‘Medical homes’ may provide the same convenience benefits of concierge medicine

Yesterday I posted on concierge medicine. One reason people choose these arrangements is faster access to their doctor. The US consistently under-performs in terms of access to same-day or next-day appointments, according to Commonwealth Fund international surveys that measure access across countries. If people can’t get an appointment, they go to the ER or put off necessary care altogether, so it’s important. However, (perhaps in a small part a response to the shame brought by international comparisons), there is a new emphasis on addressing timely access to appointments. One approach is the development of the ‘medical home’ model. Many aspects of the medical home model stress the kind of personalized attention and responsiveness to patients (through continuity of care and knowledge of t16420120-classic-analog-clock-pointing-at-9-o-clock-isolated-on-white-backgroundhe patient, and phone/email access) found in the concierge model, although I am definitely not saying they are the same! But I do think it’s interesting that there are alternatives to the concierge model aimed at improving the patient experience that also make sense in terms of improving health. It’s not perfect, but it’s a start.

In addition, once you get there, concierge medicine supposedly minimizes the time spent in the waiting room. That could also reflect the healthier patient population. But on average, across all kinds of practices, people actually only wait 21 minutes.

That doesn’t seem like long to me, but it may feel like a long time in actuality—does the perception of time get warped in the waiting room? Perhaps it’s like the studies quoted in Daniel Kahneman’s book ‘Thinking, Fast and Slow’ on how time is experienced differently. I hate to wait too, but within limits, it’s usually not enough time—I sometimes feel like I’m being yanked from reading something extremely engaging–right at the moment when they call my name. I’d like to say, “can’t I just finish this terrific article?”

Comments

  1. Mona Williams says

    An average waiting time of 21 minutes is long if it is counted starting from when the scheduled appointment start time–and I’m sure that’s what it is. Then it should be called something else, like average appointment-delay-because-of-overscheduling-because-of-practicioner’s-desire-to-maximize-profit time.

    • Paul says

      Or, it may be a doctor’s genuine interest in devoting whatever time is necessary to comprehensively treat a patient’s problem. She may be an outlier, but my doctor is such a practitioner. And so, I never get agitated when kept beyond my appointed time as I know I’ll get the same courtesy when it’s my turn.

      • J. Michael Neal says

        These are the same thing. If a doctor takes more time per patient, then they need to schedule fewer patients in order to stay on time. For any given level of doctor dedication, consistently being behind schedule is a consequence of trying to see too many patients.

      • Kiwanda says

        Long waiting times represent a desire to maximize the efficient use of the physician’s time: if there’s a steady backlog of patients, then the doctor will not be idle themselves. The fact that this efficiency for the doctor comes at the expense of the patient is regarded as a fair trade: the doctor’s time is viewed as valuable, and the patient’s time is not. A similar calculation implies that the discomfort of a patient waiting for a long time in chilled room wearing only a flimsy gown is of no consequence relative to the doctor’s convenience.

        As others have expressed, the overall time spent waiting includes more than the time in the waiting room; I just cannot believe that 21 minutes covers it. I typically spend at least half an hour waiting for physician interactions that last maybe five minutes.

        Family experiences include an optometrist (OK, not a doctor) seen going out to lunch as patients sit in the waiting room; gynecologists stepping out for a moment, leaving the door open on their patient in the stirrups, hours-long wait in emergency rooms with no thought of food or fluids, etc. The time, dignity, and comfort of patients is not a high medical priority.

  2. SamChevre says

    A measure of waiting time should include waiting within the appointment.

    A common pattern at soem doctors we deal with: wait 5 minutes in the waiting room; get the basic check-in (temperature/weight etc); wait 15 minutes, until a nurse comes in and takes your history for 5 minutes; wait another 20 minutes until the doctor comes in and sees you for 5 minutes. An appointment takes an hour and can take two (which is important if you need to schedule child-care or time off from work), but the actual time needed is only 15 minutes.

  3. H says

    While, of course, it would be nice to not wait at all. But, this is not possible. Unexpected things are always happening. Incoming calls from specialists, the pharmacy. Or, a routine visit which turns out to have complications.

    Usually, when I go to see my primary Doc I get in right away (at the scheduled time) and am impressed by the efficiency with which matters are handled. But, there is sometimes an emergency, the kid with sliced arm that needs stitches right away or whatever. I understand that. And, as my Doc pointed out, when I come in with a cut in my scalp (darn kitchen cabinet corners) without an appointment I get seen and treated even though someone else may have to wait a bit.

    And, things have improved a lot. When I was a kid and young adult I recall waiting for hours to see a Doc. This rarely happens anymore. I suspect there is more competition for paying patients these days. Plus, when there is a wait, the Docs have even started to apologize for keeping me waiting!

  4. Ohio Mom says

    Just bring the magazine into the examining room with you. That’s what I do. As SamC points out, there’s still plenty of waiting once you walk through the door from the waiting room.

  5. Bostonian in Brooklyn says

    My personal worst was four hours for a neuropthamologist. Not once many many times. They tended to run out of chairs. (neuropthamologist patients tend to not come on their own.) After the first visit I learned to bring, not only reading matter but food – lots of food. We were the envy of the starving hordes.

    I have advised friends to get their children into professions that begin with “neuro”.

  6. Byomtov says

    My worst waiting experiences have been not at my doctor’s office, which operates very smoothly, but on a couple of occasions when I went to the hospital for an outpatient “procedure.” Not only have waits been unconscionably long, but I’ve had to endure them while sitting in a chilly waiting room wearing a hospital gown, and with a TV blaring morning show inanity in my ear. To top it all, on those occasions, the doctor, when he finally showed, did not have the courtesy to apologize for being an hour late.

    • Bostonian in Brooklyn says

      What I was put on earth to do was to be the person in the waiting room who said “No one seems to be looking at the TV. Could I turn it off?” There were usually grateful smiles. No one ever said no.

      The exception was the place that hooked me on Law and Order. There we all watched.

  7. paul says

    21 minutes? That’s less than I wait for phone support when my washer/dryer is busted.

    But it’s probably not the average that counts so much as the shape of the curve. If I’m going to the doctor often, I’m going to remember the wait time that was a couple standard deviations (ahem) out from the mean.

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