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Why Are Doctors Always Late???

by Dr.Sal MD on author

doctor time relativity

You might think doctors are always late because we don't value your time. The truth is more complicated - obviously. If you've ever wondered why doctors are notoriously late for appointments, keep you fasted then cancel your operation at the last second, and fill out your urgent paperwork only after the second notice, then permit me to reveal the fundamental flaws in the clinic encounter and human nature that perpetuates this affront.

Do Doctors make you wait because "they don't value your time"?

The stuff people come up with. Absolutely not. I get heartburn every time I keep someone waiting an hour to see me. But the problem, like predicting our weather, is trying to see the future. Our clerks have to scratch their heads and hazard a guess how long each visit will take. So they use an average. But when reality walks into the waiting room, some peoples problems take longer to fix than others. These mis-estimations accumulate over the day with each successive appointment being a little bit further off schedule. And because no doctor wants to be sitting vacant playing Angry Birds on their phone, our clerks pack extra appointments into each day to make up for people who said they'd come and don't bother or cancel. This can backfire if our absenteeism rate falls short. Some doctors may appear cavalier about keeping you waiting but this is because we've accepted waits at a doctor's office as being as much a part of the experience as having your temperature taken.

How does Game Theory lead to Doctors always Running Late?

Bottom line is that the culture of patients patiently waiting in clinics until their eyeballs burn and their bums go numb is a result of a collision of self-interest. Patients versus doctors is a game where each side is vying for maximal personal gain on a clinical chessboard. Patients looking to maximize their utility come in with wish lists pooled over months or years then expect their physician to solve them all in fifteen minutes. Doctors looking to keep the queue moving and maximize their volume per day book extra patients to replace losses due to cancellations and drop outs which adds chaos to the time schedule continuum. If all parties could set aside their egocentricity wait times could be dramatically reduced. If patients limited their complaints per visit taking into consideration the other patients waiting to come in, if they didn't set up appointments then flake out at the last minute, if they kept chit-chat to a minimum, if they were considerate of the other patients in the waiting room, this article wouldn't exist. Ultimately though, in this equation, it is systemic bad behavior on the part of a critical mass of patients that leads to all patients waiting and waiting. No-one wants to given up their 20 minutes of fame with their doctor and limit their service requests because there's no guarantee that the other patients waiting in line will too, in fact, some may then devour even more time if they could - a tragedy of the commons - so everyone competes to use as much service as they can, so everyone waits longer.

Another example of how boorish self-centeredness and gluttony for Health Services condemns everyone to longer wait times can be seen at walk-in clinics which are intended for sub-acute care, yet we have patients presenting with acute conditions like heart attacks, COPD exacerbations, drug overdoses, and even the occasional DOA - Dead on Arrival - cases which are grossly, obviously, emergencies and should have had the presence of mind to go to an emergency department. These people are hoping to circumvent the wait times associated with emergency rooms and jump the queue. We cannot plan ahead for these acute cases and they throw a wrench into the patient care mechanism: we have to assess them, call for an ambulance, discuss the case with the intake emergency room physician, and document what we found. This redundancy is time consuming and explodes the time frame for all patients that come afterwards on that day. Another very frequent type of gluttony self-service is the patient who avoids seeking Health Care for months, even years, and then presents with a shopping list of problems. Often they have let so much pathology built up that they can't just be dismissed or deferred with good concience.

Now why are surgical operations often canceled? You sit there in your Johnny shirt, fasted from morning waiting for your show-time, then at 3pm a nurse comes in with a dinner tray and politely informs you "it's not happening today buddy". This is more in the province of Murphy's Law then churlish clinic behavior. Murphy's Law simply says that if something can go wrong it will and this is probably nowhere better demonstrated than in the operating theatre. Each surgery that encounters unexpected complications runs over budget on time which would not be a problem if some surgeries took less time than anticipated, but generally the asymmetry is that they almost universally take more, not less. These budget infractions accumulate as the operating day progresses until some cases must be squeezed off of the list. The rub is that we know this but the alternative for Hospital planners is worse. Operating rooms are very expensive to let run idle which could happen if schedulers booked less cases. So their optimal utilization of operating rooms is to overbook knowing that some people will be inconvenienced (at no expense to themselves) - a game theory externality.

And why do doctors often set your insurance and legal forms in a slush pile until the second or third request? Simple psychology. Paperwork is perceived as important, not urgent. Someone sitting in front of you is a much more persuasive motivator than a sheet of paper. We also in our heart of hearts hope that some of our paper Mt.Everest might dissappear like dirt under a mat if we just ignore it long enough - and sometimes requests do fizzle out as no longer needed. And the final motive - or lack their of - is one of lucre. Paperwork is often tedious and less remuneratively rewarding than seeing patients. So it gets pushed to the back burner.

Did the term “Patient” come from Doctors making you wait?

Sitting waiting to see your doctor for an hour, or limping for two years waiting for a knee replacement can make it seem obvious that “patient” must come from “patience”. And you would be wrong. “Patient” comes from the Latin 'patiens' which means “to suffer”.

So if you're looking to end the ungodly wait times at your clinic, become part of the 'Stink Eye Movement'. The next time you see some glutton ahead of you walk out from your doctor after gobbling up 45 minutes of their time, realize that that's your time, and given them a searing stink eye as they leave. If enough patients gang up these abusers will get the point and be more cautious and concerned for everyone's time.

 


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