Hurry up, I have important things to do!

Have you ever been waiting at a doctor’s surgery for hours, even when you have an appointment?  How frustrating! Have you ever spent hours and hours waiting in a hospital emergency department!?  This is a common occurrence, why do we have wait so long?

This is an issue that comes up often: wait times.  You make an appointment with your family doctor for 1pm and don’t get in until 3pm.  Sorry to tell you, but this is often not the doctor’s fault and lies well beyond their control.  Let me explain…

A standard appointment is 15 minutes, in many cases this is what is booked unless the patient asks for a longer appointment time.  A patient comes to their family doctor with a simple problem- an earache.  Sounds simple enough.  The patient waits for an hour beyond their appointment time and walks into the doctor’s office.  The doctor looks at his ear and diagnoses a mild case of otitis externa and gives the patient some eardrops.  Just as the appointment is coming to a close the patient also wants 3 scripts, is hypertensive, has chronic diarrhoea and asks for an asthma management plan.  The appointment now takes close to an hour.

Unfortunately there are limited solutions to this problem because a lot of the cause is patient driven.  Yes, doctors can be faster but they shouldn’t be several hour behind if their normal appointments only lasted the allocated 15 minutes and those who required a longer appointment requested one in advance.  And even then, unfortunately patients might not remember to ask for a longer appointment for their asthma management plan the 3 days earlier they booked the appointment.

The emergency department is a slightly different story.  In most emergency departments there will be a set number of doctors on every shift, this does not change.  On one particular evening there may only be a few patients attend and the wait time could be as little as 20 minutes.  On a bad night the emergency department may be overflowing with patients, the number of doctors is the same and you may be waiting close to 10 hours (yes 10) to be seen.  This also depends on your triage category.  When you arrive at a hospital you are usually seen by nurses who give you a category between 1 and 5.  Category 1 means see immediately, this is usually patients who have gone into cardiac arrest or who are unconscious and require resuscitation.  Category 2 patients are to be seen within a few minutes, this includes patients with chest pain, severe allergic reactions etc. Category 1 patients are always seen immediately and category 2 patients are usually seen within 5-20 minutes.  Category 3-5 patients are a different story.  They are often seen in the order they attend the emergency department and their category because less important.  Category 5 patients in most circumstances are patients that should not have attended emergency, they present with problems such as mild abnormal blood tests or requesting medication.

On a busy shift in emergency, there might be 20 people waiting to be seen by 4 doctors.  On top of that two category 1 patients have come in requiring urgent life saving resuscitation.  To make matters worse, one of the previously stable patients has started to deteriorate and their symptoms have become life threatening and they need to be moved to the resuscitation area.  On the same night there are also 2 aggressive mental health patients requiring restraint.  It is times like these when non-urgent patients may be waiting all night.  Doctors in emergency do try their best, but medicine is something that is highly variable and unpredictable.  Doctors often miss their lunch breaks, don’t go to the bathroom or stay back late in an attempt to catch up. So next time you are waiting for hours at a family doctor or emergency department, just remember the doctors are doing their best.

– The Doctor

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