A Country Doctor Writes:

Not only have we shortened medical appointments to 15 minutes. We also sometimes double book them.

I get the feeling that non-providers think of this as something fairly ordinary, and even reasonable. But it is often a very difficult and destructive thing to do.

The term “double booking” and the way it looks in an ordinary doctor’s scheduling grid suggest that the physician might possibly be expected to be in two places at the same time. That is hardly ever the case for those of us who are mere mortals.

Sometimes a patient does need a lot of non-provider time, for example to get undressed and ready for a Pap smear. In such a case the doctor could take a quick look at another patient’s sutures or something simple like that in another exam room while the first patient is getting ready.

There is a tendency to squeeze in simple things almost anywhere, but, depending on who is losing half of their fifteen minute appointment, that might be a very unkind thing to do. In today’s reality, with Meaningful Use, ACOs and Patient Centered Medical Homes, we have to screen for various conditions and risk factors, update medication lists, immunizations and family and social history in every single visit. There really are no in-and-out quick visits anymore, thanks to our well meaning(?) Government.

In small practices, where the scheduler knows patients really well, it might be possible to predict better whose visit will be short and whose will take more time. But we have found as we have grown that this kind of knowledge is disappearing a little, and in some computer programs, the scheduling grid doesn’t show the names or concerns of scheduled patients, just that a slot is already filled.

This is why, the other day, somebody else got double booked with an elderly patient of mine who was given only a fifteen minute appointment for depression.

Double booking is sometimes used as a strategy to manage no-shows. That can be really bad.

In some practices, patients who have no-showed too many times are double booked with another patient, so that the expensive doctor doesn’t risk being idle for fifteen minutes. Of course, if the habitual no-show patient does make it to the appointment, the doctor is faced with managing both the catch-up of a patient who may be well overdue for whatever they came in for and the compromised visit of another unsuspecting patient. That unfortunate person ends up paying the consequences of having another patient booked in the same time slot. Two players in this triangle pay the price of the past transgressions of the third.

There is no good solution for no-shows. Dismissing such patients may seem easy for the practice, but even if you don’t believe health care is everybody’s right, some people no-show because of their economic or social situations and really need to be seen when they are finally able to keep an appointment, for example a child who is behind on immunizations.

The double booking due to being busy needs to be looked at in a humane and business-like way, and it needs the direction of the medical provider: The random double booking of unmarked squares on a computer screen is no better than throwing darts. We need to analyze our data to better predict the demand for services on a Monday morning or Friday afternoon before a long weekend.

And we need to risk a provider sometimes having fifteen unscheduled minutes. That time could be spent on patient relations or care coordination. Because doctors aren’t just faceless widget makers who produce visits. We are the ambassadors and medical leaders, or brains, if you will, of our practices.