Managing the Chronically Late Patient

“I’m late! I’m late! For a very important date!”

—The White Rabbit, Alice’s Adventures in Wonderland, Lewis Carroll

Lewis Carroll wrote about the tardiness of the White Rabbit in Alice’s Adventures in Wonderland in 1865. The problem of tardiness is older than the White Rabbit, and lack of punctuality plagues every profession and human interaction. Unfortunately, in the medical profession, patients who arrive late for appointments cost the practice not only in lost productivity but also in deterioration of staff morale. Solving the problem is usually within your grasp, and no practice has to tolerate the chronically late patient.

CREATE AN OFFICE POLICY REGARDING LATENESS

The practice should establish a concise, written policy regarding arriving late for appointments. It should clearly state the position of the office and the physicians. The policy should advise patients to arrive early to complete their paperwork or to complete the paperwork online to facilitate their office visit. Patients should be told that if they arrive late — and state a reasonable time such as 30 to 45 minutes — that they will be seen at the end of the day or will have to reschedule their appointment.

IT STARTS AT THE TOP

There is no hope of having patients arrive on time for their appointments if the doctor is chronically late. “As ye sow, so shall ye reap” (Galatians VI). That biblical saying also applies to doctors. You can’t expect patients to be on time if the doctor is chronically late. The doctor has to set the example for the staff and patients. You have to make a commitment to be an on-time physician before you can demand that patients also arrive on time.

If you are chronically late, identify the issues and problems that affect your arrival in the office on time. For example, if delays in making rounds first thing in the morning routinely make you run 15 minutes late for clinic patients, then you will need to start 15 to 20 minutes earlier at the hospital. You can also determine what time to start rounds by looking at your hospital list and making a conservative estimate of how long rounds will take. Give yourself a cushion of 10 to 15 minutes so that you arrive at the office early instead of late.

Announce to your patients that you are committed to being an on-time physician. Post a notice in the reception area informing patients the doctor is making every effort to see them on time, and would like to request that patients arrive a few minutes before their designated appointment so they can check in and be taken to the exam room in order to be seen on time.

Also, if you are running late despite your best efforts, it is a nice courtesy to have the receptionist announce the delay to the patients in the reception area, and give them the option of waiting or rescheduling.

OVERBOOKING: A NO-NO

I don’t suggest overbooking as a solution to dealing with chronically late patients. If everyone shows up on time, this will result in significant delays in seeing your patients. This is not a desirable situation and can tarnish your reputation.

LISTEN TO THE EXPLANATION OF THE DELAY

Many patients have an explanation for their delay, and it behooves the front office staff to listen to the reason — it just may be legitimate. For example, if an older patient is dependent upon a family member to bring him or her to the office, you can’t hold that against the patient. It then becomes necessary to have a discussion with the family member who is doing the driving. Certainly, the patient who is usually on time should be given some consideration for the occasional lateness.

However, you don’t need to see chronically late patients when they arrive late for their appointment. They can be moved to the end of the line or seen at the end of the day. A chronically late patient should not be put ahead of a patient who arrived on time. This is a disservice to the patients who are on time.

HAVE A “FACTS OF LIFE DISCUSSION”

When I encounter a chronically late patient, a conversation takes place between the receptionist or the office manager and the patient that goes something like this:

Receptionist: You were scheduled for 2:15, and it is now 3:15. Is there a reason for the delay?

Patient: I got caught in traffic.

Receptionist: Let me ask you a question. If you had an airline ticket for a flight from New Orleans to Atlanta, and the flight left at 2:15, what time would you arrive at the gate for the departing flight?

Patient: Probably 2:00 or 2:05.

Receptionist: We are no different than the airlines. We make every effort to see patients on time, and we expect that you are going to be on time. When you come late as you have on multiple occasions, you are taking the time slot of a patient, and that slot can’t be filled when you are late. As a result, you have left a vacant appointment slot that could have been filled by someone else if you would have let us know about the delay.

Patient: I’m sorry. I will try to be on time next visit.

Receptionist: We have no option but to see you at the end of the day or reschedule your appointment. If you make any future appointments, we will schedule you as the last appointment of the day so there will not be a problem filling your time slot if you are late. If the problem continues, the doctor will have no other option but to ask you to find another physician to take care of you.

CHARGE THE PATIENT

Charging patients a fee for being late has been tried for decades without success. It is very difficult to collect these fees and certainly will antagonize the patients. Giving patients a warning that they will not be seen or will be moved to the end of the schedule if they are late is enough of a penalty and can prevent patients from being repeatedly late.

If you decide to charge a patient, it is necessary to inform the patient of the late charge before you can levy the fine. Often, merely posting a notice in the reception area about charging patients if they are late encourages them to be on time.

DISCHARGING THE CHRONICALLY LATE PATIENT

The chronically late patient demonstrates a lack of respect for the physician and the practice’s time. This becomes an expense and a liability to your practice. After a patient is late two or three times, you might give the patient appointments only at the end of the day. If the violations continue, then sending a letter suggesting that the patient obtains his or her healthcare elsewhere is certainly appropriate. In most states, you have to give the patient two to four weeks to find another physician and provide the patient with a copy of his or her medical records.

Bottom Line: Doctors need to be efficient and productive. We cannot tolerate patients being chronically late, which creates problems for the staff and for patients who arrive on time. Developing and implementing a policy regarding lateness goes a long way to solving the problem of the chronically late patient.

Excerpted from Medicine is a Practice: The Rules for Healthcare Marketing by Neil Baum, MD.