More on Medical Office Chaos...
Wow! I love those comments on my Medical Office Chaos blog. Thank you (even to the person that called me a pompous ass, which I am not).
This has opened up a world of future blog topics for me...drug reps, interruptions in a busy day, the "hidden agendas" of patients, dealing with busy people in a busy office, toys in the waiting and examining room, medical providers who "overbook" appointments. I am going to have to quit my day job just to post some of these.
I madly took some notes as I read the many, many comments from ticked-off patients and misunderstood medical office staff/nurses/doctors, so I hope I can address some of the comments in a more general forum.
Why do we book appointments every 15 minutes when we know a visit usually takes longer?
Let's set the stage.
A person has a 9:00 a.m. appointment. They arrive promptly at nine. We have only been seeing patients for an hour, so we can't be too much behind. It take at least five minutes to do the paperwork at the front...check on insurance eligibility, take the co-pay as required by their particular insurance (we don't set the rules on the amount), and update any address or phone number changes.
It is now 9:05 a.m. Assuming that the nurse or medical assistant is pacing around back there with nothing else to do (unlikely), she will call the patient back. Time to weigh in (everyone's favorite). Let me take off my shoes and coat first. Patient tries to explain why our scale is wrong. Vital signs are taken (blood pressure, temperature, pulse). It is now 9:10AM and the doctor only has five minutes left of that 15 minute slot! The patient is escorted to the room and given a gown (usually paper that immediately tears and disintegrates with perspiration in five minutes). The medical provider gives you time to undress. God forbid we walk in early and catch you half way.
It is now about 9:15AM....the end of your appointment. Another patient is registering at the front desk.
This is our dance that happens every day in an ideal world.
If the medical provider isn't interrupted on the way to your examination room by such things as lab reports, calls from x-rays, patients in the hospital, seemingly urgent patient calls about a kid with constipation or green poop, then your visit can begin. As soon as your visit is over, however long that takes, we have to carefully document everything that we did. Our chart notes are a vital component of the visit. Recently, our office went "paperless" so we have to physically type our own notes (dictation has become way too expensive). Fortunately, I am a fairly fast typist, but I see some of my colleagues pecking way over lunch and after the clinic closes, wishing they had taken typing in high school.
We have at least two or more "No Shows" per day. Personally, I love No Shows, because I can catch up on my charts (which I tend save for times I am not physically seeing patients so people will not have to wait). On the other hand, "no shows" are wasted slots that could have been filled by someone really sick. When patients fail to show at all, and do not cancel their appointments, it make it even more difficult to accommodate everyone that wants to be seen.
Same day appointments? We have a policy called "open access". If you want to be seen today, we see you today. Isn't that a novel approach - sick people can actually be seen on the day they are sick. Even if we don't have appointments, we work in the sick ones. If I have a kid with a 105 fever in one room, and a patient bitching about me being late in another room, I am not very sympathetic. However, I do feel that it is important for my medical assistant to up date them on any of these unforeseen delays, and to apologize.
Late in the day appointments? Parents pick their kids up at day care and find out they are sick, have a rash, and can't go to day care without a doctor's note. Guess who gets an urgent call about 4:45PM from a cell phone as the parent rushes in. This is why I have patients until 8:30 PM. I left the office last night at 10:00 PM after making my last phone calls.
Late for appointments? I tend to be easy on the people who are late for appoints since I work in a pediatric office, and little kids don't drive. It's not their fault, so I see no reason to cause undue stress on the family. I agreed to see a child with an ear infection yesterday when the parent was a half hour late. I come to discover once I entered the room, that the parent was another doctor, and OB-GYN. Why didn't she look in her own kid's ear? No otoscope, and the vaginal speculum wouldn't fit in the ear. See, even medical providers need medical care.
Busy medical providers are not necessarily inefficient with time. They are simply busy. We don't waste time, but we rarely have enough hours in the day. We also like to eat occasionally; urinate from time to time, and get home in time to see our kids awake once in a while. Busy providers are often popular providers. Patients refer other patients and our practices grow. We try to staff-up to meet demands, but that is not as easy as it sounds. Patients can choose rude and incompetent providers...they tend to have more time.
I read a study years ago about patients making their own appointment slots in 15 minute increments. If you had several medical issues that you wanted to address, you would sign up for 30 minutes, or perhaps an hour. Assuming that people know in advance how long their visits may take, then this would seem like a workable solution.
The only problem, however, is payment. If we charged by the hour like my automobile mechanic (I saw $95 an hour on the sign the other day), then it would work. It does not work with insurance and HMOs, who set the price years prior, and really do not care how long it takes. A visit is a visit.
For instance, a Medicaid visit may only pay $11.00 for a half hour at work. Assuming there is a 50% overhead (conservative) in a medical office, that nets out $5.50. Doesn't even buy my lunch, assuming I get to eat. This is probably why we prostitute ourselves for free drug rep lunches.
Now I am rambling. Wasting time. Today is my day-off and this blog has been interrupted three times with calls from my office. I knew I should have gone to culinary school. At least I could eat.
This has opened up a world of future blog topics for me...drug reps, interruptions in a busy day, the "hidden agendas" of patients, dealing with busy people in a busy office, toys in the waiting and examining room, medical providers who "overbook" appointments. I am going to have to quit my day job just to post some of these.
I madly took some notes as I read the many, many comments from ticked-off patients and misunderstood medical office staff/nurses/doctors, so I hope I can address some of the comments in a more general forum.
Why do we book appointments every 15 minutes when we know a visit usually takes longer?
Let's set the stage.
A person has a 9:00 a.m. appointment. They arrive promptly at nine. We have only been seeing patients for an hour, so we can't be too much behind. It take at least five minutes to do the paperwork at the front...check on insurance eligibility, take the co-pay as required by their particular insurance (we don't set the rules on the amount), and update any address or phone number changes.
It is now 9:05 a.m. Assuming that the nurse or medical assistant is pacing around back there with nothing else to do (unlikely), she will call the patient back. Time to weigh in (everyone's favorite). Let me take off my shoes and coat first. Patient tries to explain why our scale is wrong. Vital signs are taken (blood pressure, temperature, pulse). It is now 9:10AM and the doctor only has five minutes left of that 15 minute slot! The patient is escorted to the room and given a gown (usually paper that immediately tears and disintegrates with perspiration in five minutes). The medical provider gives you time to undress. God forbid we walk in early and catch you half way.
It is now about 9:15AM....the end of your appointment. Another patient is registering at the front desk.
This is our dance that happens every day in an ideal world.
If the medical provider isn't interrupted on the way to your examination room by such things as lab reports, calls from x-rays, patients in the hospital, seemingly urgent patient calls about a kid with constipation or green poop, then your visit can begin. As soon as your visit is over, however long that takes, we have to carefully document everything that we did. Our chart notes are a vital component of the visit. Recently, our office went "paperless" so we have to physically type our own notes (dictation has become way too expensive). Fortunately, I am a fairly fast typist, but I see some of my colleagues pecking way over lunch and after the clinic closes, wishing they had taken typing in high school.
We have at least two or more "No Shows" per day. Personally, I love No Shows, because I can catch up on my charts (which I tend save for times I am not physically seeing patients so people will not have to wait). On the other hand, "no shows" are wasted slots that could have been filled by someone really sick. When patients fail to show at all, and do not cancel their appointments, it make it even more difficult to accommodate everyone that wants to be seen.
Same day appointments? We have a policy called "open access". If you want to be seen today, we see you today. Isn't that a novel approach - sick people can actually be seen on the day they are sick. Even if we don't have appointments, we work in the sick ones. If I have a kid with a 105 fever in one room, and a patient bitching about me being late in another room, I am not very sympathetic. However, I do feel that it is important for my medical assistant to up date them on any of these unforeseen delays, and to apologize.
Late in the day appointments? Parents pick their kids up at day care and find out they are sick, have a rash, and can't go to day care without a doctor's note. Guess who gets an urgent call about 4:45PM from a cell phone as the parent rushes in. This is why I have patients until 8:30 PM. I left the office last night at 10:00 PM after making my last phone calls.
Late for appointments? I tend to be easy on the people who are late for appoints since I work in a pediatric office, and little kids don't drive. It's not their fault, so I see no reason to cause undue stress on the family. I agreed to see a child with an ear infection yesterday when the parent was a half hour late. I come to discover once I entered the room, that the parent was another doctor, and OB-GYN. Why didn't she look in her own kid's ear? No otoscope, and the vaginal speculum wouldn't fit in the ear. See, even medical providers need medical care.
Busy medical providers are not necessarily inefficient with time. They are simply busy. We don't waste time, but we rarely have enough hours in the day. We also like to eat occasionally; urinate from time to time, and get home in time to see our kids awake once in a while. Busy providers are often popular providers. Patients refer other patients and our practices grow. We try to staff-up to meet demands, but that is not as easy as it sounds. Patients can choose rude and incompetent providers...they tend to have more time.
I read a study years ago about patients making their own appointment slots in 15 minute increments. If you had several medical issues that you wanted to address, you would sign up for 30 minutes, or perhaps an hour. Assuming that people know in advance how long their visits may take, then this would seem like a workable solution.
The only problem, however, is payment. If we charged by the hour like my automobile mechanic (I saw $95 an hour on the sign the other day), then it would work. It does not work with insurance and HMOs, who set the price years prior, and really do not care how long it takes. A visit is a visit.
For instance, a Medicaid visit may only pay $11.00 for a half hour at work. Assuming there is a 50% overhead (conservative) in a medical office, that nets out $5.50. Doesn't even buy my lunch, assuming I get to eat. This is probably why we prostitute ourselves for free drug rep lunches.
Now I am rambling. Wasting time. Today is my day-off and this blog has been interrupted three times with calls from my office. I knew I should have gone to culinary school. At least I could eat.
10 Comments:
Giggle. You are too funny.
As an ex-hairdresser, the reason for that appointment time is to create order. At least to make sure that you are there and the client is there and you meet up somewhere in between. I know if I talk too much during my appointment, I'm well into the next patient's space. People are idiots.
I love your blogs! they are very informative and so funny!!
I love the information that you provide. I am how ever offering a suggestion, I think you need to remove the picture of the beautiful lil girl with the chicken pox. There are so many pervs out there, that they could be utilizing it for more then observation. I am such a concerned parent of this type of behavior from pedifiles, it is a significant concern.Thank You...
I totally admire what you doctors do! I developed this respect during the time I was in the hospital trying to deliver my first baby. I was admitted into the hospital and induced with labor on the day I was supposed to deliver. I was very thankful that my OB GYN was on duty. Later on I found out that he was having night duty and office visits at the same time for 3 days at a stretch and he was still smiling! When he was just about to get off his hospital duty on the evening of thr 3rd day, it was then that docs decided to do a C-section on me as my baby was getting stressed. So my OB GYN smilingly stayed back and did the C-section!
I totally admire him and so many more doctors who are doing such great work!!
I am a nurse in very busy Pedi. office. Thank you sooooo much for covering this topic. For the most part the patient's (the parents) that come to our office are great and understand that they are not the only ones in the office with sick children, but every now and again we get " I don't care that you had to call the ambulance for a kid that can't breath, I want to be seen now". Maybe some day people will understand, until then we keep pushing on and work until the wee hours of the night.
Wish I could print your blog verbatim and post it for our parents, however since I work in a Peds office - I'm sure some uptight parents would not be very happy with some of your terminology, I HAVE printed it for the doctors in the office - am sure they will enjoy and relate to this. I know my front office staff will!
I am a parent who often runs late - and am all panicky when I arrive to the docs with a handful made up excuses that I can throw out to them in case they act mad. I usually just end up blaming my husband or if i get really desperate....the dogs!!
I am grateful that the staff is understanding and in turn I am most understading when I am being told to wait. I think it has to work both ways - the more parents that understand this the better it would be for all of us.
A little goes a long way.
Thank you!!! I work as a MA and you'd not believe (well maybe you would!) the abuse some patients heap on us because "they had a 9:45 appointment and here it is 10:30". Awww, too bad, you had to wait 45 minutes. I've actually been at doctor appointment for myself where I had to wait 3 hours. Did I bitch??? No, because I work for a Doctor I know how it goes! I've actually put a patient in a room, and had him stand over me screaming at me and asking me how the doctor runs his business because we were 20 minutes behind. No wonder I want to quit after years of doing this. Or the ones who yell at the front office girl because they have a $20.00 copay. They should try going without insurance for a year or so like I had to do because we don't get benefits at our office ... so it's hard to sympathize for patients who have insurance and then bitch about their $20.00 copay when us the people caring for them don't have the luxury of health insurance. Grrrrrrrr!!!!!!
Unfortunately, in today's world, many patients and parents alike do not have 45 minutes or 3 hours to wait at a doctor's office. Somewhere in this world there is a solution.
Post a Comment