From day one I have sought to be an “on time” doctor. This has been met with challenges however. With maximum effort I still run about 15-20 minutes late every four hours (so my morning and afternoon office sessions usually are 20 minutes behind by the end). The wait times for individual patients may vary though, with a few waiting longer, and most waiting less. The following are some of the nearly uncontrollable reasons I find that keep us running late:
1. There is an inherent asymmetry in any type of scheduled event: the odds that something happens to make me late are about 10x the odds of something happening to make me ahead of time. This asymmetry applies to all situations below.
2. It is very hard to accurately predict how long an individual patient evaluation will take. Attempts to do so always fail. We can however accurately predict averages. The solution to this is to explicitly limit visit length, and break up complex patients into multiple visits, but I think this is poor patient service.
2b. It is hard to predict visit length because my practice encompasses a range of medical problems and levels of complexity (I enjoy the diversity). I could probably predict visit length if all I saw were routine tonsil infections, but my patient complaints jump around from tonsils to cancer to sinuses to headaches to sleep apnea.
3. A single patient running late is impossible to “work in” to a full schedule without delaying those later patients. The solution here is to not allow any amount of tardiness, but that isn’t exactly good service either.
4. Typical reasons a patient runs late: (a)s/he underestimates traffic, parking, and finding the suite. (b)underestimates filling out paperwork / long prescription lists. (c)forgets to check in at the front and let anyone know they are there!! (d)physical delays of “rooming” patients with mobility impairments.
5. Computer hiccups that delay processing a prescription, looking at a study, saving a note, etc. Just one of these may delay a few minutes.
6. Having multiple internal appointments on same day in our office, such as for a hearing test and for CPAP check, exponentially increase the odds of any little something getting delayed and then running late.
7. Phone calls and same day work-ins from referring doctors. We do stay very accessible to referring physicians but unfortunately this will always keep us a little bit behind.
8. (Uncommon) true emergencies or severely unexpected issues with a scheduled procedure. This does not happen often, but when it does can truly wreck a schedule!
I do work my best to keep a balance of timeliness and good patient care. And because we try to stay on top of delays I think we run a pretty tight ship.