You and your General Practitioner

I've just read an interesting book "The Good Doctor: What Patients Want" by Prof. Ron Paterson, who was for ten years Health and Disability Commissioner in New Zealand. The book covers the obvious ethical requirements and necessary clinical standards and also discusses impaired doctors, e.g. those who are addicted to various drugs plus some convicted of quite horrendous sexual assault and rape of patients.

Reading this coincided with a visit to my own GP where - as usual - I had to wait an hour and a half.
He concedes he has a real problem with time management but doesn't ever seem to do anything to improve this.
Lovely bloke, good clinician, and possessed of genuine kindness. But oh, that waiting surrounded by coughing and snuffling, restless toddlers etc.

So I'd be interested in how you find your GP, and any specialists for that matter.
What is most important to you? Their clinical acumen? Your sense of being able to connect with them, of being listened to, cared for?

How long do you usually have to wait?

I have been seeing the same GP since 1987, and I find her very thorough in her approach. She has probably become a friend as much as a GP.
I have had days when I have had to wait an hour too, when things happen during the day and her appointments run longer than intended.
If its too long a wait, they sometimes ring me and tell me she is running an hour or more late, some people cancel, some people still go.

I could write my own book on what patients want. It's my life's study.

Chapter one: How to establish rapport.

[The GP I see never makes me wait more than 10 minutes, and it's a very busy clinic. Not that I'm there very often, thankfully.
Being a good (and quick) diagnostician is really a base level expectation that every doctor should be able to meet.]

Julia said:

I've just read an interesting book "The Good Doctor: What Patients Want" by Prof. Ron Paterson, who was for ten years Health and Disability Commissioner in New Zealand. The book covers the obvious ethical requirements and necessary clinical standards and also discusses impaired doctors, e.g. those who are addicted to various drugs plus some convicted of quite horrendous sexual assault and rape of patients.

Reading this coincided with a visit to my own GP where - as usual - I had to wait an hour and a half.
He concedes he has a real problem with time management but doesn't ever seem to do anything to improve this.
Lovely bloke, good clinician, and possessed of genuine kindness. But oh, that waiting surrounded by coughing and snuffling, restless toddlers etc.

So I'd be interested in how you find your GP, and any specialists for that matter.
What is most important to you? Their clinical acumen? Your sense of being able to connect with them, of being listened to, cared for?

How long do you usually have to wait?

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It's hard to manage time when you are a GP. Some people make a single appointment but bring their whole family in so they can get free consults for all the kids. Also, some GPs are so nice they don't know how to say "Time's up, get out of my room".

My wife's surgery uses a system like those coffee shops and pharmacies - you get a buzzer from the receptionist you can wander off and not be stuck in the waiting room.

skc said:

It's hard to manage time when you are a GP. Some people make a single appointment but bring their whole family in so they can get free consults for all the kids. Also, some GPs are so nice they don't know how to say "Time's up, get out of my room".

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The people who bring the whole family in for free treatment obviously have no consideration of others. Since that's the case, they will be used to people being quite abrupt and curt with them. You can easily say "No. I need to see your son tomorrow, so make an appointment for then" without offending them. You'd think that would be rude, but for people like that it works. And they will return the next day.

skc said:

My wife's surgery uses a system like those coffee shops and pharmacies - you get a buzzer from the receptionist you can wander off and not be stuck in the waiting room.

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That's a good idea. Other doctors I know are quite happy if you phone half an hour before your appt and ask how they're going for time. But this one of mine insists you must be there at exactly the time of your appointment, regardless of how late he is, then - even if there are five people still ahead of you - you may not go off for a walk and come back closer to the time, apparently on the basis that he might 'suddenly catch up.' I think it's this rigidity that I find unreasonable.

I live 5 mins from my GP and nearly always have to wait at least 30 mins, often closer to an hour. Best way to avoid this is to grab the first appointment of the day if possible. I have often explained when making an appointment that I am self-employed and live close enough to be there inside 5 mins, and asked if I could ring 15mins prior to my appointment to see how long the delay was likely to be. Inevitably I'm nearly always either lied to and told he's on time, or told to leave it another 20 mins and then had to wait anyway because other people (with later appointments than mine) were already in the waiting room and it "would be unfair to them/not look good" if I were seen first - despite me having an earlier appointment time.

This cavalier treatment of patients' time irks me no end - but is in no way restricted to the medical profession. Telstra informed me this week that a techinician would be out to fix my internet outage "sometime between 12 and 5" and I would need to be present. When asked if I could be called on my mobile when next on his roster so I could then pop home, I was told this was not possible. My suggestion that someone who worked for a telecommunications company would surely be equipped with a mobile phone and should know how to use it was apparently not well received. When the contractor arrived (2 hours early - luckily catching me about to leave the house) he glibly told me that he didn't like to ring to give an idea of when he'd be arriving because "some people don't answer their phones or then expect you to set an exact time to the minute, so it's just easier for us not to give any timeframe". Easier for them - apparently what's easier for the customer or the patient doesn't matter at all.

Unfortunatley when it comes to some services, such as the GP the family has seen for the past 15 years, it's just too damn unattractive a proposition to change, or the alternatives on offer are no better! The medical centre I use actually refused to see my son recently as they were overbooked and not taking any further appointments for the day. He was running a temp of nearly 40, throwing up and quite unwell, yet couldn't get in to see our family GP of 15 years and had to sit in the waiting room of the nearest bulk-billing centre for nearly an hour and a half or wait 3 days until the following Monday to be seen by his own doctor. As he had an exam that day and needed a medical certificate for his school there was no alternative but to go to another medical centre. I'd switch permanently but they're all the same in my area

I thought it was standard practice for GPs not to be on time? You mean to tell me they dont get taught that at uni?

In all seriousness my GP waiting time ranges from anywhere from 10minutes to an hour before i see him or her (there is two that I see, family practice and am comfortable with the two of them).

I did however have a go at doctor for running an hour late to my appointment. But I was the first appointment in the morning for some very minor surgery. He didnt offer any excuse as to why he was so late didnt even apologise. So I let him have it, after all you dont make the earliest possible appointment for no reason.

FIGJAM said:

I thought it was standard practice for GPs not to be on time? You mean to tell me they dont get taught that at uni?

In all seriousness my GP waiting time ranges from anywhere from 10minutes to an hour before i see him or her (there is two that I see, family practice and am comfortable with the two of them).

I did however have a go at doctor for running an hour late to my appointment. But I was the first appointment in the morning for some very minor surgery. He didnt offer any excuse as to why he was so late didnt even apologise. So I let him have it, after all you dont make the earliest possible appointment for no reason.

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Indeed. It's completely understandable that unforseen emergencies will present during the day, especially in larger centres that have a surgery attached - there's usually at least one tradie that needs stitching up per day
But being an hour late for the first appointment of the day and not even offering an apology is not acceptable and is typical of the superior and dismissive attitude some GPs display. Maybe I need to find a centre that's located within a shopping centre that uses the buzzer technique - at least you could window shop and avoid all those tiresome sick people in the waiting room

My Doctor runs the place on his own and is very popular. I've seen Bill Shorten in the waiting room and a couple from the other side of town that go to him.
He is not cheap but very thorough, no in and out in 10 minutes like in those factories.
He is excellent and has helped me immensely and I have never had to wait more than half an hour. Emergencies do happen though.
He has also saved my Dad's life who would have been dead 10 years ago if not for his thoroughness.

I know 2 different guys whose went to "free" services who died due to poor diagnostics.
one actually argued with the doctor and was fobbed off. he was right and it killed him, i would have sought a second opinion if I was him though.

Have changed doctors twice in the last 20 years, first time because the receptionist was so arrogant I just pulled my files out and left, "you want to see the doctor" "well you can't he's busy till next week" but I'm sick now, "well there's nothing I can do about that."
Second time because I just didnt have too much faith in him.
The present ones are ok, but I find they arent really as knowledable as they should be.
Always referring the their computers..........Google ?

Another thing, doctors are ok at sickness but not at health, they will advise the standard things whereas there is new knowledge out there.
Such as...........if you give up sugar you will lose weight and be healthier................without doing anything else at all.
But think about how many things you eat that have sugar in them and you'll see it takes some thought.
40 years ago there was no obesity epidemic, funny how what is happening now coincides precisely with the pushing of sugar into much of what we eat.

Julia said:

That's a good idea. Other doctors I know are quite happy if you phone half an hour before your appt and ask how they're going for time. But this one of mine insists you must be there at exactly the time of your appointment, regardless of how late he is, then - even if there are five people still ahead of you - you may not go off for a walk and come back closer to the time, apparently on the basis that he might 'suddenly catch up.' I think it's this rigidity that I find unreasonable.

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I know its easy to say but - change doctors.




Ringing up the surgery and seeing how far behind the doctor is seems the best solution to having to wait.

I agree with Tink too that its good if you can be friends with your doctor so that variations to normal consultancy is possible. As long as the friendship is not abused.(there are some drawbacks)

DocK said:

Inevitably I'm nearly always either lied to and told he's on time, or told to leave it another 20 mins and then had to wait anyway because other people (with later appointments than mine) were already in the waiting room and it "would be unfair to them/not look good" if I were seen first - despite me having an earlier appointment time.

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That's part of the principle also with my GP. Similarly if you arrive two minutes after your appt time, and someone with not much to do who has the appt after you, happens to have arrived before you, he will see that person first, again because 'it looks better to all the people in the waiting room'.

This cavalier treatment of patients' time irks me no end - but is in no way restricted to the medical profession.

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But it doesn't apply across all doctors. When I'm sitting there waiting, the other three doctors have several patients in and out at about 15 minute intervals.
Part of the problem with my GP is that he accepts interruptions, i.e. will take phone calls during a consultation.
Certainly some calls may be urgent but a good receptionist should be able to sort out much of it.
Then someone will come in with Xray results, and he'll excuse himself to go and have a look at these.
Ditto if someone calls for a prescription and he hasn't handed it out to reception, someone will come into the room asking for it.
Surely - especially when you've waited a long time - you should be able to discuss whatever it is without being interrupted.

My husband was a pretty busy GP with three partners. One of these was very laid back, chatty with everyone and his patients loved him because he was always up for a discussion of the latest grandchild etc. Obviously he got badly behind time. Very irritating for those patients of his who were just there with a sore throat and wanted to be in and out. We solved it by the other three, all of whom kept pretty much to time, seeing any of the short consults who were quite happy to see someone other than their usual GP.

Unfortunatley when it comes to some services, such as the GP the family has seen for the past 15 years, it's just too damn unattractive a proposition to change, or the alternatives on offer are no better! The medical centre I use actually refused to see my son recently as they were overbooked and not taking any further appointments for the day. He was running a temp of nearly 40, throwing up and quite unwell, yet couldn't get in to see our family GP of 15 years and had to sit in the waiting room of the nearest bulk-billing centre for nearly an hour and a half or wait 3 days until the following Monday to be seen by his own doctor. As he had an exam that day and needed a medical certificate for his school there was no alternative but to go to another medical centre. I'd switch permanently but they're all the same in my area

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That's dreadful. At least that would never happen where I go. Any acute situation is always fitted in.
Undoubtedly much of the reason for the running late.

And then I suppose their work has to be cost-effective. The obvious answer would seem to be to book fewer patients per hour, but that's going to adversely affect cash flow.

dutchie said:

I know its easy to say but - change doctors.

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That's the thing, dutchie: itis easy to say, but as Dock has said, what's on offer is often no better.
I've been with this GP for twenty years, he knows all my background, and I have confidence in his clinical abilities, something I can't say for quite a few GPs.

Ringing up the surgery and seeing how far behind the doctor is seems the best solution to having to wait.

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Yes. That seems sensible for both doctor and patient. However, as I've explained above that's not on and the patient is required to be there at the appointed time regardless of how late the doctor is running.
This is my objection, not the fact that he's late. Just seems entirely unreasonable and not in anyone's interests.

I agree with Tink too that its good if you can be friends with your doctor so that variations to normal consultancy is possible. As long as the friendship is not abused.(there are some drawbacks)

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Lots of caution required here. Better imo to keep friends as friends, and professional relationships just that.

One of the problems facing GPs is that the majority of their patients are now elderly, This is particularly so in areas such as where I live, where people go to retire and eventually die. I notice that I am waiting increasingly longer to see my doctor. Many of the patients have multiple illnesses, and a caring and conscientious doctor nearly always exceeds the 15 minutes allotted. Quite often the patient is accompanied by their partner which can cause further delays.

I would prefer my doctor to be blunt and terse and keep the line moving. However he is a decent caring man and I would hate to see him succumb to all the pressures he faces.

My dentist has none of these pressures, gives prompt service, charge like a wounded bull, and is much richer than my doctor.

It's never possible to know in advance how long it will take to work out what is wrong with a complex technical system etc and I'd expect that being a doctor is much the same. You can estimate how long actually fixing it might take, but determining with certainty what the problem is in the first place is the hard bit.

There are plenty of tradies in a hurry who wrongly diagnose the problem that's for sure and I'd rather my doctor didn't make such a mistake. Hence if I'm an hour waiting then so be it. I'd rather have a good doctor than be worried about time.

What I do find really strange however is the practice of hospitals getting all surgery patients to turn up at some early time in the morning, fully aware that most will be kept waiting far longer than necessary. If the surgeon isn't going to be ready until 1pm then what's the point of having the patient there at 7am? I don't know if all hospitals do it, but I've come across it.

Oh how lucky we are in western countries to have Doctors that actually care how you feel, or at least do a very good job of acting. I would gladly wait for hours to see my old GP in Australia, or Canada now. The Australian guy was quite caring, he recalled what i did and who i worked for. He would answer all my questions in the detail that he knew i wanted.

In the PRC, you go and line up to register at outpatients. Once you get your number and you've paid you then go to the department where they think you need to go. Once you get to see the doctor (after your number is called) he or she spends a little time with you, usually refusing to make eye contact or answer questions. They ask the questions, then assume they know exactly what is wrong with you and send you on your way with a script, on they go to process the next number. You're not likely ever get the same Doc again. There is little in the way of family doctors here. It breaks my heart to see the way they have cared for the people i care about. It sickens me to think that these people deserve to be called "Doctor". They are a total disgrace to the profession.

I now go to the Singaporean Doctor clinic in Suzhou when i can. They're trained in western medicine at either Singaporean schools or overseas. Even though they had never met me, they were kind, helpful and even seemed quite caring.

Part of the culture i really dislike about this place is the lack of humanity and empathy for your fellow man.


CanOz

I find you get what you pay for , any opinions out there on a Bulk Billing practice as opposed to those that charge over the rebate fee for consults ?

And just out of interest...The Hippocratic Oath

http://en.wikipedia.org/wiki/Physician's_Oath

Thanks for sharing that Can Oz -- I think we are lucky here too.

Agree Knobby, I can say the same thing about my doc.
I remember when I first started going there she would send me for so many tests and I would think, do I have to?
Through the years now, I am thankful she is like that.

I would rather wait and see a doctor of choice than be in and out quickly and nothing gets done.

I remember when I first started going there she would send me for so many tests and I would think, do I have to?
Through the years now, I am thankful she is like that

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Yes but thats the problem with the system though isn't it no control on costs .How many tests are ordered that are not necessary just to avoid possible liability to the doctor?:frown:

If there were tests to be done, she would tell you to do them and remind you.
She wouldnt send you for tests for no reason.