A seven-year-old girl comes home from school and tells her mother, “A boy in my class asked me to play doctor.” “Oh, dear,” the mother nervously sighed. “What happened, honey?” “Nothing. He made we wait forty-five minutes and then double-billed my insurance company.”
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Patients deplore waiting. The more apprehensive, aggravated, or inconvenienced they feel about seeing the doctor, the more volatile they become. While doctors with great bedside manner can often melt away patient hostility by entering the room with a resounding gracious welcome, it doesn’t completely remove the bad taste garnered by the wait. Furthermore, the staff will resent the doctor, as they often feel the brunt of the patients’ wrath.
Some patients will actually leave an office, never to return, due to excessive wait times. The doctor with that great bedside manner may never have the chance to win over those patients. To avoid this type of occurrence, your goal should be to see every patient on time. Realistically, this is not always possible. Human interaction and medical treatment can be unpredictable. Some patients have more complicated problems and others need more time to understand the essentials of their case. Optimal care is the goal that supersedes punctuality, so it is a forgone conclusion that you will be running late much of the day.
As a specialist who sees a vast number of emergency patients in a field that often presents unpredictable treatment needs, I sympathize with doctors who run behind schedule. There are, however, methods to control the schedule so your office runs with the same precision seen in top service industries that have to process vast numbers of customers. Those who utilize these simple techniques will have the best reputation for all the little nuances that make patients think you have a great office.
Truth In Scheduling
If your office is always running behind, or if a patient asks how long a visit usually takes when they call to make an appointment, a truthful estimate goes a long way in preventing bad feelings. Patients appreciate knowing that two hours are needed for a visit allowing them to plan the rest of their day. It is always better to overestimate. A disclaimer should always be noted:
MR. SMITH
“I need to know how long this visit will take so I can adjust my
schedule accordingly.”
RECEPTIONIST
“I can’t tell you exactly how long your visit with us will take because we, on occasion, have to deal with emergency patients. It would be best if you allot two hours from start to finish, though it usually doesn’t take that long.”
Many offices offer a time allotment based on the perfect day. Days don’t always turn out to be perfect and the complaints of the disappointed patient only make it worse.
When a patient indicates they can’t, or prefer not, to wait, it is best to offer them the first appointment in the morning or after lunch since those are the times with the least chance of being behind.
Catch-up Time Slots
To reduce the snowball effect of running behind schedule, you need to manage your time appropriately. This involves a realistic schedule you can handle with catch-up time incorporated. You should be able to figure out, with reasonable accuracy, how many emergencies you can expect on an ongoing basis. By leaving openings for these emergency patients you be less likely to run behind. Once you learn to manage your time efficiently, complex and unusual cases will no longer slow you down, and you will keep your day on schedule. Naturally, no matter how many slots you leave open, you need more, except on the days when you have too many – life is never predictable.
Knowing that time is the one commodity they cannot get more of, many doctors don’t want to stand still for a moment. They tend to overbook and never allow for catch-up time. While they may see more patients, they keep everyone waiting inordinate amounts of time and rush through the day providing less than ideal treatment.
Off-Scheduling Appointments
When you cater to late patients, you run behind and make others wait even longer. Rather than fume every time someone is late, especially the same habitually tardy disorganized patients, you need to make rules that eliminate the inappropriate behavior. Consider off-scheduling new patients from fifteen to thirty minutes before you expect to see them. This affords time for them to find your office, fill out forms, and go to the bathroom for an excessive amount of time, a ritual that seems to be necessary, especially when you are waiting for the patient to be seated. On subsequent visits you may want to continue this fifteen-minute difference between the time you tell the patient and the time you expect to see them. It helps keep you from waiting for late patients. It controls your anger.
While this seems counter to the goal of always seeing patients in a timely manner, the extra fifteen minutes helps to keep your schedule as fair as possible for the conscientious patients who respect your schedule by eliminating the wait caused by the inconsiderate patient.
If you prefer to make appointments on actual time, you may want to reserve off-scheduling for habitually late patients. If you are never on time, you won’t need any of these techniques since you are probably oblivious to time anyway.
Short Visit Priority
Most offices have look visits–certain types of appointments that can be classified as ultra-short. This visit is usually a follow-up exam to assess the progress of a treatment or response to medication. Making a patient wait an hour for a look visit is both inconsiderate and a manifestation of poor practice management. In general, give precedent to all look visits–wait time should be ten minutes or less.
Make sure you have a way to determine which patients never let you out of the room. The talker may need special attention and can throw off your timing when you expect to have a look visit and it turns into show and tell. Cryptic notes on the patient chart can alert your secretary to make sure the appointment is scheduled properly for the talker.
The assistant should screen each look visit patient before your entrance to make sure they are doing well. You don’t want a surprise: “Doctor, I don’t feel any better since you did the operation,” because that kind of visit goes from the expected ultra-short look visit to the okay, let’s start all over visit.
Obsessive Compulsive Providers
Don’t feel compelled to complete every case on the spot. If you have a difficult case or a difficult patient, you may want to reschedule them to a later date when you have more time. Without offending your patient, you can suggest they have some tests completed or that you have to wait for test results.
As an example, you realize you’re dealing with a chronic pain patient who needs a long evaluation and an extended amount of your time to explain the diagnosis and treatment protocol. Since you wanted blood tests to rule out organic pathology you can tell them you need to wait for the results. This allows you to schedule this patient for an extended second visit.
Once you learn to manage your time efficiently you avoid letting complex and unusual cases slow you down and you will keep your day on schedule.
The Running Behind Apology
When patients have to wait for unexpected delays, make sure your staff apologizes for the wait, keeps the patients apprised of the approximate amount of time until they will be seen, and offers them the option to reschedule. Most patients will appreciate that you have their time at heart too.
Make sure your staff knows exactly what to say by giving them a rehearsed script: “Dr. Jones is in the middle of a very complex case and he is running behind. Once he is finished, he will devote all of his attention to your needs, but I just wanted you to know that he won’t be able to see you for another half-hour. If this will affect your schedule adversely, we can reschedule your appointment.”
When you enter the room, apologize and explain the nature of the delay. While it’s not really your patient’s business, they always think the worst: “He probably kept me waiting, while he spoke with his stockbroker.”
The We Must Reschedule Apology
When you can’t get out of the operating room, telling a patient who has waited an hour to see you that they will have to reschedule is not an easy task. You must make sure it’s done properly. Obviously, you have to delegate tasks like this to your staff. They, too, should have a script that conveys your office policy and attitude. The way your staff handles this bad news is an extension of your bedside manner.
“The doctor won’t be getting into the office today. We’ll have to reschedule,” is not the message you want to convey about the way you run your office. All too often, your staff is burnt out and gives that kind of message with little concern. There is a proper way to tell the patient.
“Mrs. Jones, (always use a name to show personal respect and concern) I’m terribly sorry, but Dr. Smith had an emergency come up at the hospital and he won’t be able to get here for hours. I appreciate how you have waited so patiently, and again I am so sorry, but we are going to have to reschedule your appointment. Dr. Smith takes every patient’s time seriously and he wanted me to personally apologize for this inconvenience.”
When there is a waiting room full of patients, have the announcement made to all of them at once. To minimize the negative effect of situations like waiting with the possibility of rescheduling, it’s a great idea to make sure patients know in advance that the nature of your practice necessitates such inconveniences. It should be stated clearly in your office brochure and on a visible sign posted in the waiting room.
Waiting room Sign For Offices That Occasionally Need to Reschedule Patients Unexpectedly
The nature of the practice of obstetrics often results in unexpected emergencies. While we try our best to be on time, the health and wellbeing of every patient comes first and foremost before being on schedule. We do hope you understand when you have to wait or are inconvenienced by rescheduling an appointment. When it is your turn, you will want the doctor’s fullest time and attention, too.
Whenever a patient is rescheduled, it should be clearly noted in the chart so the doctor can be sure to apologize the next time the patient is seen:
DOCTOR
“Mary, I wanted to apologize and thank you for your understanding last week when I couldn’t make it in to see you. I had a complex case at the hospital. Thank you again for your understanding.”
In practices that require seeing emergencies on a regular basis make sure patients are aware of inconveniences that may arise by posting a visible sign.
Waiting Room Sign For Emergency Care Practices
The nature of our practice requires that we see emergencies. As a result, waiting to be seen by the doctor is sometimes necessary. We appreciate your understanding and know that when you need emergency care, we will be there to help you, while others will be inconvenienced.
The Floating Appointment
If you are notoriously running late, have a system set up where your secretary offers to call the patients as the time of their appointment nears in order to let them know how your schedule is flowing with an option to postpone the appointment.
The following are some excellent techniques to reduce the perception of a long wait:
Staged Waiting
Move patients from the waiting room to the treatment room in a manner that lets them wait in each space for around half of the wait time. While fifteen minutes in both places is still thirty minutes, it is perceived as less of a wait.
Entertainment
Current magazines in the waiting room, as well as in each treatment room, are the most effective, cost-efficient way to keep your patients happy and distracted. Have a variety of magazines that will appeal to your entire patient base. Outdated magazines make you look cheap and careless. Have your staff dispose of the old or tattered issues regularly.
Television in the waiting room (and even in the treatment rooms) helps make the time go by. With the advent of digital video networks, companies may provide televisions for your waiting room that offer entertaining educational content. Utilize these free services as long as the content isn’t too commercial in nature.
Cell Phones
Many doctors and facilities don’t let patients use cell phones while they wait. Since the cell phone may keep the patient busy and offer them some level of productivity, you should allow the use of cell phones, as long as it doesn’t interfere with your activities. You may want to suggest that the patient use the cell phone just outside the office, so other patients are not annoyed. You can have your assistant get them when you are ready.
The Consummate ENT
I spoke with a number of patients who I referred to a particular ENT and every one of them made the same comment: “He is the nicest guy in the world. Thank you so much for sending me to him.” Those who had any type of surgical procedure would go on about how he called them at home several times during their recovery to make sure they were well. It is that type of connection that makes patients love you.
That’s great bedside manner.
Unfortunately, it’s not enough. Two patients told me they never got to see him because the secretaries offended them. When they called for appointments, the doctor was booked out so far that they decided to see someone more accommodating. So here we have the most amazing doctor who doesn’t realize he is too busy and losing patients, or making them wait so long to see him that their health could be jeopardized. When I discussed the problem with him and suggested an associate or partner,
he had no interest.
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Partners and Associates
In the final analysis, scheduling too many patients is the main cause of inordinate wait times. While you can’t make as much money seeing fewer patients, your quality of life (and theirs) will improve. You must recognize when you work too hard, you damage your practice, your health and your personal relationships, and put your patients at risk.
It seems rather simple to remedy scheduling problems, just stop scheduling so many patients. Unfortunately, many health-care providers fall prey to financial pressures. They have all the excuses, including, “The HMO pays so little that I have to see a hundred patients a day to make ends meet.” While there may be some truth to that, more often it’s the new house, the sports car, and all the other goodies they work so hard for that need to be paid off.
In a consumer-oriented society, everyone wants the good things in life. You went to school for many years and studied while everyone else was having fun; finally it’s your turn. Now you have a way to bill for services and you’re willing to see a hundred patients a day. If you do, your reputation and bedside manner will suffer. Greed has no place in the practice of health-care sciences.
A partner or an associate will help alleviate the overwhelming patient load a doctor with the great bedside manner is sure to have.
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Jeff was complaining to his friend Biff that love-making with his wife was becoming routine and boring. "Get creative, Jeff. Break up the monotony. Why don't you try playing doctor for an hour? That's what I do," Biff said.
"Sounds great," Jeff replied, "but how do you make it last for an hour?"
"Hell, just keep her in the room waiting for fifty-five minutes!" replied Biff.