Why doctors shouldn’t call it the “waiting” room

31 Aug

by Carolyn Thomas  @HeartSisters

At least once a year, my family heads out to the world-famous Butchart Gardens, about a half hour drive from our home here in Victoria. We spend a magical Saturday evening enjoying the summer gardens, a picnic supper on the lawn, live entertainment and especially the eye-popping summer fireworks extravaganza at dusk.  We are joined by approximately a zillion other visitors from around the globe, and the minute those last fireworks have fizzled, the zillions stand up and shuffle en masse to the vast parking lot to exit.

A little secret that our family has learned over the years, however, has saved us a lot of late night aggravation trying to get out of that tour bus-clogged  traffic jam – and it also confirms social scientists’ theory that Occupied Waiting Time feels far shorter than Unoccupied Waiting Time – a profound lesson for those of us who spend way too much time cooling our heels in doctors’ waiting rooms. 

Here’s the secret: at Butchart’s, while that endless sea of humanity is shuffling s-l-o-w-l-y towards the parking lot at the end of a Saturday evening fireworks show, our family heads off cheerfully in the opposite direction. We enjoy the dramatic night lighting in the near-deserted Sunken Gardens, stroll the exquisite Japanese Garden pathways, sit down near the Ross Fountain to watch the lovely light show there and snack on our picnic  leftovers. By the time we finally mosey on back to our cars, the parking lot is almost empty. We sail out the long driveway with virtually no delay,  just behind those who have been slowly inching their way out of the parking lot for the past 45 minutes. The difference is that we are happy, while they are exhausted and cranky.

Dr. Richard Larson of M.I.T. is widely considered to be the world’s foremost expert on waiting in lines. He told the New York Times recently:

“Often the psychology of queuing is more important than the statistics of the wait itself.

“That’s why Occupied Time (a long walk to an airport’s baggage claim area, for example) feels far shorter than Unoccupied Time (just standing there waiting at the carousel).

“Research on queuing has shown that, on average, people overestimate how long they’ve been waiting by about 36 percent.”

Here’s an interesting story about that long wait to pick up luggage at the baggage claim carousel in the airport.  Some years ago, according to the Times, passengers at a Houston airport were lodging a record number of complaints about the long waits at baggage claim. So airport executives  increased the number of baggage handlers. But although the average wait fell to eight minutes, well within industry benchmarks, passenger complaints about long waits mysteriously continued.

Upon careful analysis, the puzzled  execs found that it took passengers one  minute to walk from their arrival gates to baggage claim and seven more minutes waiting to get their bags. So roughly 88 percent of their time was spent standing around waiting. A new approach was implemented: instead of reducing wait times, the airport execs moved the arrival gates away from the main terminal and routed bags to the outermost carousel. Passengers now had to walk six times longer to get their bags – and complaints dropped to near zero.  A successful example of Occupied Waiting Time!

Researchers Ziv Carmon and Daniel Kahneman have also found that we are far more concerned with how long a line is than how fast it’s moving.* They have observed that given a choice between a slow-moving short line and a fast-moving long one, we will often opt for the former, even if the waits are identical. This is why Disney hides the lengths of its lines by wrapping them around buildings and using serpentine queues.

It’s also why our local hospital Emergency Department has created an inner and outer waiting area. Incoming patients are triaged and moved into the inner area as fast as possible; wait times there may not actually be any shorter, but patients feel like things are moving along, and new incoming patients perceive that the wait may not be too bad – because they don’t see the true number of people in the queue.

People also judge waiting times based on the concept of fairness.  Just watch what happens when somebody attempts to butt into line ahead of those who have been waiting longer.

Or observe the murderous indignation of patients watching the cute blonde Big Pharma drug rep waltz through a packed waiting room into the doctor’s back office, where – to add insult to injury – they then get to wait even longer while forced to listen to the happy sounds of laughing and chatting during her sales call.

The sociological concept of Occupied vs Unoccupied Time spent waiting in line got me thinking of how doctors and hospitals could use this awareness to help patients who spend far too many hours cooling their heels in waiting rooms.

Dr. Charles Kilo of Portland, Oregon told American Medical News recently:

“Health care professionals are becoming more and more aware of waiting as a problem. The current system was really set up around physicians’ needs. It’s disrespectful.  Patients are busy people, too.”

First, let’s give patients something meaningful to occupy their time while they wait.  This seems like a profoundly simple solution that could not only make patients less cranky, but also help educate us at the same time.

I recently responded to a physician’s online article lamenting the fact that a standard 15-minute doctor’s appointment is just not long enough to advise his patients on important lifestyle improvements: lose weight, quit smoking, eat healthy, etc.  My suggestion to him:

“Why not show Dr. Mike Evans brilliant 9-minute film called ’23 and 1/2 Hourson a continuous loop in the waiting room?

“It’s a must-see video for all patients and their family members – and no doubt Dr. Mike does a better job at inspiring change than you can.”

Steve Wilkins, who writes about doctor-patient communication at Mind The Gap, asks: what if physicians actually put patients to work during wait time?

“What if physicians integrated patient wait time into the office visit by:

♥  Talking to patients (via printed handouts, electronic media, patient portals, etc). Contrary to the popular press which touts the empowered patient, most of us still assume the traditional ‘sick role’ during the office visit.  The sick role is characterized by patient passivity, limited information sharing, and minimal question-asking.

♥  Teaching people while waiting how (using the same media as above) to become ‘better patients’.   I recall an article where physicians were asked five things they wished their patients knew.  At the top of the physicians’ ‘wish list’ was a desire for patients to be better prepared and more focused during the visit – the point being that better-prepared patients would help the physician get to the correct diagnosis and treatment plan faster.”

Here are a few other options for physicians to consider for their waiting rooms:

  • free Wi-Fi can help patients pass the time by getting some work done or entertaining themselves.
  • a call-back service if you anticipate a long wait and there are other things to do in the nearby neighbourhood (like grab a cup of coffee, browse a bookshop, etc.), offer to call or send the patient a text message so they can leave the office and come back when you’re ready for them.
  • Offer people a hot beverage when they arrive. It takes several minutes for tea to steep or to brew fresh coffee, plus another 10 or 15 minutes to drink it. This can help a patient warm up from the cold, wake up in the morning, or de-stress. All of this adds value, and for just a few dollars a day. And it’s just good hospitality.

Q: What would help make your waiting room experience less painful?

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* Ziv Carmon, Daniel Kahneman. “The Experienced Utility of Queuing: Real-Time Affect and Retrospective Evaluations of Simulated Queues”. PhD dissertation, University of California at Berkeley, 1995.

See also:

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17 Responses to “Why doctors shouldn’t call it the “waiting” room”

  1. Rachel Juby September 5, 2012 at 4:58 pm #

    Girls! This is making my blood boil!

    Jetgirl… I wish I had been with you on that day. I assure you, they would have been well aware of your/my arrival. On a “bad news day” at that!!? This is unacceptable! He/She/IT should not be practicing medicine. I don’t care what the star rating is, what kind of rep the internet gives them. They either step up, or you step out! I do truly believe there are good Doctors out there. I am just disappointed at how hard they are to find.

    On my last scope, I was LITERALLY on the table, staring at that big long tube :( My Doc (Former Doc) came in carrying Chinese take-out and said “Sorry, But I’m starving, be back in a few minutes.”

    I laid there like that for 45 minutes, I could hear her laughing and talking down the hall, I could smell her food. Any body that has had a scope knows, you can not eat or drink for 12 hours before the procedure . Her nurse sat with me and looked so embarrassed at my situation. I was embarrassed for her. I got to go home, she has to deal with The Witch every day. I do ever so slightly remember telling her EXACTLY what I thought of her (right as they injected the sleep shot)… It went something like “I hope you enjoyed your lunch you selfish BI…ZZZZZZ

    Stand up for yourself. We pay them lots of money. Demand respect. We may be sick, but we are not weak (not in spirit and not in mind).

    Like

  2. Rachel Juby September 1, 2012 at 12:47 pm #

    You guys have more patience than me! 6 hour wait!! really!? The last time I was left sitting in a room for 2 hours in a PAPER gown in a freezer (what is up with paper gowns and what is up having the temp. at 20 below?) I got up, dressed and walked out and billed the Doctor for my time.

    No. He didn’t pay. He did not get my future business either.

    Like

    • Carolyn Thomas September 1, 2012 at 2:08 pm #

      Sending him a bill for your time? Love that spunk. He may not have paid, but one hopes your “invoice” gave him serious pause for thought. There’s actually been quite a trend in the U.S. towards billing physicians for patients’ time – with corresponding outrage from physicians for such a preposterous notion. Read this article from KevinMD.com for example, and especially the positively caustic replies from docs.

      Like

    • jetgirl September 3, 2012 at 8:51 am #

      AHHHH but I was waiting for the results of a complicated scan that did in fact show me THAT DAY that I had a life threatening tumor and THAT was why I was so sick and on his waiting room floor. So since it was over a two hour drive to see him AND another two hours to get back home and I had a driver on that particular day – what’s a girl to do??

      Suck it up and wait in the haze of pain.

      Like

      • Carolyn Thomas September 3, 2012 at 11:35 am #

        Appalling….

        Like

  3. Elaine Schattner, M.D. August 31, 2012 at 6:34 am #

    Hi Carolyn,
    Quiet would be nice. As far as reading goes – I’d rather pick my own materials than take what the doctor wants me to read.

    Like

    • Carolyn Thomas August 31, 2012 at 6:57 am #

      Sometimes, I like quiet too! But what would you suggest for situations like JetGirl’s waiting experiences?

      Like

      • Carolyn Thomas September 3, 2012 at 8:16 am #

        PS Wanted to share responses to this post via Twitter from cardiologist Dr. Seth Bilazarian, who blogs at theheart.org: “Excellent. Useful for doc waiting rooms. I tried patient education approach but complaints, so back to HGTV.”

        When I asked why his patients complained, he replied:
        “Patients complained that educational TV in waiting room wasn’t interesting if it didn’t pertain to their particular medical problem.”

        Liked by 1 person

  4. JetGirl August 31, 2012 at 6:17 am #

    Points well taken, Carolyn!

    In my experience a 2 hour wait in the waiting room and a 2 hour wait in the exam room is still too long. Just tell me the Dr. is backed up 2 hours when I sign in and give me the CHOICE to stay or reschedule.

    Did have a horror of a 6 hour wait – in a specialist’s office, not the ER. Was so sick that I eventually just laid down on the carpet wrapped in a blanket from my car. My driver had half a sweater knit by the time we got home.

    JG

    Like

    • Carolyn Thomas August 31, 2012 at 6:36 am #

      A six-hour wait?! That is INSANE. So is two hours in the waiting room and two hours in the exam room. This has got to stop. Even watching Dr. Mike’s great video on a continuous loop would not help that nightmare . . .

      Like

      • patientwaitingpatiently September 1, 2012 at 6:20 am #

        I can usually deal with a wait in the waiting room. It’s being put in a miserably ice cold, tiny square box of an exam room, told to put on a gown, and that hearing the words “the doctor will be in shortly,” only to then sit there shaking for over an hour.

        This happened the last two times I saw a particular specialist as the last appointment of the day. I ended up going through the supply cabinet, taking out a dozen gowns and making a blanket to warm up. Then, after the one hour exam room wait, a nurse steps in and says the doctor is running late (no apologizing), and she has to pick up her kiddies. This same scenario happened two appointments in a row (including the exact same words from nurse). When the doctor came rushing in, she was so not in the present and not really listening to me. The hospital gown blanket should have given her a message, too.

        When I walked past the receptionist, she stopped me to say we need to schedule the next 3-month follow up, and I just said “no thank you” and walked out.

        Like

        • Carolyn Thomas September 1, 2012 at 7:13 am #

          Okay. 1. Note to Self: do NOT book the last appointment of the day (you’ll be paying the price for the accumulated delay from all afternoon appointments) and 2. Note to Doctors: be warned that if you abandon patients in the (icy cold) exam room for too long, they will rummage through your supply cabinets at will.

          Like

          • Pamela Schaberg September 1, 2012 at 3:47 pm #

            hmmmmm – wonder what little treasures I could find in the exam room? Maybe a year’s supply of Band-Aids!

            Like

      • Pamela Schaberg September 1, 2012 at 6:48 am #

        My former cardiologist used to keep me waiting at least 3 hours after my appointment time before putting me in an exam room, and at least an hour in the exam room.

        I used to take books and a snack when I had an appointment- I’m diabetic and can’t miss my snack without problems.

        He yelled at me for bringing in food. I told him that I wouldn’t have to if he would see me at my appointment time. He didn’t like that, and by that time I really didn’t care if he liked what I said or not – lol.

        I have since switched doctors, and she has never kept me waiting for more than 10 minutes past my appointment time.

        Like

        • Carolyn Thomas September 1, 2012 at 7:03 am #

          “He yelled at me for bringing in food…” Are you kidding me? He should have provided a buffet for patients waiting that long. That’s pure scheduling mismanagement. Glad you switched docs, Pamela – your new cardio also demonstrates that scheduling competence is possible.

          Like

          • Pamela Schaberg September 1, 2012 at 3:53 pm #

            I should have switched long before I did. I saw the first cardio at the hospital recently, and he actually asked me why I switched. I explained my reasons and actually got an apology from him! But I’m definitely staying with my new cardiologist.

            Like

            • Carolyn Thomas September 1, 2012 at 9:08 pm #

              He kept his patients waiting for four hours – and he yelled at you for bringing in your snack – and he still actually had the gall to ask why you switched docs? My cardiologist has never kept me waiting more than 10 minutes – ever! – so I just don’t buy the “it can’t be helped – emergencies happen” rationale from specialists. If it were true, than ALL patient wait times would be comparably long.

              Like

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