The health center where I get my yearly mammogram has three tiers of waiting rooms, each tier more stressful than the last. First, there’s the reception room, a large, bright space with picture windows, pale blue walls and comfortable chairs. Everyone’s wearing street clothes; friends and spouses are checking their phones. When the nurse calls your name, you move into the second-tier “inner sanctum,” a smaller, windowless room that’s patients-only. Everyone’s in gowns and you’re surrounded by pamphlets and posters with the word “cancer.” Pre-mammogram nerves are palpable. Not even Wendy Williams, on the TV mounted overhead, can lighten the mood.
“I’m going to throw up,” one woman says aloud to herself. She takes a bottle of water out of her purse, pours some into her palm and splashes it on the back of her neck. Two other women are talking about chemo. “My hair didn’t fall out,” one says. “Did yours?”
Everyone starts bonding, sharing illness stories. I’m fortunate not to have one of my own, but just listening makes my anxiety soar. I try not to make eye contact with anyone lest I get roped into a conversation. There’s a woman next to me with long, white hair and Clark Kent eyeglasses, hiding behind a year-old Christmas issue of Better Homes and Gardens. “Tis the Season!” it says on the cover, in June. I feel the tiniest bit of comfort that someone else feels exactly how I do: not wanting to connect, just wanting to leave.
Waiting can feel like a hassle in any situation. But in the context of healthcare, it can become an especially potent agent of anxiety, frustration and hopelessness.
“You feel your heart beat, you’re looking at your cell phone to see what time it is, you’re very acutely aware of the passage of time, and people get really frustrated,” says Richard Larson, a professor at MIT’s Institute for Data, Systems and Society. “If you don’t know how long it’s going to be, you have no management of expectations. [It’s like] you’re in a prison and you don’t know when you’re going to be let out.”
“Waiting rooms are places in which inequalities and privileges are reproduced.”
Old magazines and daytime talk shows only go so far. The time we spend waiting for doctors is significant. In fact, patients might spend as much or more time waiting to see doctors as they do actually seeing them. A survey by Medical Group Management Association put the average wait time for U.S. patients at 20 minutes, which is exactly how long they typically spend in the exam room, according to a 2017 University of Cambridge study. That number is up from a few years earlier, when 15-minute appointments were the norm.
In the ER, where patients are (hopefully) seen according to the severity of their condition, wait times are hard to anticipate. But when you have a set appointment with a doctor, you know ahead of time you’ll probably have to wait, making the whole process more frustrating.
A recent survey by the design and development company Sequence suggests that across the board, most people consider waiting to be the worst thing about going to the doctor. Sixty-three percent of patients surveyed said it was the most stressful aspect of their visit.
But the waiting-room experience actually isn’t the same for everyone, according to Margaret Waltz, a postdoctoral research associate at the University of North Carolina at Chapel Hill who has studied waiting rooms extensively.
“They are places in which inequalities and privileges are reproduced,” says Waltz. “White people don’t wait as long as Black and Hispanic people. People of high socioeconomic status have shorter wait times compared to people of low socioeconomic status. And women wait more often in these spaces than men. These seemingly innocuous places where we think nothing happens have a lot happening within them.”
In her research, Waltz observed how different patients cope in different ways. “People bonded in waiting rooms, joking with each other and sharing stories of illness experiences. I saw this mostly with women,” she says. In her view, this behavior is a type of emotional labor that women tend to perform in these spaces.
Stress can be proportional to the gravity of a patient’s appointment reason. For example, waiting at your primary care provider’s office for your yearly physical is likely less nerve-wracking than waiting for a serious test result. Either way, the heart of the matter tends to relate to feelings of helplessness. Finding a distraction is one of the best ways to cope. If you’re not into the available entertainment options, the app EZ Waiting Room has a vast library of stories, books, videos and games that you can download onto a phone or tablet, and it’s free to use for the first four hours (which is hopefully far longer than any waiting patient needs). That said, the app still requires a device, which not every patient owns.
One recent study suggests that providers can capitalize on the time patients spend waiting by providing educational materials, like a video on preventive care or a specific condition. The waiting room can also be a place for patients to fill out questionnaires, like a depression screening, ahead of their appointments, or to write down topics they’d like to discuss with their providers. In a research experiment, the Physicians Committee for Responsible Medicine, a D.C.-based nonprofit, turned the waiting room into a classroom, teaching nutrition to patients with Type 2 diabetes.
Though Disney theme parks are a far cry from medical offices, Larson cites the Disney model as a master class in managing people who are waiting. “Disney does this with long lines,” he points out, giving customers estimated wait times for rides. “Typically they deliberately overestimate, and that one-hour estimated wait is really more like 45 minutes. So when you’re finally boarding Space Mountain, ‘We’re 15 minutes ahead of schedule!’ The psychology of that — of having people wait 45 minutes for a four-minute service and thinking they’re happy because they’re ahead of schedule — it’s brilliant.”
Healthcare providers, Larson suggests, could do something similar, and give patients overestimated wait times whenever possible: “I think anxiety and frustration would be greatly reduced.”
There’s also the standard process of being moved from the waiting room into an exam room, only to wait more. But even that shift can bring comfort, Waltz says. The impression of making progress can alleviate some boredom and stress. “And probably just the moving around makes people feel like they are doing something, which occupies their time and makes them feel like they are waiting less,” she notes.
Some experts are pushing to get rid of waiting rooms altogether, an approach called “self-rooming.” In an Oregon Medical Group pilot program, patients check in and receive an electronic badge that tracks them. They’re directed straight to an exam room, where they’re met by a medical assistant who takes care of any prep, like entering information into electronic health records. After the patient’s clinical visit is over, the assistant returns and either directs them to their next service, such as imaging or blood work, or sees them out. The program directors say this system has decreased wait times and increased time spent with clinicians. It also eliminates the social aspects of waiting, which some people enjoy. But I don’t.
After my mammogram, a nurse directed me to that third-tier waiting room, the post-mammogram, see-if-you-need-more-tests waiting room. It’s the most stressful room of all, but the staff seems to sense that and they try to get you out quickly. I’m dismissed soon after I arrive, grateful for an uneventful visit. As I walk to my car, I see the woman with the white hair who was hiding behind the magazine. She looks up at me. “You OK?” she asks gently. I nod. “You?” I ask. She smiles and nods, and we go our separate ways.