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Science & Health
Wed April 2, 2014
Why The Doctor's Always Late
Originally published on Wed April 2, 2014 1:51 pm
Patients wait an average of about 20 minutes at doctors’ offices, according to national data from healthcare consultants. It’s a major annoyance for patients who are stuck leafing through dated magazines, and worrying about work piling up on their desks.
What’s the hold-up? What’s happening behind that waiting room door?
From the Here & Now Contributors Network, Maiken Scott of WHYY wanted to find out, so she spent a morning with Dr. Peter Gearhart of Penn Ob/Gyn and Midwifery Care, a busy practice in Philadelphia.
ROBIN YOUNG, HOST:
It's HERE AND NOW. With more than 7.1 million Americans signing up for insurance coverage under the Affordable Care Act, more people will likely be showing up at doctors' offices, and that in turn can mean more time in the waiting room. Right now according to the Vitals Index, patients spend an average 20 minutes and 16 seconds in the waiting room, leafing through often dated magazines.
Have you ever wondered what's the holdup? Well, from the HERE AND NOW contributors network, Maiken Scott of WHYY went to find out. She spent a morning with Dr. Peter Gearhart of Penn Ob/Gyn and Midwifery Care, a busy practice in Philadelphia.
PETER GEARHART: We really got to go. We're going to be late.
MAIKEN SCOTT: At 8 o'clock on a recent Monday morning, Peter Gearhart is trying to get three little dogs and one of his three sons out the door.
SCOTT: On his way to his practice, Gearhart drops the dogs off at his wife's office, drops his son off at school, then he gets a call from Pennsylvania Hospital. A patient he operated on the previous week is ready for discharge. They want to know if he wants to see her before she leaves. He dictates a text message into his phone while walking.
GEARHART: Yes, she can go home; however, I won't be able to see her until the afternoon because I am in the office this morning. If she wants to see me, she'll have to wait, otherwise...
SCOTT: Moments later he changes his mind.
GEARHART: We should see her. You know, the problem is I didn't really get to see her over the weekend, and it's kind of not cool to not see her before she goes home. You don't want to just hear from some random person that everything's fine, and you're OK. You want to hear it from the surgeon that operated on you.
SCOTT: He races into the hospital, sees his patient and minutes later is back on his way toward his practice. He arrives there a few minutes late. He has patients scheduled from 8:45 to 4:15.
GEARHART: So this is my 9 o'clock patient I'm going to see first. Is that right? OK, so I'll see my 9 o'clock patient, and then I'll see my 8:45 patient who just got here. OK, great.
KATRINA DRAKE: He's seeing his second patient first because his first patient was late.
SCOTT: Katrina Drake is the lead medical assistant in the practice. She weighs patients, takes their blood pressure, goes over their medical issues, and she keeps Gearhart on track and patients flowing in and out of five different exam rooms. She's constantly checking a computer screen were different colored dots tell her where patients are.
Is it kind of like playing Tetris, where...?
DRAKE: It is absolutely like playing Tetris. I'm constantly refreshing the screen, looking at his schedule, and a five minute visit can turn into a 20 minute visit, or what you think is a 20 minute visit could actually be a five minute visit. So it's kind of hard to gauge, but you just go patient by patient.
SCOTT: Gearhart comes out of one of the exam rooms. So far he's pretty much on time. So you've seen two patients so far?
GEARHART: I've seen three people so far.
SCOTT: Three? How did you do that? I only saw you see two.
GEARHART: I don't know. You just have to be quick.
SCOTT: At her computer screen, Katrina Drake is trying to deal with a problem. A pregnant patient who came in for a so-called non-stress test that monitors the baby's heart rate is not getting a good reading.
GEARHART: We moved her over to the ultrasound machine.
SCOTT: So that could tack another five to 10 minutes onto the visit. As of right now, Gearhart is only about 15 minutes behind, but that's because two patients haven't shown up yet.
DRAKE: So if they show up, then we'll have a different story.
GEARHART: It's always a good thing-bad thing when there's a cancellation because it helps catch up the schedule. On the other hand, it means somebody's not getting seen, and they probably have some kind of an issue.
SCOTT: But then the late patients walk in. One is 45 minutes late, the other 30 minutes. So the schedule is completely off. The practice does not turn away late patients; they just might get bumped, or they have to wait. But it causes problems.
GEARHART: I mean, you hear a patient coming in here waiting. You don't know that the person who was ahead of you was 45 minutes late. All you know is that you were on time.
SCOTT: Gearhart races from room to room trying to catch up.
GEARHART: Hello. Hello. Hello. How are you?
SCOTT: Then another problem arises that will throw off the schedule further.
GEARHART: So I just saw a patient who is here for a routine screening visit, and she has some problems that we have discovered today. She's going to require a minor surgery in order to deal with those problems. And I am forced to either tell her to come back so we can deal with that, or I can deal with it now, I can answer her questions and set up, schedule the surgery and all of that sort of thing.
SCOTT: He opts to deal with the issue now.
GEARHART: You know, it's a real problem now for the patient, and for me to tell her that I don't have time to deal with it is incredibly insensitive.
DRAKE: So what do you need to get for him?
GEARHART: I also have to go pee.
GEARHART: Which yeah, I have to go get paperwork. So she's getting dressed. I'm now officially behind schedule. Hey, how are you. Sorry, I'm running behind schedule.
SCOTT: Gearhart was supposed to take a lunch break around noon, but Drake knows that won't happen.
DRAKE: He is still finishing out with his 11:30, and it's now 12:12.
SCOTT: By 12:30 he's seen 18 patients. He steps into his office for five minutes to wolf down his lunch, portable food as he calls it.
GEARHART: It's a burrito wrap with whatever was leftover from dinner thrown in there.
SCOTT: He says a day in the office is the hardest part of his job, harder than a difficult birth or any operation.
GEARHART: In the office, your brain is constantly trying to think about three or four different things at once while making sure that you slow down enough to look the patient in the eye, hold her hand if she needs it, listen. Listening is - excuse me - listening is very important.
SCOTT: So why doesn't he just schedule fewer patients in a day? He says it's not an option.
GEARHART: Who would see those other patients? All of my colleagues are equally busy. And what we're seeing with expanded access to health care is there is even more patients waiting in line to be seen.
SCOTT: And with that, lunch is pretty much over.
GEARHART: This is my third bite. I'm going to have one more right now, and then I'll save the rest for later.
SCOTT: And it's on to round two, the afternoon patients. For HERE AND NOW, I'm Maiken Scott. Transcript provided by NPR, Copyright NPR.