Why are my patients late?

Yesterday I had office hours; 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late.

Now, I have to admit this is a unique complaint.  Google yields 52 million hits for “why is my doctor always late?," verses, well, verses none (i.e. zero) for “why are my patients always late?” (Actually, the later search just defaults to the late doctor issue).  Apparently, doctors have not yet begun a postponed patient protest.  There are voluminous excuses posted on line for late doctors, but even more patient anger and frustration.

As an oncologist, I detest running late, because it means leaving people with cancer on their minds, stewing in my waiting room.  Personally, I worry when I am waiting at the dentist for a cleaning; what goes on in the mind of someone waiting to see me? Given the skyrocketing blood pressures of the average visitor to our office, I do not wish to add to that anxiety by leaving patients to stare at our fireplace or leaf blankly through a popular magazine.

Making another person wait seems disrespectful.  It says, “I am more important than you.”  Now of course one can read too much into the everyday necessities that cause delay, so I try not to be offended when they take too long to de-ice my plane before a winter flight.  Still, as part of the patient-doctor relationship, our obligation is to prepare to meet at a particular moment, and when you add the anxiety and complexity of medical care, that moment is very important.  If I was a cancer patient trying to understand disease, treatment and side effects, worrying about picking up the kids after school, and at the same time keep my nerves under control, it would not help to watch an hour or two of the chaotic dance of an oncologist’s office, before finally being allowed into chambers.

I try to be on time to see my patients.  Even, if there is a heavy schedule, I extend rather than double book, because by definition double booking means being already late.   I try to anticipate emergencies and distractions and adjust to maintain a reasonable flow.  In a busy office that can be a challenge, so I get anxious when patients add stress by being late.

When patients are late, there are several solutions.  As a kid when I was tardy for dinner, my Mom would start the meal without me.  If they finished eating before I showed up, it was going to be a hungry night.  Therefore, I tried starting the appointment before the patient arrived.  My staff was not encouraged to hear me talking in exam room #1, by myself.

Therefore, the obvious answer is that if a patient shows up 20 minutes late, without calling, make them reschedule.  Did I say these are cancer patients?  I would have to be a pretty cold fish to tell someone that a few minutes of my day is more precious than their fight for survival.  Therefore, yes, I always see them.  I take a deep breath and do not even mention that their tardiness has caused me angst.  I know, not very good patient parenting skills, but then my wife was always the disciplinarian.  The sentence, “well it looks like you need more chemo because the tumor is growing, but I am upset you were late,” is just not in my vocabulary.

So, let’s make a deal.  I will beat up on my colleagues about their lateness; explain time management, office organization, communication and mutual respect. Tell them to have staff inform patients when the doc is running late and build reasonable, achievable schedules.  In return, I only request that patients show up, more or less, on time.   Patients are not the only one anxious for each appointment.  I am anxious.  Anxious to see that each person gets the absolute best care possible and it seems to me that we start by doing the first thing we agreed, which is begin on time.

As published in Sunrise Rounds.

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