{"id":10592,"date":"2011-10-28T19:33:45","date_gmt":"2011-10-28T23:33:45","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=10592"},"modified":"2011-10-28T19:33:45","modified_gmt":"2011-10-28T23:33:45","slug":"lisa-gualtieri-must-waiting-be-inherent-to-medical-care","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2011\/10\/lisa-gualtieri-must-waiting-be-inherent-to-medical-care.html","title":{"rendered":"Lisa Gualtieri: Must waiting be inherent to medical care?"},"content":{"rendered":"

This guest post by Lisa Gualtieri originally appeared in the author’s health blog<\/a>.<\/em><\/p>\n

\u201cBy the time you see the doctor, you\u2019re either dead or you\u2019re better,\u201d my mother-in-law told me. She had to have multiple tests, all with long waits to get the appointments and the results, before her health insurer would allow her to make an appointment with a specialist.<\/span><\/span><\/p>\n

\u201cWaiting is the bane of the medical system,\u201d a former student, an RN, concurred. Advances in medicine and technology have improved medical outcomes, but have often resulted in more waiting at a time when every other aspect of life is speeding up. Waiting is a systemic problem exacerbated by advances in medicine and by health care reform. <\/span><\/span><\/p>\n

Some of the ways we wait:<\/span><\/span><\/p>\n

    \n
  1. Wait to see if the symptoms go away or get worse.<\/strong> We all struggle with these decisions: do we need to be seen about the fever, back pain, or rash? Sometimes we wait because of denial or hopelessness; sometimes because of the cost or availability of medical care. I make decisions about when I need to see the doctor by asking myself if, under the same circumstances, I would take one of my children to the doctor. <\/span><\/span><\/li>\n
  2. Wait to get an appointment scheduled.<\/strong> I\u2019ve made appointments for a sick child by channeling an old friend who could be relentless: \u201cThat is not acceptable. I need an appointment today.\u201d Obnoxious but it sometimes worked. The rest of the time, though, the period between making and having an appointment can feel very long. <\/span><\/span><\/li>\n
  3. Wait to get to the appointment.<\/strong> Doctors and hospitals are more abundant in Greater Boston, where I live, than in other places, although traffic and parking can be problematic. <\/span><\/span>Melody Smith Jones<\/span><\/a> described a man\u2019s six hour commute to see a doctor.<\/span><\/span><\/li>\n
  4. Wait to be seen by the doctor.<\/strong> It isn\u2019t called the waiting room for nothing. <\/span><\/span>Dr. Atul Gawande<\/span><\/a> wrote in The Checklist Manifesto<\/em> about people in the waiting room getting irate when he was running two hours behind on a hectic day. Being irate \u2013 or anxious or bored \u2013 is unlikely to increase the quality of physician-patient communication.<\/span><\/span><\/li>\n
  5. Wait in the examining room.<\/strong> At least in a waiting room you are dressed. If it is cold and you are wearing a paper or cloth johnny, distractions don\u2019t work as well and examining rooms have fewer than waiting rooms. <\/span><\/span><\/li>\n
  6. See the doctor. <\/strong>Nowadays, as my mother-in-law recounted, you have to wait for the doctor to review your records before even looking at you. I find it surprising that <\/span><\/span>physician rating systems<\/span><\/a> give equal weight to wait times as they do to \u201ccommunicates\u201d and \u201clistens\u201d, when the latter are so much more important.<\/span><\/span><\/li>\n
  7. Wait in the lab.<\/strong> The selection of magazines is skimpier. You may be reviewing what you were told not to eat or drink: will that cup of black coffee skew the results?<\/span><\/span><\/li>\n
  8. Wait for lab results.<\/strong> If there are any non-routine reasons for testing, this can be interminable. I leave a lab asking when results will be ready and then I call. A former student told me about using Harvard Vanguard\u2019s <\/span><\/span>MyHealth Online<\/span><\/a>. She said, \u201cI love getting the lab results immediately online but I can see how those without clinical training could be overwhelmed or confused by the data and how to interpret them.\u201d<\/span><\/span><\/li>\n
  9. Wait for the doctor\u2019s interpretation of lab results.<\/strong> Lab results can be hard to decipher without clinical training, as my student said above. Even when I know results are available and the doctor has seen them, it can take many phone calls to obtain the doctor\u2019s message via the secretary. Asking the doctor follow-up questions takes even longer. These are waits with a cell phone never turned off so you don\u2019t miss the call.<\/span><\/span><\/li>\n
  10. Loop. <\/strong>You think you\u2019re done but you may need to see <\/strong>a specialist, get a second opinion, or have more tests. As my mother-in-law pointed out, this process can be controlled more by insurance companies than by doctors\u2019 availability. Another type of waiting also takes place now: waiting to get better. A friend bemoaned how she \u201ccouldn\u2019t wait\u201d for her black eye resulting from a fall to clear up because she was tired of people staring at her.<\/span><\/span><\/li>\n<\/ol>\n

    Waiting Reduction<\/span><\/span><\/strong><\/p>\n

    We all have to wait. Waiting is an inherent part of being ill. But here are some ways to reduce wait time or lessen the impact:<\/span><\/span><\/p>\n

      \n
    1. Schedule tests and doctor\u2019s appointments together.<\/strong> My exercise teacher told me about her husband\u2019s hospital visit that started with a CT scan and ended with a doctor\u2019s appointment to discuss the results. With no problems detected and a year until they next visit, they both said what a relief it was to get it over with quickly. Scheduling appointments together reduced both waiting time and anxiety, although not all tests results can be interpreted this quickly. Personally I find it is much easier to deal with a diagnosis than fear of what a symptom could mean.<\/span><\/span><\/li>\n
    2. Avoid unnecessary appointments through email or phone.<\/strong> A Dutch friend, whose sister and aunt are doctors, recounted instances when she was able to get quick answers by email or phone to questions, be reassured, and save a lot of time and effort. One instance: \u201cOnce I was on holiday in Greece and sent my sister a picture when my eye was infected. She told me to buy drops and that it would go away.\u201d Since most people do not have convenient relatives with medical degrees to talk to, being able to easily reach a doctor or nurse by email could provide a way to get a quick answer. <\/span><\/span>Dr. Danny Sands<\/span><\/a> has long been a proponent of physician-patient email, but most practices do not support it. I can easily see the benefits because email forces you to describe a situation concisely and images can be attached as appropriate.<\/span><\/span><\/li>\n
    3. Meet Dr. Skype.<\/strong> Melody Smith Jones posed the question, \u201cCan telehealth be used to end this man\u2019s 6 hour commute by providing him access to the specialists he requires? What barriers and challenges still lay before us to make this a reality?\u201d <\/span><\/span>Dr. Joseph Kvedar<\/span><\/a> answers this, saying \u201cWe have to move beyond the antiquated notion that you must visit a physical space and talk real-time with your health care provider to fulfill the process of care. Seamless communication between you the patient and the system (including your provider but also your health information) will allow us to cut through what is a falsely complex and inefficient system to achieve more efficiency, less waiting and less anxiety.\u201d<\/span><\/span><\/li>\n
    4. Ask the expert. <\/strong>Self-proclaimed experts and community-verified experts provide advice in many <\/strong>sites like <\/span><\/span>Yahoo! Answers<\/span><\/a>. Recently there has been a proliferation of sites supporting health Q&A. A new entry, <\/span>HealthTap<\/span><\/a>, promotes that it has \u201cAnswers from 5,000 U.S. licensed physicians. No waiting room.\u201d I tried it and questioned why I needed to answer so many personal questions during the registration process. Once registered, I started to ask a question but was stumped by how much context to provide. In general one of the things I like about Ask the Expert is the ability to browse other people\u2019s questions \u2013 sometimes you learn more from questions you never would have thought to ask \u2013 and answers.<\/span><\/span><\/li>\n
    5. Use clinics for non-urgent care<\/strong>. I had a friend who believed that it was important to see the same doctor because he or she could notice changes that might not otherwise be detected. While I agree, the Minute Clinic (note the name) model can potentially reduce some of the use of doctors for non-urgent care.<\/span><\/span><\/li>\n
    6. Enhance health literacy skills<\/strong>. With <\/span><\/span>80% of US internet users<\/span><\/a> looking online for health information, better health literacy skills are needed to guide the strategies used to seek, select, and use online health information. This is rarely taught in schools or by doctors, and is increasingly necessary because of the lower barriers with social media: it is easier than ever to promote herbal supplements and bad advice.<\/span><\/span><\/li>\n
    7. Make waiting fun \u2013 or at least less stressful.<\/strong> <\/span><\/span>Deirdre Walsh<\/span><\/a>, a health coach and a former student, said, \u201cThe pain and frustration of endless waiting seems needlessly cruel. But it\u2019s often the emotional toll of fear and uncertainty that does the most damage from the negative effects of stress chemicals on energy, sleep and mood. If waiting is inevitable, there are self-awareness exercises that restore calm, power, and the sense of control. \u201d Games and gamification have potential as well: a <\/span>version<\/span><\/a> of \u201cWait, wait\u2026 don\u2019t tell me!\u201d for the waiting room?<\/span><\/span><\/li>\n
    8. Is there an app for that? <\/strong>Not that I know of, but social media is being used by public health departments to post flu clinic waits and by emergency rooms to post wait times. What about for doctor\u2019s visits? <\/span><\/span>Dr. Richard Besser<\/span><\/a> said, \u201cYou shouldn’t have to wait more than 15 minutes unless there’s an emergency. Social media might be a great place for people to share waiting times.\u201d Along those lines, I <\/span>read<\/span><\/a> about, but have not tried, <\/span>WaitChecker<\/span><\/a>, a web-based service to alert patients to appointment delays.<\/span><\/span><\/li>\n
    9. Set expectations.<\/strong> The metaphor Trisha Torrey<\/a> uses is “when you arrive at a busy restaurant on a Friday night, what\u2019s your question to the host? How long is the wait? It\u2019s only fair that providers manage our expectations about wait times, too.” It is easier to be patient with expectations set, not just for the length of a wait but the course of a disease. <\/span><\/span><\/li>\n
    10. Use waiting time on task.<\/strong> A student once told me that she had a rash when pregnant and assumed it was unrelated to her pregnancy. She searched for information on her iPhone while in the waiting room, decided it might be related after all, and asked her doctor, who treated it. She saved another doctor’s appointment. What if all waiting rooms provided mobile devices? Or promoted prevention with education, exercises, and healthy snacks. Talk about captive audiences.<\/span><\/span><\/li>\n<\/ol>\n

      Quality of Health Care Is Paramount<\/span><\/span><\/strong><\/p>\n

      It is important to maintain perspective: quality of health care is paramount. Everyone wants the best care possible and sometimes waiting is unavoidable. With no health advantages to waiting, put , as Dr. Ted Eytan<\/a> said, “the patients’ cost of care, which includes the time they spend waiting, into the equation. Everything follows from that.” There is no reason to accept that it\u2019s part of our health system, but, instead to work to reduce waiting, and to reduce the impact of waiting.<\/span><\/span><\/p>\n

       <\/p>\n","protected":false},"excerpt":{"rendered":"

      This guest post by Lisa Gualtieri originally appeared in the author’s health blog. \u201cBy the time you see the doctor, you\u2019re either dead or you\u2019re better,\u201d my mother-in-law told me. 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