BAD MEDICINE The following is a real letter I wrote a few months ago to my family doc----no, wait, my primary care physician.--E.W. Dear Dr. B---: Two days ago, on Tuesday, February 4, after waiting in your office waiting room for one and a half hours to see you, I demanded my copayment back and walked out, angry, disgusted and disappointed--not to mention undiagnosed and still physically uncomfortable. What has the medical system done to you? What has it done to the way you provide (or fail to provide) service? How will you reclaim the respect of your patients and your full usefulness as a physician in a system designed to turn you into little more than a turnstile for patients? When I first met you several years ago, in your previous office, I came away singing your praises. Your office then was pleasant, intimate, and caring. You never had more than two patients waiting in your outer office at a time. We patients often spent our waiting time talking about what a good doctor you were and what a wonderful office you had. I never had to wait more than two days for an appointment--less, if I was seriously sick. Your nurses, out in the open with the patients, with nothing but a counter between us, were friendly, chatty, caring and considerate. You yourself provided the best care of any doctor I had seen since coming to this part of the country 11 years ago. The first time I saw you, you spent 40 minutes learning about my history, my personal life and my habits. Occasionally, you were late for appointments. When that happened, your nurses let us know that you had been delayed in emergency surgery, or that you had agreed to see a seriously ill patient at the last minute. I told my friends I had the best doctor in the state. Now let me tell you about my most recent experience dealing with your new office: On January 21 (I believe it was), I called your office for an appointment. I had a mild skin condition on my arms, and I was having trouble sleeping because of the itching--not a serious ailment, but annoying, unsightly and a bit worrisome. The woman in your office who answered my call cared about none of this. Brusquely, she asked, Whats your name? What insurance do you have? She actually seemed annoyed when I said I wanted to see you specifically instead of any other doctor in your new multi-doctor practice. Our first appointment is February 4, she said. That was two weeks away. I asked if there wasnt something sooner? February fourth, she repeated, impatiently. I took the appointment. Meanwhile, still having trouble sleeping, I decided that self-diagnosis was my best option. So I went on the Internet, checked the dermatology sites, found a (thankfully benign) condition that seemed to match my symptoms, and started treating myself. What was my alternative? By February 4, my symptoms had started to abate somewhat, but I wanted to keep my appointment, hoping to get my annual checkup and a confirming diagnosis of my skin condition all at once. I arrived for my noon appointment five minutes early. The waiting room was half full. Here in your new office, the nursing and clerical staff were isolated from us patients behind glass windows--a decidedly coldblooded layout. Talking to the receptionist was like dealing with a pawnbroker behind bulletproof (in this case, I suppose, germ-proof) glass. When I signed in, neither the receptionist nor anyone else asked me how I was feeling, what was wrong, or why I needed to see the doctor. Instead, I was told to fill out forms. I did that. Then I waited. And waited. And waited. Remember, I had arrived at 11:55. Well, 12:30 came and went. Then 12:45, then one oclock. The waiting room by then was full. Pretty soon there was no place left to hang a coat, and patients were jockeying for seats. Occasionally a pleasant nurse would pass through on her lunch break, making a joke about leaving when there was such a crowd. (The nurses seemed to want to treat patients as human beings instead of disease-carriers.) One-fifteen came and went. Several old and clearly sick patients, haggard and feverish, had been waiting almost as long as me. One-thirty came and went. Id been kept waiting an hour and a half, with no apologies and no explanation, and I had had enough. So I complained to the receptionist on the other side of the glass, got my $20 co-payment back and walked out. The receptionist didnt seem to care in the least that I was leaving. She simply wrote the words walk-out next to my name on the appointment sheet. Apparently walk-outs have become common in your office. At no point during all this did anyone behind those glass windows ever emerge to explain why we had been kept waiting so long. At no point did anyone even seem to acknowledge that we had been waiting so long. The wait was bad enough. Your offices failure to explain and apologize for that wait was worse: it was stunningly inconsiderate. There were people sicker than me in that waiting room. I decided it was wrong to make them wait any longer than they had to. At least I could get out of their way. Besides, I have a life to live. I wasnt going to waste it waiting fruitlessly in the dark, even to see a doctor. So I left. In some ways, this must be the ideal situation for the HMOs and insurance companies: the patient keeps sending in his monthly payments, but the company rarely has to provide any medical service, because getting service is such torture that the patient suffers in silence and stasis rather than trying to get help. I still think you are a terrific doctor. You told a friend of mine that you had to join a multi-doctor practice because your small one-man, two-nurse office couldnt keep up with the insurance forms. I understand that. I understand some of the pressures doctors today are under from Medicare, HMOs and the rest of the health care system. You have too much paperwork. You have too many patients youre expected to process. Your malpractice insurance is too high. I can guess how much a letter like this must pain you. But something must be done. And some things are easy to do:
Teach your phone receptionist to be polite and to show some care that the person calling for an appointment is sick.
Get rid of the glass partition between the nurses/clerics station and the patients waiting room. At least pretend that youre in the business, not of making money, but of getting people healthy again and that your employees are sympathetic to the sick. If you cant take down the glass wall, then place a desk in the waiting room with a person out in the open whose job it is to act as concierge or ombudsman to help the patients and answer their concerns.
Every fifteen minutes that an appointment is delayed, give the waiting patients an apology and an explanation.
If you, as the doctor, know youll be very late for an appointment, call the patient before he leaves home, so he can reschedule or come later that day.
By my calculations, you wasted at least 30 man-hours of peoples time just in the hour and a half I was waiting in your office. Im sure patients are sometimes late and waste your time, but even if every patient missed every appointment on a given day, theyd have wasted no more than 10 of your personal man-hours. What I saw on February 4 was unforgivable inefficiency in the human economy. As for the monetary economy, I charge $50 an hour, minimum, for my time. Again by my calculations, your office owes me $125 for 2 1/2 hours of fruitless travel time and useless waiting.
But the money isnt the point at all. The point is that you are a good doctor--and a good man--and you have been forced into the position of shortchanging your patients, if not ignoring them altogether. This is not quite a tragedy, but it is a real disappointment--and very bad medicine.
Ed Weathers (former patient)
Endnote: Three months later, Doctor B----- still has not responded to my letter. My ailment went away on its own.