The REAL reason you are waiting for ages in public outpatient clinics

You arrived at 2:25pm. Your appointment was at 2:30pm. Now it’s 3:25pm and you’re still waiting.

It seems like only one or two doctors are even calling anyone AND it feels like everyone else is being called except you. In fact, that woman with the three kids arrived after you and she’s already been called!

Did they forget you? Has your chart been lost? Are they all just sitting at the back and having a coffee??

The problem is that the maths is wrong

If it makes you feel any better (it probably doesn’t), it is almost as anxiety provoking to see a room full of patients waiting as being the patient waiting! There’s nothing worse than turning up to start a clinic at the appointed time and seeing that ALREADY there are a million people waiting to be seen.

How can this be?

There’s a viral blog this week by Dr Eric Levi, an ENT surgeon (https://ericlevi.com/2017/05/13/the-dark-side-of-doctoring/) and the reason we are jumping up and down saying “Yes!” is that he’s said what no one else has dared to say yet.

He says: “I have little say in organising my very own operating lists or clinics. Even the power to re-order the operating list has been taken from the surgeon. The thing that I love doing (operating & seeing patients) is being measured, recorded and benchmarked. The clinics are overbooked to get numbers through. The paperwork for each patient encounter is increasing with each passing year. There are so many other non-clinical departments dictating what I should do and how best to do it. The mantra is “cost-effectiveness and increased productivity.”

Thus it is that the clinic appointment template is set up (by someone in fairyland probably) so that when clinic starts at 8:30am, say, eight people have an appointment at this time. Week after week, I saw this and the problem is that it doesn’t make sense!

There would be eight patients booked at 8:30am but there were only six doctors so… some simple maths means that only six patients will be seen at 8:30am. So what happens to the remaining two patients?

Naturally, they are not seen until the first lucky patients are seen (since we haven’t perfected time travel yet).

I’ve had patients wondering what the heck is going on since they booked ‘the first appointment’ so shouldn’t have had to wait. Unfortunately, so did seven other people!

Worse, there’s another eight patients booked at 8:45am.

So if there’s still two patients to see from 8:30am, then by 8:45am, there’s now ten patients waiting to be seen! And still only six doctors to see them.

That’s assuming all doctors turn up on time – they might be caught up on the ward or call in sick or whatever. Then we need to only take 15 minutes with each patient – except we might need to spend five minutes chasing an ultrasound report, ten minutes explaining a complex procedure to the patient, and we haven’t even started the examination yet! Patient ID stickers are the best invention since sliced bread but I have to spend another two minutes finding a Medical Imaging form (there’s never any in the drawer despite grabbing a handful and stuffing it there last clinic), filling it in, and faxing it. I could find a midwife/nurse to fax it for me but the time spent finding one and explaining what needs to be done is probably longer than just shoving it into the fax machine.

So by 9am, when another eight patients turn up, there’s now at least twelve patients to be seen! Still only six doctors. Uh oh, now at least six patients will have to wait at least another round to be seen.

Anyone else getting palpitations yet?!

Not all six doctors are specialists – there’s a hierarchy. Usually, a few of the doctors are junior and need to discuss most cases with the senior doctors so the chances of getting through a patient in 15 minutes are slim… So that’s one patient from the previous round not being seen until yet another round of appointments.

Then there are complex cases that take more than 15 minutes – say 30-45 minutes. That’s another 2, maybe even three, patients kept waiting.

By 10am, the avalanche is in full swing. I’m almost afraid to open the door to see the sea of expectant (and sometimes cranky) faces.

Then the midwife asks if she can add a patient to the clinic as they need to be seen ‘urgently’…

On a good day, all the patients have arrived, and we catch up by the end of the clinic, having gone through hell and back. On a bad day, the clinic drags on until hours after it was supposed to finish.

More than once, I’ve questioned this – “Hey, this doesn’t make sense! How can we change this?” But the reply has been “That’s the template and it’s set in stone”. Okaaaay…

This has been one of the joys of my own practice. No stupid double booking. No more waiting. More than 15 minutes so there is time to say more than “Hi! All good? Great. Bye”. No more palpitations!

So why does she get seen first when she arrived after me?

Fair or not, if you arrive early and someone else arrives on time, the someone else will be seen first.

The other fact about public clinics is that there may be more than one ‘clinic’ operating at the same time, using the same waiting room. The other person may be in another ‘clinic’ – maybe the other clinic is ahead.

But last week I was seen on time!

On some lucky days, all the stars are aligned. Everyone is on time (or even early), all patients are not complex and only take up the allotted 15 minutes and no more, maybe some patients don’t even turn up, and miraculously most patients are seen on time. Those are the days we stand around bewildered that we were actually finished on time and say, “Huh! That wasn’t too bad”