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Old 12-17-2013, 06:13 PM   #21
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My dentist is always on time given and most of my doctors are on time about half the time and up to 15 mins late the other half.
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Old 12-17-2013, 06:21 PM   #22
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My experience with dentists is that they are almost always on time. That's because they know what they are going to do, they do it every day, and if something else comes to light during a checkup, they always make a separate appointment.

My experience with doctors is that they are getting better and there is now at least a 70% chance that I will be seen on schedule.

I am an ex-doctor myself, although I didn't have a clinic. But I did participate in projects to improve patient flow. Here are some of the reasons that doctors are notoriously late:

1. Patients make appointments for minor complaints and once in the office reveal that the situation is way more complex, e.g presenting complaint: longstanding high blood pressure, prescription needs renewal (estimated appointment time 15 minutes); what's really going on: insomnia, weight gain, depression, suicidal ideation (actual time required at least 45 minutes). You get the picture. This is why many doctors have a policy of one complaint per visit. I am not sure this makes sense for the patient though, as you really need to see the big picture.

2. Emergencies that require the doctor to drop everything and deal with them STAT actually do occur. This is more likely with certain types of doctors, notably OBs (babies have no sense of timing), doctors who are on call that day, who are covering the ER, etc. One might ask why they don't separate these activities. That works when there is sufficient activity and staff to do so. However, in a small town, your doctor may be responsible for everything. I'll just get my a Superman cape on.....

3. People keep interrupting the doctor's work and throwing off the schedule. It can be anything from a patient without an appointment who needs to be seen right away, to a phone call from the lab, to a reply from a specialist that the doc has been chasing on your behalf. One clinic doing a patient flow project found that the doctors were interrupted an average of four times during each appointment.

4. Some patients are no shows. This usually happens when the office is quiet. Then they show up the following week when the office is crazy busy and cause inconvenience for everyone.

5. Until very recently, doctors were not well informed about the theory of constraints (operations management). But the penny is dropping. Progressive doctors and clinics are realizing that they need to know, not guess, how long it takes to see patients with common problems, that they need to planning for the worst case scenario by assuming that patients will need an amount of time at the upper end of the range rather than the average time, and by incorporating free time into the schedule to compensate for the inevitable delays that will surely happen because of all the above factors.

This is not a comprehensive list. The bottom line is that when choosing a doctor, if efficiency is one of your criteria, ask whether the clinic is following LEAN principles and has an Open Access policy (meaning that there is room in the schedule to see patients on the day they present). I hope that's helpful.
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Old 12-17-2013, 06:57 PM   #23
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I just fired my last physician for a combination of being 1-2 hours late for multiple appointments combined with a very rude and unprofessional administrative staff. Between the two, I think it's the rude staff that bothers me the most. I mean, if the doc is really going to be an hour late, couldn't the staff at least come out from behind the desk and acknowledge this and apologize on their behalf, rather than just treating it like it's business as usual? If they just made a point to say something I could probably tolerate it. But when they just say nothing, what they are really saying is "we don't really value your time". And if they don't value my time, I don't need to do business with them.

In fact, the admin person who I got into an argument with said she would pass my complaint on to a supervisor...who never called me back. So it's a good thing I fired him.

Overall though, I find that very small offices with either an individual physician, or just a few, tend to be very respectful of people's time. Big operations with dozens of doctors who are just "employees" and don't feel much ownership for the patient's overall satisfaction tend to be the most chronically late all the time.
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Old 12-17-2013, 06:57 PM   #24
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My dentist's assistant takes X-rays within 5 minutes of me arriving and the dentist comes in about 5 minutes after that. This is pretty good because I'm generally 10 minutes early. I've only been to a doctor's office once in the last several years and I can't remember if he came in on time or not. I was taken care of promptly in my last couple of emergency room visits, but I waited 3 or 4 hours in an emergency room when I broke my wrist 10 years ago.
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Old 12-17-2013, 07:36 PM   #25
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This is not a comprehensive list. The bottom line is that when choosing a doctor, if efficiency is one of your criteria, ask whether the clinic is following LEAN principles and has an Open Access policy (meaning that there is room in the schedule to see patients on the day they present). I hope that's helpful.
It was a helpful post, thanks. As I noted at the outset, I can well understand being late on an exception basis, but not chronically late, especially for the first appt as in my case. Guess my doctors haven't heard of LEAN, interesting since we implemented ISO, Six Sigma, LEAN and 5S in manufacturing beginning in the mid 90's.

The volume of paper still in the medical profession is amusing too. Some (not all) of the old timers seem to be resisting technology with gusto. One of my friends is an accomplished 64 yo orthopedic surgeon, totally illiterate technology wise, email is a challenge to him...he just mastered texting recently, thinks it's pretty cool! But maybe he's not representative.
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Old 12-17-2013, 07:38 PM   #26
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I think it may? have happened once or twice with a dentist since 1966 but not with any of the doctors that I remember.

heh heh heh -
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Old 12-17-2013, 09:50 PM   #27
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It was a helpful post, thanks. As I noted at the outset, I can well understand being late on an exception basis, but not chronically late, especially for the first appt as in my case. Guess my doctors haven't heard of LEAN, interesting since we implemented ISO, Six Sigma, LEAN and 5S in manufacturing beginning in the mid 90's.



The volume of paper still in the medical profession is amusing too. Some (not all) of the old timers seem to be resisting technology with gusto. One of my friends is an accomplished 64 yo orthopedic surgeon, totally illiterate technology wise, email is a challenge to him...he just mastered texting recently, thinks it's pretty cool! But maybe he's not representative.

Thanks Midpack. To put It in perspective, I'll bet that manufacturers wouldn't necessarily know enough about healthcare to be able to diagnose and treat the illnesses of their employees. They would delegate that responsibility by providing health insurance benefits......unless they were small businesses, in which case they might not have the resources to do that. Well, most physicians in private practice are running small businesses. And they often don't know what they don't know.
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Old 12-17-2013, 10:07 PM   #28
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My dentist not only is on time, but when I arrive a few minutes early (as is my custom), frequently he will see me early.

My doctor used to have all of his appointments at the same time. Then he would see all of us over however many hours it took. I hated that, and it was crowded and felt like border clinic I recall visiting in the past. So, he changed his policy and now we each have our own appointment. It is still crowded. Usually I get called back to the examining rooms maybe 60-90 minutes after my appointment, and then sit there maybe another 30 minutes until he can see me.

When he finally DOES see me, he spends whatever time he needs with me. He never acts rushed.
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Old 12-17-2013, 10:21 PM   #29
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I am an ex-doctor myself, although I didn't have a clinic. But I did participate in projects to improve patient flow. Here are some of the reasons that doctors are notoriously late:
That was a helpful list. My perception is that those who are always late are generally guilty of over scheduling. I always had the feeling that they wanted to schedule every minute of the day so that they wouldn't have a hole if a patient didn't show up. And, frankly, they didn't really care if you had to wait.... But I do think it is better in more recent years.

On an aside -- aren't you a retired doctor, not an ex-doctor? I mean I don't think I would ever see myself as an ex-lawyer... Even if I let my license go inactive I don't think I would see myself as an ex-lawyer.
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Old 12-17-2013, 10:55 PM   #30
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This discussion is typical of those concerning the deficiencies of the US medical system in that it overlooks the obvious. The medical business did not succeed in sequestering the largest share of the largest economy in the world without paying careful attention to economic incentives. In the case of doctors' scheduling of their billable time that means double-booking. My favorite case is a dermatologist I went to several years ago in NYC. I arrived on time and was kept waiting an unconscionably long period of time during which I complained to the receptionist. She matter-of-factly replied that of course the doctor double-booked; they all do. Sometime later the dermatologist appeared at last at which point I complained loudly about being kept waiting because of double-booking. The doctor looked me right in the eye and replied, "We never double-book." The punchline to the story is that the dermatologist spent about 4 minutes looking me over, decided a couple of moles could be suspicious, and told me to come back for biopsies. Why couldn't she take the samples right then? Because by making me come back for a second visit she collects another payment thereby further wasting my time while defrauding the insurance company. All routine.

So the economic incentives are the doctor can risk the occasional loss of revenue because of your no-show or routinely abuse his patients' time by double-booking for his gain and their loss. Is it any surprise that patients have to wait?

Although I have had doctors whom I respected in various ways, as a group I despise them.
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Old 12-18-2013, 05:15 AM   #31
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I had an appointment with my PCP for 9:15 AM on Monday; arrived at 8:55 AM; and was practically done with the appointment (it was intended to be a short follow-up) at 9:20 AM. I deliberately switched doctors several years ago, intentionally choosing a more patient-focused practice over one that was clearly more doctor-focused.
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Old 12-18-2013, 06:49 AM   #32
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Thanks Midpack. To put It in perspective, I'll bet that manufacturers wouldn't necessarily know enough about healthcare to be able to diagnose and treat the illnesses of their employees. They would delegate that responsibility by providing health insurance benefits......unless they were small businesses, in which case they might not have the resources to do that. Well, most physicians in private practice are running small businesses. And they often don't know what they don't know.
Somewhat tongue in cheek? At least where I am, many doctors seem to have consolidated practices and joined much larger health networks. And I thought that was happening nationwide. I would think these large/huge organizations would "know" what they don't know - and I know some have indeed implemented LEAN and other productivity tools. I thought the independent, small business practices were rapidly disappearing?

I don't know for sure, I am asking...

The high cost of healthcare in the US is a compounding issue for me. And our local hospital was just torn down after a new one was built. The new one is like a high tech 5-star resort. And I just had a prescription filled that retailed for $670, and cost us $50 - that's nonsense IMO. So my objectivity may be in question...
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Old 12-18-2013, 07:48 AM   #33
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I think most doctors/dentists want to be accommodating to their patients health concerns as well as time constraints. Scheduling is definitely an art. Three days of the typical doctors or dentists schedule and most of you engineers would kill yourselves. Try putting together a spreadsheet in the dark, looking backwards in a mirror with a massive tongue randomly swiping across the keyboard, all in a mist of blood borne pathogens. And complete it in 30 minutes, not 32.
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Old 12-18-2013, 08:17 AM   #34
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Being a morning person, I like to make appointments first thing in the AM and very seldom if ever have to wait. On appointments made during the day, very seldom do you get your appointment on time. If you ever worked in a profession where you saw people based on appointment time(s) you understand how easy it can be to get backed up. Patience is a virtue I lack according to DW but it is something I work on. I think it comes from standing in line while in the service, hurry up and wait was the cliché if memory serves me correctly.
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Old 12-18-2013, 08:30 AM   #35
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I wait maybe 10 minutes from checking in to seeing my doctor, but I don't mind waiting longer for her. Sometimes there is some triage going on that is not obvious. I never wait more than 5 minutes for specialists or tests like mris, colonoscopies, mammograms. My dentist is almost always waiting for me even if I get there early.

I would change doctors if something annoyed me--serenity now--because that is all you can do about it.

The cool young dental implant guy our dentist sent me to was horrible--always 30 minutes late for my three or four appointments, while he met with salesmen, talked on the phone, joked around with his staff, schmoozed a plastic surgeon about doing a cosmetic procedure package with him (hello I can hear you, buddy). When DH needed an implant later, he told our dentist I did not want DH go there and why, and was sent to an amazing caring practice instead.
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Old 12-18-2013, 11:32 AM   #36
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The Dr. and denist I go to now are prompt and on schedule, that's one litmus 'test' I use. If they can't schedule their time, why would I trust them with my health?

I would understand a specialist or a Dr. that took emergency calls being unable to predict unpredictable events being late.

I left my last dentist, he and his wife/office manager were having marital issues. They couldn't manage to keep it out of the office. I deceided I could stay out of their office. Very happy I did.
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Old 12-18-2013, 01:41 PM   #37
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Midpack - your comment about larger organizations learning efficiency might have some merit. I've been a client of Kaiser Permanente for most of my life - and rarely have to wait for an appointment. The walk in nurses clinic is a whole different story - I had to wait 3 hours to get my tb test read earlier this year.

KP seems to have put in scheduling processes that result in mostly on time (within 15 minutes) appointments.

My dentist is a sole proprietor office - but he and his staff seem to have things down pretty well... the dentist moves between rooms, while the staff does all of the prep/cleanup/cleanings...
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Old 12-18-2013, 06:22 PM   #38
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Midpack - your comment about larger organizations learning efficiency might have some merit. I've been a client of Kaiser Permanente for most of my life - and rarely have to wait for an appointment. The walk in nurses clinic is a whole different story - I had to wait 3 hours to get my tb test read earlier this year. KP seems to have put in scheduling processes that result in mostly on time (within 15 minutes) appointments. My dentist is a sole proprietor office - but he and his staff seem to have things down pretty well... the dentist moves between rooms, while the staff does all of the prep/cleanup/cleanings...
Sounds familiar. I'm another Kaiser customer. I don't think I've ever had to wait over 15 minutes on a scheduled appointment.

The dentist I see now has three dentists in the office, and the usual supply of assistants and techs. Again, no waiting there.
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Old 12-19-2013, 05:40 AM   #39
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For profit organizations have a powerful incentive to be efficient.
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Old 12-19-2013, 05:43 AM   #40
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On an aside -- aren't you a retired doctor, not an ex-doctor? I mean I don't think I would ever see myself as an ex-lawyer... Even if I let my license go inactive I don't think I would see myself as an ex-lawyer.

Point taken, pardon my imprecision. I am debating whether to cut the cord and let my license go.
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