The Top Five Reasons Why Patients Are Dissatisfied, Part 1
Our medical group and administration spends a great deal of time trying to make things better for our patients. Medical care is now a buyer's market, so it is up to us to identify areas of improvement to make our patients happier. In a recent survey, there were five areas of dissatisfaction that were identified that I would like to share with you in the next five Blog posts.1. Keeping patients informed if appointment time is delayed (14.8%)
As I have mentioned in past posts, medical providers never really know what is behind door number #2. Patients often make appointments for one problem, and then decided to tack on a few more once they have our attention.
Most appointments in our pediatric practice are in 15 minute slots; some are for 30 minutes (such as minor surgeries). On Monday, my first appointment was a 30 minute visit to remove an ingrown toenail. The patient arrived on time; it took about 10 minutes to register them and check the insurance status. It took another ten minutes or so for my medical assistant to take the vital signs, enter the information into the EMR (electronic medical record) and set up the surgical tray.
I was handed the chart five minutes later; twenty-five minutes after they arrived. My 9:00 AM physical had now arrived, and I have yet to do the surgical procedure. Let the patient juggle begin...
I explained the toenail removal procedure to the anxious ten year old girl; prepped the toe, and injected the local anesthesia. Since it takes a few minutes to take effect, I shot in to the kindergarten physical and took the appropriate history. I excused myself after ten minutes, ran back to the ingrown toenail and performed the now, painless procedure.
I gave the family the aftercare instructions, and shot back in to finish the physical. By now, I had two more patients (sick ones) "in the rack." I finished the physical and made it to the first sick one only 15 minutes behind schedule (not bad), only to be faced with a really sick baby that was going to take longer than 15 minutes for sure. To complicate matters, the mother brought another child, equally as sick. Welcome to my Mondays.
As much as we would like medical visits to be clear-cut, predictable, and straight-forward, they rarely are. This is what we deal with every day -- extra, add-on patients, patients that try to get five years worth of postponed medical care done in one visit, illness that are more complicated than anticipated, emergency phone calls, critical laboratory reports, doctor-to-doctor consultations, pharmacy calls, and patient calls. It is no wonder that I got kidney stones a few years ago. I don't have time to drink anything or pee!
Time is money for all of us. Patients are busy people, too, with lives and time commitments just like us. There has to be a common ground. Our patients should be informed that their visit may be delayed, but it is rarely appropriate to offer the reason, and most of the time we are too busy to make an announcement to the waiting room. If they see an ambulance pull up and a lot of activity, then they understand; but when their appointment time is becoming later and later, they start to get anxious.
Hopefully, my patients know that I am not sitting on my butt, drinking coffee with my feet up on the desk talking to my broker. When I enter the room for their visit, I do apologize and offer a general explanation for the delay and quickly get on with their visit in a friendly and non-rushed manner. Most patients understand about unanticipated delays; some do not. I say that I had a very sick child that took some additional time to adequately evaluated and treat and hope that they understand. Some day, I add, their child may need that extra time, too.
My patients are often shocked when I come into the room literally seconds after the medical assistant tells them I will be there "in a moment." I smile and tell them that this makes up for all the times in the past (and in the future) that they had to wait. I pay the price for seeing patients as promptly as I can. That price is that I delay doing my charting until lunch or after appointment hours. Last Monday, I came home at 10:30 PM, long after most of the patients that I saw that day were asleep.
Our group wants us to put up a white board in the waiting room that is frequently updated to let patients know the estimated delay. I guess that is better than having a number like the deli that says "Now serving number 4," or that annoying computer announcement that tells you the average waiting time for your call will be 18 minutes. The white board may work in a single-provider office, but we can have as many as a dozen medical providers working at the same time, each seeing 30-40 patients. That is nearly 500 opportunities for delays. We are going to need an electronic ticker tape circling the waiting room, like Wall Street.
Abby, one of my frequent ENT Board posters complained that she had to wait three hours to see her ENT and she was angry. One of our pediatric urologists routinely has patients waiting this long. Adults are one thing, but having a sick child (or ANY child) wait three hours is a nightmare. We certainly do better than this.
A family practice physician allowed his patients to select the number of ten minute increments of time that they thought THEY would need at their medical visit. Guess what? Patients were much more accurate in anticipating how much time their visit would require than the appointment schedulers or the doctor. Of course, this family practice physician charged accordingly for these ten minute increments. If you want your sore throat addressed, have a mole removed, and have a discussion about your divorce all on the same visit, then book as many slots as you need. Patients are charged accordingly. I really don't see a problem with this method. That's how my car mechanic does it.
An OB-GYN gives his patients a beeper, so they can shop or do other errands. Non-C-section babies arrive without appointments and pregnant ladies understand this.
Maybe we need to see fewer patients per day or hire more medical providers? Maybe we can build in more decompression, catch-up slots in our schedule? I don't really have the ultimate solution, but I would sure like to hear yours.
Today is my day off. I shouldn't even be thinking about this stuff.
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23 Comments:
Reason #2 will follow soon...my Internet is temporarily down due to the snow blizzard.
Maybe the wait would be a little easier if the front office staff could be trained to be just a little friendlier. Doctors' offices, in my pretty extensive experience, have the coldest, downright nastiest people working there, and I have to think the doctors approve of their behavior. How do I know? Because my dentist's office is the complete opposite - there I am always welcomed by name with a smile and a friendly good morning. At doctors' offices the women don't even look up at you, but thrust a stack of papers in your chest and bark "fill these out". I've been going to the same doctor for 18 years, and not one of the staff ever seems to recognize me.
Another thought - we all have cell phones - maybe the receptionist could just give us a call to let us know how late the doctor is running half an hour or so before our scheduled appointment. That way, no one's time would be wasted.
I had been going to the same doctor for 18 years. When he decided to retire the office closed and the other doctors went to other places. When I would walk into that office they knew exactly who I was and my parents (even my dad who very rarely took us to the doctr). When I switched to a new office I too feel like everytime I got no one knows who I am. I have been going their for eight years now. I even followed one of the doctor's from the previous office to this one so the doctor knows me, but the staff don't. I agree with the above post. They should take a class on how to be friendly to patients 101.:)
I can't do the message board without signing up, which I'm not allowed to do. I only need a yes or no answer, so please respond. I'm at a loss. I CANNOT find an answer to this question anyplace, here or elsewhere, and this was the best place that I could find to ask it, so here goes:
On my 10th birthday, I got my earlobes pierced for the first time. A few months later, my dog was licking my face and accidentally swallowed one of my earrings, so I stopped wearing earrings for about 5-6 weeks. When I tried to insert a pair later, I found that my ear had begun to heal.
The next time my birthday rolled around (my eleventh) I tried again. Unfortunately, I started playing field hockey. (For some perspective, my birthday is in mid-April, and the season starts around October.)
Earrings are not allowed on the playing field, unless you were recently pierced and they cannot be taken out yet, in which case they are masking-taped over. I could not get away with this, and often forgot to re-insert mine after the game. by the end of the season...drumroll please... they had grown over.
It will be my thirteenth birthday soon, and I want to try piercing my ears again. Problem is, you can still see where they were pierced last time, and if I finger my right earlobe there, I can feel a scab or something hard in between what used to be the piercing-holes. (I can't see it.) So what I want to know is, is it safe to try piercing my earlobes again, or not?
You probbly have a keloid I had some problems with them when i had my cartlige peariced and when a dog riped an earring out. if you want to try agin i would suggest useing the same holes as it does not sound as if they have completly healed
I'm always waiting to see the doctor, I can't stand it when they stick you in the room and then set there for 1/2 hour or 1 hour. That is rude, at least they could come and say the doctor will be a few minutes late. They don't think we have things to do, places to go and have other appointments. I don't understand why patients are treated like crap and they reminder you when your late and if you have problem and can't make the appointment and you don't cancel right away they charge you $25. I show up on time why can't the doctors and then they blame the patient for being late. That just makes be so mad. There is one doctors office I go to and if they smile it might crack their face! They treat you like you are not there. And what's this about calling people by a number, I ask why they are doing that and they said because of the private act, I was with a name not a number !!!!
If the patient has a specific time with the physician, then why not have the patient come in early IF, and only IF, there are tasks such as paperwork to be done first, possibly with a suggestion of 15 minutes early or so? That way, these things can be accomplished, and THEN the patient can see the physician AT or CLOSER TO the actual appointment time with the physician. This obviously will not solve all problems, but it could help to keep the physician closer to being on time with other patients, and reduce the caregiver's stress.
I see many doctors in my medical group. In some of the practices, the staff at the desks know me by name and in others they don't. However, I am always told when I need to arrive early to fill out paper work or to have x-rays done before my appointment time. And 95% of the time, the receptionist staff is very friendly.
I don't arrive early unless instructed to do so, since I don't wait very well. I am always told when my doctor is running late.
The main reason people are dissatisfied is because most doctors see us just as "patients", and not "people." Although I know that doctors see hundreds of patients a year, and can't possibly remember someone who comes into the office a couple of times a year for routine reasons,we all would like to think the doctor actually remembers us, and what we tell him ! And why do some doctors keep asking the same questions on every visit ? If it was important enough to ask the first time, write down the answer !
The one and only reason I have changed doctors is the incompetence and lack of consideration. I hate it when they yell across the room "what's your date of birth?" Also, it is increasing to have an office answer the phone saying "can you hold please and then immediately putting you on hold without obtaining your agreement.
I am a solo practice specialist physician with almost 20 years experience. I always find it interesting that people who are unhappy with their MD's don't switch!
I hear lots of complaints from people, eg at the baseball field, about various ones, but a year later, they still go.
wI'm an RN, so I see both sides of this issue. The doctors ususally do hospital rounds in the morning before going to the office. They allot so much time for this but they never know what may come up at the hospital. Then they go to the office and may already be starting late and that sets the rest of the day in motion for lateness. They may also be called out for emergencies from the hospital. Especially at a rural hospital campus like I worked at for a while. I know most docs don't do this on purpose, but then I've seen some take 2 hour lunches while their patients wait. I don't know the answer, but it seems more careful scheduling might be of benefit.
As a SAHM homeschooler with 4 young kiddos, I can certainly understand that things don't always go as planned. And therefore sometimes (often?) we have to wait past our appt time or have the doc coming in & out. office! BUT a little respect for our time & being cooped up with kiddos would be nice. We may not want to hear that the doc is delayed, but it is better than just sitting in silence. (or cacophony of kiddos) At least we know that we are not forgotten, that the doc is in fact going to see us. (or not...if not then it would be nice to know that as soon as you know that. I say that because a few times I have waited way past my appt time to have a nurse come in and say "oh he left over 45 mins ago to ...." UGH, not that I don't understand emergencies-but hello, someone could inform us a little sooner?)Also I understand you can't share detail (privacy) but vague explanations would be good--remember we are stuck in a small room while time is ticking away-some of us with sick or boisterous children & we forget to think logically--we just think, here I am waiting and waiting, AGAIN...and I might just lose my mind. So yes some method of informing us the doc will indeed be with us soon would be greatly appreciated. The message board sounds interesting. But my wait is usually once I am in the exam room, with a closed door. Is every one so busy that no one could peek their head in on the way past? (I have actually been forgoten before--suddenly someone will open the door(to put another pt in)--and exclaim "oh you're still waiting?" well, hello I wasn't about to go anywhere?)
Oh and when the doc does come in, why do so many act like they care more about getting the appt accomplished than actually listening to you? For example, at my preemie dd's 8 wk check up, neither nurse nor doc asked about her developement, sleeping, eating, or concerns I had, nor looked at her growth chart (3" length increase only 1 lb gain since birth). And when I brought up my concerns-ie about her weird breathing & slow wt gain-he dismissed me, closed her records & said see you in 2 mos. HUH? (He was about 1 hr behind coming in to see us) If I bring up an issue that concerns why I made the appt, address it please, if it is maybe ot & you don't have time, tell me to come back please.
I have many health issues and see many different Doctors in a months time. I am always amused by the complete differences in offices. In my opinion, I feel as though the doctors that care the most about their patients are the ones that allot 30 min. for each visit. The staff are much happier and there for much more pleasant. {including the MD themselves}. The folks that frequent these types of Doctors offices are the best advertisment/reference for these offices and MDs. It's a real irritation to hurry up and wait...wonder how long a doctor would 'wait' in a waiting room to see their MD?
I agree 100% with the above post.. loving MD..here in PA:}
I am very upset that my MD left the area and I had to pick a name off of a index card of another MD in that office, because I can not afford to 'wait' and research for a new MD..I have to have ongoing medical care and medication. Turns out this new 'index MD' is offel. She is rude, irritable and demeaning with each visit. I can't seem to find an answer of how to find another MD that would work better with me. Any suggestions?
Yes, first of all, learn how to spell. the appropriate word is spelled "awful."
Notes also help when speaking with a doctor.
Be organized, they are.
I worked with doctors for almost 10 years. I was always stumped by the desire to cram as many patients in as possible. I have NEVER had to wait on my gastroenterologist. Why? He schedules "buffer time" every few appointments so that if he runs over on an appointment it doesn't throw the entire day into chaos. His nurses and techs are wonderful, however, the non-medical staff who handle insurance, scheduling and reception are cold, distant and seem to think that they are in charge of your healthcare. I'm not sure why these non-professionals seem to have such problems with the public but it seems to be almost universal.
At any rate, I get very tired of the excuses offered by doctors who simply are trying to see as many patients as they can regardless of the inconvenience to the patient (or even themselves). Time management is a concept that should also be taught in med school.
It would be nice if they let you know that the doctor is running late, but that would mean the staff would actually have to talk to you. The worst thing is listening to them complain about their day, something that needs to be kept for break time and out of the public eye.
I just want to comment to all the participants in part 1 of this series on dissatifaction that i have just benefited the most by the laughs enjoyed while reading a doctors tongue-in cheek effort to blow off steam without losing it completley only to have his efforts completely lost in the first eighteen respondents whining and complaining about why they are treated bad by a doctor and by god they have the perfect solution to his "laugh' here dilemma! Some are down right looney! People the man wants not looney suggestions just maybe someone to see both sides! Not just one selfish I'm so special but whoa is me position! I'd be concerned if it were not so important in my life to see that someone else is also misunderstood but hey who cares? "Laugh"
FIRST OF ALL, RUDENESS ISN'T PROFESSIONAL OR NON-PROFESSIONAL, I HAVE BEEN TO DOCTORS THAT WERE RUDE BEFORE. I WORK IN THE MEDICAL FIELD AND THE FRONT OFFICE ISN'T ALWAYS RUDE-THEY CATCH THE GRIEF OF DOCTORS AND NURSES FAULTS WHEN IT HAS NOTHING TO DO WITH THEM. FRONT OFFICE STAFF ARE TREATED LIKE CRAP. PATIENT ARE CONSTANTLY YELLING AND CURSING AT THE FROMT OFFICE WHEN SOMETHING HAPPENS BECAUSE THEY ARE THE FIRST ONE THE PATIENT COMES IN CONTACT WITH, ON THE PHONE AND IN THE OFFICE. PATIENTS-THINK ABOUT HOW YOU ACT BEFORE BASHING MEDICAL OFFICE STAFF. AND WHOEVER WROTE THE COMMENT ABOUT CALLING PEOPLE BEFORE THERE APPOINTMENTS BEOFRE TIME TO LET THEM KNOW IF THE DOCTOR IS RUNNING LATE.....GET REAL!!! WE BARELY HAVE ENOUGH OFFICE STAFF TO DO DAY TO DAY DUTIES IN THE OFFICE. DOCTORS DON'T WANT TO SPEND THE EXTRA MONEY TO HAVE A FULL STAFF AND DO THE EXTRA DUTIES THAT WOULD MAKE PATIENTS HAPPY. FRONT OFFICE STAFF IS OFTEN UNDERPAID FOR THE CRAP THEY PUT UP WITH ALSO-WHICH IS THEIR CHOICE.
I have to say the chiropractor I use to go to would call the patients if the doctor is running behind. They would then tell us to come in however many minutes late they were running behind. It was nice. They also do the same for the physical therepist they also have at that office. At a regular doctor's office though there are more patients being seen and they are a lot more hectic. It would be impossible to call each patient and also get the other work done. It depends on the doctor and the staff. If they feel they need to do that then they would, but most don't. They have other responsibilites to do and I understand that. I do feel though that the staff can be rude, but if they are constantly having to argue with patients or patients yell at them I would be rude back. Dealing with sick people is not fun. Just give them break!
Fast-food has really given us some twisted standards, hasn't it? We all want McDonalds drive-thru wait times and Ruth-Chris Steakhouse service.
I have to admit that I seem to be a rare patient. I figure I am walking into the doctor's world/turf, I have to be willing to accomodate them. It is their business, they will and can run it they way they want. Face it, the only thing that will change their practice is losing patients--of course that would end of problem about too much work for them and make wait times shorter.
Most of my docs are accomodating about giving me appointments when it works into my schedule and I always figure on at least an hour for an appointment between the wait, etc--although, I don't tend to schedule much afterward in case it runs over.
At my job, in my "world/turf", I know people wait for me occasionally too. It happens when there is more work than time. (Of course I am obnoxious about being on time so not too often.)
When going to a doctor, I take something to do with me (maybe read War and Peace--again?) so I don't watch the clock in the waiting room. Once in the exam room, I continue my reading (why it helps to bring your own reading materials) until the doctor is there. I am probably more surprised when I don't have to wait than anything.
There are alternatives out there to the long waits but if you want your healthcare at McDoctors speed, you are going to get fast-food service in the exam room too.
Do you want fries with that?
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