There's a rule in the clinic: if the patient is half an hour late, we're not supposed to see them. In theory, this prevents patients from being late. In practice, it creates angry patients who argue until finally someone relents and agrees to see them.
I suppose the "right" position I should take is that the half-hour rule is a good one, it keeps us from running too far behind, it keeps us from punishing the patients who are on time just because one patient is late, it creates a strong incentive to be on time...
Except most of these people are taking public transportation, or they work at a low-wage job where it's hard to leave, or they have three kids they're shuttling around... plus they're sick, or at least there's some reason why they're coming in to see a doctor. A lot of them have decent-enough reasons for being late, and it feels terrible to turn them away and then watch them fight just to see us. If they don't see us, it's not like they're going to go to another doctor. They're not going to go to a doctor, they're not going to come back here... and so they're just going to get sicker, and end up in the emergency room at some point. We should be rewarding people who decide to come to the clinic and get treated instead of waiting until it's an emergency room problem.
And so I think we shouldn't necessarily see them right when they get here, an hour and a half late, but we should just do our best to accommodate. And not yell at them like they're children, tell them we won't see them, and send them back on the street to get sicker.
I think in a lot of cases there isn't enough paternalism in medicine-- I think we give patients too much choice when it comes to treatment-- because it's uninformed choice, for the most part, and people end up making decisions without accurate information or accurate explanations that they can understand to make the right choices. But when it comes to showing up on time for an appointment-- at a clinic for the uninsured, not at a plastic surgeon where you're paying out of pocket, not for a population that has options and advantages and lots of ways to get decent medical care-- I think it's ridiculous to try and teach these adults a lesson about promptness. We should be treating them like people who need our help, not treating them like children.
And we end up seeing them anyway, after they throw a fit, and then they hate us, we hate them, everyone in the waiting room hates them and hates us for giving in-- and we end up throwing off the whole schedule anyway.
Besides-- nothing bad happens to us when we're running two hours late-- we have excuses, often legitimate ones. Why can't we assume our patients might have legitimate excuses for being late as well?
It would be easier to argue the other side-- our time is valuable, how can they expect us to wait for them, we're trying to do the most good for the most people and that can't happen if we have late patients-- but I just can't shake the feeling most of these people aren't trying to be late, and their lives are a lot more complicated and difficult than mine is.
A rare show of sympathy in the blog, I know. :)