Dr.Roach writes: In a recent column, I gave my opinion that physicians who are habitually late are disrespectful to their patients, and advised readers to try to get the first appointment of the day or to consider switching doctors. This generated some letters, two of which are here:

Dear Dr. Roach: When I read this morning's item about the wait time in doctors' offices, I just had to set the record straight. There is no way to avoid a wait in a doctor's office. In fact, the 20-30 minutes that the reader complained about is mild. Most waits can be -- and usually are -- 45 minutes to an hour. In my area, I know that two-hour waits are very common and, believe it or not, patients put up with it to go to that doctor.

You must wake up out of this idealized La La Land that you practice in. It just doesn't work like that in today's world. You are building your readers up for disastrous expectations when you advise these things.

-- M.W.

Dear Dr. Roach: As a physician for more than 40 years, I occasionally was 15 or more minutes late for a patient appointment. On these occasions, I had my staff advise those patients in the waiting room and call those who had not yet arrived to ask if they wanted to reschedule.

Medicine is not 100 percent predictable. We need to take care of patients as their needs arise, not on a fixed "15-minute appointment" schedule. Sometimes it takes a little extra time to provide good medical care.

Unfortunately, the last patient of the day often winds up having all the "extra 5 minutes" the other patients needed tacked on to their waiting time. Medical needs trump scheduling. Do you think your doctor "scheduled" your 2 a.m. emergency-room visit or your newly diagnosed cancer or your son's drug problems that delayed his entire day? It's not a business, it's a medical practice.

That being said, a doctor who routinely runs behind needs to revise his or her scheduling. Of course, that might mean prolonged delays getting appointments. It's a no-win scenario.

-- J.L.S., M.D.

A: I looked up the reported wait times for a primary care doctor around the country, and they vary from 15 to 23 minutes. I think Dr. J.L.S. does at least one very important thing: When he is late, he lets his patients know. I feel very badly for M.W., but find it hard to believe that there are no doctors in the area who are not habitually late.

Testosterone gel

Dear Dr. Roach: I have read the questions and answers in your column regarding the application of testosterone gel. Is it acceptable to apply it to the upper legs, above the knees, on the inside of the thighs?

-- D.P.

A: There are four different testosterone gel preparations, and they all have specific instructions, which need to be followed for consistent results. For example, AndroGel is absorbed 30 percent better when applied to the arms and shoulders than to the abdomen. Fortesta is recommended to be applied to the front and inner thighs, and Axiron is supposed to be applied to the underarms. I recommend following the manufacturer's directions, as absorption can be variable.

Itching shingles

Dear Dr. Roach: I am an 86-year-old woman, and I have had shingles on my scalp and left eye for four years. I have no pain, but the itching is terrible. Doctors cannot seem to find anything that helps. Your column mentioned gabapentin, which I tried, but it did no good. Do you have any suggestions?

-- N.G.

A: Most people have pain after shingles, but a minority of people are bothered more by itching, which can be severe and lead to severe complications from scratching. Treatment can be frustrating, as you have already found. Four years also is a long time to be living with this, so you really have been unfortunate.

Topical anesthetic agents can be helpful. If the itching is in a location where a lidocaine patch can be applied, that can be very helpful. Long-acting anesthetics can be injected into the area. Some people have had good results with mexiletine, an oral medication analogous to lidocaine.

I continue to recommend the shingles vaccine, which reduces the risk of both shingles and its later complications.

* * *

Readers: The arthritis booklet discusses rheumatoid arthritis, osteoarthritis and lupus. Readers can order a copy by writing: Dr. Roach, Book No. 301, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow four weeks for delivery.

Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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