Dealing with Late and No-Show Patients

 "I’m late! I’m late! For a very important date!"

- the White Rabbit from "Alice in Wonderland"
 

It is said that time is money; we would all like to save it in a bottle and we never seem to have enough of it. We plan our time in the office carefully, but sometimes the best laid plans can go awry.

A late-arriving patient will totally throw my schedule into a tailspin. We have a policy that if a patient arrives 15 minutes after their scheduled physical exam or consult appointment time, the front desk will ask them to reschedule. If I am not jam-packed for the day, my nurse will ask if I can work them in (I always try to accommodate them; I have had bad days too, when I have arrived late to an appointment.).

However, this can backfire if the late patient has a ton of needs that day, asks many questions, or you find something serious that needs medical attention. The patients that are on your schedule after that patient will be left waiting. In order to work in a late-arriving patient, I stipulate that if there are going to be complicated issues to deal with, I will ask them to reschedule in order to have enough time to give them without taking away from other scheduled patients.

So what do we do with the chronic late-arriving patient? It is very tempting to tell them that the appointment is 15 minutes earlier that you actually have on the schedule and we have actually done this for the patient that consistently arrives late (we know who they are). This is probably not a good solution.

The best solution is for the physician to speak briefly with the patient and let them know you appreciate being able to know them and care for their medical needs, but that their chronic late arrival is hurting this relationship and is not fair to other patients on the schedule who are kept waiting (and even the late patient doesn’t like to wait!). If this continues to be a problem, then scheduling them near the end of the r day will minimize the impact on subsequent patient appointments (but don’t schedule them for the last appointment or you will be made to wait for them).

How about the patient that makes appointments but frequently "no-shows"? We have a policy to charge $50 for a patient that doesn’t show up for a physical exam or consult time. But for those that don’t show for a regular office visit, we just "grin and bear it" if it happens once or twice. For those that consistently abuse our policy of trying to see children in a timely manner, I have spoken to the parents to tell them that by making an appointment, it blocks someone else from getting an appointment. There have been times when I am completely full and cannot add any appointments for that day (and these parents have probably experienced being unable to get a same day office appointment). These chronic "no-show" parents usually understand this concept. I stress that if they cannot make the appointment, please call the office as soon as possible to cancel. I also mention that if it continues, we will need to seriously consider our medical relationship and whether it can continue. Recently I had to send a letter to a family that had "no-showed" about five times in a row because none of the telephone numbers in the demographics was correct!

We also have an office policy of never scheduling three physicals from the same family, except for triplets. Not only is it chaotic to deal with more than two at a time, if the family doesn’t show up, it totally blasts a hole in that part of your schedule. I have occasionally been asked by a family to do this. I will allow it if I know the family well and we have a long relationship. I do let them know why the policy exists and to make sure to arrive or cancel with appropriate notice. So far, I haven’t had a problem with the exceptions that I have warned in advance.

These are just a few ways we deal with the issue of tardiness and patients. I would love to hear how other practices deal with this problem.