The Executive Suite: 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

Every practice has patients who are chronically late. This wreaks havoc with your schedule and makes you less productive. Patients can be trained to respect your time and arrive at the office on time. This article discusses several approaches to managing chronically late patients.

Lewis Carroll wrote about the delay of the White Rabbit in Alice's adventures in Wonderland in 1865. The delay problem is older than the other White Rabbit, and lack of punctuality plagues every profession and human interaction. Unfortunately, in the medical profession, a patient who arrives late for appointments causes the practice not only to lose productivity but also to deteriorate staff morale. Solving the problem is usually within your grasp, and no practice has to tolerate the chronically late patient.

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--they will be seen at the end of the day or must reschedule their appointment.

It starts at the top

There is no hope of having patience arrive on time for their appointments if the doctor is chronically late. "As ye sow, so shall ye reap" (Galatians VI). That debacle saying also applies to doctors. You can't expect patience to be on time if the doctor is chronically late. The doctor must set an example for the staff and the patients. You must commit to being on time 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 so that you can see the patients at their designated appointment times. For example, if making rounds first thing in the morning routinely makes you 15 minutes late for office patients, 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 to 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. The doctor requests the patients arrive a few minutes before their designated appointment so they can check in and be taken to the exam room to be seen on time.

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

Don’t overbook

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 patience. 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 may be legitimate. For example, if an older patient is dependent upon a family member to bring them to the office, you can't hold that against the patient. Then becomes necessary to have a discussion with the Family member who is bringing the patient to the office. Certainly, the patient who is usually on time should be given 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 ahead of a patient who arrived on time. This is AJ service to the patients who are on time.

A "facts of life discussion"

When I encounter a chronically late patient, a conversation takes place between the receptionist\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 expect you to be on time. When you come late, as you have on multiple occasions, you are taking the timeslot 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 had let us know about the delay.

Patient: I'm sorry. I will 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 timeslot if you are late. If the problem continues, the doctor will have no other option but ask you to find another physician to take care of you.

Charge the patient

Charging a patient a fee for being late has been tried for decades without success. It is difficult to collect these fees. This will antagonize the patient. 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.

Discharging the chronically late patient

The chronically late patient demonstrates and 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 may give the patient appointments only at the end of the day. In most states, you must give the patient two to four weeks to find another physician and provide the patient with a copy of their medical records. If the violations continue, consider sending a letter suggesting that the patient obtain their healthcare elsewhere.

Bottom line:

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