| Monday, January 01, 0001
So here's the scenario: it's the middle of the week and it's late in the day. Your waiting room is full to bursting with agitated patients, bawling children and (let's make things interesting) a broken air conditioner...and your 4:30 appointment is nowhere to be found. Phone calls, text messages and even Emails have all proven fruitless and given the outlook for the rest of the day, you're seconds away from ripping your hair out in chunks...so what do you do?
Before we explore the veritable ins and outs of patient lateness, let's touch on one obvious, but important fact: chronically late, and patients who altogether miss their scheduled appointments (referred to as "no show patients" for the remainder of this article) can throw an already tepid schedule horribly out of whack. From minor tardiness foibles, to extensive "no call, no show" episodes, here's a few things to keep in mind when dealing with these kinds of patient scenarios, and how hurried physicians can keep things on track even when the appointment book isn't.
Immediately Identify the Source of the Problem
Before rushing to any kind of action, whenever possible it's important for physicians to directly contact the patient to get to the bottom of the problem. Generally speaking, patients have a good reason for not showing up to a scheduled appointment on time. Maybe it's a house full of mischievous kids or delayed traffic due to a wreck on the freeway. Compound these kinds of day-to-day life struggles with the general embarrassment that they may already feel from running late, and you run into a potential "no show" problem. When a caring physician takes time to establish honest contact with the patient, insomuch that communication can occur, often times these problems can be solved with nary a hassle. However, it's important to remember that these can be delicate subjects, so inquiring physicians should tread lightly. If a patient can tell that the physician is making contact to better serve their medical needs, and not to chide or pass judgment, they are more likely to be open and forthright, and in turn, more likely to correct the problem down the road. In her Physician's News article Dealing with Frequently Late Patients, Audrey McLaughlin, RN, suggests charting the patient's answers and making notes in the appointment system. For example, if it's known that the patient is a single parent struggling to get three kids on the road every single time she makes an appointment, these types of factors can be made when planning future appointments. Perhaps they can be strategically planned for a time the kids are at school, or they can be made earlier in the day to allow a buffer period for lateness. In all cases, communication is key.
We're all familiar with the pink slips given in grade school to warn parents of errant child behavior. So too can a physician call attention to problematic patient behavior. Physicians should remember that this isn't a "shaming" procedure, but a simple, albeit firm reminder that patients should do their absolute best to keep their appointments. These warnings shouldn't be condescending or emotional, but brief, friendly and business-like. It's also important to remember that in some cases, patients may not even know that they're late, or that their lateness is a problem. Including a simple detail such as "in order for us to adequately provide for all of our patients with scheduled appointments today, it is of utmost importance that you are on time to your appointments so as not to disrupt the schedule of anyone else."
Some physicians like to give as many warnings as possible, and so a "tiered" written warning system may be put into place. For instance, patients who commit their first "offense" (perhaps they are more than 15 minutes late for their appointment) are given a friendly written warning and an invitation to keep future appointments without lateness. A second offense will be slightly more firm, stating something like "this is the second appointment for which you have arrived late. If there's any way we can adjust your appointments to make them more appropriate, please let us know." Finally, on a third offense, more drastic action can be taken. Some physicians will "fire" a patient who is late for three appointments in a row, while others think this is too harsh. This is a decision that should be made with the help of staff and a careful consideration of everything from general patient load, to hour-by-hour busy-ness before rendering any final ruling.
Open the Door for Communication Back
As stated earlier, late patients generally know they are late. When a physician goes out of their way to let the patient know that they can call and get in touch, it may eliminate communication snags in the future. In fact, some patients may not even be aware of the fact that they can call to give a pre-emptive warning that they're running late. It may be helpful to establish a practice policy for cancelling appointments. If a patient is made well aware of the policy, they're much more likely to follow it when it comes up.
Additionally, physicians can let patients know that "no call, no show" appointments aren't only inconvenient...but can be hazardous to their health. In the event that a legitimate or complicated health problem should arise, it is troubling for physicians when patients aren't keeping their appointments to receive consultation and treatment.
This is a procedure that should be done carefully and only with patients with a long and chronic history of lateness, but can prevent scheduling snafus, particularly with office software and wait staff. For those patients who always seem to run 15-30 minutes later than their scheduled appointment, simply put their appointment in the system a half an hour later than the agreed upon time. For example, if the appointment is made for 3:00 PM, schedule it for 3:30 PM without telling the patient. That way, when the patient shows up predictably late for their 3:00 PM appointment, the computer is none the wiser and no real adjustments must be made. However, it should be noted that some practices may not wish to do this, as it can be seen as a) "rewarding" the "misbehavior" of the patient and b) confusing to those in charge of scheduling, particularly in cases of new hires to wait staff, who aren't as familiar with the patient base.
Please note that I do use the term "penalties" quite lightly here, but they are penalties none the less. In cases where exceptions cannot be made and where late and no show patients are creating more chaos than can be controlled, small penalties can be a prime motivator. Nominal fees, such as $25-50 for unexplained missed appointments, or for a "third strike" late appointment may be what keeps patients on the clock. In some cases, a simple WARNING of the penalties that CAN occur for a late or abandoned appointment will be enough to dissuade an errant behavior. When these measures are taken, they should always be accompanied with plenty of warning, and in every case with a measure of understanding. Patients need to know that the only reason they are being penalized is because they are putting more unnecessary work on you as the physician and are also disrupting the schedules of patients who have been diligent about keeping their appointments.
Ultimately, it's important for patients to see that physicians just want to be the best caregivers they can. They aren't in the business of "shaming" others, nor are they trying to judge. Patients who can see that a practice is run with efficiency and authority are far more likely to abide by its policies, and to comply with treatment, when they can see caring physicians at the helm. To quote Rebecca Fox, MD's Physician's News article Dealing with Late and No Show Patients, "all in all, the best practice is to use compassion and empathy. Remember that even though you are in the business of medicine, you are still in the customer service business."
Of course it'd be ridiculous to posit that anything could be a cure-all for the busy physician schedule. Daily, they are prone to knock out of skew one way or the other, with very little warning. Still, when physicians and patients are both working together to keep things steady and on course, the ship sails much smoother, and with much fewer disruptions.
Fox, Rebecca, MD. "Dealing with Late and No-Show Patients." Physicianspractice.com.
Physician's Practice, 14 July 2013. Web. 13 Aug. 2013.
McLaughlin, Audrey, RN. "Dealing with Frequently Late Patients."Physicianspractice.com.
Physician's Practice, 6 Sept. 2012. Web. 13 Aug. 2013
Skeptical Scalpel. "Skeptical Scalpel: Who Is at Fault If a Patient Doesn't Follow Up?"
Skeptical Scalpel: Who Is at Fault If a Patient Doesn't Follow Up? N.p., 19
July 2013. Web. 13 Aug. 2013.
Dylan Chadwick is a graduate of Brigham Young University where he earned a Bachelor of arts in English and a minor in Spanish. Though spending his formative years in Cardiff Wales, he came to adolescence in Elizabethtown Kentucky, and considers it his home. He received the Eagle Scout Award, served a voluntary humanitarian mission to inner-city Los Angeles from 2007 to 2009, and once met Alan Alda on a golf course. He's an avid writer who cut his teeth contributing to student papers and continues writing for various print magazines, blogs and web resources. A ravenous fan of baseball, rock music and Dan Aykroyd-era Saturday Night Live, he plans on one day utilizing these interests in a Masters degree in American Studies and Literature. He also maintains a freelance illustration company on the side.