The Case of the Disappearing Patient

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There is an air of resentment within physician waiting rooms that is sweeping the land. Why, you ask? Many patients are tired of waiting in your aptly named “waiting room”. When you make patients wait for what they perceive as too long, you are making the following statements to them: “My time is more valuable than yours” “I don’t care what you think or how you feel” “I don’t care if you remain my patient or not” Guess what? Before you know it, they have left your practice and you are left shaking your head and asking “Why”? Did you hear the one about the physician who said “…..my patients don’t mind waiting for me, regardless of how long they have to wait”. Don’t delude yourself into thinking that that your patients can’t live without you. If you are not sensitive to their needs, they can and will leave you! As a consultant constantly trying to implement methods to increase physicians’ patient volume and, in turn, their revenue, I am as guilty as anyone for pushing doctors to see more patients. At the same time, I won’t do it without finding a way to effectively accommodate current and increased volume. Doctors must have the same attitude toward their patients. If not, they will leave and not come back. How do we combat disappearing patients? To begin with, let’s rethink the entire patient scheduling process. What should the primary objectives be? As a consultant, I seek to • minimize patient “wait time” • take advantage of the differences between “the tortoise and the hare” • provide easy accessibility • accommodate unforeseen delays and communicate delays to patients • monitor, adjust, monitor, adjust, monitor, adjust... Minimizing patient “wait time” Is it reasonable to expect that, from the moment a patient arrives in your waiting room until the moment you begin their visit in the exam room or consult room, only five minutes will have elapsed—can you do that? No—how about ten minutes? Fifteen minutes? For some patients, any wait is too long. If you acknowledge that we can do a better job of minimizing patient’s wait time, you’ll need to evaluate: • scheduling template(s) • computer software • job descriptions of front and back office staff • check-in and check-out procedures • office visit volume and hours worked by provider • office hours • monitoring system Accordingly, you cannot expect a patient to wait in your waiting room and then have to endure a wait of the same duration in your exam room. If they are, you need to examine the cause(s). As a consultant, I want you to get your patients out of the waiting room and into the exam or consult room quickly to be seen, not to hide them or forget about them. Take advantage of the differences between “the tortoise and the hare” The tortoise and the hare’s styles are both necessary to meet all of your patients’ needs. Providers work at different speeds and see a different volume of patients over the course of their day. While recognizing their different styles, I try to minimize template variations amongst the providers since this makes the training and scheduling components for the staff as simple and straightforward as possible. Also, computer software is frequently limited relative to the variety of template variations that can be accommodated. However, it may be necessary at times to create a separate template for each physician if this is the only way to a)provide a comfort level for the desired pace of their work day b)minimize patients’ waiting time and c)maximize each doctor’s productivity. Again, any changes require an understanding of the computer software and the critical need for staff training. Provide easy accessibility Do you offer a reasonable number of office hours to your patients? Are your office hours convenient for your patients? Early morning hours before work? Evening hours after work? Saturdays? If you don’t meet your patients’ needs for flexible hours, your competitors will. Accommodating unforeseen delays and communicating the delays Problems crop up during the day. A sick provider, family emergencies, power outages, etc. These situations should be dealt with in a professional manner by communicating the cause(s) of the delay to your patients as soon as possible and by providing them with some options (such as seeing another provider or a convenient rescheduling of their appointment). At the same time, don’t create delays by overbooking patients or seeing patients indiscriminately while “on call”. If you monitor patient volume and practice hours daily, you will know what patient volume the office can handle. Your triage staff should know your protocol for where they can put “sick” visits in a provider’s schedule and the type of visit(s) that can be added. Your staff should be well trained in the areas of “add-ons”, “blocking”, appointment types and rescheduling appointments. Additionally, seeing patients while “on call” for some specialties is asking for trouble. If it is financially necessary for your practice to do so, you must have guidelines that your staff can refer to for the type of patients to be seen-ideally, problem or other short visits, not exams or procedures- and how and when the patients are to be notified when you have to leave. Remember, we’re talking nothing more than exhibiting common courtesy and sound business policy. Don’t make your patients have to ask the front desk what is going on. Be proactive and have the front desk tell them what is going on. The professionalism and empathy shown by your staff for a patient’ needs can greatly diminish or eliminate a patient’s anger! Monitor, Adjust, Monitor, Adjust, ……………… Every action you take, every strategy you put into place when scheduling patients must be flexible and subject to change. Daily monitoring of what is going on by the practice manager or administrator, discussing details with the provider(s) and changing templates when and where necessary should be part of the patient scheduling process. I ask you to consider implementing some or all of these measures now, with or without a consultant’s help. By doing so, my next article on this subject could read something like “Wave of Patient Satisfaction Sweeps Over Medical Community”.
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  • appointment software
    appointment software
    I’ve been a mechanic for thirty years now and have had my own station for the past twenty.  I have seen a lot of things come and go- mostly other independent service stations- and now I mostly ignore everything that comes through the door.  Sure glad I didn’t ignore this product when it came to my attention.  It was for online appointment scheduling.  
  • Julie
    Julie
    We as patients are also being charged for a missed appoinments, copies of our medical  records, forms and made to wait. Often FP's , Internists must see high volume in order to make better money. They spend 10 minutes with us.  The new "boutique medicine" while pricey is what we once received ..FREE.Watch for more changes in quality of care.
  • Brian Ramos
    Brian Ramos
    Lynne,I don't know of a search engine.  Some practice websites indicate if they use an electronic medical record.  Best to ask when calling the practice for the first time.  Better, ask them if they have a patient portal where you can communicate with your clinician online and get routine business (prescription refills, referrals) resolved without picking up the phone.  Good luck.
  • Michael Plishka
    Michael Plishka
    In addition to minimizing waits, the problem of making that time useful should be solved as well.  An interesting summary on this is here: http://sloanreview.mit.edu/the-magazine/articles/2009/summer/50407/designing-waits-that-work/
  • Lynne Ordoyne
    Lynne Ordoyne
    I have to relay an expereince that happened to my husband and I. My husband went to our doctor and was put in an examination room only to be totally forgotten about. After an hour he poked his head out of the examination room and an extremely embarrassed nurse apologized profusely admitted they had forgotten about him and had the doctor in the room within two minutes. The following day I had to go to the same doctor and had barely taken my seat in the waiting room when I was called to the examining room and when I entered the room the doctor was sitting waiting for me. He explained they were so mortified with what happened to my husband the previous day they made a point of being ready for me. This expereinced showed me there are some caring doctors out there still. The one comment I will make is that doctors practice had a computerized charting system which made the office extremely organized and allowed then to track incidents such us the one that happened to my husband. Unfortunately we have since moved out of the area and now have to deal with long patient waits again at our new doctors office. I would love to find another doctor that uses a fully automated documentation system. Does anyone know how I can research doctors who have a computerized charting system?
  • Abraham J. Rodriguez
    Abraham J. Rodriguez
    Last week I was 10 minutes late for my medical appointment, this was almost the begining of the end to my appiontment, receptionist said wait let me see if the doctor will still see you. That made me me feel angry since I have only been with this doctor for 4 months, I have waited for a half hour one time and 40 minutes another and yet she walks in and says what are you here for today, since you were late 10 minutes I have to move fast.  One more time I feel I will move on.
  • drug rehab
    drug rehab
    Don't delude yourself into thinking that your patients can't live without you. You are right. I couldn't have said that better myself.
  • Ada Wakeman
    Ada Wakeman
    'Don't delude yourself into thinking that your patients can't live without you. If you are not sensitive to their needs, they can and will leave you!'Well, this is a very good quote that every doctor should think about. The patients should always be the most important in a doctor's life, like for a soldier the most important is the country and for an actor, the viewer...Ada
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