When you can't get a doctor's appointment soon

Although I am retired from medical practice now, friends often complain to me that their doctor's office can't work them in until six weeks from now.

"But I'm sick now! The pain just started Friday, and it's getting worse! His office clerk told me to go to the hospital emergency room, but the doctor there just gave me a prescription for hydrocodone and told me if it didn't work, to see my doctor Monday. When I told the ER doc that I'd already tried get an appointment and the first opening wasn't till six weeks from now, he acted like that wasn't his problem. And the ER visit cost me $160."

It's true, most doctors keep busy. There may be several reasons for difficulty getting an appointment. Office appointment secretaries often book the schedule full for days in advance, instead of leaving room for walk-ins. Sometime in the year, the doctor will take vacation time, or maybe update his knowledge at a medical conference, or maybe need some sick-time himself. And there may be times when he has a big emergency at the hospital or office that wipes out several appointments and delays everyone.

That being said, the doctor can remedy long waits by using a different appointment policy, and here it is. I used it for fifteen years of solo office practice, and I know it works. It should work even easier when several doctors share an office (if they don't all demand the same day off.)

Doctors: Leave space open for the walk-ins, and make life easier for yourself, your staff, and your patients.

Walk-ins happen. Half the patients you see only got sick or injured a day or two ago. So leave time for them. Here's how it works:

Figure out how long it takes you to see the average return visit, or minor new complaint. In my case, it averaged around 15 minutes - 4 patient appointments each hour, If my secretary knew it would be a new OB or a diagnostic workup, she scheduled it for 2 or more time slots. I was dependably in my office from 10 to 5 Mon-Tues-Thurs-Fri, + Wed and Sat from 10 till noon. An hour off for lunch. I did hospital rounds and/or minor surgery from 8-10. Work out your own schedule as you choose, then stick to it and let your patients know it.

Now, I told the front office to fill two of those four slots each hour ahead of the day. If those fill up six weeks in advance, so be it; they are only routine return checkups. That leaves two slots for each hour when each day begins. The secretary knows she can fill one of those for each hour for anybody who phones in that morning - Mrs. Jones' kid, who developed a fever in the night; or Mr. Smith with a cold that now has cough and chest pain, whatever. That leaves one opening each hour for emergency walk-ins, and they do happen. But done this way, it doesn't mean making your other patients wait past their appointment time. Sometimes there will still be waits. But your patients will be more likely to accept that because they know they can usually get in on the same day they phone in. If you're in surgery or the delivery room, or going to be away next week, the secretary makes sure the patients know that right away, and she offers to reschedule those who wish.

Sometimes a slot never filled. No problem; I used that time to catch up on my medical journals or correspondence. And I usually was able to accept new patients at their first call. It requires a doctor to stick to his office hours and start on time - read the newspaper later. It requires a knowledgeable person on the front desk, and you need to pay her wages accordingly, and instruct her how to handle calls. A good helper rarely has to call you out of an examining room, but be sure to answer your phone messages or e-mails promptly.

Readers: You can help make the visit easier, too, by doing some preparation before seeing the doctor: (1) If there is any question of fever, take your temperature (preferably in the evening, when it's likely to be highest) before you see the doc. It doesn't help him for you to say, "well I felt my forehead and it didn't feel hot."

(2) Write down a brief list of whatever problems you need to talk to your doc about. The reason you are coming, of course, with the major symptoms; and perhaps some ongoing problems you want to be sure to remind him of. Don't hit your doc with an "Oh, and by the way . . ." as he or you are going out the door. Take time to communicate - no essays or orations are necessary - just so long as he is aware of your major problem(s) of the day. Let him get to the next sick person on time, if you can.

(3) have a list of your allergies and medications written down, in case the doc or the nurse asks."I take a white pill and a green one," is not adequate. Spell the medicine's name and dose.

(4) It helps to let the doctor know you appreciate the pleasant surprise of getting an appointment the same day you called.