Letting your schedule run late shows disrespect

Scenario: What responsibility do physicians have to keep appointments as scheduled?

Reply:

This question posed by a reader of American Medical News echoes a concern often expressed in patient surveys. Physician tardiness is often the leading cause of patient dissatisfaction with medical care. The problem seems to be the most acutely perceived in the setting of the doctor's office but is also often confronted in the delivery of hospital-based and outpatient medical services.

The answer would seem to be a "no-brainer." If a physician's office schedule is designed to deliver optimum, efficient, quality medical care, common sense would dictate that any significant deviation from that schedule would represent movement in the direction of lesser quality care.

Physicians often perceive this decline as more of a public relations issue than a substantive problem. Appointment delays are seen as a simple reality of modern medical practice, an issue both unsurprising and unimportant. We are all too familiar with the ready explanations and excuses offered by physicians for the delays that patients experience in their office -- emergencies, unexpectedly sicker patients requiring more than the allotted time, interruptions by hospital and doctor calls, late arrivals of scheduled patients and unexpected arrivals of unscheduled patients.

Physicians often hide behind the relatively sophisticated and high-minded utilitarian argument that their responsibility is to use their time and expert skills to provide the greatest good to the greatest number of patients.

Even patients will usually concede that the medically needy and sicker patients should be attended to first and will most often express willingness to accept delays in their care in deference to patients in greater need. But we would be deceitful if we fail to acknowledge that most office appointment delays are due to more mundane and less defensible reasons.

All too often, such delays are simply due to overbooking of appointments, often justified as excusable because of expected "no shows." But we all know that such scheduling practices rarely regularize a schedule and more often contribute to congestion and crowding of too many patients into too little time and the resulting delays of which patients rightfully complain. One must recognize that something is wrong in offices where appointment delays are the rule and not the exception. These events translate into a meeting between harried physicians and frustrated, angry patients for whom there is inadequate time for optimal consultation.

I know of no physicians who are not offended when they themselves are kept waiting by thoughtless colleagues and who are not irritated when they themselves confront appointment delays when they become the waiting patient. What one realizes when kept waiting is that this simply represents, when not excusable by an honest emergency, an act of disrespect. Patients interpret the consistent lateness of physicians as a tacit statement that physicians consider their own time is more important than the patient's.

An appointment arranged between two individuals is an explicit agreement; a promise based upon mutual respect that each individual will make an effort to keep that commitment. Further, if one respects another individual, one accepts that a unique quality of that individual is the value of their time.

Even under the best circumstances, a doctor's visit for a patient represents a significant time commitment. It is not at all exceptional for a doctor's visit to represent a half-day project, an interval of time quickly extended when inordinate delays are encountered in a doctor's office. A doctor's visit for the patient represents time absent from other responsibilities, involves transportation and often child care issues, and may itself conflict with other scheduled appointments when the doctor's visit is delayed. A prolonged office visit may represent excessive consumption of precious hours of sick leave or personal leave. Patients appropriately consider their time to be as valuable as their doctor's and a commodity not to be wasted gratuitously.

Therefore, I believe that it is our responsibility and obligation as caring physicians to provide the highest quality of care, ever respectful of our patients -- their person and their time.

We should steadfastly avoid scheduling practices that have no hope of temporal efficiency. We must recognize that our patients' lives are significantly and adversely affected by inordinate delays in our offices and that the respect which we would hope to receive from our patients must be reciprocated.

We must understand that most reasonable patients will accept and tolerate unpreventable delays and are understanding when our attention is diverted to those in greater need. But we owe our patients a sincere commitment to avoidance of delays and the courtesy of an explanation when such delays occur. Our patients deserve to receive information about the length of expected delays, an acknowledgement that they have not been forgotten, and an apology when appropriate. Such simple courtesies, naturally extended to our friends, also should be extended to our patients.

--Ian M. Shenk, MD gastroenterologist, Fairfax Hospital, Fairfax, Va.; clinical assistant professor at Georgetown University, Washington, D.C.