Monday, 28 July 2008

Punctuality

Nobody likes to be kept waiting. It can be a sign of disrespect, though not always. Louis XVIII of France said that punctuality is the politeness of kings, but it seems difficult to provide in a medical environment. Businessmen may be able to keep their meetings on time, but those meetings are relatively long and have a set agenda. A GP “surgery” will comprise 15 or more consultations lasting little more than 10 minutes each. Patients may bring as much or as little material as they wish, and the doctor will probably have his own tasks that he wants to perform. Intimate examinations that require extra time may become necessary. Hospital staff may need to be contacted immediately (though never swiftly). And of course there may be interruptions of various sorts. So it is little wonder that GPs tend to run late.

Some GPs keep to time fairly well, and I suspect that they keep a firm hold on proceedings in order to do so. Their patients must be kept on a tight rein. In our practice we cut our patients a little more slack, and consequently tend to run late. That is the sort of practice we are. In a town people can choose their GP practice to some extent, and we tend to retain patients who like our way of doing things and lose those who are frustrated by it.

Recently I saw two patients who illustrated this quite well. The first was a new patient, who is used to a high degree of respect in his job . I was running 20 minutes late when I saw him, which I consider to be pretty good going by the second half of the morning. He looked bothered and his first comment was that we would have to be quick because he had another appointment to get to. However he seemed to relax a little during the consultation and appreciate the way I dealt with his problem, although he rushed off as soon as we had finished. I hope he will eventually decide that the sort of consulting we provide is worth allowing a little more time in his busy schedule.

The second was a mother with her young child. I didn't really recognise her since I see lots of mothers with young children, but it turned out that she remembered me. Her child was almost the last patient I saw at the end of a busy Monday morning surgery, and they had been waiting for over an hour. I felt bad to have kept them waiting so long, and I apologised as we walked down the corridor together. The unexpected and totally charming reply was “that's alright, we don't mind waiting to see you, Dr Brown”.

The more I think about it, the more delighted I am by her response.

17 comments:

Disillusioned said...

The two GPs I prefer to see both have the philosophy (which one put into words for me) "You can have as much time as you need." Both run late. Like your lst patient, I don't mind. To my mind, if someone else needs the time, they are entitled to it - and I know I will get the time I need too. Sometimes that is 2 minutes, sometimes a lot longer. It's a good tradeoff, in my opinion, for good care.

Anonymous said...

At my current GP surgery, which we have been with for 18 months, I can never remember who my "assigned" GP is supposed to be and have seen most of the seven or eight GPs at some point. However I now have a "favourite" who I will try to see if I can. He is the only one who is unfailingly running late, but I don't care, because (unlike the others) he is smiling, relaxed and welcoming when he calls you through, takes plenty of time to listen, discusses the options with you as opposed to telling you what to do, is full of personal anecdotes to illustrate his understanding of his patient's point of view, and (surprisingly I suppose) actually makes physical contact - a handshake, a reassuring touch on the arm etc etc. (and was the only one of a couple of GPs I saw about some stomach pain who actually physically examined my stomach). You leave a consultation with him feeling as though it was worth the effort (and for me it is a great effort) - not always the case with others. And he never seems fazed by me turning up with husband and both small children (husband can't control them both on his own in the waiting room so we have to come in as a family).

A very long comment, but I suppose the key word here is flexibility. Patients appreciate flexibility. (Well I do anyway.)

Anonymous said...

I am a GP too. If I run more than ten minutes late I start getting anxious so I build catch up times into my surgeries and don't consult for longer than two hours without a half hour break. I suppose my patients don't usually find me running very late unless a catastrophe has happened. This is probably why they are less tolerant of lateness! At the same time as trying to run to time I'm trying to make them feel I have all the time in the world and no thought for anyone but them (and certainly not the queue in the waiting room). Now I describe it I see why I get stressed.

Petra Huijts said...

Some GP surgeries in the Netherlands ask their patients whether they think they'll need 10 minutes or maybe 20 is better. If the patient declares that he needs a lot of time, two consecutive appointments are booked and can be used.

In my current GP surgery, the assistant already asks at the phone what the appointment is about. I'm not completely sure whether they use this information to plan the length of my appointment; but sometimes they have given me information over the phone that was enough to help me, so I didn't need an appointment after all.

Other GP surgeries even have a note hanging somewhere, that it is only allowed to have one complaint per appointment (and that, if needed, patients can book more than one consecutive appointment), but I find that a little bit impolite; and the GP then also sometimes really has to say: "I am sorry, but this is a new complaint you bring up now, so please make another appointment." . This may not be the way you would like to work!!

If you know that you are always running one hour late at the end of the day; I would suggest to put in two half-hour or four quarter-hour "breaks" in between your appointments, that will almost always be used in catching up... And if you are lucky you might really get one!

That way, you will most of the times be "only" 10-30 minutes late on schedule and not more.

I think it is worthwhile for you to think about this and try and find something that works just a little bit better. It will not stand in the way of emergencies (they will be handled immediately anyway) and it will make life a little bit easier for you and for your patients.

Again, I love reading your columns, and I was glad to read that you feel much better than last year.

alhi said...

Like your last patient I don't mind having to wait and see my GP. She knows my history by now, never makes you feel as if you are holding her back and always has time to listen. It is also the same with the two hospital consultants I am currently under. Inevitably they run late, but again they take the time to listen, talk through any concerns you have and just generally make you feel as if you are their favourite patient:)

madsadgirl said...

You sound like my kind of GP. I would rather be kept waiting to see someone who obviously takes pride in the job that they do and makes sure that the patient receives the care that they deserve, rather than someone who races through a consultation and may fail to spot the things that my body rather than my words are telling him. You are the kind of doctor that makes our GP system the envy of so much of the world.

my alter ego said...

My aunt's oncologist told her at the first appointment that she would ALWAYS be late, but that whenever she got there she would take as much time as needed. I think this was a good approach - and people for whom the punctuality aspect is more important can go elsewhere, and being forewarned is much better than sitting in the waiting room, not knowing when, if ever, they will get to you. I try to tell this to new patients myself.

Xavier Emmanuelle said...

I totally agree with your philosophy, take the time you need.

Normally I'm a stickler for punctuality, but in terms of medical care I don't mind waiting because it generally means that I will be getting better care (won't be barely listened to and rushed out in 5 minutes).

That is indeed a lovely thing your patient said to you :)

Flossy said...

I 'enjoy' going to my GP with 'look - sore throat in child!' or 'look - bad eye!' comforted by the fact thant these simple, 2 minute appointments allow him to catch up a bit, meaning he has the time for me when I (or my kids) are a bit more complicated :) Keep it up - we appreciate that some people need more of your time than others and we don't mind waiting (it might be us needing the time one day...)

janeway said...

All my children had ear problems when they were younger, and the specialist who treated them habitually ran up to 3 hours behind. In the end, I didn't mind, because he was a wonderful doctor, but I learned (quickly) to call his office before the appointment to check out the situation before I left.

ageing student said...

To Anonymous who posted on 28 July at 22:03, you must be registered at the same practice as I am and seeing the same partner! What you say sounds just like him though I suspect there are others around with the same inter-personal skills. Actually the only diference is that my GP rarely touches anyone. I think he comes from the Sir Lancelot Spratt school of medicine which preaches that you examine the patient with your eyes, not your hands. The first time I saw this partner was about one of my children who had been having panic attacks and he spent over an hour with us. I was so impressed that like you I rarely see any of the others.

No One said...

yes GPs have a unique job, and for many of the reasons you state it can be difficult to stick to a schedule

BUT having accessed GPs in New Zealand, Italy, Belgium etc etc I can tell you they are by and large much much better at keeping their time slots than UK GPs

Now those foreign docs are doing exactly the same kind of work as UK GPs, indeed some of them ARE UK GPs working abroad

So you can see why folk who have experienced this get dicked off with the usual chaos and mismanagement at the typical UK surgery

AND some surgerys are REALLY bad, eg EVERYONE knows some of the docs are just sleeping in and turning up a few hours late regularly

In the absense of some free market economics with patients able to vote with their feet the suppliers (GPs) can and do what they want

So sympathies, especially for the better GPs, but as a system for the UK its totally failing, especially for those with the bottom 20% of GPs

Anonymous said...

buy a copy of the gaurdian today (i normally dont read it) cos it does give a useful map of where the better GPs are versus the worse GPs

Anonymous said...

When we recently audited (yuk!) our surgery times, we discovered that all of the partners were taking on average 14 mins per consultation - so we made our surgeries longer to see the same number of patients but with 15 min slots. The effect has been wonderful and sometimes we are even ahead of ourselves! It is so much more relaxing to not feel under pressure. The surgeries look better to the PCT because they are longer - although in practical terms they are no longer than we were actually doing anyway! Another advantage has arisen from switching to advanced bookings - we now regularly have at least one DNA (Did Not Attend) per surgery - which helps with time management! In the past with only booking 48hrs in advance we had virtually no DNAs.
Viz a vis patients making nice comments, one middle aged lady said to me earlier this week "I cry when you're on holiday" - crumbs!

acountrydoctorwrites said...

Hello. I, too am a middle aged Family Practitioner. I live in the US, but was born and trained in Sweden. I am so pleased to have found your blog. I write about similar things. Time and puctuality are always issues in our profession, and our patients' tolerance varies greatly.

I am adding you to my Blogroll.
http://acountrydoctorwrites.wordpress.com

Jobbing Doctor said...

I am a rather slow and methodical consultor. I allocate 10 minute slots, and sometimes I run to time and frequently I don't.

I make it my business to let people in my waiting room know I am running late and nobody complains - the say 'If I needed the time, Jobbing Doctor, I know I'd get it'. This takes some of the pressure off.

Many of my patients are regulars, so it might be the 37th consultation in a series - and it can be quite short because it is a continuation of the last one: a little like a circus performer spinning plates - you need to give them an occasional tweak.

JD.

Dr Andrew Brown said...

Many thanks to all for your thought-provoking and informative comments. It's good to get this sort of feedback.

My appointments are currently set at 14 minute intervals. I worry that if I lengthened the time available I would slow down further. Some sense of pressure is needed.