Answer: You have good reason to feel annoyed. Many Canadians, at some point, have found themselves waiting a long time for an appointment with a doctor who was running behind schedule. Yet it’s unusual for patients to be sent home without even seeing the physician.
It’s also understandable that you don’t want to go back to that physician’s clinic. However, asking your family doctor for a referral to another specialist may lead to additional delays in getting the expert medical advice you are seeking from a specialist. After all, you’re likely going to start at the bottom of a new waiting list.
So it may be worthwhile giving the specialist another chance. At the very least, it will give you an opportunity to tell the doctor you weren’t happy with what happened.
“Direct communication is always the best,” says Dr. Joshua Tepper, president of Health Quality Ontario, an arms-length agency of the provincial government.
“It’s important for physicians to get feedback from their patients,” especially when something has apparently gone wrong.
The doctor may have a reasonable explanation for why your first appointment was essentially cancelled after you had arrived.
Dr. Tepper notes that doctors working in hospitals often have competing demands on their time. “They can be pulled in multiple directions,” he says. “They may be running a clinic, but may also be on call for the emergency department or have sick patients in the wards.”
Medicine can be unpredictable, too. “Sometimes it just takes one very sick patient to really throw off your schedule,” says Dr. Tepper. “It might take an hour or more to get that patient properly cared for.” And on days when there are several of those cases, the schedule could go totally out the window – which might have happened in your situation.
Dr. Tepper acknowledges that some doctors could do a better job in how they schedule patients “and work better as a group of doctors to help each other when things are busy or unexpected events occur.”
In your case, the clinic’s waiting room was already full of other patients by the time you arrived. It sounds like the physician’s office booked a group of patients for the same time slot and you just happened to be the last one through the door.
It’s also worthwhile mentioning that some doctors intentionally overbook their clinics, anticipating that a certain percentage of patients won’t show up or will cancel at the last moment. They run into problems when all the patients do arrive for their appointments.
If you are still reluctant to talk directly to the specialist who stood you up, you can lodge a complaint with the hospital. Most medical centres have departments that deal specifically with the concerns of patients and their families. At Sunnybrook Health Sciences Centre, that department is called Office of The Patient Experience.
“You could also write, or phone, the hospital CEO or the chief of the department,” where the doctor works, suggests Dr. Tepper.
Hopefully, you will get an explanation for what happened. You deserve to be treated in a more respectful manner.
Indeed, opinion polls repeatedly show that Canadians generally support public health care. But our system sometimes falls short on what could be called “customer” service.
“Patients are expected to arrive for their appointments on time and to give proper notice if they can’t make it. So physicians should do their best to be on schedule,” says Sally Bean, an Ethicist and Policy Advisor at Sunnybrook.
“Certainly unforeseen things come up. We can all appreciate that. But then it becomes a matter of managing the patients’ expectations,” she adds.
If a doctor is running exceptionally late, the patients in the waiting room should be informed of the delay. “The support staff … could let people know what’s going on, so they have an awareness of the situation,” says Ms. Bean. Keeping patients in the loop is a way of acknowledging that their time is valuable, too. “I feel it really is a matter of mutual respect.”
Dr. Tepper points out that efforts are now underway in Ontario to make health care more “patient-centred.”
In 2010, the provincial government established Health Quality Ontario (HQO) with a mandate to increase service-providers’ accountability and boost the voice of patients in the system.
For starters, it has been running a program that teaches family physicians (and their staff) how to book appointments so that patients get timely access to health care.
HQO is now in the process of setting up an Institute of Patient Engagement.
And in early December, the Ontario legislature passed a bill creating a new patients’ ombudsman office that will be based at HQO.
The ombudsman will become another option for patients who have concerns about their care. “Patients should deal with their health-care provider first and their local [hospital] institution first,” explains Dr. Tepper. If a patient still feels an issue has not been properly addressed, then the ombudsman could look into the case.
“Ideally, the better job we do at the front end of patient engagement, the less we will have a need for an ombudsman at the back end,” he adds.
Of course, the health-care system isn’t going to change overnight. But let’s hope these various initiatives will eventually put a little more customer focus into the delivery of medicine. Maybe then what happened to you would become a very, very rare occurrence.
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Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
The comments section is closed.
The fact that we are still mentioning patient-centred care means that it still is not happening yet.
It would be easier to perform “patient centred” care (whatever that means) if I didn’t have to deal with 5 problems per visit with a waiting room full of 30 people; each of whom want 15-20 minutes though 15-20 patients per hour are showing up at my door. If I had three patients per hour, I would come in with a fresh beverage of choice for the patient. Of course, I would also be bankrupt because the pay per visit is so miniscule.
This is a difficult and inflammatory subject for both patient and doctor. I find that often even when a Doc is speaking with you that their mind has already moved on to the next “case”. If proper attention to the patient is paid and a thorough physical done it can often reveal surprising and interesting observations that assist medical experts in determining the appropriate level of care. Diagnostics and technology are in no way a replacement for the human evaluation.
Overbooked clinics are now the norm not the exception. If we had stats on the amount of work time missed by people waiting to see their health care provider I am sure that it would outstrip the man hours lost to labour unrest and strike activity. What makes this ok? What are the consequences of complaining about prolonged waits in clinics? Does a complaint actually seem like anything more that an annoyance from a troublesome patient?
Respect, excellent communication and cooperation are all that is required to improve the overall health care experience for those in Ontario. Electronic health records that are universally accessible and one electronic systems are long overdue. It will take public engagement and courage to move this issue forward in light of the last electronic health record debacle. It is time to insist that all care providers in Ontario use one information and record management system with a consistent format. In fact the entire country could use this model.
Minor or even major improvements to the booking system will in no way solve the issue of long waits
and demand is great and we have limited resources. If you are diabetic and booked into a clinic, always take food and a drink with you as well as any medications you may need. It is likely to remain a long wait.