Another Great Patient Advocacy Blog, “BodBoss”

May 4, 2012Carole No Comments »

A while back, I wrote the article, Participatory medicine – the e-patient revolution which talked about e-patient Dave and the Society for Participatory Medicine.   There appears to be increasing momentum to encourage patients to become more involved in healthcare decisions. The very concept that patients don’t have to be bystanders in their health care is  liberating for patients who wanted to play a more active decision-making role in their health care. Well, I found another great patient advocacy blog written by a nurse, Barbara Bronson Gray, who has worked in hospitals, created a website for WEb MD, and advocates for patients in her blog   “BodBoss”

Although her blog has nothing specifically to do with ART, many of her observations about health care are highly relevant. I particularly liked her post “Long waits at the doctor’s office disrespects patients” that was recently featured on the (mostly) physician authored aggregated blog Kevin MD.  She makes a very important point which dovetails with what has been bugging me about financially successful IVF practices who run patients through the office like a herd of cattle. She points out that except for rare emergencies, long patient delays don’t have to happen if offices would schedule the patients with patient care in mind, instead of just their bottom line. In her own words:

“A practice that doesn’t make you wait has undoubtedly made a philosophical and financial decision that it’s not right to make patients sit very long in the waiting room. They respect your time as much as they respect their own. So they are careful to reserve a few slots every day in their schedule in case a patient’s visit takes longer than expected or there’s an emergency. They also create some “breathing time” in the schedule to help ensure the ebb and flow of people in and out won’t create a frustrating and tiring delay for their patients.  A practice that always makes you wait has a different perspective. They are typically maximizing revenue, over-booking multiple appointments to allow for some “no-shows,” and even encouraging extended patient visits and un-planned procedures because they increase the day’s revenue. Basically:

More Patients + More Procedures = More Practice and Personal Revenue
Sometimes, the practice is just lax. I had the first appointment of the day to see my general practitioner and waited a very long hour. When I asked the office staff how that could possibly be, and was there an emergency, they said, “Oh, no, she comes in when she comes in.”

And lest you think that this is a problem with just family care generalists, specialists typically have longer wait times than the family doctor. Unfortunately, overbooking patients is a very common phenomenon in ART practices and totally avoidable. Offices make appointments every day and every day they gain real world experience on how long it takes their docs to see a certain kind of patient for a certain kind of procedure or test. So if they haven’t figured this out within their first month of business, they are making a decision to let you wait. Period.

It is not unusual to double book appointment times in fertility clinics. If the doctor is double booked, he can still only see one patient at a time so someone waits. In the andrology lab where some specimens are subjected to semen analysis and other specimens are processed for inseminations or IVF, this practice of double-booking is not only disrespectful but particularly dangerous. Why? Because andrology labs are often understaffed and so a few technicians (sometimes only one) are processing multiple specimens at the same time in the same space. Even with safeguards like special labeling or color coding, it quickly becomes a mental chore to keep all the steps straight for each patient in order to make their insemination appointment “on time” or to process the specimen “within an hour” as required by the protocol.

Why does this overbooking happen? Again, because adding staff costs money and spreading patient appointments apart costs money. Ideally, patienst and their samples are spread out throughout the day when staffing levels are lean, but ironically this approach, though best for patient care may also displease patients who are asked to come at less popular times. Clinics know that patients want to come before work or at lunchtime or late afternoon on Friday to accommodate their busy lives and asking them to come at less popular times may displease patients. So clinics give everyone the time slot they want and patients think they are being well served, but if it increases the potential for a lab mistake, any perceived advantage is lost.  So stacking patients up ultimately benefits only  the bottom line for the clinic, not the patient. Consider that the next time you wait for the doctor for hours or have the same appointment time as one (or more) fellow patients for an IUI. Or better yet, get out your smart phone and start looking up their competition.


© 2012, Carole. All rights reserved.

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