Some thoughts on why Doctors run late and how patients can help

Thanks to Jack Forbush, D.O., for sharing this.

by Jill of All Trades, MD

A friend recently asked me in great frustration after her visit to her doctor why doctors “always run late.”

Why do doctors make their patients “dance around” the office, getting moved around to different spots in the clinic, but still having to wait and wait at each location? Instead of explaining what really goes on at the doctor’s office, I ended up emailing her a couple of links to some of my favorite blogs that have quite eloquently addressed this issue already (click below to read):

1. Lockup Doc
2. Common Sense Family Doctor

Dr. Rob Lamberts also designed a very concise  list of both patient and doctor “rules,” important for every patient and physician to read (click to read):

1. Patient Rules
2. Doctor Rules

I believe it worked, having her read these illuminating posts on why doctors’ offices do what they do. Then it dawned on me, if only I can convince all patients to not only read these eloquent posts, but to go one step further – to learn what they can actively do during their office visit, as well.

If patients simply learned “how to dance” while they are in my clinic, perhaps I wouldn’t be running as late, I’d be able to provide thorough and more focused care, and I’d be able to perhaps get all my extra work done on time, and maybe even have time to eat lunch. But every patient would have to be on the same page, learning the same dance moves. The clinic would run so efficiently if every patient learned these basic “dance steps,” and we’d all be doing the tango effortlessly.

Here are the 5 basic dance steps each patient should learn in order to dance like the stars at the doctor’s office:

Step 1. Arrive on Time to Dance Class: In fact, try to arrive 10 minutes earlier than your appointment slot. This will give you enough time to park, check in at the front desk, and compensate for the unpredictable. Like a domino effect, one late patient causes everyone else for that day to run late, including the doctor. And that may just cause the judges to deduct points during a poor dance performance – and we want that trophy now, don’t we?

Step 2. Don’t Try to Learn More Than One Dance at a Time: This is perhaps the most important lesson of all to learn. It will become much too confusing to learn the Samba, the Salsa, and the Merengue at the same time, wouldn’t it?

The doctor will have 15 minutes to spend with you at the most (some doctors even less). Therefore, your expectations need to be realistic. The doctor will not be able to address every single issue you may have on your list. Select 1, or at the very most 2 problems per visit. Why? Because each problem requires the proper line of questioning (called the history), the physical exam, and a possible work-up of tests.

If you come in with a longer list, your visit will not allow the greatest focus and proper attention that each problem deserves, and something’s got to give. I would assume you would want your doctor to be very thorough, no? You don’t want the doctor to gloss over something important in this very detailed and meticulous process by becoming distracted, and your health is too important for that.

Don’t risk it. If you need to be seen once a week every week until all your problems have been addressed, then so be it. Then, you will have learned each dance thoroughly well, ready to earn a perfect score in the end.

Step 3. Make Sure You Sign Up for the Correct Dance Class: Tell the nurse who takes your vital signs and places you in the exam room exactly what you are there for. If you have 1 or 2 problems, make sure you tell the nurse BOTH problems. If you need refills on your medications, make sure to tell the nurse that, too.

Why is this? Several reasons. First, the room will need to be set up a certain way depending on your symptoms. For instance, if you are there for a pap smear, the nurse will need to give you a gown to have you change into it and set up the proper supplies. If you are there for chest pain, they may need an electrocardiogram (EKG) before they see you. If you do this after you are already with the doctor, the doctor will need to leave the room (which may cause you to wait while the next patient is seen), ask the nurse return to set up the room, and then return again. This is very inefficient, and it causes a big delay in the patient schedule.

Second, the doctor really needs to know why you are there so that they can plan your 15 minute slot appropriately from the get-go. If you are there for headaches and a diabetes follow-up, and you also need your medications refilled, the doctor needs to know all of this before they see you so that they can come up with a timeline of how your short visit time will flow. Whatever you do, do not bring up a new problem after the visit has already begun. So when you sign up to dance, make sure your instructor knows which class you signed up for beforehand – you don’t want to show up for a tap class when you signed up for the tango!

Step 4. Don’t Forget Your Dancing Shoes: As important as those dancing shoes are to learn how to dance, so are your medication bottles when you visit your doctor. A simple “list” is not sufficient. Why? First of all, the amount of information you get from looking at the bottle is invaluable. When I look at the bottle, I can tell when the patient filled it, how many refills they have, when it expires, and how many pills are left in the bottle.

Just because a medication is on the patient’s electronic pharmacy records doesn’t mean that they are actually taking it. Also, I occasionally catch mistakes that the pharmacy has made on patient prescriptions in this way. Whatever you do, don’t tell your doctor that you don’t know the name of your medication, only that it’s a “little white pill.” Almost every pill is a “little white pill”!

Step 5. Don’t Forget to Practice Your Moves at Home: If you have diabetes, bring your blood sugar log with you. If you have high blood pressure, bring your blood pressure log with you. This information is very important. Although your doctor may check your blood sugar level or blood pressure while you are in the office, this is just one number for one day. What your numbers look like over time are so much more important, and are significant chunks of information for the doctor. No one wins the competition without practicing the moves at home!

Now that you have learned the 5 basic dancing steps to make the most of your visit with your doctor, go ahead and show off your dance moves!  

Jill of All Trades is a family physician who blogs at her self-titled site, Jill of All Trades, MD.

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• Doctor appointment tips every patient can use
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• Questions patients should be asking their doctors
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via kevinmd.com

Here are some things patients can simply "understand":
1. babies come when babies come....sorry
2 hospital patients get sick at inconvenient times
3. insurance companies don't understand that Doctors want to practice medicine, not sit on the phone trying to justify (to an uneducated bean-counter) why they want/need to do what they've ordered
4. undoubtedly more examples to come...