Jeff Segal, MD, JD, FACS recently reported the case of Elaine Farstad. An IT specialist from Everett, WA, who became angry when her physician was late for a scheduled appointment, Ms. Farstad calculated her hourly wage rate and billed her doctor for the time she had to wait – to the tune of $100. Interestingly, her doctor sent her a check for the full amount.

In fact, many practitioners are now using cash, gifts or credit for future appointments to “compensate” patients for time spent in waiting rooms.

To be sure, most doctors are not drinking coffee and reading the paper while patients are waiting. More often than not, they are seeing other patients who demand and need additional time. Complex clinical questions rarely reduce to a satisfactory solution in 5 minutes. These unpredictable “interruptions” have a cascade effect, not dissimilar to catching a plane from LaGuardia late in the afternoon.

The airlines have already come up with their solution. While it used to take one hour of flying time to get from New York to Greensboro, N.C., today, the difference between departure and arrival time for the same flight is often closer to two hours. So, if the plane lands within that two hour window, the stat books record it as “on-time.” But, in reality, the passenger had to wait.

The airlines also have another tool. If the departure time is likely to be delayed, they can use automated text and email notification systems to warn the passenger. The passenger can now use the extra time more productively than purchasing overpriced food in the food court. Analogously, many doctors’ offices notify patients if the doctor is behind. And some offices provide pagers to patients so they are not confined to the waiting room competing for year-old copies of Readers’ Digest. Most patients appreciate this courtesy and these methods generally sidestep any anger most patients have for waiting.

I know that when I call tech-support for software snafus, I prefer knowing I will be in queue for 25 minutes as opposed to “unknown” wait. I can leave the phone on speaker and work in the background. When the support technician is available, I am ready to go.

Most patients understand that if they are kept waiting, it is because the doctor was tending to patients before them. They rightly assume that if their problems are complex, doctors will take a reasonable amount of time needed to solve their problem. And the next patient will be delayed.

The airline industry is hardly the best role model for how service should be delivered. But their technique of notifying the “customer” when flights are delayed 30 minutes or longer could be a good idea. The broader issue here is establishing pro-active communication that rebuilds the doctor patient relationship – a relationship that has been under attack for many years. If we can address this greater problem, then I doubt any patients would send their doctor a symbolic bill.