A patient's perspective on the "15-minute appointment"

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Two areas of concern to patients are 1) access to care and 2) how long they wait once in the office to see the doctor. The doctor's awareness of these two issues related to the patient's concept of time can provide their practice with a strategic advantage. If your practice is looking to attract new patients or retain existing patients by respecting their time, read this.

Look at the traditional "15-minute appointment" from the patient's perspective. Consider a typical urology patient's experience with their doctor.

A 30-year-old man awakens in the morning with acute onset of testicular pain. The patient calls the office and is told by the answering service to call back at 9:00 A.M. The man returns the call at 9:00. He is told to come to the office to "be worked in" at 11:30. The patient arrives at 11:00 to complete the paperwork and is seen by the doctor at 12:15. The doctor spends 15-minutes with the patient. The doctor wants to be sure he doesn't have a testicular torsion and refers him to radiology for a scrotal Doppler study. He goes to the hospital's radiology department and waits 1 1\2 hours for the study.

The technician doesn't provide the man with the diagnosis but tells him to go back to see the urologist. The patient returns to the urologist's office at 2:30 P.M. He is taken to the exam room at 3:05. The report from the radiologist has yet to be dictated. The urologist asks the nurse or medical assistant to get the radiologist on the phone to provide the results of the Doppler ultrasound study. At 3:35, the urologist learns that the study demonstrates increased blood flow to the testis, confirming the diagnosis of epididmorchitis.

The doctor returns to the exam room at 3:50 and spends 10 minutes with the patient, explaining the diagnosis, discussing the treatment, and providing him with prescriptions for anti-inflammatory medication and antibiotics. The patient leaves the urologist's office to go to the pharmacy at 4:45 and waits 30 minutes to fill his prescription. The time lapse is nearly 8 hours, of which 25 minutes were spent with the urologist.

Now, if you ask this patient how he feels about the healthcare system and if he had a positive experience, the answer will be an unequivocal no! If you ask the doctor if they have any idea how much time the patient spent waiting for the doctor, waiting for the imaging study, and waiting for the prescriptions to be filled, they won't have a clue.

This man's experience is not uncommon and is the usual and customary experience of many of our patients. While a doctor's appointment may not require an entire day, the typical visit occupies a significant portion of the patient's day and requires substantially more time than the doctor and staff might realize. Certainly, I am not implicating that the doctor is entirely to blame for the extended time that may be required to reach a diagnosis, however, being aware and sensitive to the potential for this extended outside time and improving the wait-time for the initial access to the practice and then reducing patient waits while in the office are certainly within the control of the doctor.

The practice that learns how to control access and waiting within the office will go a long way to improving patient satisfaction, treatment outcomes, practice profitability, enhancing online reputation, and decreasing the risk of litigation.

Easy patient access and short waits require streamlined practice operations. If you plan to make changes in your practice, removing barriers to entry is an excellent place to start.

I have found that most practices have 2-3 urgencies or emergencies each day, just like the patient we described with acute scrotal pain. If the practice left just two fifteen-minute unfilled slots in the schedule and a patient who had to be seen that day, the patient with emergency could be placed in one of those open slots and told to come at the designated opening, thus avoiding long wait times. Also, patients inserted or squeezed into the schedule often delay previously scheduled patients, resulting in decreased patient satisfaction for more than the patient with emergency\urgency.

You can also reduce wait times in the office by asking patients to complete the health questionnaire before they come to the office. They should also fill out their insurance and demographic information before coming to the office. Finally, patients can be educated through your website. The receptionist or the scheduling person should ask about the purpose of the visit and direct the patient to educational materials on your website.

And just one more thing: The doctor must start the office clinic on time. Delays in starting the day will negatively impact the schedule, and it is almost impossible to make up time if the doctor is late and spends time sorting through messages and E e-mails, having a cup of coffee, and returning a few phone calls.

Instead, we recommend the doctor arrive at least 15 minutes before the first patient is placed in the exam room.

Bottom Line: Nearly all practices are interested in attracting new patients and giving the existing patients a positive experience. Often, we need to meet patients' expectations. Therefore, it is a good idea to get into a patient's mindset and hear what they are experiencing. Then, it is imperative to act on your findings and find ways to reduce entry barriers to our practices and enhance the patient experience once they are in the practice.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.