How can symptom checkers improve patients’ experience in the waiting room?

Time spent unnecessarily in a waiting room can be a cause of stress for both patient and doctor. Paradoxically, this unexploited resource could be used to improve the quality of care. What do medicine, queues and Disney World have in common, and how does AI turn long minutes of boredom and frustration into valuable data?

Illustration by Aga Więckowska

Have you ever entered the doctor’s office right after checking in at the registration desk? Sometimes you wait just a few minutes, but sometimes even hours pass before the doctor can see you. Feeling annoyed and with a sense that your life is slipping away, you browse out-of-date magazines, watch some videos, check Facebook, or make to-do lists. This is not exactly what you want when you’re worried about a health issue.

The psychology of queuing

Whether in a traffic jam, uploading a big file, or trying to reach customer service over the phone, people don’t like finding themselves on hold. The reason is simple: an uncomfortable feeling of losing precious time and of unfairness, the impression that someone is stealing a piece of their freedom or even a small piece of their life. Professor Richard Larson, of the Massachusetts Institute of Technology, also known as “Dr. Queue”, claims that some people spend a year or two of their lives waiting in line. Globally, billions of hours each year slip through our fingers. Wasting time in line means gigantic losses for the economy, as well as stress for those who personally have to wait.  It can even trigger aggressive behavior. Think of how your adrenaline level increases when somebody tries to cut in line using various tricks. Finally, bad impressions from the waiting room affect your overall satisfaction with your visit to the doctor and negatively influence even the best service and quality of care received in a clinic.

Can we do something about this? The bad news is that some lines are unavoidable. Even in  a perfectly organized system for scheduling appointments, it’s impossible to completely eliminate waiting times. Patients come with a variety of problems, and some cases require more attention and time. Even if the time allotted for one appointment is limited by the reimbursement rate offered by health insurance, whether private or public, doctors can’t see patients with a stopwatch in their hand. Nonetheless, an understanding of the art of medicine doesn’t help those who have to wait.

Why do we focus on no-value-adding entertainment?

Even the most sophisticated IT solutions have only replaced paper calendars with electronic ones, without reducing the time spent in the waiting room. That’s why healthcare facilities try to improve patients’ experience using methods and tricks developed by scientists and proven in other industries. Unfortunately, these methods only help to reduce the perceived waiting time. In many healthcare facilities, patients can choose from a range of magazines, there are play areas for children, and waiting rooms are painted in bright colors or decorated with nature motifs. Pictures of sunsets or waterfalls should make patients feel calm and satisfied. Do they?

The master of waiting-time management is Walt Disney World, where waiting time is being changed into entertainment in itself. The Disney app and displays located in front of every attraction show the estimated waiting times, and the long corridors are part of the fun. Another example is airports. If you’re wondering why you have to walk such a long way to the baggage claim, the answer is easy: to cut waiting time. Although the Disney World strategy works well in amusement parks, and long airport corridors help to improve passenger satisfaction, this is not what matters to patients.

“It’s not how long you wait, it’s what happens – or does not happen – while you wait. Today’s default is eyeballs staring at hands with their smart phones. But that soon becomes exasperating and depressing. We need something else, and that something is not the boring magazines left around doctors’ offices. Manage customers’ expectations and then deliver service that exceeds expectations.  Even a small token of acknowledgment of a patient's time and related anxiety can go a long way to reducing stress and annoyance”, Professor Richard Larson told me when I asked him about the science behind making waiting time in healthcare acceptable for patients. Fortunately, new technologies are making it possible to exploit the time before entering a doctor’s office in a far more efficient way. Here’s how.

Mindshift: Data instead of boredom

The average time of a doctor’s appointment is often shorter than the time spent in the waiting room. So why not make the waiting time an integral part of the visit? When a patient finally enters the doctor’s office, time is short. The doctor asks a few questions to find out what’s wrong, makes notes on a computer, checks the medical records, examines the patient, and writes a prescription. Nowadays there isn’t time for any deeper interaction. The human relationship between the patient and the doctor has been significantly reduced. This is a concern for both patients and doctors.

Things could change dramatically if the patient could complete a self-performed preliminary health assessment based on a digital interview form while still in the waiting room. With the help of algorithms and pre-diagnosis systems, this is already technically possible. A visit to a healthcare facility would look like this: after checking in, the patient is asked to take an AI-based test. Once the patient has entered the symptoms and answered personalized questions, the symptom checker generates a report that includes symptoms reported by the patient and their possible causes. While waiting for the next patient, the doctor could enter the data to get an initial picture of the state of his or her health. Now the doctor need only complete the data, review it, and make a final diagnosis. What’s more, the data could be archived automatically in an electronic medical record. The symptom checker could be operated on a tablet or as an intuitive and user-friendly app installed directly on patients’ smartphones (ready for use during the next visit or even at home).

Illustration by Aga Więckowska

The health assessment, which usually takes a few minutes, can change the way patients feel treated. Unproductive waiting time is replaced by a pre-diagnosis. Patients have more time to think about all their symptoms than they do while talking directly to the doctor, they become involved, and most of all – they feel empowered. Doctors receive reliable data and can make the best use of the time between patients and focus on an in-depth interview. There are many ways this few extra minutes can be used: viewing the detailed data collected in the electronic health record, asking more relevant questions, including questions about the patient’s concerns and expectations, or explaining the diagnosis and the treatment plan in detail. Doctors have more time for the physical examination, and eye contact replaces looking at the computer. Patients gain time to think about important details about their illness, and a feeling of engagement replaces the time pressure.

As a patient who has experienced many long hours in a waiting room, I would welcome such a solution. Not just to kill the boredom, but most of all to become the doctor’s equal partner in the diagnosis process and to contribute to improving the quality of care.