Long Waits A Problem?

Isn't there a way to get in sooner?

Because of the experience of a very close friend, we are re-visiting wishful thinking. In this case. it's the idea that you get to see the doctor the same day you call his office!

The tried and true old way goes like this: "Oh, you say you need to see Dr. Jones? You have a pain in your belly? Well, let's just see here -- I can look up the appointment book on my computer -- don't you just love computers? They're so fast and all -- Hmm --Looks like we can fit you in about next March. How does that sound? What's that? Did you say today's date is October 6? Well, don't get huffy! If that's your attitude, you'll simply have to go back to that nasty old ER, won't you?"

A six month's wait to see some physicians is increasingly the norm, and it's absolutely nuts, but it's the traditional mark of a successful practice. ("He must be really good - you can't get in to see him until after you're dead!") We've said it before - the office manager loves to see a full appointment book, but it's hard on the patients.

The IHI link (on our links page, or more specifically, here's the url: http://ihi.org/idealized/idcop/index.asp) contains information about changing the old ways. Although this is intended for professionals in the business of healthcare delivery, it doesn't hurt for the rest of you to be aware of how things can be done better. Explore the IHI web-site, and become an educated consumer! (It may also help if you click on the link at the bottom of this page. It will take you to our previous column on the subject of "reasonable waits" to see a doctor.)

Incidentally, HMOs probably aren't to blame for long waits. There is a shortage of physicians in certain specialties, worsened by the loss of some foreign physicians after 9 / 11. New doctors are less willing to undergo additional residency or fellowship training because financial rewards aren't as great as they used to be. (Medicare and other insurances are paying less than they used to pay for many procedures.) Cardiologists, gastroenterologists, and neurologists are some of the subspecialists in short supply.

General internists and family physicians have to be able to take up some of the slack, but they are not always trained to do so, unfortunately. In training, mostly in hospitals, there is always someone ready to take the difficult cases off your hands. Well, suck it up, primary care people, you may be all alone in the trenches.

The solution to this problem is as follows (Take note, doctors, and heal thyselves):

1. Enter the url listed above on the appropriate line of your browser, and when you get there READ IT ALL!

2. Starting today, leave a small number of appointments open for "call-ins".

3. Next week (or month), increase the daily "call-in" space by fifty percent.

4. Continue to do this until there is at least half of the appointment day available for immediate access by patients who need it.

5. After six months on this schedule, they wait-time for an appointment will have diminished to next to nothing. At the end of each doctor's day, there will have been plenty of business, the office manager will be happy, and the patients will be even happier!

A bonus attached to this type of practice change is that there are far fewer phone calls for the front office to manage. Problems get solved faster, and questions answered promptly by a staff which is doing "today's work today."

(You have our permission to print this and take it to the office of the last person who told you that the wait would be more than a week or so.)