I'm not sure if this is a patients'-rights issue or what, so please help me out. I work in a very busy physician's office, where patients often wait an hour or more before being called into an exam room. Then, after receiving a routine screening, they might wait another half hour to see the physician. Most patients don't complain about their wait to the physician, but the nurses and office staff often get an earful. How should we handle this problem?-M.W., OHIO

Many ethical issues are, at their heart, issues of common courtesy. They can also become legal issues when someone becomes so upset with conditions that he strikes back. For example, recently, a busy chief executive officer who spent 4 painful hours sitting in a crowded waiting room before being treated sued his physician for neglect-and won. The judgment is being appealed.

Be proactive and advocate for a win-win situation. Most likely this is a systems problem rather than a people problem. To determine the extent and nature of the delays, keep a log of appointment times, time when the physician sees the patient, and amount of time spent with the patient. Over a designated period-say, 3 months-calculate the average wait time and look for patterns that suggest where you can make improvements. For example, are too many patients scheduled per hour? Has enough time been built in to allow for the average time the physician spends with a patient? If a patient is likely to need more time with the physician-for example, because she's a new patient-is that time scheduled for her? Also consider circulating a survey to patients asking for their input. Besides gathering valuable information, a patient survey will reduce complaints to staff.

Discuss your findings with the physician. She may not realize how long her patients are kept waiting if they aren't complaining to her. If she doesn't already employ an office manager for her practice, suggest that option. Hiring a manager with scheduling expertise (or an experienced scheduler to work with her current manager) should quickly improve the situation.

Your employer sounds as if she has a busy practice. She should be thinking about bringing in additional physicians or advanced practice nurses to handle the caseload. Help her communicate anticipated changes to staff.

Finally, inform all your patients about the improvements. A letter or brochure describing the new scheduling system, introducing additional health care providers, and reaffirming their rights will go a long way toward improving patient satisfaction.