Waiting rooms and the unconscious.

If you ask patients what they dislike about seeing doctors, there is a fair chance they will mention having to sit in waiting rooms for ages. Doctors tend to get defensive when they hear this and are likely to offer reasons why it happens. These usually include the following. ‘There are never enough doctors, so we are always working against the clock.’ ‘Consultations are unpredictable and may go on longer than anyone expected, delaying others.’ ‘Doctors may be called away from a clinic or surgery to deal with emergencies, leaving remaining colleagues to fit in other patients’. ‘Some patients will always fail to turn up for their appointments, and it is better to have others ready than to have doctors twiddling their thumbs.’ And so on and so forth. These explanations are not very convincing, and it is easy to find counterarguments. Consultation lengths and emergencies do vary, but they have a statistical pattern that you can monitor so you can adjust your booking system accordingly; it’s just that most institutions don’t bother to do so. (Does yours?) Some doctors regularly finish an hour or two late, yet their patients are still stacked up for appointments every session without the remotest chance they will ever be seen on time. When gaps do occur in sessions, doctors are usually happy to catch up on their phone calls and emails, review a patient’s notes, or do some teaching; to suggest we should never wait for anyone else because our own time is more important is presumptuous and even insulting. Essentially, all the reasons we offer for long waiting times fall under the general category of rationalisations: arguments that fail to convince anyone, but serve as good excuses for not changing anything we don’t particularly want to. However, they make better sense in the light of several different theories from fields outside medicine, including the social sciences and psychology. These may not be as familiar, or as comfortable, as the yarns we spin for ourselves, but they provide better ways of understanding what happens in practice, without the special pleading of professionals who have vested interests in the ‘status quo’. Three kinds of theory are particularly helpful. They relate to power, ceremonies and the unconscious mind.