Arriving Late To Appointment Can Shorten Your Visit With The Doctor Interview with:
Chester G. Chambers, Ph.D.
Director, Enterprise Risk Management Program, Johns Hopkins Carey Business School
Joint Appointment in Anesthesiology and Critical Care Medicine
Maqbool Dada, Ph.D.
Joint Appointment in Anesthesiology and Critical Care Medicine
John Hopkins Medicine
Kayode Ayodele Williams, M.B.A., M.B.B.S., M.D
Medical Director : Blaustein Pain Treatment Center
Associate Professor of Anesthesiology and Critical Care Medicine
John Hopkins Medicine What is the background for this study? What are the main findings?

Response: The result is based on a retrospective analysis of three specialty clinics in the Johns Hopkins System: a private practice low-volume clinic with one physician and no residents; a medium volume clinic that used one attending physician for each clinic session and included residents; and a high-volume clinic with multiple attending physicians and several residents.

Our main finding is that physicians adjust face time based on congestion in the clinic, and seem to do this without always knowing they are doing it. Patients who arrive early and whose service begins before their appointment times, tend to get more face-time then other patients. This is similar to other service systems in which first-line providers speed-up when they see long queues at their stations.This is important because most of the prior research in this setting assumed that this never takes place. We verified that it does happen in multiple settings and the changes in processing rates are statistically significant. This means we need to rethink many earlier conclusions about how clinics run. What should readers take away from your report?

Response: While we find no evidence that quality of care is not affected, if face-time is important to the patient, that patient should arrive much earlier than their appointment time. If they are tardy, the face-time will tend to be short. Clinic managers need to understand that provider behavior is adding a new dimension of variability that was not properly accounted for in earlier works. This has implications regarding how costs, capacity, and waiting times are estimated. What recommendations do you have for future research as a result of this study?

Response: Clinicians should be made aware that they tend to respond to congestion in clinics. If the goal is to spend about the same time with each patient then a more structured approach should be used when interacting with patients. We also need to revisit a lot of older publications to see how this finding changes the results of those studies. More work needs to be done to document how this happens. Sometimes providers simply move faster, but that does not mean it is sustainable over a long period of time. Sometimes the process flow is being altered, especially when teaching is involved. Is there anything else you would like to add?

Response: This paper is part of a series of on-going studies on improving patient-flows in outpatient clinics. Any time you add variability to a service process, you have to think carefully about whether this increases or decreases value because it almost always degrades some measure of performance. Thank you for your contribution to the community.


Chambers CG, Dada M, Elnahal S, et al
Changes to physician processing times in response to clinic congestion and patient punctuality: a retrospective study
BMJ Open 2016;6:e011730. doi: 10.1136/bmjopen-2016-011730

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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