Q: My doctor was seriously late for my appointment, which caused me to miss some work and basically penalized me financially. Can I demand at least a partial refund?

A: Just this week I went to a specialist and noticed a sign at the front desk: Patients who don't cancel appointments 24 hours in advance will be charged a $30 no-show fee. I was then promptly told that my doctor was running 30 minutes late. The inequity of the situation started to make my blood boil. Jonathan Kaplan, a professor of philosophy who teaches a course on biomedical ethics at Oregon State University, told me that these "unfair asymmetries . . . really bother people." I agree, professor.

Charging patients late fees is part of a transactional mentality that has crept into the doctor-patient relationship, and Kaplan thinks penalizing doctors for lateness would just make things worse. He mentioned a study in which a preschool initiated fines for parents who picked up their kids late. "The fines were meant to cut down on parents being late," Kaplan said, "but they had the opposite effect, by turning what had been a moral problem into a financial exchange. Parents now felt morally justified in being late, because they were 'paying for it.' " In the end, more parents were late in picking up their kids.

It's somewhat different when at issue are concerns about one's health, but putting a meter on appointment times runs the risk of leading both patients and doctors to flout schedules more flagrantly and create more animosity and entitlement. That's not the path to ensuring respect for each other's time, which I think is the underlying issue.

In my case, the staff at my doctor's office took pains to apologize at numerous junctures. The 30-minute delay (which is far from the most egregious doctor lateness example out there), was acknowledged by the receptionist when I checked in, the doctor's aide after that and the surgeon himself, who hadn't even closed the door behind him before saying: "I'm very sorry for being late."

I asked him about it (nicely). "Was there an emergency?" No, but the first two patients after lunch proved to be more complicated cases than he could accommodate in the 15 minutes allotted to them. Just a few patients who require a couple of extra minutes can throw off the entire schedule and create fuming in the waiting room.

I reminded myself that a few months earlier I had been the complex situation when a small mass turned out to be, well, complex. Naturally, I expected my doctor to attend to me for as long as it took, although I did worry about patients who were delayed as a result.

There are many legitimate reasons doctors run late, including patients who themselves are late or who may divulge during a routine appointment that they're having chest pains. Moreover, 15-minute slots are utilized too frequently, often not providing the physician sufficient time. I don't believe a doctor can say, "Sorry, time's up. My waiting room is full." But the front office staff can and should give an update to his or her patients or, even better, call or email them ahead of time.

Kevin Pho, an internist and founder/editor of KevinMD.com, a respected blog for physicians, noted the many pressures on doctors' schedules, citing "electronic medical record requirements" that many doctors find onerous as the worst. He is also concerned that "productivity factors into many physician salary formulas." That is certainly true – many doctors try to limit routine visits to 15 minutes so they can see four patients an hour – about 20 in a full day. My doctor, an orthopedic surgeon, confirmed that if he doesn't see a certain number of patients each week, he couldn't fill his surgical calendar, which is what generates the bulk of his clinic's income.

Pho believes that "giving discounts to patients may be the impetus to force health systems to reduce the burdens doctors face," which is to say longer time slots and assistance with completing medical records.

At least one medical organization seems to agree. Two years ago the new chief executive at Geisinger Health System, which has 10 hospitals serving a population of nearly 3 million in Pennsylvania and New Jersey, decided to give refunds to patients who reported a poor health care experience. Greg Burke, Geisinger's "chief patient experience officer" and a doctor, told me: "If we fail, we'll give them their money back." That, he said, includes unnecessary delays, communications failures, "hospitality" issues (such as getting stuck in the ER waiting for an inpatient hospital bed) and much more.

How has that been working out? After the program was announced, Geisinger saw an increase in the number of complaints. But requests for refunds haven't shot up – they've been about $500,000 in each of the past two years. Burke says that is "relatively small" in light of the billions of dollars Geisinger takes in. He's not sure why there hasn't been an increase in requests for refunds, but says he thinks it's because people feel they're being heard when they complain now. "They believe that the system is trying to improve."

Great news for patients, I thought, and asked how many other hospital systems had followed their lead. His answer: None that he has heard about.

So to answer the question, no, I don't think you're entitled to a discount if your doctor is late. But I also don't think doctors should be charging no-show fees, and you should argue that point if you find yourself being charged.

Meanwhile, there are some things you can do to minimize your sitting-around time:

  • Make early morning appointments or try to nab one right after lunch. Doctors are more likely to be on time at the beginning of a session.
  • Call an hour or so before you appointment to see whether the doctor is on time.
  • If your doctor is late occasionally, don't make a federal case of it, but do ask why and explain that your time is valuable as well. If the doctor is always late, consider a different doctor.
  • Be considerate of the patients coming after you by being on time for your own appointment and letting the scheduler know in advance if you have new issues to discuss that might lengthen the time you need with the doctor.
  • Push when you can — in patient surveys, discussions with your doctor, discussions with your insurance – to encourage others to adopt something like the Geisinger program.

This story is part of an occasional series of patient questions, answered. Send general questions – but not specific ones – dealing with personal health problems to stevenpetrow@gmail.com.