Editorial
Managing "Clinic Waiting Room Crisis" - Attempting to Leap Over a Rising Obstacle to a High-Quality Oncologic Care
Ali Khojasteh*
Columbia Comprehensive Cancer Care Clinic, USA
*Corresponding author: Ali Khojasteh, Columbia Comprehensive Cancer Care Clinic, USA
Published: 16 Dec, 2016
Cite this article as: Khojasteh A. Managing "Clinic Waiting
Room Crisis" - Attempting to Leap Over
a Rising Obstacle to a High-Quality
Oncologic Care. Clin Oncol. 2016; 1:
1163.
Editorial
A growing body of evidence in recent years supports the alarming notion that oncologic
practitioners are facing an increasing rate of emotional "burnout". Consequently this medical crisis
has overtly jeopardized the success of ongoing efforts to promote the precision personalized cancer
care, including the newly proposed “cancer moon shot” project.
Lately the analytic dissection of these observational studies has added further emerging
dimension of burnout impacts on the depleting oncologic work force. The common denominators
of the conclusion of these surveys have been a heightening dissatisfaction of practitioners with
current growing trends of excessive struggles to balance documentation of the care delivery with
the distressing distraction from the paramount goals of providing traditional care at bedsides or
clinic rooms! The most recent published survey by Shanafelt TD, et al. [1] did reveal a strikingly low
satisfaction of 6,375 practitioners with the extent of time that they are spending on clerical tasks,
including electronic medical record documentation, electronic prescribing, electronic patient portals
and computerized physician ordering. Beside the burden of these organizational factors leading
to burnout, personal factors that are more unique to fabrics of oncology practices than any other
specialty have dramatically increased the magnitude of this burnout momentum. The latter factors
include: emotional grief arising from losing response to treatment, demise of patients, observing
the painful burden of cancer care givers at home, and guilt feeling from shortened period of faceto-
face patient interviews and examination. A high propensity for practitioners' for job-derived
burnout has been further augmented by financial struggles, personal and social life disruptions by
demanding clinical responsibilities as well as increasing practice expenses and decreasing revenues.
What is strikingly missing from the landscape of literature on this rapidly growing medical crisis
is that little or not all is known about how the immediate outcomes of modern electronic medical
technologies have noticeably impacted the patients and their associates' satisfaction in the “waiting
room” of the clinics and emergency departments. Currently the data to reflect opinion of patients,
the ultimate beneficiary of care, on this important matter are very scarce or essentially overlooked.
Anecdotal surveys in clinics, including ours, have demonstrated a rising concern and dissatisfaction
of this determinant cohort with extended time staying in waiting room and shortened time left for
them in examination rooms of the physician offices as well as hospital emergency rooms. Their
overwhelming perceptions of blame by patients for causes of this qualitative and lost time in clinic
settings has been overextended engagements of practitioners with “electronic record processing
adventure”. The patients have increasingly raised their concerns about the quality of visitation with
health care professionals. A patient asked me recently to look for an alternative primary practitioner
for her. She rationalized her demand on the ground that texting the medical records by practitioner
while visiting a patient in an examination room, should be viewed as risky and as deadly as texting
and driving, rightfully some of the diagnostic and therapeutic errors arising from these common
practices can lead to immediate catastrophic outcomes. Therefore reliable analytic surveys, with
special attention to parameters gauging the quality and quantity of time of spending in doctor's
offices, by patients to reflect the extent of their immediate satisfaction with visiting health providers
are desperately needed. Within the context of the commonly accepted concept of “patient-centered
practice” as the core pillar of the care delivery, the ultimate strategic goal of medical reform should
include avoiding the lengthy patients stay in “limbo” of waiting rooms and adding a reasonable
duration of their visitation with health care professionals in examination and treatment areas.
Beside all astonishing technical medical innovations, this honorable goal of reviving the traditional respect for medical practitioners as true healers with highest advocacy
for the humanity and the conventional guardians of the kingdom of
Tender, Love and Care on earth.