Opinion: Waiting room — the value of time

Albert Einstein wrote about it. So did Stephen Hawking. Now, it’s my turn. I’ve been concerned (to put it mildly and in terms that can be published in a family newspaper) about the value that is placed on time. But I’m not going to try to fool anyone into thinking that I know anything about Einstein’s time-space continuum or Hawking’s concepts regarding cosmology and physics.

In particular, I’ve been upset by the inequality of the value of time for high-status people (let’s say physicians) versus low-status people (let’s say patients). How often have you arrived early or right on time for an appointment with a physician only to find that there are three of four people already seated on those flimsy plastic chairs? And, you all have the same appointment time.

Overbooking

In “The Doctor Is…Overbooked,” at the New York Times’ City Room Blog, Evan Falchuk reprints an excerpt from Joel Cohen, “…my wife and I are convinced that all medical students should have to pass Overbooking 101 before they can become (practicing) doctors.” The most common reasons that I’ve heard concerning the phenomenon of overbooking include (1) patients not showing up for their appointments, and (2) patients arriving late.

In and of itself, absent patients should not cause an overcrowded waiting room. If fact, it should lessen the time that patients have to flip through copies of National Geographic or House and Garden before being shown into examination rooms. However, physicians know this and book several people for the same time slot to allow for other patients who either skip or show up late.

Second, the problem of patients arriving late can be solved with a proactive approach. If a patient is 25 or 30 minutes late, send him or her home with a new appointment scheduled. Of course, if this were to happen, the doctor then sees $$ walking out the door.

Interim time

Another part of the problem is “interim time,” that is the elapsed time since the previous time that the physician has seen the patient until the present appointment. Most people don’t see their personal-care physician on a weekly basis. It may have been months between visits, and during that time it is likely that the doctor has seen hundreds, if not thousands, of patients. The physician cannot possibly remember what the patient’s condition is, what tests may have been made, or what she or he has previously prescribed. So, the physician has to review the client’s file between patient visits.

It would speed things up considerably if physicians reviewed the history of the patients the night before their appointments, but that would surely intrude on their home life. Then, imagine the wasted time if one or some of those patients canceled!

The bottom line

I think that the bottom line is that we need more physicians and some way to allay the number of patients who don’t really need to see their physicians. One solution is to encourage the training of more certified physician’s assistants, nurse practitioners, general practitioners.

Today, everything in medicine is specialized. Most people don’t need to occupy a specialist’s time for a cold, flu, or minor condition. Some years ago, a few medical schools were amenable to admitting 45- or 50-year-old students who had taken early retirements with reasonably good pensions. The idea was to train these people to handle common health problems. During the Vietnam War, many civilians had to be trained to handle common problems as well as battle-field injuries. That model could be used.

That would certainly help, but it would have had no effect on the three separate trips that I recently made to Fresno to get results from medical tests. Each trip took four hours of my day, and each time I was told that the results were “normal,” no problems. I asked why I couldn’t have received that information by phone. None of the staff had a satisfactory answer. My time simply had no value, except that having me come to the office allowed the physician to charge my insurance for an office visit.

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Jim Glynn is Professor Emeritus of Sociology. He may be contacted at j_glynn@att.net.