Clinical General Opinion Patient-Centered Care Quality Improvement

Notes from a waiting room: What are doctors doing while I’m waiting?

Hello Clinical Laboratory, my old friend,

I’ve come to take my blood test with you again. Because my specialist wants the latest update, so I visit you every 3 months. My appointment was 48 minutes ago, and there are 16 people who arrived earlier than me, still waiting. As the clock ticks, I can hear everything but the sound of silence. Of course you are not alone, Clinical Lab; my other doctors made me wait for them as well. On average, Americans wait 19 minutes and 16 seconds to see a physician, according to Vitals’ Wait Time Report [1]. But the report forgot to add the wait time for check-in at registration and in the examination room. The funny thing about waiting in a clinical laboratory is that a majority of the patients have been fasting before a blood test. So now your patients are not just becoming impatient, but also hungry (or as young people like to call it, “hangry”) as we enter lunchtime.

You offered some reading material to help us pass the time. Many clinics present entertainments like magazines and television to improve the waiting experience [2]. I once visited a fancy clinic that provided an espresso machine for parents and a touchscreen-wall video game for their children. But I have to tell you: I have watched this Judge Judy episode four times in other clinics’ waiting rooms, and I have no desire to touch this well-thumbed Cosmopolitan magazine. Thank you, but, no thanks.

You might wonder why I care about waiting so much. Let me be honest with you: like most of your patients, I compare the waiting time with the time actually spent with the doctor [3]. As patients, if we spend 45 minutes waiting but only get 5 minutes of the doctor’s time, we won’t feel all that waiting was worth it. Certainly, I understand that a vast amount of effort was made behind the scenes. Like the story of Picasso and the bold woman, most people don’t understand that a seemingly effortless one-stroke drawing actually took a lifetime of practice to achieve [4]. I imagine that Dan Ariely and Jeff Kreisler would happily back me up in their book Dollars and Sense: “Assessing the level of effort that went into anything is a common shortcut we use to assess the fairness of the price we’re asked to pay” (in our case, we pay with time).  To solve the problem of customers being reluctant to pay for “invisible effort,” Dan offered the solution of providing transparency [5]. For example, shipping tracking shows all the transactions in each location, and an open-kitchen restaurant shows its staff busy fulfilling food orders. Needless to say, due to medical confidentiality, you can’t have an “open clinic” that shows the staff taking blood pressures or running tests to everyone in the waiting room. But perhaps you could still give us some indication of the “behind the scenes work.” Tell me that you were reading my medical history, that you were double-checking my results, or that you were researching the latest cure. It would make me feel much better to know that you were doing all the “ground work” while I was waiting for you. And I will pretend that I didn’t see you eating bonbons and doing crossword puzzles as I walked past the doctors’ lounge.

And now, I would like to end this letter with a quote from Oscar Wilde’s “The Importance of Being Earnest”:

If you are not too long, I will wait here for you all my life.

Yours truly,




  1. Vitals wait time report. (2018). Retrieved from
  2. Ahmad, B., Khairatul, K., & Farnaza, A. (2017). An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian Family Physician : The Official Journal of the Academy of Family Physicians of Malaysia, 12(1), 14–21.
  3. Huang, X. (1994). Patient attitude towards waiting in an outpatient clinic and it’s applications. Health service management research. Retrieved from
  4. Airey, D. (2017, September 25). Picasso and pricing your design work. Retrieved from
  5. Ariely, D., & Kreisler, J. (2017). Dollars And Sense: How We Misthink Money And How To Spend Smarter. Harper


Author: Yi-Lin Cheng (website)

Editor: Mary Abramczuk

Image credit: Abraham Solomon, “Waiting for the Verdict” (England. 1859), The J. Paul Getty Museum, via

Clinical General Healthcare Costs Opinion Patient-Centered Care Reflection

Excellent, good, or fair? How accurately can patient satisfaction surveys measure quality of care?

Last week I had my semiannual dentist appointment. Right after I stepped out the door, I received an email: Dental Office – Patient Satisfaction Survey. Hi, thank you for visiting the dental office. Please take a minute to complete the survey…. Was it a déjà vu? Didn’t I just fill this out recently? Oh wait no. That was for the hygienist? Or was it for that new periodontist? Maybe it was my other specialists?

So besides rating my favorite restaurants and shops on Yelp and Google, now my clinics and insurance companies also want to know how I would rate my doctors– how splendid!

To my surprise, when I clicked the link, the questions were trickier than I expected. According to the email title, it seemed like the survey was about my dentist, but 75% of the questions were about the clinic itself: Waiting time in reception area, appointment phone call answering friendliness, waiting room neatness, office decoration….(Wait…my dentist is responsible for decoration? Great, let’s talk about changing the interior lighting and repainting the wall at the next appointment). As I was filling out the questionnaires, my head started to spin with my own questions: It was a normal checkup appointment, will “fair” be good enough? But I remembered I had given the hygienist an “excellent,” and honestly I couldn’t tell which one was better…oh boy! How are they going to use my answers? Who will be reading my survey responses? Who will be affected by my answers?

To me, it’s difficult to judge the doctors’ performance fairly. I can measure a finance manager by his portfolio performance, a designer by how many designs have been ordered, and a lawyer by how many lawsuits she has won. But judging a doctor is more like judging a piece of artwork: there’s a lot of subjectivity. How do I know Dr. ABC is better than Dr. XYZ? By my test result? Or by the number of medications they prescribe? Like with my dental visit, I couldn’t really tell the difference between that cleaning from the previous ones. Interestingly, some physician groups use patient satisfaction surveys to allocate bonuses [1]. That would make the weight of responsibility seem heavier; I would hate to find out that my dentist lost his Christmas bonus because of my thoughtless answers.

Needless to say, it’s difficult for management to evaluate every department and employee in a large organization. I truly hope that upper management does not blindly rely on this “big data” to determine a doctor’s career path. I would very much like my doctor to focus on my health, instead of for him or her to be driven by monetary incentives and to act as a salesperson. If the survey data is used for allocating the budget, perhaps the survey needs to be transparent about how the clinic is going to use the result: “This survey is for quality training purposes only” or “this survey is for determining the best doctor of the month and who gets the nearest parking spot.” I suspect that knowing the purpose of the survey helps the respondent think twice before jotting down comments or complaints. It might motivate patients to actually finish the survey (I would very much like to meet the saintly soul who is able to finish 30 ambiguous questions without losing their temper). Also, I would like to suggest that since we are giving patients such power, perhaps we can give some power to the physicians too and allow them to rate their patients (like how Airbnb and Uber lets hosts/drivers grade their guests/riders).

Surveys and ratings can be important sources of information. If I need to find a new doctor or specialist, the first thing I do is go on Yelp and sort the list by how many stars they have. Some industries routinely rely on survey systems to improve their customers’ experiences [2].

I understand that the idea behind patient satisfaction surveys is to encourage more communication. But at the end of the day, I believe that the doctor and the patient should have a strong mutual trust that enables them to communicate and give feedback freely and respectfully, without needing to rely on 30 ambiguous survey questions.



  1. White, B. (1999, January 01). Measuring Patient Satisfaction: How to Do It and Why to Bother. Retrieved April 17, 2018, from
  2. Columbus, L. (2018, April 22). “The State of Digital Business Transformation, 2018.” Retrieved April 25, 2018, from

Edited by Shaun Webb

Photo credit: Steve Harris

Special thanks to Blog Associate Editor, Janie Cao, for some last-minute content revisions

To learn more about the author, please visit her website here