Mei Wen is a medical student in the Class of 2019 at the University of Toronto
Last week, I was at the eye clinic at a downtown hospital as a medical student learning about ophthalmology. This week, I was there as a patient. And although I was at the exact same clinic only one week later, the contrast between these experiences couldn’t be greater.
My first astounding realization as a patient was that there was a sign advertising the wait time to be one to four hours — despite the fact that this was a booked appointment. I am ashamed to say that as a medical student on the the other side, it had never occurred to me to wonder how long the patient has been sitting in the waiting room before they were able to get to me. Had they eaten? Were they hungry? Were they told beforehand how long they’d have to wait? Was there at least a good TV show playing?
Unfortunately, based on my experience the previous week I could see why those questions had never occurred to me. As a medical student, I went to my clinical skills session in the clinic and was able to see the doctor/tutor at the time I was expecting to (in fact, I was the one that was late). We had full access to the equipment to check each others’ eyes with no barriers. We were able to have photographs of our retinas taken with ease. But if we never had to sit for hours before accessing a physician, equipment, or investigation during our learning, how could we pause and notice what everyone else in the clinic might be experiencing? Only in hindsight as a patient did I realize how different and unrepresentative my experience as a learner at the clinic was to the reality of the clinic environment from the patient’s perspective.
Until now, I had never personally understood why people were so frustrated with our Canadian healthcare system’s wait times. But I realized firsthand that there are undeniable concerns in our system and we must work to improve upon it further. Fortunately, there are organizations looking into how we can achieve better quality under the one-tier, universal health care system. There are also smaller scale improvements geared around patient-centredness. For example, If I had simply been told ahead of time that the wait was going to be so long, I could have brought a book. In the case of a parent, they may have been able to plan ahead of time and arrange for someone else to pick up their child.
The second key realization I had was that the importance of kindness in healthcare cannot be overemphasized. I was seen by a resident before the staff physician, and the resident explained to me that the exam I was about to undergo was one of the most uncomfortable exams in ophthalmology. She apologized throughout and checked to see that I was doing okay, which I truly appreciated. She may not remember me, but she made a deep impression regarding how to speak to patients.
Don’t ever let someone else tell you that you don’t need to be polite when talking to a patient, or that you are apologizing too much to a patient.
There lies an undeniable power differential between physician and patient — given the vulnerable state the patient is in, hearing an apology and genuine kindness in acknowledging the patient experience can make a huge difference. It certainly did for me.
Do not underestimate the power of kindness in shaping the patient experience.
As a physician, it may be the tenth patient you’ve seen that day; but to the patient, five minutes with you meant months of waiting for the appointment and hours of sitting in the clinic before finally having this moment with you.
Ultimately, I may not have thought about these small ways to improve patients’ experiences if I hadn’t had the patient experience. This experience points out the importance of programs like Longitudinal Integrated Clerkship, where medical students have the opportunity to follow patients as they navigate the healthcare system and understand the system from their perspective. It is far easier to recognize deficiencies in the healthcare system as a patient than as a provider. If healthcare providers were able to better appreciate the healthcare experience from a patient’s perspective, perhaps our actions on an individual level and advocacy on a system level would be more patient-centred as a result. After all, the healthcare system exists to serve patients — perhaps it is time we, as providers, push for it to be designed that way, too.
Dr. Donald Prior (Retired)
Although you were in a “public” system, private Ophthalmology Offices are no different. My usual wait time to see my Ophthalmologist in his private clinic with a booked appointment is 2 hours. Despite the modern digital computerized system, the reality is it means little if no one in the office analyzes the effective time and adjusts the times accordingly. Since the wait times have always been 2 hours the physician has accepted this as normal and acceptable to him. It is not acceptable for patients!
When I was in orthopaedic practice, I was upset if I was greater than 15 min. behind!
Simply caring is not enough–I have seen too many health care practitioners wringing their hands and being totally ineffectual. I have seen others spend so much time caring for a few patients that others have to wait for hours. Care for the person in front of you in their suffering and care about the system that is responsible for getting that person in front of you.
Do we need learning programs to teach med students and residents that waiting sucks when there is no need for it? Do they work, where they have been used?
I remember working in a relatively primitive hospital in Dublin, Ireland many years ago and even there, we as senior students and young interns and residents could see that some clinics were so badly organized that everyone got frustrated, not least the waiting patients.
As for needing private care to eliminate wait times, I don’t agree with that. Our access to primary care in our little clinic is pretty good and we work hard to ensure folk don’t wait long in the waiting room–and we are totally Medicare.
Creating a private system that operates alongside the public system is the only way to reduce wait times.