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Have we kept you waiting?

July 3, 2020


Have we kept you waiting?

This week we got a very irate, anonymous complaint about our failure to run to time. It is not the first one, and I very much doubt it will be the last, unfortunately.

We are always sorry for keeping people waiting, it makes us uncomfortable because we understand that you have better things to do than sit in our waiting room. We respect that you have other commitments and that your time is valuable, and we completely understand the frustration a delay may cause. We agree, it is hard to keep small children entertained when they are waiting. However, perhaps we need to come clean, be completely honest and say it as it is. We are a medical centre; we deal with complex medical issues and there is no hope of running a quality medical service consistently to time. We unashamedly place quality of care above timeliness.

None of our doctors, nurses or administrative staff enjoy us running late either. We all much prefer to run to time and to deal with delighted patients who have not had to wait. None of us like to have to work through our tea break or our entire lunch hour to catch up. None of us like being late out at the end of the day, struggling to make commitments like picking up our own children from school or attending engagements. When we are running late it impacts negatively on our lives as well as the lives of our waiting patients, and we do not get overtime. We absolutely hate keeping you waiting, it does not sit comfortably with any of us and if possible, we would avoid this scenario if it was within our capability.

We really appreciate that so many of our patients are completely understanding of delays and generously brush off our apologies. Thank you very much for this. Your selflessness and kindness really help lift our spirits when we have been under pressure.

Please do not worry, Katherine Brewer, our Staff and Capabilities Manager, is vigilant in checking our staff turn up on time for work.

So, if it is not our staff slacking off, why are we running late?

We are obliged to drop everything and deal with significant medical emergencies immediately. Often the very worst type of these will not even have an appointment but will walk in, in extremis. Normally it is the very elderly and the very young who need our help in emergencies. Please know we will always drop everything for you if you are having a similar emergency. Sometimes the emergency is not in front of us – we may have hospice on the phone asking for urgent assistance, such as a morphine pump prescription for a palliative care patient.

Whilst the average consult lasts 15 minutes, occasionally we must spend 45 minutes to an hour with a patient who needs unexpectedly extra time for a crisis. That absolutely sets us back, it is completely unpredictable and is something that will unfortunately continue to happen occasionally. When we are having a bad day and running late, it unfortunately means some of our preceding patients have been having an extremely bad day. It is noticeable that when those kept waiting see an ambulance leave Medplus they are always very understanding. Not all these difficult scenarios end up requiring an ambulance, however.

Often the delay can be put down to what we call a bad combination: - several time-needy patients booked back to back with no quick-and-easy issues interspersed to even out average appointment lengths. Can we identify the patients who will take a long time? Sometimes we can, and we do insist that some of our patients book double appointments every time entirely for this reason. Some conditions just take a long time, first time. An acute grief reaction, terrible sorrow, a life falling apart cannot be managed with one eye on the clock. Many lengthy consults are out of the blue. It is interesting how often a patient who has a serious issue, for example they have been having chest pain, fails to mention it until the very last minute of their consultation just as they were about to leave. It is often the same for severe depression, or those with suicidal thoughts. For these patients, we cannot ask them to come back another day but need to address the problem immediately. We wish we had the luxury of more time.

We do try to break up our day with tea breaks, so that there is slack in the system to cushion us when we are running late. Most of the time this is enough.

There are some areas we can improve in, with your cooperation.

We need to get better at drawing a line with patients who bring a shopping list of problems and expect us to deal with all of them in a single consultation. We try to be as efficient as we can in a consultation, and deal with as much as possible. However, 15 minutes of booked time is only 10 minutes of face to face and 5 minutes of note keeping and referral writing. We need to get better at asking our patients which of their issues are a priority and to address them first. We need to keep trying to convince our patients to book a double appointment if they have multiple or complex issues. What we are not interested in doing is having a warning timer buzzer go off signalling the need to end an appointment, that is not the type of medical centre we are. Neither will we start insisting that there is only one issue per consult – that is not our way of working – if you want that there are plenty of other medical centres out there.

We also need to be consistent in asking other family members to make another appointment rather than trying to deal with their issues in someone else's appointment. Please therefore do not be offended or take it personally if we do ask you to make your own appointment.

We also need to be firmer in dealing with those few patients who arrive late. When we are on time it really messes our scheduling up if our patients are late. Our policy is that anyone who is more than 10 minutes late has missed their appointment, unless the GP agrees to see them at the end of their session. Our reception staff find it very difficult to implement this as they hate to cause offense. Please save them the embarrassment and be prompt for your appointment.

A delay can quickly happen right before your appointment, giving our reception team no signal to warn you that we may be running late. Also, we are adept at catching up quickly given the opportunity (even if it means missing our breaks) so if we are running late, we prefer you wait rather than leave and come back later. A late cancellation may save the day and suddenly we are back on time. Our reception team do identify and inform waiting patients as much as they can do, but they have absolutely no idea what most patients are consulting about nor how long it will take. Psychic powers have proven tricky to find so far.

So, what can you do to avoid being kept waiting?

Book the first appointment of the day, or straight after a tea break or straight after lunch to avoid most delays.

If it is difficult being out of the office, or you have small children to entertain, is your issue something we could deal with as a phone consult? Ask the Medical Assistant. If so, we still may keep you waiting, but if you can continue working or entertaining the children at home whilst you wait it may be much more efficient for you.

Perhaps you also need to adjust your expectations? Be realistic when making an appointment. The time is only a guide. It is very probable you will be waiting up to 15 minutes, it will be rare (but not impossible) to wait more than 30 minutes. Leave plenty of time for your appointment so you do not feel under pressure.

Ask the receptionists which doctors are more generous with their time and avoid them! The reception staff know who has a greater tendency to run late. Some of our team, whose appointments only get booked on the day of the appointment (rather in advance) will run more to time as they will typically have fewer complex patients to deal with.

So, if we have kept you waiting, our sincere apologies. We hope that you can understand our line of business is very personal and very unpredictable and that your appointment time is only a guide. We hope that the service you receive is worth the wait.