Why Do Doctors Run Late?

You know how it is, right? You’re sitting in the waiting room with your child, bored out of your mind, while snotty nosed toddlers cough, sneeze, and wipe their boogers on every imaginable surface, including you and your previously healthy baby. You wonder if you have been forgotten, it has been 20 minutes, then 30. Finally you are escorted to an exam room, told the doctor will be with you shortly, and the door is closed. Claustrophobia sets in. It’s warm and stuffy, and there is no window. Your children turn into unrecognizable beings that must belong to someone else. They open drawers, pull out tongue depressors, rip off exam table paper, and spill crackers on the floor. Someone has to go potty. You’re not sure if you have time to make it to the bathroom and back—what if the doctor comes in right then? Finally you open the door to make sure they still remember you are here, take a step into the hallway to find the potty, and there I am—it’s your turn!

I have looked at my own schedule many times. While I can’t answer the question of why other doctors run behind on their schedules I have thought a lot about why I might get behind. I do understand it better, and have made improvements, but as many of you know, I have not solved this problem after fourteen years in private practice!

Why do I sometimes run behind in my schedule? From day-to-day this is the one thing that causes me a great deal of stomach churning, acid refluxing, and gut flip-flopping, head-aching stress! Often I will think back on my day, and if I have stayed close to my schedule and not finished too late it has been a good day. If I’ve run behind I’ll end the day feeling frazzled and out of breath, apologizing to everyone, and will go home to tell my family what an awful day I had.

One message I would like you to take home from this blog post is that I really do care about your schedule. I hate making people wait for me, and I am thinking about it constantly throughout the day.

I have done audits on myself. I’ll take several days and write down my starting and ending time for each appointment, and then compare it to my schedule. While it is fresh in my mind I’ll jot down any special circumstances that might have made an appointment start or end at a different time than it was scheduled. The first time I did this I was trying to find the one problem I was having that would explain getting off schedule. There must be something simple that could be adjusted, right? Perhaps it is just an improper scheduling issue?

What I have found when I audit myself is that there are MANY reasons I can get behind in a day. Most of them are UNPREDICTABLE. Most of them are UNAVOIDABLE if I am to provide good quality patient care. You must understand that it is my goal to provide the best possible care to each child in my office. I cannot sacrifice good care in favor of staying on schedule. I do set priorities each day, and at times cannot satisfy every need a patient has in one office visit.

Let me give you some examples of where things can go wrong, and why you might end up waiting for me. I, of course, have changed these scenarios to protect the privacy of my patients, but you will understand the general principles. I will use my NEXT blog to go into more detail about why each of these can affect my schedule so much, why I don’t think there are simple answers to each schedule-wrecking situation, what I do to try to keep myself on track, and what parents can do to help me stay on schedule.

1. My first patient of the morning is seven minutes late.

2. An appointment was given for one child, but it turns out the sibling is also ill and needs to be seen.

3. A middle-school student is in the office for a sore throat. After the office visit is completed, and I get up to leave, the parent asks their child to step out because they want to discuss something privately with the doctor

4. A teenager was given a ten minute appointment for the primary complaint of a sore throat. When I get to the room she tells me that she was too embarrassed to say anything to the receptionist, but actually she is having problems with her periods. By the way, she has also recently become sexually active, and is worried about STDs and pregnancy prevention.

5. A two year old is in the office at 2pm because of two to three days of fever and fatigue. The usual ten minute time slot was allotted for this basic, acute illness. During the exam it quickly becomes apparent she will need to be hospitalized. She is so pale and lethargic that it is clear something is seriously wrong.

6. Another scenario is the “by the way, doctor” that is added on as I am walking out the door. This could be a list of questions from the patient who hardly ever comes into the office, is here today, and needs some answers. Or, it could be a behavioral question, potty training, ADHD, a child’s grief, parents’ divorce, bed-wetting/constipation/soiling the underpants, sleep, etc.

7. I was given a ten minute time slot for a patient with apparently just two days of headache, but actually it turns out this problem has been going on for more than a year, and also there has been ongoing problems with abdominal pain.

8. During one office day I received several phone calls from the hospital to tell me urgent things about patients in the hospital. I am interrupted from office visits with patients to take these calls.

9. My eight year old patient won’t cooperate for a strep test.

10. Someone walked in with an injury needing urgent treatment and didn’t have an appointment.

I will probably think of more. On any one day my schedule can probably handle one or two of these without disastrous effects. But some days, especially if there is an admission to the hospital, I just end up terribly behind. I can tell you that when auditing myself I see many different reasons throughout the day to explain how my schedule went awry. Sometimes there is a single thing, such as the hospital admission, that explains everything. But more often it is many different situations throughout the day which add up to put me behind. And I am certainly not just standing around drinking coffee or chatting on the phone with my mother while you are waiting for me.

As a parent there are things you can do to get your questions and needs addressed while still helping me to stay on track. There are times in the day when I am less likely to be behind in my schedule. And if, to you, the above scenarios seem easy to solve—then wait for my next blog and I’ll explain why they might be more complicated than they appear at first glance.

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