Patients are losing patience, and they’re speaking out
Marta Frank was accustomed to waiting past her appointment time to see her ophthalmologist at Massachusetts Eye and Ear Infirmary, a prominent Harvard specialty hospital. But she just couldn’t stay silent when she sat in a waiting room for what she calculated was upward of an hour and a half on a recent visit.
Frank progressed from the main waiting room to a “sub waiting room,’’ where she exchanged stories of frustration with other patients. One woman told Frank she had been kept waiting so long she missed her 4 p.m. ride on a previous occasion and had to wait until 8 p.m. for another, Frank recalled. Another weary patient shared that she had once returned a Mass. Eye and Ear fund-raising letter with the message, “Not until you give me better service.’’ “Elder abuse!’’ one man called his long wait, she said.
Frank, a former women’s rights activist and nurse, told her fellow patients that she, for one, was going to speak up. She has company in her annoyed impatience. Patients have long been plagued by waiting room delays, but many are now becoming more vocal, particularly through social media. And the medical establishment is starting to react.
True to her vow, Frank took her grievance up the ladder. She complained to her ophthalmologist, to the hospital’s “patient relations specialist,’’ and to the associate director of ophthalmology — all of whom apologized. She went to her insurers, Blue Cross Blue Shield of Massachusetts and the federal Medicare program, and to the Massachusetts Department of Public Health.
Those organizations all indicated that wait times were essentially outside their jurisdiction, she said, a response she found frustrating. “I have kind of taken on a sacred cow,’’ said Frank, 71, who has glaucoma and praises the hospital’s medical care.
Mass. Eye and Ear said it is implementing a host of improvements as executives have become more aware of complaints like Frank’s. In March, the hospital hired a full-time “patient flow coordinator’’ for its busiest clinics. It is actively recruiting more specialists and has instituted same-day appointments for more routine visits to improve customer service.
“We are working very hard on this,’’ said spokeswoman Jennifer Street.
Many hospitals and doctors offices, however, don’t recognize long waits by patients as a top priority, and an article in the New England Journal of Medicine last month suggested a reason why: Solving the problem could harm their bottom line. Much as airlines overbook to be sure every seat is filled, a backlog of patients helps keep examining rooms in full use.
Long waits to schedule appointments with specialists are linked to long waits once in the waiting room, according to two prominent doctors. The further into the future providers schedule appointments, the greater the no-show rate. To compensate for this, practices often overbook patients, which can create a roomful of irked people when everyone shows up.
“The result may be chaos, with angry patients waiting an hour or more and dispirited clinicians and staff trying to both appease and care for them,’’ wrote Dr. Jaewon Ryu, chief medical officer at Geisinger Health System in Pennsylvania, and Dr. Thomas H. Lee, a doctor at Brigham and Women’s Hospital and chief medical officer at Press Ganey Associates, a hospital consulting firm.
Hospitals also overbook as they accommodate ill patients — something that happens at Mass. Eye and Ear. That approach makes sense medically, but it is also good business because sicker patients need more tests and procedures, “which translates to more services billed and more dollars collected,” Ryu and Lee wrote.
Street, at Mass. Eye and Ear, said executives agree that there is a “short-sighted financial gain from overbooking. But we believe the long-term negative impact of any one unhappy, angry, and frustrated patient far outweighs the short-term gain,’’ she wrote in an e-mail. “That is why we’re working so diligently to reduce wait times in necessarily busy clinics — and why we do not plan to overbook.’’
It’s hard to put a number to how bad the waiting room problem is. Many hospitals don’t consistently monitor delays. And there’s little public industrywide data on the issue or on if delays are worsening.
Ryu, in an interview, said it’s hard to persuade providers to change their ways when their waiting rooms are jammed. “They think people can vote with their feet, and yet they are here with me so they must be satisfied. If people are eating at your restaurant, why change your menu?’’
Frank, who lives in Charlestown, is well aware of this irony. She says she has gotten great care at Mass. Eye and Ear. That is why she has remained a customer, despite the delays.
At her recent six-month check up, March 22, a visual field test was scheduled for 2 p.m. and her appointment with her doctor for 2:30 p.m. The hospital computer said her test occurred at 2:37. Frank said she saw her doctor at about 4:15 p.m., for about 10 minutes. Frank said her providers didn’t like to keep patients waiting either and they encouraged her to talk to administrators.
The hospital confirmed she left at 4:32 p.m., but pointed out that patients like Frank will also see a trainee during the wait and may have other tests.
When Jon Mazzone, the associate director of ophthalmology, called her days later to apologize for the delays that day, Frank suggested giving patients beepers or texting them when the doctor is ready — an approach the Massachusetts General Hospital Cancer Center is testing.
Street said the hospital knows patient frustration over waits has been discussed on social media. “That is helping open our eyes to the issues, rather than assuming people don’t mind waiting because it’s Mass. Eye and Ear,’’ she said.
Given the complex nature of glaucoma, a disease where pressure in the eye can cause nerve damage, doctors have to accommodate patients with urgent needs nearly every day, which can throw off schedules, she said.
“We’re never going to turn away someone who says, ‘I need help right now,’ ’’ Street said.
To lessen the impact, the hospital hired a “patient flow coordinator” to help patients understand the wait and how much longer it will be. “If the patient is still sitting there at 2:20 when appointment was at 2, that person goes and investigates why,’’ said Deborah Cronin-Waelde, executive director of ambulatory operations.
Mass. General also believes patients will be more accepting of the need to wait if they have more information. Spokeswoman Peggy Slasman said some practices post notices on white boards if doctors are running late. “Delays can occur because providers are delivering difficult news to a patient or family,’’ Slasman wrote in an e-mail. She said doctors want to be sure to give every patient all the time they need.
Paul Little doesn’t recall getting this type of information as he waited past his appointment time at Mass. General in May. He had scheduled a visit with a renowned orthopedic specialist for persistent foot pain.
He posted what he called “a rant’’ about “one of the issues we all face with our health care system’’ on his Facebook page. Little, 48, said he waited more than an hour. “I brought it up with the doctor and she said I am sorry we get a little backed up,’’ he said.
Slasman said the hospital could not discuss specific patients because of privacy rules.
Dana-Farber Cancer Institute and Beth Israel Deaconess Medical Center said they routinely monitor waits across their institutions. Patients at Dana-Farber get badges with a chip that allows the hospital to track their movements from waiting rooms to offices. With help from this information, the hospital took steps to reduce waits for blood tests, including adding more staffing during the busy times.
At Beth Israel Deaconess, staff “round’’ every 20 to 30 minutes in waiting rooms and offer patients options like taking their phone number so they can go get coffee or a snack.
It’s about “treating patients and families with respect and dignity,’’ said spokeswoman Jennifer Kritz.