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    Making patients wait can prove costly

    Dr. Skin has been in practice for 20 years. He has a very busy practice, and like many practitioners, he has patients who love him and others who are not his biggest fans. Many of his patients complain of long delays in his waiting room.

    In a recent medical malpractice case against Dr. Skin, a patient sued over a scar resulting from a procedure. That case was evaluated according to the standard medical malpractice process. Did Dr. Skin breach a reasonable duty, and was there a nexus between that breach and resultant damages?

    Dr. Goldberg
    One of the more disturbing aspects of the case was how angry the patient was at Dr. Skin's poor communication skills. More than once, the aggrieved plaintiff complained about how long she had to wait to see him. She said had Dr. Skin communicated better, she might never have initiated a lawsuit.

    Dr. Skin has learned a lesson from this lawsuit. He wants to keep his patients happier. He tries very hard to run on time and communicate if he is behind. Recently, he saw an IT specialist who became angry when Dr. Skin was late for a scheduled appointment. The IT specialist calculated his hourly wage and billed his doctor for the time he had to wait. Dr. Skin chose to pay the bill. Was this a smart move?

    Today, many doctors are using cash, gifts and/or credit for future appointments to compensate patients for time spent in the waiting room. Needless to say, however, most dermatologists are not drinking coffee or reading the paper while their patients are in the waiting room. More often than not, they are seeing other patients who demand and need additional time.

    Complex clinical dermatologic questions rarely can be answered in five minutes. These unpredictable interruptions have a cascade effect not dissimilar to catching a plane at any major international airport in the late afternoon rush hour.

    Flying lessons

    Of note, the airlines have come up with answers — although most are not applicable to the dermatology practice. For example, while it used to take only an hour to fly from New York City to North Carolina, today, the difference between the announced departure and arrival times is up to two hours. So, if the plane lands within the two-hour time period, the statistical books say it has landed on time — despite the fact that the passenger waited.

    The airlines also have another tool. If the departure time is likely to be delayed, they can use automated text and email notifications to warn passengers. Analogously many doctors' offices now notify patients if a doctor is behind. Some offices provide patients with pagers so they do not feel confined to the waiting room. Many patients appreciate these courtesies, and such efforts often subdue any anger patients may feel about waiting.

    Most reasonable patients understand that if they are kept waiting, it is because the doctor is dealing with patients. They rightly assume that if their problems are complex, the doctor will take the appropriate time to deal with their own problems as well. With that, of course, however, the next patient may be delayed.

    The airline industry may be among the worst when looking at role models for how service should be delivered, but their technique of notifying passengers after 30-minute delays is a great idea.

    However, the broader issue here for Dr. Skin (and all dermatologists) is the concept of establishing proactive communication. This helps to build the very core of the patient-physician relationship. By dealing with this proactively, Dr. Skin is unlikely to receive many patient bills demanding time spent waiting.

    David Goldberg, M.D., J.D., is director of Skin Laser & Surgery Specialists of New York and New Jersey; director of laser research, Mount Sinai School of Medicine; and adjunct professor of law, Fordham Law School.

    David J. Goldberg, M.D., J.D.
    Dr. Goldberg is Director of Skin Laser & Surgery Specialists of New York and New Jersey, Director of Mohs Surgery and laser research, ...

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