The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Wednesday, August 16, 2006

Some Patients Just Don't Get It.

A hypothetical conversation:

Random Person: The thing I hate most about my family doctor is that he's always running behind. I have to wait at least an hour every time I have an appointment. It's so inconsiderate.

Me: Yeah, that's rough. But people frequently come into their family doctor with 3 or 4 problems that they expect to have managed in one appointment, even if their appointment was just for a prescription refill. It's hard from the doctor's point of view as well.

Random Person: So then the asshole doctor just rushes the patient out the door. It's so rude.

Me: Which would you prefer... to have the doctor allow you as much time as you need to deal with all of your problems and not feel rushed, or run perfectly on time?

RP: I shouldn't have to choose. These doctors are only in it for the money. They schedule too many people. If they'd just schedule patients further apart, like every 20 minutes or so, they'd run on time and wouldn't rush me out the door. But they're too greedy, and want to make more money.

Me (trying to supress hysterical laughter): Actually, very few doctors in Canada (in urban centres, anyway) are still paid on a fee-for-service basis. So they get paid the same regardless of how many patients they see per hour. They're paid based on the number of people enrolled in their practice.

RP: See? So they SHOULD be booking less.

Me: How long does it take you to get in to see your doctor?

RP: If it's urgent, within a day or so. But for other stuff I have to wait 1-2 weeks. And for general physicals, sometimes I have to book a couple of months ahead. It's awful.

Me: (no longer able to avoid sarcasm) Well, when your doctor starts seeing half the number of patients a day so that you don't feel rushed and don't have to wait, I'm sure it will be much easier to get in to see him quickly.


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Blogger Leah said...

Guess I'm lucky. I've only ever had to wait about 20 minutes for my doctor.

But, making me wait in exam room rather than the waiting room doesn't fool me into thinking I've been helped faster. It IS entertaining though cause I can hear the lady's complaints in the next room. :)

Funny until I realize that the patient after me gets to hear MY problems while he sits in the other exam room.

6:55 PM

Blogger ArizonaDB said...

its a double edged sword with no easy solution. Frustrating from the patient's AND doctor's point of view.

9:08 PM

Anonymous Anonymous said...

Imagine working in a busy ED with loads of trauma and high acuity cases only to have a chronic toothacher complained that she'd been waiting for 4 hours, she bitches and moans and writes a letter to the hospital administrators. Meanwhile, her teeth are all nasty and rotten and have been that way for years. All of the sudden, it becomes a medical emergency at 3AM in the morning and she expects you to drop everything and give her lortab.

10:16 PM

Blogger Couz said...

Oh yeah. Seen it.

Only here they ask for Percocet. Because they're conveniently "allergic" to all NSAIDs, codiene and morphine.

It's the people who abuse the system the most who act the most entitled to it.

10:21 PM

Blogger Kungfukitten said...

I have an HMO and when I see my primary care I always bring a novel with me. If I'm feeling really crappy I'll sometimes just fall asleep in the room curled up on the bed. I'm so used to it now it doesn't phase me to wait 15-60 minutes. For some reason the specialists are always on time and even see me early if I show up early. Craziness.

4:45 AM

Anonymous Ex Phleb said...

I used to work in a very busy family practice. The nurse and I carefully screened patients when we made appointments so that we were then able to fully utilize the doctor’s and the patient’s time. We scheduled four physicals a week which was blocked out 30 minutes each. Colds, sore throats and the like we labeled “in and outs”, so we were able to fit these in throughout the day. Of course when somebody called and said that they had a personal medical issue to discuss with the doctor we blocked more time for that patient. Patients who lost a family member or patients with depression problems were also given longer appointment times. But we also had patients that tried to abuse the system by making an appointment for one child and then drag their other four in to the office to see if we could squeeze them in, depending on our patient workload sometimes we said no. We also had patients coming in with a long list of complaints but we asked them to keep it down to two and then we would schedule them for physicals so that the doctor could address all their medial complaints. (These patients had their labs drawn so that we had the results by the time they came in for their physicals) When we were extremely busy non emergent cases were not seen the same day but were scheduled within one to two days. It does help to know your patients and we always tried to teach them doctor’s office etiquette. In the three years that I worked there we only had one complaint from patient (sore throat pain) waiting ten minutes past her appointment time. This person was obnoxious and relished being a pain whenever she came in to the office.
Unless there is an emergency I blame the office staff for lousy time management if a patient waits for more then thirty minutes for their doctor.

9:03 AM

Anonymous Anonymous said...

I do get your point, but do you remember a family doctor of ours? Dr. T? I would call 30 miuntes before my scheduled appointment and ask how late she was running. The receptionist would tell me to come an hour/hour and a half later. 15 minutes before the "new" appointment time, I'd call again and ask when I should be there. They'd postpone it another half hour. I'd show up, and every time, wait at *least* another hour.

I'm not exaggerating in saying I did this before EVERY appointment, whether it was in the morning or afternoon. I can't believe that these kind of scheduling problems are only the patient's fault.

I know you wouldn't make ME wait that long though, so I love you regardless.


12:18 PM

Anonymous Anonymous said...

I'm not sure why Canadians feel so entitled when it comes to medical care--I mean in my city you should consider yourself lucky to even have a family doctor instead of whining about how long you have to wait to see him or her. Part of the problem would be alleviated if people didn't show up to the doctor when they have the sniffles.

I wish that the public would recognize what a great system we have and that when you really need something it gets dealt with in a mighty hurry! In any health care system with finite resources and infinite demands there is a cost to the patient, in the US the cost is financial, in Canada the cost is time and waiting. I wish patients would ask themselves which "cost" is more reasonable to them.

5:30 PM

Anonymous Anonymous said...

Well, what exactly is the point of the post? That doctors should spend 10-15 mins per patient max, and the patient should come in separately for each and every question/complaint he has?

I can understand if a new doctor has scheduling problems seeing as he doesn't know his patients or how long it takes him to talk/treat an "average" patient. However, if a doctor has been in practice for a very long time, it's reprehensible to make patients wait for an hour. Their time isn't any less valuable than his, and you'll notice that most (if not all doctors) actually charge you for missed appointments. Wouldn't it be grand that if the doctor is more than 15 minutes late you'd automatically charge him $25 :)

On the other hand, my child's pediatrician is amazing in this regard. He's been on time 99% of the time, and he doesn't take patients who are late (i.e. they have to wait until the next available time slot). The same goes for my OB. I wish there were more doctors around like them.

11:48 PM

Blogger doctor T said...

Are doctors in BC still paid per visit? Because there are huge differences in the wages of the doctors around here.

But my old doctor was a total overbooker. Always late, and always rushed me through an appointment. She never read my chart, would write me the wrong prescriptions and never talked to me for more than 5 minutes(I timed her). There are just plain bad doctors out there, unfortunately.

3:12 AM

Blogger Medstudentgod said...

I have seen both sides of this debate. I think I would rather have a physician that takes their time with each patient, gets to know you, and makes you feel good but is habitually "swamped" as opposed to one that is quick to move you along, yet inefficient.

I say this because I surmise that the amount of patients who complained about the physician was far greater towards the quick, speedy, yet ineffective doc.

8:56 PM

Anonymous Anonymous said...

So, anyone considered going to a nurse practioner then?

10:46 AM

Blogger Miette said...

Anon 11:48,
The point is patients can't complain about having to wait too long, and then complain that the doctor spends too little time with them. I mean, the pretty obvious conclusion is that if your doctor is spending more than 15 minutes with everyone who needs it, you included, they are going to run behind on occassion. I would much rather my doctor be behind because someone needed there time a little more than I did, rather than be rushed out at the end of 15 minutes and told to come back.

Anyways, I'm a pretty busy person, and I don't complain about waiting up to three hours to see my doc every single time. I know he won't ship me or anyone out prematurely, telling them to come back again because their time is up.

I would hate for medicine to be a conveyer belt of convenient 15 min. appointment times. We're all more human than that.

12:44 PM

Anonymous Anonymous said...

Hey Couz,
This is your cousin from Maine...all I have to do to get in to the doctor is waive my visa in the


2:53 PM

Anonymous jojo said...

Oh my, I can't count how many times I've had this exact same conversation.

7:57 AM

Blogger adventures in disaster said...

The problem is with the office staff.
They chronically overbook and if the doctor is complicit they are to blame to.
Fifteen minutes is a long time..for a basic GP visit you don't need much more time.
Book each appt for fifteen minutes except for known physicals, they get thirty.
Don't double book into that time.
Emergencies are for the Emergency room, anything that can be seen by your family doc is NOT an emergency therefore it can wait.
Unscheduled appt's can be offered but the patient must know they may wait and wait and wait.
The minute you start assigning "in and out" and only "Rx" to reasons for appt you get into trouble. Just keep fifteen minute appt's no matter will fill any extra time with so called emergencies or unscheduled.
Or maybe you wont...who cares if every patient got real time with the doc?.

12:16 AM

Anonymous Anonymous said...

Just to correct you - actually most doctors in Canada are still paid by fee-for-service, not capitation as in Hamilton and other areas of Ontario. And the problem with capitation is exactly the one you saw with your collegue - screening out patients that will take too much time (hence more work for same money). And the problem with ffs is exactly what your friend was complaining about - booking too many patients in a day and each for only one issue. The primary problem comes down to both too few doctors in general and the rational reaction of doctors to alter their practice style to meet a given income expectation given the system (ffs or capitation) within which they work.
a health economist

2:52 PM

Blogger Couz said...

Hi health economist!

You're right, academic centres (particularly in Ontario) are not representative of Canada as a whole when it comes to the number of family doctors enrolled in FHN's, FHT's and other 'alternative funding' arrangements.

But let me correct YOU-- it isn't 'more work for the same pay'. If you enroll a person in your practice, the amount of money you get per month is dependent on a few factors. Among them, the patient's age (old people are worth more money per month because on average they use the health care system more) and diagnoses such as mental illness or any chronic disease that is likely to mean that they'll be seeing their family doc more than any other person of the same age.

So it's really not as simple as 'this 55-year-old with chronic pain will take up more time than an otherwise healthy 55-year-old', because the monthly fee that the family doc gets from the government will be more for the complicated patient.

Thanks for commenting!

4:44 PM

Anonymous Anonymous said...

All of thiese comments are valuable and candid (at least I choose to believe so...), but....when it comes to the evaluation of the system.....the only place to which we compare ourselves is USA. How about EUROPE???
I have spent a lot of years in Germany, in Scandinavia and in other developed countries and I have to tell you that I have never seen patient waiting as long as Canadians wait for the medical service. We are used to taking things the way they are given to us....we assume that we have to wait because waiting is the part of the great service that we have. It is treated as the great gift from the God. You now what??? In Europe, existance of public medical service is not even questioned. Lets stop looking at States. Medical service is not something that was given to us. WE DECIDED TO HAVE IT THIS WAY. Unless Canada is not a democratic country...... Let me remind you...Government of Canada, through its decisions, represents will and interest of all And....thnks God that we decided to have medical services public in this country, becouse in other civilized, democratic countries people figured this long time ago.
Now, do not get me wrong...I am not trying to say that we have a bad medical service. This is not my intention. We do have a good service, but it still is far from the greatness. I think that instead of glorifyig or criticizing what we have we could think how to improve it.

5:52 PM

Anonymous Soma said...

What can I do to get my child examined by an Orthopedics physian?
My kid's arm was broken and after been healed now he have same pains and we got an appointment of June 2009?

6:45 AM


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