That’s none of your damn business!

None of your biz 2012-07-31

Or is it?

I had to make an appointment recently to see my GP. Nothing major, but the issue was a little more personal and complex than my usual, infrequent appointment requests.

Me: Hi, I need to make an appointment to see Dr. X
Receptionist: What is it regarding?
Long pause…
Me: It’s uhhh. Well, you see, I have a… ummm…

I finally blurted out, in probably too much detail, what I wanted to see my doctor about. After I got off the phone, I wasn’t feeling too good about the experience.

It got me thinking about THE QUESTION. I had a pretty good idea why the receptionist asked it. But I couldn’t help but wonder whether there might be a better way.

The rationale behind THE QUESTION

I decided to do a little digging. I started by calling my doctor’s office again. I explained that I was a patient, and had a few questions about making appointments. Here’s what I learned:

  • You don’t have to say what your problem is, if you don’t want to. It’s okay to simply say “It’s personal.” (Who knew? I didn’t. “Personal” strikes me as a funny label though. When it comes to our “health” – broadly defined – it’s all pretty personal, isn’t it?)
  • Receptionists at my doctor’s office ask THE QUESTION for two main reasons: to determine how much time to allot for me, and to determine whether they need to prepare any materials – for example, supplies for removing a wart.
  • When it comes to scheduling appointments, my doctor’s office uses four broad categories: regular garden-variety requests get 15 minutes; minor surgical procedures (e.g. an excision) get 30 minutes; physicals are budgeted 30 minutes; and, appointments requiring the doctor to fill out and sign forms are booked for 30 minutes.
  • When patients say their health issue is “personal,” office staff book them for a 15-minute appointment.

The survey says…it’s not just me who squirms

I decided to poll my colleagues here at HQC, to find out whether their doctors’ offices ask the same question, and if so, how they feel about it.

Wow. I was blown away by both the response rate, and the richness of replies. This issue really seems to resonate with people.

Three-quarters of my office mates reported that their doctors’ office also ask THE QUESTION. But less than half are 100% comfortable with being asked.

Here’s a sampling of comments from people who are cool with it:

  • I feel good, like they are preparing for us.
  • I don’t mind at all because I think it helps them prioritize the appointments.
  • It helps everyone do their jobs better. i.e., doc can prepare (yes, I’m optimistic), and medical office assistant can book the right length of appointment and type of exam room, and/or let me know if I need to do anything to prepare for the appointment.
  • Different issues require more or less time. Physicals are done at a certain time of the day.

Okay…fair enough.

Now let’s hear from the other side:

  • I would prefer that they didn’t ask. I feel it’s between myself and the doctor. I know I’m allowed to say “it’s private” to the receptionist, but I would still prefer they didn’t ask. It feels like a violation of privacy.
  • I don’t care for feeling like I need to get into the details of why, as sometimes they can be personal!
  • I felt super weird mostly because I wasn’t sure how much detail she needed. I was a little confused, whether it was for time/booking purposes or was it directly related with my care (i.e., don’t eat before you come kind of things) which I guess could have changed my response.
  • It can feel invasive/uncomfortable when she asks the question depending on what I’m calling about. My doctor is a sole practitioner with one staff who is both receptionist and MOA. I think I would feel more hesitant to share if she was a receptionist only but that’s just a hunch.
  • If they asked, I don’t believe I would say because I don’t feel it is any of their business.

Okay, so I’m not the only one who has issues with THE QUESTION. People “get” why they’re asked, but they still don’t necessarily like it.

One colleague reported gaming the system: “I don’t always answer honestly – usually I say what I think will give me the time I want. For example, if urgent then I make myself sound needy so they give me an appointment within the week (my doc uses a carve out model). If not urgent but I want a particular time I usually try to negotiate a bit – in other words haggle for the time I want. I look forward to the day that I can just say what time I want and not have to explain myself or lie to get what I want.”

So let’s recap: THE QUESTION is not universally loved by patients. There’s variation in practice, with some offices asking, and others not. And some patients feel forced to “cheat” in order to get what they want.

What do you think? Are there good reasons for maintaining the status quo? Or is this an outdated practice ripe for a patient-centred makeover, perhaps through standardization?

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12 Responses to “That’s none of your damn business!”

  1. les stone
    August 17, 2014 at 11:29 pm #

    What do you want to see the Dr. for? What symptoms are you having? I’m in the waiting room and other patients can hear. You actually see their ears perk up. It’s personal does not register with this girl. She raises her voice and says we need to know so we know how much time to allot you. Do I say I have a rash on my genitals…..now I have to turn around and every eye is on me. How do you answer? It’s so embarrassing. Why can’t they just give you a form to fill out. The Dr. wants to give 15″ at a cost of $200 or more. Things have really changed. Everyone is so greedy for money that they schedule 10 people for 9:30 am. You’re still waiting at 11:15… then you wait 30 minutes more in the patients room. This doctor closes for 1 1/2 hrs for lunch and was almost 30 minutes getting back. Patients backed up behind me standing outside a locked door. No apologies or explanations..just business as usual. After waiting almost 2hrs and a half I walked out and never looked back…never seeing the doctor.

  2. Heather Thiessen
    August 1, 2012 at 12:09 am #

    I have been pleasently surprised in my doctors office of two neat things. One being that i can now book an appointment online for my doctor and the second, is that when I come in I goto a computer screen and check myself in without going and talking to the receptionist.

    I do know though that when I have to call to make an appointment I do am almost whispering to them in hopes they whisper too when asking me questions.

    It is sad that most doctor offices forget this little bit of privacy that their patients not only want but deserve. Especially those in a smaller community. I know I get to hear about mr. x or mrs. y , when I am sitting waiting to see my doctor. It hard for me to sit and have to listen, so i usually start fiddling with my i touch or phone.

    I am not sure what the answer is, it does help with these small changes my doctors office does Maybe someday receptionists will think hmmm maybe time to take calls in a more private area.

    • Greg Basky
      Greg Basky
      August 1, 2012 at 8:49 am #

      Hello Heather. It’s great to hear that some physician practices are taking advantage of IT solutions that make things better for both patients and office staff. Interesting juxtaposition between this topic and that of Dr. Shaw’s recent post: in one case, it may be time to retire the telephone as our tool of choice, in the other, the (mobile) phone is emerging as innovative way to to more closely involve patients’ family members.

  3. Steven Lewis
    July 31, 2012 at 10:48 am #

    From what people have said, it seems that the intrusive query is mainly a proxy for 2 legitimate questions: 1) how much time will the appointment likely take, and 2) is there anything special the doctor needs to do to prepare so the appointment goes smoothly and efficiently. Both could be addressed by moderately sensitive patient-centred communication, by asking, in the first instance, “We normally book 15 minutes for an appointment. Is the reason for wanting to see the doctor likely to need more time?” And for the second, a simple checklist, e.g., “Does the reason for the appointment involve potential minor surgery like a wart or mole removal”?
    But come to think of it, we book plane and theatre tickets and buy all sorts of goods on-line. A friend of mine moved to Copenhagen, found and enrolled in a clinic, and made an initial appointment on line. Why not offer that to the 90% of people who would likely use that option, and include an option questionnaire that would become part of the EHR as well as a primer for the visit?

    • Nadine
      July 31, 2012 at 11:01 am #

      I would absolutely appreciate having these 2 questions asked in this way, rather than the dreaded “And what do you need to see the doctor about”. Excellent point, Steven

      • Greg Basky
        Greg Basky
        July 31, 2012 at 11:22 am #

        Thanks for joining the conversation, Nadine. Glad to hear from someone at our sister agency to the West.

    • Greg Basky
      Greg Basky
      July 31, 2012 at 11:29 am #

      Hey, you’re scooping my topic for a follow-up post 🙂 Health care can surely borrow a page from online scheduling solutions used by other service industries that are focused on respecting their customers’ preferences and giving the people what they want, when they want it. Stay tuned.

  4. Anonymous
    July 31, 2012 at 10:37 am #

    Another issue is that the reception area at my doctor’s office is not very private. So all conversations that are had by his receptionist can be easily heard by everyone sitting in the waiting area. Whenever I am sitting there listening to her conversations, I always imagine other people listening to her conversation with me or about me. So if I answer “The Question”, who else will hear the conversation?

    • Greg Basky
      Greg Basky
      July 31, 2012 at 11:21 am #

      Thanks, Anonymous and Sue, for flagging another problem with the old model. One of my colleagues here told me the reception desk in her doctor’s office actually juts out into the waiting room. So the audience of WAITING patients is seated theatre-style, with these telephone conversations going on “centre stage.”

  5. Sue
    July 31, 2012 at 10:26 am #

    You have missed another huge issue…most receptionists are in close proximity to the waiting room. Gives those siiting and waiting for their turn, lots of opportunity to know who is calling and what their issue is. Think back, did the receptionist repeat back to you anything like…well hello Mr. XYZ or perhaps “and you need to see the doctor about your …” The smaller the community, the more likely your information is being shared beyond the receptionist and the physician.

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