Impatient Patients

Q. I'm often stuck in the doctor's waiting room for hours! Doesn't he owe me something for my wasted time? 

A. The Shulchan Arukh (authoritative Code of Jewish Law) states: "One who puts someone into a room and closes the door on him, preventing him from working, is liable for his lost time." This is certainly how the patient (or parent) feels -- as if he or she is trapped in the doctor's office.

But realistically, a patient is not imprisoned in the waiting room, and it's not really fair to expect the practitioner to compensate you for your time – which after all you're not using for the doctor's benefit.

Still, so many readers asked this question that I am devoting a special column to how we can deal with this exasperating situation with dignity. Like most interpersonal dilemmas, the key to curing the waiting-room blues is mutual thoughtfulness.

Patients should keep in mind that there are many valid reasons for delays. Greed and sadism are not really the only factors at work! For one thing, the carelessness and missed appointments of patients themselves compels practitioners to overbook in order to keep hard at work at all times. When people do show up, long lines are the result. A better on-time record for patients will ultimately mean shorter waits at the doctor's.

Another reason is emergency calls. As one doctor exclaimed when I asked him about this problem, "How am I supposed to know when some woman is going to come in with chest pains?" We expect the physician to put his regular schedule aside when we have a medical emergency; we need to have patience for the extra wait this imposes on us when, thank God, there is no emergency.

One thing patients can do to shorten waits is to call ahead. If you have a two o'clock appointment, call the receptionist at one! If she says that the doctor is just now taking patients with 11:30 appointments, you know that you don't have to arrive any earlier that 3:15 or so. Of course doctors and receptionists should be forthcoming with this information.

Physicians should contribute their share too. If you really care about your patients' time, don't wait for them to call -- have the receptionist call up patients and inform them that their appointment is delayed! If possible, allow them to reschedule. A small extra investment in receptionist hours can save your patients dozens of hours each day.

Practitioners can also adopt more effective scheduling practices. Dr. Leon Zacharowicz informs me that he has dramatically cut no-shows at his practice by not giving exact times for distant appointments. Instead, the patient is at first given a generous advance "window" in which to schedule; a few days beforehand the patient calls to set an exact time. (Example: in November the patient is told to call "in two months". Only at the beginning of January does the patient call back and set an exact time. Of course the practitioner has to learn to keep enough empty slots for patients who have been instructed to call.)

If emergencies are an ongoing part of a practice then the schedule should partially reflect this. (Probably obstetricians and cardiologists have more of these than dermatologists.)

The best advice of all is: take it easy! Learn to take advantage of the waiting time. It is ironic that the harried parent who is chafing at the long line at the pediatrician is the same parent who complains that he or she just doesn't have enough time to spend with the children. And the busy executive who is apoplectic about the wait at the periodontist is the same person who complains that he or she has no time for Torah learning.

A final note: for anyone who thinks that long waits at the doctor are something new, here is an excerpt from a letter written eight hundred years ago by Maimonides, who was not only one of the greatest scholars and leaders in Jewish history but also a prominent physician: "I do not return to Fostat until the afternoon. Then I am famished, but I find the antechambers filled with people, Jews and Gentiles, nobles and common people, judges and policemen, friends and enemies - a mixed multitude who await the time of my return. . . . [I] ask them to bear with me while I take some light refreshment, the only meal I eat in twenty-four hours. Then I go to attend to my patients and write prescriptions and directions for their ailments. Patients go in and out until nightfall and sometimes even, as the Torah is my faith, until two hours or more into the night."

SOURCES: Shulchan Arukh Choshen Mishpat 420:11; Maimonides' letter to Shmuel Ibn Tibbon.