Patient complaints in healthcare often stem from the concept of time. It takes months to get an appointment with a renowned specialist. I spent two hours in the waiting room until I was finally called in to see my primary care doctor. Why is time so warped in healthcare?

Two main reasons. First, there is a supply and demand mismatch. There is a finite amount of “the best neurologist” that “everyone wants to see” so people schedule appointments for 3 months in advance. But if you want to see the young neurologist fresh out of residency, she’s available later this afternoon. You gotta wait for quality and experience.

Second, delivering services to patients with varying complexities and trying to fit each patient into the same 15 minute time slot means some appointments are inevitably going to go longer. Each patient’s problems can’t be solved by the same 15 minute widget of time being sold. When a patient who needs acute, more complex time-sucking care shows up, the rest of the day is shot. It’s just the nature of delivering a service to a population of folks with unknown requirements. And all it takes is one complex patient in the morning to throw off the entire day. Sometimes, even the Apple Genius Bar makes you wait because a few back to back complex broken MacBooks came before you. Primary care offices in the last 20 years or so have been experimenting with novel means of scheduling, called Open Access, but this hasn’t really taken off mostly because it’s just different than what’s always been done.

Of course all of this stems from healthcare paternalism. Doctors have been deified by our culture. They can sometimes work miracles. It’s been since day one, “doctor knows best” and the conversation around patients coming first has only recently begun. I obviously welcome this conversation and I’ve given my career to putting the patient first in healthcare delivery.

There’s recently been another conversation happening in healthcare about “on demand” healthcare. The concept of “on-demand” only works if the demander does not care who the supplier is and there is plenty of supply. If the demander cares who the supplier is, the demander will be subject to the supplier’s schedule. And when you are subject to the supplier’s schedule, it’s the waiting game all over again. You must wait for the doctor’s schedule to free up. Never mind that you have meetings and work to be done throughout the day. But now that healthcare can be delivered via on-demand video visits with doctors, we’re seeing patients are now being given the choice to choose their doctor and wait for them via video. Essentially, it’s a “video waiting room.” This assumes so many pain in the ass things:

  • Suppliers (doctors) have a dedicated period throughout their day devoted to only video visits
  • Doctors get paid the same amount for video visits vs. in-person visits. If not, they’ll skip time spent on the lesser paid visit.
  • Patients will accept the same concept as waiting for the cable guy to show up “anytime between 9am and 5pm tomorrow”
  • When the doctor is ready for the patient, patients will be immediately available to have a video chat with their doctor, in a private place in an era of open office spaces. This means they have to stop whatever they’re doing and find a private, secure place to have a medical conversation with their doctor about things that are often private and embarrassing and nothing you want your co-workers to overhear.

The concept of optimized time in healthcare is an elusive devil. For decades, doctors have been on their own schedules, patients be damned. But now, with the advent of “on-demand healthcare,” the assumption is doctor culture and their respect for time will change for a technology and a process that is by no means beloved, nor deemed safe or high quality, by either doctors or patients.

All of this is fixed when doctor-patient communication happens asynchronously, like email or texting. Patients can communicate when convenient and this enables more thoughtful conversations. Removing the expectation that healthcare conversations need to be in real time creates an efficiency orders of magnitude higher than today’s exam room or video conversations.