Why are my patients late?

Yesterday I had office hours; 26 patients at 15-minute intervals, followed by 3 new patients for one-hour visits, interspersed with 4 emergencies and 33 phone calls. An active normal day.  However, the 1:30, 1:45, 2:00 patients all arrived at 2:15 and suddenly I was looking at an afternoon that would run deeply into eve.  I really hate it when patients are late.

Now, I have to admit this is a unique complaint.  Google yields 52 million hits for “why is my doctor always late?,” verses, well, verses none (i.e. zero) for “why are my patients always late?” (Actually, the later search just defaults to the late doctor issue).  Apparently, doctors have not yet begun a postponed patient protest.  There are voluminous excuses posted on line for late doctors, but even more patient anger and frustration.

As an oncologist, I detest running late, because it means leaving people with cancer on their minds, stewing in my waiting room.  Personally, I worry when I am waiting at the dentist for a cleaning; what goes on in the mind of someone waiting to see me? Given the skyrocketing blood pressures of the average visitor to our office, I do not wish to add to that anxiety by leaving patients to stare at our fireplace or leaf blankly through a popular magazine.

Making another person wait seems disrespectful.  It says, “I am more important than you.”  Now of course one can read too much into the everyday necessities that cause delay, so I try not to be offended when they take too long to de-ice my plane before a winter flight.  Still, as part of the patient-doctor relationship, our obligation is to prepare to meet at a particular moment, and when you add the anxiety and complexity of medical care, that moment is very important.  If I was a cancer patient trying to understand disease, treatment and side effects, worrying about picking up the kids after school, and at the same time keep my nerves under control, it would not help to watch an hour or two of the chaotic dance of an oncologist’s office, before finally being allowed into chambers.

I try to be on time to see my patients.  Even, if there is a heavy schedule, I extend rather than double book, because by definition double booking means being already late.   I try to anticipate emergencies and distractions and adjust to maintain a reasonable flow.  In a busy office that can be a challenge, so I get anxious when patients add stress by being late.

When patients are late, there are several solutions.  As a kid when I was tardy for dinner, my Mom would start the meal without me.  If they finished eating before I showed up, it was going to be a hungry night.  Therefore, I tried starting the appointment before the patient arrived.  My staff was not encouraged to hear me talking in exam room #1, by myself.

Therefore, the obvious answer is that if a patient shows up 20 minutes late, without calling, make them reschedule.  Did I say these are cancer patients?  I would have to be a pretty cold fish to tell someone that a few minutes of my day is more precious than their fight for survival.  Therefore, yes, I always see them.  I take a deep breath and do not even mention that their tardiness has caused me angst.  I know, not very good patient parenting skills, but then my wife was always the disciplinarian.  The sentence, “well it looks like you need more chemo because the tumor is growing, but I am upset you were late,” is just not in my vocabulary.

So, let’s make a deal.  I will beat up on my colleagues about their lateness; explain time management, office organization, communication and mutual respect. Tell them to have staff inform patients when the doc is running late and build reasonable, achievable schedules.  In return, I only request that patients show up, more or less, on time.   Patients are not the only one anxious for each appointment.  I am anxious.  Anxious to see that each person gets the absolute best care possible and it seems to me that we start by doing the first thing we agreed, which is begin on time.


  • Alyce
    My oncologist is late about 80percent of the time. I do not resent the waiting because he always spends his time with me like iI was his only concern at the moment. I know tha I am not his only Patient but I appreciate his attentiveness. Alyce Kowal
    • James Salwitz, MD
      That is an important balance... the expectation of the patient with the quality of the care. How do you adust for your doctors lateness? Do you show up on time and wait or do you call and check on the status? Would a call from the office or a posting online regarding how late he is running be of help to you? Your thoughts appreciated, jcs
  • Morris Burkett
    Having lived with lymphoma for the last nine years I have spent considerable time in the waiting room of various offices. I also am aware that many emergencies can arise in the doctors work day that interfere with their planned schedule. I have one doctor, the surgeon, that must schedule his office visits in the afternoon. His office has been kind enough to call me on more than one occasion to let me know that he is going to be running at least an hour to two hours late. I appreciate his courtesy. I’ m also aware that is not always possible to do this. I usually expect to spend at least an hour to two hours waiting in the waiting room when I go to my oncologist. Again, this office is been cooperative in letting me know ahead of time if there was going to be an extended wait. One thing that I might point out concerning patients being late for appointments: many of us are dependent upon someone else for transportation. Our caregivers, transportation sources, may not always be careful as we would like about being on time.
    • James Salwitz, MD
      Good point ... one of the real challenges of dealing with an illness that makes us at least partially dependent on others. Added to this are other doctors appointments, time consuming treatments and the basic physical limits of being ill which screw up the patient's timing and mobility. Thanks, jcs
  • GingerR
    What's your parking lot like? We've got some doctors with easy-peasy parking lots that never fill up and always have an empty space near the door. Often these are in the Suburbs and the parking is a surface lot. As fate would have it these are the doctors we see once in a blue moon. Other doctors are in buildings with many other Physicians, an attached garage that has a ticket machine, many levels and small parking spaces. In your example your patients were all late in the early afternoon. Could this have been because there is a rush for patients parking to catch the blessed "first after lunch" appointment at 1:30? All it takes is lunchtime traffic on neighboring streets, one broken ticket machine, a few vehicles with handicaped passengers moving slowly, a couple of cautious drivers who insist on waiting on the first level while someone pulling out slowly pulls out to turn what should be a 5 minute exercise into 20 minutes.
    • James Salwitz, MD
      Great point. Our parking lot can be sporatic. While there are generally spots in this particular office, sometimes it can require a hike, which is tough on patients, especially in wheelchairs and in winter. Perhaps the main reason we are moving one of our offices to new quarters this spring. Thanks, jcs
  • aern
    I absolutely APPLAUD your decision to not double book your schedule,and to see patients even when they run later than 15 minutes.I deal with physicians who routinely double book,all day,and therefore run behind more and more as the day progresses. It is only because the physician is good that I stay with them. I have dealt with a phychiatrist who consistently made his patients wait 2 or more hours for their appt. and thought it was okay because he gave out sample meds. You are the EXCEPTION TO THE RULE. I wish more physicians were more like you.
  • T
    Point taken and acknowledged. But let me point out that you are a highly compensated professional. Angst should never enter your vocabulary. If I even once suspected that any medical professional was aggravated with me, their medical opinion would be immediately discarded.
    • James Salwitz, MD
      Good comment and appreciated. In a phrase, it is the professional's job to "suck it up." On the other hand, we need to be careful not to ignore the passion which dedicated physicians bring to their work, and therefore the emotional committment to the patient. I would tend to discard the opinion of the totally objective doctor. jcs
  • Interesting discussion. As a patient of another doctor at your practice, I have to say I'm always pleasantly surprised that my wait times at your office never seem extreme (usually 15 minutes or less). However, through my illness I experienced some incredibly obnoxious times, and now have the rule, 40 minutes and I walk. Furthermore my time is money. I'm self-employed and if I'm not at my desk working, I'm not earning. Some simple things doctors can do to make the wait tolerable - WiFi, coffee. As far as your late patients, I agree it's rude to the doctor but it is also, I think, disrespectful to the patients that come after them, for example, in your case, what if I am the legitimate 2:15 appointment? Do I have to wait for you to now clear the 1:45 and 2:00pm that were late? In this age of cell phones, if something comes up, and knowing the distance to my doctors' offices, how long it takes, etc., I call if I'm going to be late (late ride, traffic, etc.) and I wouldn't expect to be taken right away - I've missed my slot, I'd hope the doctor could squeeze me. And let's face it, everyone in your waiting room is suffering from some form of cancer so why should the late patient take priority to over those patients that arrived on time.
    • James Salwitz, MD
      Thanks for the comment. I agree that for me a significant part of my anxiety when a patient is late is indeed its effect on other patients. One wonders how often when doctors are running significantly late it is because patients have arrived late. There is a delicate balance of flexibility and patient need. jcs
  • If you're not early, you're late. These pts also probably start the day with an empty gas tank, and don't account for the very traffic on which they blame their tardiness. Traffic happens. Budget time accordingly. It's not really complicated. It's a psych issue, as much as anything. Doctors also know pts will be late. Schedule accordingly. Have them arrive at 11:15 for what is actually an 11:45 appt. If you're on time, they are early. Or, have them reschedule. Lack of preparation on their part always seems to constitute expectation of scrambling on ours (in their eyes). Uniquely tough choice in oncology, where time is a big factor.

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