Yeah, right. Your six-year-old wakes up this morning with a really sore throat, a cough and a fever. Or maybe she has an earache. Or perhaps you've found a lump in your breast. Your family doctor's telephone receptionist gives you the run-around, "Our next open appointment is in six weeks. If you're really concerned, go to the hospital emergency room . . .would you like their number?"
No, thanks, you already have their number. A doctor who has never seen you before, and likely will not be on call the next time either, will put an automatic thermometer in your kid's ear, glance down her throat, and give you a prescription for a cough syrup you've already tried at home. See your doctor in three days if there's no improvement. Your doctor's already-full schedule is not the ER doc's problem. You'll get a bill for several days worth of your wages, and are no better off than before you came in. The ER doc is reasonably sure your child will be better soon, but he fails to convince you.
This really doesn't need to happen. You shouldn't have to use the expensive ER for an urgent, but non-emergency problem just because no doctor's office has any time open.
Doctors who allow the front desk to fill their appointment schedule chock-full ahead of time are not thinking things through. Common sense will tell any primary care doctor that many people's sickness appears without warning and they need help today, not next week or next month. And people merely needing a follow-up visit usually don't care if their next appointment is seven days or seventeen days from now, as long as they know they have one..
During my partnership days, my partners' habits drove me crazy. They all booked all their time in advance; one doc overbooked two extra people for each hour "because someone might not show up." Our large waiting room was usually full of irate patients, some of them waiting two hours after their appointment time. My partners were good doctors, but were clueless about office management, as long as the office looked busy. "The patients can always get in; they just have to wait a while if we're busy."
I decided I could run an office better by leaving the partnership and going solo, and I did.
Here is what works: The doctor sits down with his staff and they decide how much the average routine visit takes of the doctor's time. Not how long he'd like it to take, but how long it really does take, according to the people who work with him. Say, for example, that on average he can handle four visits per hour. More complex problems—a new patient, or a new pregnancy— might take 30 minutes or an hour, and so would have one or more extra time slots assigned. In my own practice, I could usually handle repeat office visits in 15 minutes. Saving some time for hospital rounds, record-keeping, minor surgery, etc. each day, I usually had around six hours per day for patients' office visits.
I told my receptionist she could fill two 15-minute slots for each of those hours ahead of the day. A third one each hour could be filled from the phone calls from people who wanted to get in that day for something they thought urgent. The fourth slot each hour was saved for walk-ins. People rarely had to wait more than 10 minutes beyond their appointment time, unless I had emergency surgery or a baby delivery in progress.
Was it a problem to have an occcasional empty appointment slot? Not for me it wasn't. I used the time to return phone calls,sign or dictate letters, catch up on my medical journals, order supplies, or enjoy a cup of coffee at my desk. My patients were more relaxed, and so was I, not having to keep pace with an always over-full schedule. I found that it's not always necessary to bring someone in every month just for a blood pressure check or a blood sugar, once their condition stabilized.
Not every patient who only had a question required an appointment; sometimes the question could be handled by phone. My receptionist always brought the patient's record to my desk along with the call-back number, She only called me out of a patient's exam room if she judged the call truly urgent, or if another doctor was calling about a patient, but I tried to answer the less urgent calls as soon as possible.
This system of scheduling even gave me time to see occasional people who hadn't been able to get an appointment with their own doctor. Many had a problem that could be dealt with in a single visit, after which they could go back to the other doctor again.
So - Doctors, rethink your appointment scheduling. Packing your schedule full ahead of time causes tension, always trying to keep up, and it makes your waiting patients fidgety, even miserable if they are feeling pain or are otherwise ill. You'll also be more at ease if you get in the habit of starting on time, and limiting the length of your coffee break. (Read the newspaper at home.)
Receptionist, If the doctor is unavoidably behind schedule (and hey, it can happen) let the patients know. If the doc is way behind, offer to reschedule them. If he's avoidably behind very often, let him know.