The Chronically Late Patient

In my book I mention “difficult patients”.  This is a very small percentage of a DPC practice but in life there are all types of people.  Some are just not that easy to understand, get along with, work with or partner with.  It is what it is.  Here is a topic I didn’t really speak about in the book, that being chronically late patients.

  1. How do y’all handle patient whom are chronically late to scheduled appointments? I am fairly quick to fire anyone who is a complete no-show without notifications (I usually only give 1 warning), but struggle more with people are are moderately late (10-20 minutes). I generally will not see anyone who are more than 20 minutes late — regardless of our schedule — because I’ve learned it will only embolden this issue. About 80% of our visit are scheduled within 2-3 days of request (50% probably same-day), so I don’t think we can do much better on this issue. We try to educate new members that our appointment actually and shockingly start on time — and remind people who are late each time, but try not to be over bearing. I suppose I could just say “who cares” because our current daily volume is low enough to manage it, but I know this type of thing will really become much more of an issue when my panel builds to 700-800. Or actually prevent me from reaching that number due to a tighter schedule. I’m certainly not given up $20-30k/year in pay to accomodate late-arrivers.
  2. Tell them the appointment is 15 min earlier than the actual time.
  3. Have thought about that, but biggest issue is our EMR does send reminders (SMS and emails) with details of appointment — which are awesome and useful. I suppose we could just mentally know our actual daily schedule is 15 minutes different. But, the other issue is that some of our patients arrive 15-20 minutes early already! Of course, typically directly after the person who is late arriving. We have had our 10 am appt show up before our 9:30a on many occasions. Perhaps, I should just get over the issue and roll with the punches. It’s more of a principal issue of respect that gets me riled up. People always bitch about doctors running late, but when a doctor runs a very accurate schedule, many people don’t show the mutual respect.
  4. Do you have the option to double book in your EMR? If so just have whoever is scheduling place the appt 15 min prior to actual time (which will look like a double book) and book for 45 min instead of 30….or 15 min longer than whatever your appt length is.
  5. I’m not that busy either, and struggle with the temptation to just squeeze them in when they’re late or walk-in asking to be seen without even calling. Sometimes I will, but I agree that usually they’ll give even less of a crap if they’re not smacked down once in a while. They basically need to be treated like children. So if they’re really late, we just tell them we’re happy to reschedule them at a time that they can make work. However, sometimes they call telling us they are going to be late because [insert excuse here], and then I almost always still accommodate them unless it’s really a struggle to do so, because hey, at least they gave us a heads up and that’s them showing consideration, so I give consideration in return.
  6. Yes, I would strongly suggest NOT accepting walk-ins if you don’t plan to do so in the long-run. I made a big mistake in my first year doing that. It took me about 1-2 more years to untrain people from doing this. No matter how you preface “usually we do NOT do that, but . . . ” the person will not really listen to that and continue to walk-in. We occasionally get patients walking in, but unless they are bleeding heavily or disoriented anatomy, we only offer to schedule them at least 2 hours in the future.
  7. I am always super annoyed when patients show up late. If they’re more than 15 min late (without a courtesy phone call), I usually* give them the option to reschedule or wait until after my next patient (assuming there is another patient in/coming in soon). Otherwise, I often just do a “Glad you made it, but since you are running late, we’ll need to keep this short since we only have 10 min before my next appointment”. We do charge a $25 no-show fee, but haven’t gone so far as a “late” fee…
  8. I think being too lenient is a huge slippery slope. They start to become really high maintenance and demanding. Those are also the ones that will give you a bad online cries the minute you do something to piss them off, no matter how unreasonable. We all know our patients well enough. “I’ve been known to say “dude, you were late again. I don’t keep you waiting.”
  9. I think it’s good to give reasonable people Grace. Especially if they’re not normally late. I have been running late more recently and so I’m grateful I don’t have a real firm policy on this. However we have a few people who never show up anywhere close to on time and will say things like oh we were out at lunch. . . That’s just ridiculous. I’m starting to tell people who are late how much time we have left in their allotted visit like “but we only have seven minutes we better get to work ” but that doesn’t work that well either because when the visit time is up they keep talking. . . Are used to think, what do I care if people are late or no-show they’re still paying the monthly fee. But what ends up happening is they eat up two or three visits spots in a week. And as we’ve grown I just don’t have that kind of capacity. So then perfectly capable reasonable nice people don’t have their needs met … So I think it’s good to have a policy. What you cultivate is a population of bill payers who show up. And that’s ideal