WAITING AT THE DOCTOR’S: CAN IT BE AVOIDED??

Sitting in the waiting room, waiting for a doctor always seems like a very long time. More than likely, the receptionist always asks to sit and wait for an indefinite amount of time.

Every doctor would term this long wait as a “necessary evil,” a consequence of having to reserve time in his schedule for patients with urgent problems. Doctors are of the view that they can never provide immediate care to the sickest patients if they tried to accommodate the schedules of all patients.

There is some truth to these claims. But they are far from complete explanations of patient delays. People today expect their services to be performed quickly, but a visit to a doctor is frequently an exception.

In many areas, mainly rural and sub-urban areas, there is a shortage of doctors. This is especially true for specialists. In these areas, there is simply not enough supply to meet demand, leading to unavoidable delays. Individuals in rural areas understand this reality. Rather than wait, they frequently choose to travel long distances to major cities for their routine medical care. Those in economically challenged and medically underserved communities often find themselves with no choice but to forgo medical care altogether, or land in the hands of quacks. But this is not the case in most urban areas. If managed efficiently and effectively, there are enough doctors to treat the population’s total needs. In these well-staffed places, every patient should be able to see a doctor in a timely manner for routine care, as well as for urgent problems.

But patients in these communities often experience similar delays. In this case, it’s not an issue of too few doctors but rather a failure of health care system design. Reputed doctors, particularly specialists who work as practitioners, receive a lot of referrals and appointment requests, with likelihood that other doctors of the same speciality having a lower demand. The result is that patients in one doctor’s practice are waiting to be seen while a second doctor is only partially scheduled. The reason that one doctor is busy and one is available has to do with patient preference. It is a matter of choice. And when a doctor has to see a last-minute urgent case, people with more routine needs end up waiting even longer.

When doctors work together as one, they can manage this variation effectively. But when each doctor works independently, then patients inevitably will wait for care even though the specialist expertise is readily available nearby.

To address the variation in demand, a few ideas could be implemented. Doctors could form a single medical group of highly qualified individuals and schedule each patient to see the first available doctor to care for his problem. But this solution would not be deemed feasible in most communities, the reason being economics. Doctors charge a particular consultation fee for each visit. As a result, they would fear the loss of personal revenue every time a patient saw another doctor. Therefore, patients with routine problems end up waiting when they don’t have to.

Delays in hospitals have a different cause. Hospital administrators try to maximize care on weekdays and limit care to medical emergencies on weekends. That is because doctors, nurses and staff are reluctant to work on weekends for personal reasons, and would rather wait until Monday to provide routine treatment.

In most hospitals, only one doctor from each specialty is assigned to deliver care on weekends, with the nurses and technicians providing only emergency diagnostic and interventional services. When the single on-call doctor for a particular specialty is in the operation theatre performing an emergency surgery, all of the other patients whose problems are not as severe are forced to wait.

And if a stable patient admitted on Sunday morning requires some diagnostic test or a non-emergency surgical procedure, the hospital staff may decide not to call in the stand-by team over the weekend, preferring to wait until Monday. And that is why patients admitted over the weekend end up staying longer than patients admitted for the same problem on any weekday.

But what is considered a medically appropriate delay can have negative consequences for patients. Hospital delays increase the risk of a patient experiencing an avoidable complication, such as a hospital-acquired infection. And in some cases, the added time may allow the patient’s condition to worsen. Delays could be minimized without increasing costs if hospitals evened out staffing across all seven days.

Doctors, whenever asked about the weekends, do always assure that they are always available to provide “emergency care.” But providing routine care sooner, and thereby decreasing the risks to patients while lowering total cost, is not their imperative. And the medical culture also supports this view.

Many patients accept delays in health care because they do not realize anything else is possible. Change is possible, although it is never easy. Doctors would need to implement new systems and technologies that allow patients to see the first available doctor. And hospitals would need to confront the weekday model and deal with unhappy doctors, nurses and staff.

But once patients experience this level of control over their health care, they would never accept delays again. The world is entering a new era of consumerism. People want the same level of convenience from health care they experience elsewhere in their lives. And the best part is that with a few changes, they can have it.