How doctors can make more by doing less

 By MUNGAI KIHANYA

The Sunday Nation

Nairobi,

10 October 2010

Why is it that our doctors never keep an appointments book? Is it because they can’t keep time? Do they fear that patients will not be, well, very patient with them? Or perhaps they don’t think it is possible to know how long they will take with a client.

I suspect the last reason is the most probable; so let me offer some help. I estimate that every time I visit a doctor, I stay about 15 to 20 minutes in the consultation room. A very long visit may last up to 30min and a quick one will be 5min to 10min.

With that in mind, a doctor can create a simple appointments timetable with 30-minute slots from 8am to 5pm. Allowing for tea and lunch breaks, such a plan, would have 14 sessions per day. This is probably the same number of patients that the average doctor sees daily.

One of the advantages of keeping an appointments timetable is that the doctor no longer needs a large waiting room at the clinic. In addition, the stress from the sight of ten sickly people waiting for treatment is virtually eliminated.

But does the doctor lose business when operating with such a timetable? On the contrary, I think there will be more business since patients generally don’t like waiting for long to see a doctor.

Personally, I would prefer a clinic where I am sure to be seen immediately upon arrival over one where I have to wait for many hours not knowing when I will be treated; or indeed whether I will be seen before the end of the day.

If it is any consolation; doctors’ clinics are not alone in this predicament: Hospitals are even worse. I recently took a sick relative to the Kenyatta National Hospital and after arriving there at 8pm, we finally got an admission at 4.30am – eight and a half hours later!

But it is not just a problem in public facilities. A few year ago I took a friend to one of the largest private hospitals in Nairobi. He was complaining of pain in the chest. We arrived at 1pm and went through the following processes:

3 minutes at the registration desk; 5minutes taking his vital signs (temperature, blood pressure etc); 10 minutes in consultation with a doctor; 3 minutes at the electrocardiogram (ECG) machine; 5minutes with a second doctor to review ECG results; 2 minutes at the pharmacy; one minute paying at the cashier; and one final minute at the pharmacy to collect drugs.

In total we got a cumulative 30minutes of actual services at the hospital. However, we left at 6.30pm – 5.5 hours later. So what were we doing in the rest of the five hours? Waiting at each of the stations!

Looking at the time spent at each station, it is clear that the staffers were working very efficiently, but we still spent 90 percent of the time waiting for service.