Key thoughts:
• The modern era and quest for automation in medicine are increasingly leading to on-line appointment scheduling for patients.
• Time constraints in standard appointments generally do not allow for multiple problems, complex disease processes, and a history of complications.
• Scheduling support, physician engagement, and appropriate patient expectations are crucial to a successful on-line scheduling process.
The trend towards immediate care is as much driven by patient demand, as it is by business efficiency. People are increasingly seeking medical information on-line, have limited patience for long hold-times or answering trees, and are increasingly connected to electronics for their time management. The business of medicine is also attracted to efficiency through automation, leaving out variability within a call-center, linking patients to physician and staff scheduling, and creating a seamless flow of patient information to their physician at the time of the visit.
The danger of leaving a person out of the process is that real-time decisions and discussion with the patient cannot be made, and they may not be making the best choices about the ideal physician for their needs. On-line scheduling also comes with the implied expectation of the physician running on-time, much like choosing a seat on an airline flight at the time of booking.
While patients appreciate (or expect) when a physician runs on time, they do not always understand when doctors do not walk in at the appointment time. Administratively, this may be due to previous patients running late, emergency overbooks, building in un-compensated no-shows to the schedule, insufficient support staff, and on-call emergencies. From the physician standpoint, needing to address multiple medical problems, complicated disease processes, patients with prior surgeries or complications, and lack of pertinent prior information all add to the time needed for an appointment. Here, the “one-problem” appointment is more akin to the express-line at the supermarket, rather than a generic airplane seat.
On-line scheduling should be screened by a qualified nurse or physician assistant that scrubs a physician’s schedule for complex patients. Alternatively, the most efficient on-line scheduling process would include taking an on-line patient history that creates an appropriate time block for the appointment. This would also be an ideal opportunity to be best prepared for a more efficient physician-patient interaction.
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This column is part of a series devoted to clarifying and enhancing the physician-health system relationship. Dr. Ken Altman is Chief of Otolaryngology at Baylor St. Luke’s Medical Center in Houston, TX. He is also Secretary/Treasurer-Elect of the American Academy of Otolaryngology – HNS, and past-President of the American Laryngological Association.