Hairdressers do it. Why can’t doctors?

2012-08-17

Thanks to readers who weighed in on my last post (That’s none of your damn business!). Your comments suggest it’s high time we stop asking patients The Question. A suggestion from Steven Lewis serves as a great segue to the topic of making appointments online:

“…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?”

I knew my GP offered online booking, but I’d never looked at the form too closely. Here it is:

 

 

Frankly, I’ve always been kinda skeptical about booking doctor appointments online. I’m not sure why that is. I use the web to book appointments with my massage therapist, and that system works great.

Maybe my reluctance has something to do with the fact that when I’m booking to see my GP, I usually want to get in as quick as I can. And, for whatever reason, I figure I’ll get in faster if I talk to a real live person – even if I do have to answer that pesky question.

I got back on the phone to my own doctor’s office, to ask a few questions about their online booking. Here’s what I found out:

  • They harvest online requests once a day. Office staff deal with requests in the order they come in.
  • They receive anywhere from 6 online requests, on a slow day, to more than 20. Typically, about 10 to 15 requests come in over the weekend.
  • The day after you log a request, they call back to let you know whether you can see your doctor on the day you asked for; if that date isn’t available they offer you a second option.
  • They follow a “one strike and you’re out” rule. If you don’t answer when they call back, they won’t leave you a message, and your request gets deleted.
  • According to the receptionist I talked to, you’re either a “regular” (which get a 15-minute slot) or a “physical” (which gets booked for 30 minutes).

Okay. So I can avoid The Question; I get to choose how much or how little detail I provide about my health issue. But there’s no mechanism for tailoring the appointment length to my specific needs. And the ball’s in my court if I miss their call.

Better, I guess. But still. What if I miss that call? I’m not sure how realistic that one strike rule is for most people.

When I originally canvassed my colleagues here at HQC, one of them shared an observation similar to Steven’s – that it probably wouldn’t be too much of a stretch for health care to borrow a page from another personal service, when it comes to making appointments:

 

 

“My hairdresser has online booking on her website, and she has a list of services with an indication of how much time they take. You book yourself for what you need, and it automatically schedules you for the correct amount of time. (Plus sends a reminder update.) Along with your booking request, you can also insert a note for her. Really, how hard is that?!”

Standard time blocks for standard types of services? Check. Eliminating the need to ask The Question? Check.

How hard, indeed.

PS – As my colleague Kyla noted in her latest post (Standing O for eHealth), you can give your thumbs up to online booking in eHealth Saskatchewan’s online survey about electronic health records.

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4 Responses to “Hairdressers do it. Why can’t doctors?”

  1. Steven Lewis
    August 21, 2012 at 11:05 am #

    Hi Greg,
    Interesting how your doctor’s office has it half right, but it seems to me they could take 2 more steps to make the system really hum. First, forget the phone call confirmation – it’s a total waste of time and a recipe for repeat failures. Hotels.com doesn’t phone me to confirm my reservation. I can customize my search (i.e., express non-standard needs). I am fully informed of the consequences of no-shows. Second, the whole calendar of appointment time slots should be visible to patients (anonymized of course for the ones already filled in). Most people don’t have entire days available, so why not let them see and choose the exact times that suit them (see: patient-centred care). Once you find a fit, your choice should be confirmed instantly in real time via e-mail. Hotels.com doesn’t phone me to confirm my picks. I can customize my search (i.e., express non-standard needs). I am fully informed of the consequences of no-shows. If there’s something truly unusual about the reasons(s) for the appointment, the request form could be programmed to trigger a review before confirming, or send a message requesting that I phone in.

    Even better, the request form could in essence take my history and rationale for the visit, which would save face time and likely increase the accuracy and comprehensiveness of my account. It could also ask if I need an in-person visit, vs. telephone or e-mail. And it could be a combination of standardized, short questionnaire plus prompts for further elaboration. It could even build in some triggers for a more immediate response (e.g., if I reported a symptom that suggested potentially elevated risk).

    • Greg Basky
      Greg Basky
      August 21, 2012 at 5:25 pm #

      A step in the right direction, yes, but as you and Anonymous note, not a very big step. I like the suggestions you have for making the booking system as useful as possible. As a patient, I would be fine with investing the time required to provide the details you suggest — provided I didn’t have to repeat this same stuff in-person. There would likely be more work involved for office staff, when they harvest the “report” for each booking, but it should save time, and with the right triggers, identify those patients who need to be seen sooner. Are you aware of any places in North American or abroad that have anything like this in place?

  2. Anonymous
    August 21, 2012 at 9:35 am #

    I absolutely believe online booking for any health professional should be available as long as the system can protect privacy & confidentiality.
    As you noted, massage therapists are good examples of effective use of this system. With my massage therapist I can see what slots of time are available and what slots are unavailble. If I need an appointment within 24 hours I know I am required to make a phone call.
    No one should need to spill their guts to an unknown person about their medical concerns to obtain an appointment with a physician.
    By the way, the online form your doctor’s office uses is ridiculous. That system does not constitute online booking – it is simply leaving a ‘voice’ message to book an appointment.

    • Greg Basky
      Greg Basky
      August 21, 2012 at 11:07 am #

      True that, Anonymous, re protecting privacy and confidentiality. But, as Steven noted, other countries such as Denmark seem to have sorted this out. Most of us don’t think twice about banking online, or entering our credit card details into Amazon’s site, or Mountain Equipment Coop’s, to order new stuff. Love your assessment of my GP’s online booking: leaving a voicemail message on the web 🙂

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