Waiting-Room Blues
Why can’t you see the doctor on time?  

Martin Tanguay

At l’Actuel, a world-renowned Montreal clinic specializing in preventing and screening for sexually transmitted infections (STIs) and HIV, a sign on the receptionists’ counter delivers the following message: “The receptionists are not able to estimate waiting times.” Clearly, more than one disgruntled patient had asked them “How much longer?”

“It’s true that office staff can’t estimate a patient’s waiting time because the doctor himself handles his schedule, and it’s not possible for us to know at what point the physician is in his consultations,” says Line Provost, the clinic’s general manager.

We live in an era of too many patients and not enough doctors — Canada recently ranked 17th out of 20 Organisation for Economic Co-operation and Development countries in the ratio of doctors to population. Given the high demand for doctors’ services, a medical receptionist will generally allocate 10 minutes for a routine consultation — unless a patient specifies at the time of booking that he will need more time. “An initial visit always takes longer, usually more than 15 minutes, because that’s when doctor and patient get to know each other,” Provost says.

Sometimes a consultation lasts longer for unexpected reasons. Say, for instance, a woman calls to book an appointment for a “sore foot.” At examination, the doctor finds that she in fact has a serious infection due to her diabetes and requires immediate admission to the hospital. In that case, he might first consult with a colleague to confirm the diagnosis, then proceed to make arrangements for hospitalization.

“When a doctor has to make a serious diagnosis, she has everything to gain by carefully evaluating the situation, judging the patient’s reaction and perhaps offering psychological support,” Provost adds. As a result, the routine consultation for the sore foot may take an additional 20 minutes, or more, throwing off the schedule irreparably. The result? The next several patients will experience a delay.

Other time-gobbling surprises can also arise. In this context, Dr. Stéphane Lavoie, an HIV and STI specialist at l’Actuel, recalls one patient who showed up for her own appointment wanting him to examine her five-year-old, who was suffering from a dreadful cold. Clearly, the woman herself was there for a completely different reason but, hey, why not kill two birds with one stone? “I checked her out — I had studied general medicine, after all — but the dynamic of the consultation was spoiled. The presence of a third person threw off the quality of the doctor-patient interface and took more time,” Lavoie says.

Finally, bear in mind that a doctor who devotes part of her day to examining patients in a hospital will sometimes be held up by an emergency there, which delays her arrival at the office and increases patient waiting time.

On a more hopeful note, Lavoie points to a fundamental difference in attitudes to managing schedules  between different generations of doctors. “Gone are the days when a doctor would schedule everyone for about the same time. Older doctors take it for granted that patients have to wait,” he says. “But today, new doctors are made aware of the importance of good time management.”