An aged patient sat in a doctor's waiting room.

And sat. And sat.

And finally gave up.

"I'm leaving," he said. "I'm going to go home and die a natural death."

It's an old joke, but it has a ring of bitter truth to a lot of patients.

Elizabeth Parsons of Reston is a free-lance landscape designer and interpreter who loses money when she has to sit in a waiting room.

"I would be very interested in a discussion of the scheduling problem in doctors' offices," she says. "I went to a specialist after making an appointment several weeks earlier and was kept waiting for an hour, then another 15 minutes in the examining room.

"I was just about to walk out when he finally came in, without any explanation or apology. Since this was my first visit, I was hesitant to start out by complaining."

More or less the same thing happened on every visit, she says. Sitting in the examining room on one visit, she adds, she could hear the doctor dictating, opening mail and making personal phone calls.

The doctor was an orthopedist treating her for a broken wrist. On subsequent visits, things didn't improve much, and "as a result, my relationship with this doctor will always be problematic, I fear, since I am still angry, and he probably reacts, subconsciously or otherwise, to my hostility. If he weren't so highly recommended, I would not go back."

"What is the patient to do?" she asks. "Enough of my friends complain about similar problems to make me believe there is quite a bit of this. We generally suspect it is due to overscheduling and improper time management, and only rarely due to real emergencies."

Beyond that, "I am troubled by the fact that I rarely see a physician who seems to even recognize the fact that long waits cause problems to patients" -- and to friends or family who have to accompany patients. Her proof of this: the lack more often than not of any explanation. "This reinforces the impression I frequently get that physicans think of themselves as such wonderful human beings that I should be thankful they are even taking care of me. Is there a solution to this problem?" ::

Is there a solution?

The Health section recently reported two doctors' odd idea (in our weekly feature, The Cutting Edge). In a communication they and the editors of the ordinarily sensitive and humane New England Journal of Medicine must have considered funny, Toledo Drs. Walter and E. Dorinda Shelley suggested "a new office waiting game" to physicians.

"We have experienced . . . such patient malcontent," they wrote, "ranging from the mute hostility of eyes focused on the wristwatch, through 'My time is as valuable as yours,' to the walkout who slams the door, vowing never to return. As sinful physicians, we have tried with less than reportable success to instruct patients on the use of adversity -- the values of napping, reading, knitting and similar activities."

But now, they said, "we perceive a way of making the patient dread seeing the doctor on time." How? By installing a machine in the waiting room to give every patient a free state lottery ticket for every 15 minutes of waiting time. After which "the waiting room would be filled with the hush of happy expectancy . . . We can even anticipate patients saying to one another, 'No, you go first. I'd rather wait.' . . . Your state lottery office awaits a call for early installation of this waiting room treasure chest."

To paraphrase Queen Victoria and Miss Manners, we patients are not amused. ::

The Medical Society of the District of Columbia's MSDC News takes the subject more seriously. It recently gave a full page to an article on "how to improve patient scheduling," supplied by the Health Care Group of Bala Cynwyd, Pa.

These health care consultants say a drumfire of patients' complaints may mean inept scheduling. They tell physicians:Both physician and staff should be in the office at least 15 minutes prior to the first appointment to get ready for patients.Schedule as many patients as possible, rather than telling patients without urgent problems to "drop by." And don't make scheduled patients wait while you see walk-ins unless the walk-in is a true emergency. Have rules, clear to the staff, on "when a patient should be seen immediately," by the end of the day, within 24 hours or at some future time by appointment.

Above all, in my opinion, these consultants tell doctors: "Think through" your schedule. How many patients, they ask, is a doctor "willing to see each day?"

We all like to maximize our incomes. A doctor who maximizes his or hers by being "willing" to see too many patients -- patients who wait until they feel like going home to die -- deserves no patients at all.

Is there a solution, ask patients and, ineptly, the Drs. Shelley of the lottery ticket solution.

Why not courtesy?

Even the most efficient and conscientious doctors run late sometimes. Why can't the staff keep waiting patients informed? Why not tell us after we've sat around for 20 minutes or a half hour, or when we first arrive in the office, "We're sorry but Dr. Caring is running late today because ------. You shouldn't have to wait longer than another ---- minutes. We'll make the wait as short as we can."

Or even, to some patients with nearby homes or offices, "Would you like to come back later?"

In eons of seeing and often waiting for doctors, I can't remember ever being told anything of the kind.

Unless I asked.

If you're tired of waiting, ask.Next Week: How to choose a health plan -- the latest advice from experts and Washington area patients.