Of patients and doctors; in Puerto Rico you’ve got to be patient to go to the doctor

This is probably the first of a small series of blogs about this issue, so bear with me and my concern...

When I had just arrived to Puerto Rico it caught my attention that many, if not most of the people passing near my table when I was eating would say “buen provecho” or as Shakespeare would’ve put it better “bon appétit” (oh, pardon my French). And, what does it have to do with doctors and patients? Not much, but it may explain the courtesy sentences used by Puerto Ricans in different occasions. One of them is “que salgan pronto”, which translated to English means “I hope you get out soon”. No, it’s not the sentence used when visiting a prisoner; it would certainly make sense there; but no, it’s the one sentence every person going out of a doctor’s office would say to all remaining there. Sadly, it makes sense if you are a patient because you have probably been waiting to see the doctor for several hours, so the best wish anyone can hope for you is to get out soon!

I’d be surprised if no one had written about this before, especially foreigners like me, because the doctors’ appointment system in Puerto Rico is different from at least the other two countries I’ve known: Colombia and USA. At least in these two countries doctors give appointments by date and time so patients get to the doctors office a few minutes before the time of the appointment. Well, since time is money, Americans would plan the day ahead and may get there calmly; but some Colombians may rush into the traffic to arrive there right on time or a couple of minutes late; but they will make it. In the waiting room the waiting time may range from a few minutes to an hour or so, tops. Occasionally the doctor will reschedule the appointment due to an emergency; but all this is only natural, and understandable; or should I say bearable.

Now, let’s move to the enchanted island. If you call a doctor’s office and the secretary gives you an appointment with date and time, play the lotto that day. You’ll hit rich. The odds of such thing are extremely low. So far I haven’t had such wonderful experience. The second best, but don’t play the lotto since this is more likely to occur, is to get an appointment for a given date and you get to choose morning or afternoon.

If your appointment is in the morning you are told to arrive from 7:00 till 10:30, or something like that, and write your name down on a roster. Now, you may think that if you get at 7:00 you’ll get turn 1 or 2 and the doctor will see you at 7:00 and you’ll leave by 7:30. Well… I’m sorry to disappoint you but the doctor will get to the office around 9:30 or 10:00, so if you got turn number 1 the doctor will see you by 10:00. Yes, you will have to wait at least three hours. If you got other turn, you’ll have to wait 3, 4, 5 hours, maybe more. But also, you will probably see an admonition on the door, counter or wall that reads something like “If you are called by the doctor and you are not in the waiting room you will loose your turn”. Therefore, if you want to sneak out of the office, do it strategically or else…

Now, if you want to get turn number 1, don’t get to the office at the time they open because, I assure you, there will be 5 to 10 people ahead of you, maybe more. Your effective waiting time may be longer than 4 hours: half an hour to an hour outside the doctor’s office and three hours in the waiting room till the doctor arrives.

Now, let’s say you are not an early bird and choose the afternoon. You are told to arrive from 1:00 to 2:30. Now, let’s say you want to play it smart and go in the morning to write your name down on the roster… Think again. The secretary will tell you that you have to wait until 1:00. You may make number 1 in the afternoon but you will have waited several hours anyway. Now, you may say that since the doctor is in the office since 10:00 you will be called at 1:00… Wrong again. The doctor will have a backlog from morning appointments and will start to see afternoon patients by 3:00. Again your waiting time is longer than three hours.

If you think what I have narrated so far is bad, hold your horses. Worse things exist. There are doctors that give appointments by date, period. You have to go in the morning, or at the time they open the office, write your name down and see what turn you made. Yet, there are doctors that don’t give appointments! You just show up in their office at the time they open and … you know the rest of the story.

If you think this sounds terrible, let me reaffirm you on that; it’s hideous. I wonder whether someone, an illustrious university professor or a consultant has studied the cost of this practice. I’d love to see such study, but show it to me before doctors know about it. Surely doctors would try to make it disappear.