Temporal communication deals with "time as the message." Accordingly, it is our conception and perception of time that gives shape and meaning to our lives.
You rarely see a clock on the wall in a waiting room because it tends to accentuate the length of time a patient is obliged to wait. While there are certainly patients who are not offended by excessively long waiting periods to see the doctor, many resent having to wait more than 15 to 20 minutes beyond their scheduled appointment. Paradoxically, an inordinate number of people in this country expect to be kept waiting when they go to the doctor. Such an expectation, however, does not usually exist in most of the business world. Why, then, should waiting and health care be interchangeable?
As your patients have lives outside of your office, to have them spend excessive amounts of time "cooling their heels" in your waiting room could be construed as a lack of consideration.
What are some of the reasons many doctors have waiting rooms in which patients are made to wait in excess of half an hour? Overbooking is one possible explanation. Depending upon how much time the doctor allows for each patient, secretaries or receptionists schedule patients accordingly. Also, to be factored in: (1) certain patients occasionally require a little more time; (2) late arrivals; (3) receptionists who, because they anticipate cancellations or "no shows," overbook; (4) doctors who are either impervious to time or have a poor sense of it. Anyone or a combination of these things could create backup in a waiting room.
I am reminded of a doctor of chiropractic some years back who had an enormous practice. It was so overflowing that wives came in the morning and sat all day in his waiting room just to save a place for their husbands who came in for treatment after work. This of course is an exceptional case.
A patient's tolerance for waiting must take into account such variables as their occupation, temperament, health status, culture, lifestyle, personal experience, and personality. Any one of these could easily placate or exacerbate one's ability or willingness to wait.
Could prolonged waiting by susceptible patients have such physiological consequences as tachycardia, increased flow of adrenalin, excessive perspiration, muscle tension, or dyspepsia? What about such psychological effects as anxiety (as suggested in the title), apprehension, irritability, annoyance, or outright anger? Patients inclined to experience these phenomena, when finally admitted for treatment, are not the same as when they entered the doctor's office. In fact, the benefits derived from the treatment received in some instances, can be either undermined or negated.
It might be fitting, here, to relate a story told by the late comedian Danny Thomas:
"I was once driving out West and on a deserted stretch of road in the middle of nowhere I had a flat tire. I soon discovered that I had no jack. Remembering a gas station a few miles back, I started walking. As I walked, it grew dark and rather chilly. I thought to myself, "Just my luck. When the guy at the gas station recognizes me from my films and on television, he'll probably charge me an arm and a leg for the use of a jack." The farther I walked, the more infuriated I became. By the time I reached the gas station, I had become so unhinged by the thought of being overcharged that my emotions literally exploded."The moral of this story is self-evident. People under any form of duress undergo varying degrees of uneasiness. Waiting room anxiety is one such form of duress. The question should now be begged, "How should such a situation be averted?" The first thing is to acknowledge that the problem exists; the second, that it warrants a remedy. Not infrequently, certain doctors equate the crowded waiting room as a status symbol: a symbol of success. While this may well be true, it does not excuse the imposition it imposes on faithful patients. Within reasonable limits (and we must define the word reasonable), a patient's scheduled appointment should be given the respect it rightfully deserves.
Cognitive dissonance exists when an individual is confronted by two opposing forces. An insensitive comedian once spoke of his mother-in-law driving off a cliff in his new Cadillac. On the one hand, he wanted her out of his life, but on the other, he valued his new Cadillac. Doubtless, he was on the horns of a dilemma. To which of the two options should he defer? This is cognitive dissonance. An analogy can be drawn with the crowded waiting room, the one in which patients are obliged to wait well beyond their scheduled appointment time. On the one hand, doctors enjoy the exultation of having an overflowing waiting room; in the opposite direction, they are unhappy about being confronted by the exasperated patient who has been waiting over an hour. Doctors with patients obliged to wait for treatment in excess of 15 minutes should re-examine their priorities. Doctors should also put themselves in the patient's place and recall how it feels to be kept waiting when seeking treatment from another member of the healing arts. Regardless of who is involved, time must be afforded the respect it deserves. As it is, we spend too much of our lives waiting. Why add waiting room anxiety to the experience? Re-evaluate, reorganize, and restructure your management of time.
Abne Eisenberg, DC, PhD
Croton-on-Hudson, New York
Editor's note: As a professor of communication, Dr. Eisenberg is frequently asked to speak at conventions and regional meetings. For further information regarding speaking engagements, you may call (914) 271-4441 or write to Two Wells Avenue, Croton-on-Hudson, New York 10520.
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
Spearheaded by burgeoning scientific and clinical research literature, psychedelics have reached a level of media coverage and popular interest that has not been seen for over half a century. By “psychedelics,” we are referring to the unique class of substances that includes psilocybin (the active compound found in so-called “magic mushrooms”), LSD, dimethyltryptamine (DMT), ayahuasca, 5-MeO-DMT, and mescaline – each of which occurs in the natural world (except for LSD, which is a semi-synthetic compound).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
