-15 min each for everyone, including for my father.

Normally I am very patient and understanding about potential conflict of time, but this doctor gives me a bad feeling, so I will be asking my father's GP for a potential alternative. In the meantime, I have booked a follow up appointment for after lunch.

Thanks for all of your responses.
posted by vespertinism at 10:52 AM on November 8 [4 favorites]


I used to be an outpatient receptionist in a busy clinic with 5 lead physicians (and a team of junior doctors and specialist nursing staff). Some of the clinics ran like clockwork, other clinics were always late. All the doctors had other commitments (ward rounds, teaching, clinical meetings etc) but the lateness seemed to be very much based on their personalities.

One was very in demand and cared deeply about his patients but this meant he had a higher number of complicated patients who took longer to see and I suspect he was bad at rounding things up if the appointment was going on longer than needed. He would also always have more patients than slots in the clinic due to adding extra urgent patients. One seemed to be a bit disorganised and distracted and often arrived late or ran seemingly from trying to juggle in other activities or squeeze more tests into the clinic time, one basically spent ages on the 25% of patients he was interested in and expected his junior to see the other 75% of patients (those clinics took forever). Two of the leads had clinics that consistently ran on time. They were extremely competent but not very touchy feely and if I'd needed to be seen myself I probably would have picked the in demand doc and put up with the wait.

As admin staff we got all the complaints (I don't think many people complained to the doctors themselves) but we had no control over their lateness and no power to compel them to improve. YMMV in Canada but I think if this doctor was motivated and organised enough to be on time he would already be on time and there is likely nothing anyone can do to get him to improve. If there is a magic key (i.e. on Fridays he's never/always late) the clinic admin staff will know what it is and may tell you if you ask nicely.
posted by Odd Socks at 11:32 AM on November 8 [4 favorites]


it doesn’t indicate he’s doing anything wrong
Yeah, it does. If he commits to an appointment at $X time, then he should be available at $X time.

Sure, emergencies can happen, but there's not an emergency EVERY TIME.

If he is never able to meet the agreed-upon appointment times, then he's overbooking, and is in fact doing something wrong.

Doctors do this because many people will let them get away with it. Don't. I fired my previous ophthalmologist over this -- she couldn't be on time when I was the first appointment of the damn day, for crying out loud.
posted by uberchet at 12:04 PM on November 8 [1 favorite]


I don’t think I’ve ever waited less than an hour in a GTA-area specialist’s waiting room (excluding sports medicine appointments and a lone spiffy walk-in clinic staffed by like a hundred young doctors). But a specialist? Not Ever ever. My guess is this doctor is thorough (which is what you want!!!) because he’s good at his job, especially considering he’s mostly treating or delivering sad news to seniors (who may have hearing issues, cognitive issues, communication issues, especially in our diverse city where people are from everywhere - and/or additional health issues that complicate things, any of which could add time...). I bet he runs over time routinely as a result and overbooks, if he does, because otherwise people’s time on the wait list would be 18 months vs 12 (or 6 or 2). If the only complaints are about wait times and front office, and his actual medical treatment is great, write off the time.

I go to medical appointments with an elderly parent, and for the kinds of specialists they’re likely to need, you basically have to write off half the day, if not the full day. Take a book. And if you have siblings or a spouse, talk to them about taking turns to share the load.
posted by cotton dress sock at 12:09 PM on November 8 [2 favorites]


I've worked with doctors and there are doctors who just run late. Not just with patients, but simply don't get out the door of their house on time, ever. And doctors in private practice don't have a boss likely to chastise them for it. None of us know about this particular doctor, but it's silly to assume that his running late (especially for the first appointment of the day!) automatically means that he's a wonderful thorough life-saving clinician.
posted by lazuli at 1:27 PM on November 8 [3 favorites]


Yes, it would be silly to assume that in the absence of the information that this specialist was highly recommended by the referring doctor.

What I have noticed is that what patients sometimes complain about most in reviews - length of time spent in a waiting room, receptionist’s manner - is least relevant when it comes to finding a competent specialist in the Ontario landscape within a reasonable timeframe as far as waitlists go. You’re in a waiting room for a whole morning? Not great but better than waiting a year for any appointment at all. Or waiting a year and seeing someone for all of 10 minutes.
posted by cotton dress sock at 1:36 PM on November 8 [1 favorite]


Do what I do with my GP (whose generally 30-45 min late for every appointment) call ahead before you get in the car and ask if they’re on schedule. The receptionist generally tells me she’s running thirty minutes late and I act accordingly. I understand that you’re annoyed but now you know what the deal is, you can plan ahead too.
posted by Jubey at 1:42 PM on November 8 [4 favorites]


I once had an appointment with a medical specialist at 9:00 in the morning where I wasn't called into his office until 10:30. How someone could already be an hour and a half behind schedule half an hour after their office opened was beyond me, but a lot of doctors in Ontario seem to book, like, ten million patients a day and scheduled appointment times are more of a polite fiction than anything which adheres to our lived reality.
posted by The Card Cheat at 2:46 PM on November 8 [1 favorite]


My old GP used to regularly run more than an hour late, especially if you had an afternoon appointment. Sometimes I had to leave to feed the parking meter before even being seen! He ran late because he was patient and thorough and I presume his many other patients loved that about him just as much as I did. I would still be seeing him if he had not moved away. So if this neurologist really is excellent in that way it might be worth persevering, particularly if it's only for a short course of treatment.
posted by Cheese Monster at 9:01 PM on November 8


If someone in literally any other line of work regularly ran more than an hour late to appointments with paying customers, they'd be fired.

Just saying.

Maybe he's patient as all get out, but once it becomes a pattern the correct thing to do is schedule fewer appointments, not decide your customers' time has no value and that they can just wait for you.
posted by uberchet at 8:26 AM on November 9


Well, the correct thing to do is to stop handing over practice management to bean counters who want to "increase throughput" and will fire you if you don't meet your 25-30 patients a day target, but yes, more time for fewer patients is what we all want.

Coming in from home > 1 hour late is pretty egregious, though.
posted by basalganglia at 2:10 PM on November 9


I had the same problem. Neurologist had appointments start at 9am, never arrived before 10. I asked reception if I could just book for 10 but she said the doc insisted bookings start at nine, so a 10am appointment would not be seen till 11. I booked the first appointment for 9 because I opened my business at 10. Eventually i switched to another doctor. I was very lucky to be able to do that, I know. Yes, in Canada. I wish you luck, and sorry I can't help.
posted by Enid Lareg at 9:14 AM on November 10 [1 favorite]


(I was locked into an office because of this kind of thing!)

GASTROENTEROLOGIST

The nurse complemented me
On my protuberant veins
And took several tubes of blood
While I looked in the other
Direction

Thought it best not to mention
For a brief time I was a
Professional blood-donor
(Those were the days!) She slapped on
A Band-Aid

And told me to wait for you
In examining room three
Where I sat for some time and
Watched people walk by the door
Tugging on

Coats, rushing home, thankfully
Anticipating dinner
And the tube – soon I could have
Have heard the proverbial pin
Dropping, so

I got up and walked around
The office on cold bare feet
In one of those threadbare gowns
I’m never sure of which side
Is the front

I was the only one there
Lights were off in the waiting
Room and I wondered briefly
Was anything worth stealing?
In the end

I just took some rubber gloves
You know, pal; it’s above all
Do no harm – not above all
Avoid seeing the patient
At least this

Beats last year when I sat in
Your tedious waiting room
For well over six hours
No doubt I have a clean bill
Of health since

You don’t return my calls or
Answer my emails but I
Noticed you lost no time in
Cashing my co-pay check you
Rat bastard
posted by Wylie Kyoto at 10:32 AM on November 11 [2 favorites]


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