The doctor is late? Here’s my bill

After waiting two hours to see her doctor for a scheduled appointment, Elaine Farstad got angry. She went home, calculated her hourly pay and sent a bill to the doctor for her time.

“It’s ludicrous – why would I wait for free?” Farstad told CNN in a recent story for its Empowered Patient series. Over the years she has billed six doctors who were more than 30 minutes late; half of them paid her.

Few things rile up patients more than long waits at the doctor’s office. For years, most people simply complained and put up with it. But when patients like Farstad start sending invoices for their time, it seems the balance of power decidedly is changing. Especially if the physician actually agrees to pay the bill.

It’s not clear what to make of this trend, if it indeed is a trend. CNN talked to a doctor in New York who gives patients $5 in cash if they have to wait longer than 15 minutes for their appointment. Another physician in Oregon gives gifts of handmade soap or lotion whenever patients have more than a 10-minute wait to see her. Is this the norm? I doubt it (although it sounds nice).

Judging from the 1,200-plus comments, the CNN article obviously hit a nerve. A similar discussion has been raging at Kevin, MD, here and here.

The debate might seem simple. Beleaguered patients vs. greedy doctors. Hard-working doctors vs. demanding, self-entitled patients. If one thing emerges from the discussion, though, it’s that both patients and doctors are frustrated by the wait-time issue.

Do doctors often keep patients waiting? Of course they do, for a variety of reasons they can’t necessarily control. Dr. Emily Gibson writes:

The patient who is angry about waiting for me to arrive in the exam room can’t know that three patients before them I saw a woman who found out that her upset stomach was caused by an unplanned and unwanted pregnancy. Perhaps they might be more understanding if they knew that an earlier patient came in with severe self-injury so deep it required repair. Or the woman with a week of cough and new rib pain with a deep breath that could be a simple viral infection, but is showing signs of a pulmonary embolism caused by oral contraceptives.

Patients themselves can contribute to the doctor’s lateness by showing up tardy for the appointment, rambling instead of answering the doctor’s questions directly, raising too many issues to address in a single appointment, and waiting until the doctor’s hand is on the doorknob to bring up their most important concern.

The other side of the story? Some practices are disorganized and inefficient, resulting in a physician who’s consistently behind schedule. Sometimes appointment slots are double- or even triple-booked. Some organizations seem tone-deaf to patients’ frustrations with long waits – for instance, clinics like this one, who don’t book appointments for X-rays and thus force patients to literally stand in line waiting their turn. And what about practices who charge patients a late fee if they don’t show up on time, yet don’t hold themselves to the same standard?

Some of the research on patient satisfaction suggests it isn’t the lengthy waiting time that upsets patients; it’s lengthy waiting times with no information. Studies on this issue have found that when patients know the doctor is behind schedule, they want to be told – and they also want to be given the option of coming in later or rescheduling the appointment.

In another study, researchers analyzed patient satisfaction data that included wait times and the amount of time spent with the doctor. Their conclusion: Although long wait times are associated with lower patient satisfaction, what seems to matter most is the quality of time spent with the doctor. Patients who spent a long time in the waiting room and then were hurried through their appointment reported the lowest satisfaction. But when patients felt they had adequate face time with the doctor, they were more likely to view a longer wait as an acceptable tradeoff

What do readers think? At what point does the wait become too long – 20 minutes? Half an hour? Do you think it’s acceptable to bill the doctor for your time? (For what it’s worth, I think this is a bad idea – sure to tarnish the relationship and put the physician on the defensive, as well as being a poor use of health care dollars.) Share your thoughts in the comment section. If there are any clinicians out there, I’d be interested in your reaction as well.

Photo: Wikimedia Commons

7 thoughts on “The doctor is late? Here’s my bill

  1. I FEEL THERE ARE MANY OCCASIONS WHEREBY DOCTORS CANNOT CONTROL THEIR TIME AS THEY WISH. TOO MANY UNKNOWNS. HOWEVER, IF THERE IS AN EMERGENCY PLEASE INFORM US. AS FOR ME THAT WOULD HONE MY PATIENCE. BUT DON’T LET US SIT AND WAIT NOT KNOWING WHAT IS CAUSING THE WAIT. I REALLY DON’T EXPECT DOCTORS TO BE ABLE TO STAY ON THE MINUTE. ONE EXPERIENCE I HAD: WAITED ONE HOUR IN WAITING ROOM. PLACED IN EXAM ROOM FINALLY. READING MY BOOK. I LOOK AT MY WATCH. OBVIOUSLY, THE NOON HOUR NOW. I HAVE BEEN WAITING 45 MINUTES. AGAIN. I HEAR NO ACTIVITY. I STEP OUT IN THE HALLWAY. NO ONE. THEN I SEE ONE NURSE DOWN THE HALL. SHE IS AGHAST TO KNOW I AM THERE. I TOLD HER HOW LONG I HAD BEEN WAITING. AFTER A SHORT WHILE THE DOCTOR WALKS IN. SHE WAS NEW TO ME AS MY DOCTOR HAD RETIRED. SHE ACTED AS THOUGH NOTHING HAD TRANSPIRED OF A NEGATIVE NATURE. IT IS COMMON SENSE TO KNOW THAT THIS CAN HAPPEN. THE NURSE WHO DID MY VITALS WAS PLAINLY RATTLED AND STRESSED. THE HUGE NEGATIVE FOR ME WAS THAT THE DOCTOR ACTED AS THOUGH NOTHING NEGATIVE, OUT OF ORDER HAD OCCURRED. A ‘GEE I AM SORRY ABOUT THIS’ WOULD HAVE MADE IT A POSITIVE SITUATION. I AM FULLY AWARE THAT THESE SITUATIONS CAN AND DO OCCUR AND IT IS A FACT OF LIFE. SHE WAS A NEW DOCTOR FOR ME AS MY PREVIOUS DOCTOR HAD JUST RETIRED. I NEVER WENT BACK. IT MADE ME WONDER HOW EFFECTIVE SHE WOULD BE IN TREATING MY HEALTH ISSUES. THOSE FEW WORDS OF NOTING WHAT HAPPENED WOULD HAVE MADE ME STAY WITH HER AND CONTINUE TO ALLOW HER TO PROVE HERSELF. SIMPLE MATTER OF MANNERS AND CONCERN FOR OTHERS. WHEN DOCTORS SCHEDULES HAVE BEEN REALLY BACK UP AND THEY COME OUT AND ASK IF ANYONE IS WILLING TO COME BACK AT A LATER TIME TL EASE THE SCHEDULE. I HAVE VOLUNTEERED. AS I LOOK AROUND THE ROOM I SEE EVIDENCE THAT OTHERS NEEDS ARE GREATER THAN MINE TO SEE THE DOCTOR. THIS DOCTOR ACKNOWLEDGED WHAT I DID AND I THOUGHT THAT WAS A GREAT GESTURE. I LET HIM KNOW THAT I APPRECIATED HIS THOUGHTFULNESS. HERE IS THE NEGATIVE AND THE POSITIVE. WE SHOULD WORK TOGETHER AND NOT GET CONFRONTATIONAL ABOUT IT. WORK TOGETHER. I DON’T WANT MONEY, I WANT GREAT MEDICAL CARE. I AM AN ELDERLY WOMAN, SOON TO BE 79 YEARS OLD. WAITING A LONG TIME IS NOT ALWAYS EASY FOR US EITHER. DOCTORS NEED TO ADDRESS THIS AND FORMULATE A SOLUTION THAT WORKS FOR OTHERS. AFTER ALL, THEY ARE SMART ENOUGH TO BE DOCTORS…..THIS SHOULD NOT BE INSURMOUNTABLE TO “FIX”…AMEN!

  2. Keep me informed. As the day goes on the doctor may get further behind. Just give me a call and let me know. If I’m already in the office I may choose to run errands. Making me sit in a waiting room with people that may have something contagious isn’t going to make me a happy patient. I’m a very patient patient – when I’m kept in the loop.

  3. If I can be seen within 30 minutes, to me that is “on time.” I can’t remember the last time when I had to wait longer than this, so clearly it is an attainable goal for the practice to stay reasonably on time. If you’ve already had to book your appointment 3-4 weeks out and the next available opening isn’t for another 3-4 weeks, rescheduling isn’t always an option… but I think most patients like to at least be offered the choice.

    I have mixed feelings about keeping patients waiting in exam rooms. A lot of practices do this. It does allow them to take your vitals and review the medication list and generally help speed the schedule along, plus it seems to psychologically prep the patient for being seen soon. The down side is that you’re stuck in a small room behind a closed door where no one can see you. I had a friend who once waited in an exam room for almost two hours. She finally got dressed again and went out to find someone to ask what was going on… and it turned out they had forgotten she was there. At that point the doctor was just too busy to see her so she had to reschedule. The doctor called her at home later to apologize but she was still quite upset about it.

    A lot of this seems to be about mutual respect and a willingness to give and take – on both sides.

  4. Pingback: What do patients want, anyway? | HealthBeat

  5. I have worked for physicians for years and very few times has there been a real emergency that caused them to be late. The truth is they sleep late, they are seeing their mistress on the way to work, they are in their office doing paper work or charts that should have been done days ago.

  6. It’s not hard to imagine all the reasons a doctor may be late. I’m always understanding, even after waiting for more than an hour. BUT… that’s with my GP, who doesn’t make it a habit. I’ve had doctors who I expect will keep me waiting. When that happens, I know they’re double-booking. These would be the same ones that charge late fees. If you’re getting nickle/dimed and wait a lot longer than your seen… odds are he/she will do more harm than good, then charge you to fix what they broke. Like car mechanics… good ones and bad ones. Habitual wait times mean they want to sell you an $80 air filter.

  7. Been waiting now for one hour and fifteen minutes. Found out that the staff books 10 patients for a three hour period. Sounds reasonable, I suppose, but did he allow for return calls, taking calls from other doctor’s, writing prescriptions, emergencies? Guess not. I vote that I don’t pay my co-pay of $20 since my hourly wage is more than that. In addition, I called 15 minutes before my appointment and they said he was on schedule with two people waiting.

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