When handling a patient who arrives late for an appointment, the medical assistant should:

1. Science
2. Health Science
3. Gastroenterology

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Every medical practice has them - patients who are persistently late for appointments. Here are four tips to turn the tardy into time conscious.

We have all had them, that handful of patients that is always 20 minutes to 30 minutes late, and sometimes even unapologetically. Having been in several different practices, I can personally attest to finding them everywhere. And after last week’s post, I know that you all are experiencing them as well.

So what do you do when you have implemented all of the ideas from last weeks post, and you still have a few chronically tardy patients? Here are some ideas to move things along:

1. First get to the bottom of why they are chronically late: Is it a mom with kids hanging off of her that is obviously distressed or are they coming from a great distance? It has been my experience over the past 12 or so years that there are very, very few people that are intentionally late or just don’t care. Most of the time, the attitude of not caring comes from embarrassment that they are late - again. Make sure you ask your patients, nicely, why they were late. Sometimes the answer is in the reason. Chart the answer, or make notes in the appointment system, so that the next time a person schedules the appointment the reason can be taken into account.

2. Give patients written warnings. When a patient is more than 10 minutes late, give them a pre-printed written or verbal warning, and make sure to note these in the charts.

First Offense: “Thank you for coming to your appointment today. We will work you in today, although you may have a wait to account for the patients that arrived at their scheduled appointment times. In the future, please call to let us know you are late and on your way so that we can try to make necessary adjustments. “

Second Offense: “Thank you for coming to your appointment today. This is your second warning that you have arrived late for two appointments in a row. Please let us know if we can schedule you at a more convenient time. We schedule our patients to see everyone as efficiently and effectively as possible. If you must be late, please call and let us know in advance. If you are late for a third time, we will have to limit you to our 4:30 p.m. slots.”

Third Offense: Some offices would fire a patient at this point, but I would suggest limiting that patient to the first slot or the last slot of the day, or at the lunch hour.

3. Make notes in your scheduling system to tell the patient they are scheduled for 3 p.m. but actually have them on the schedule for 3:30 p.m. That may sound crazy, but it works.

4. And if all else fails, you can certainly officially “fire” a patient with a certified letter, but I advise people to use that for more grievous actions than arriving late.

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 and you should make every attempt to make the customer/patient happy.

You will find a few that abuse the system. If you are finding more than a few and it is becoming a real hindrance to the practice, then it’s likely time to have an objective third-party opinion or to poll your patients for the answers.

Find out more about Audrey "Christie" McLaughlin and our other Practice Notes bloggers.

Ear, Nose and Throat Consultants, Inc. values the goodwill of all our patients, caregivers, and families. We appreciate the busy pace of your lives and respect the fact that your time is precious. With your cooperation, we can improve our ability to make your visits with us more efficient, enjoyable, and stress-free.

When a patient arrives late for a visit, we do everything in our power to see that patient without significantly inconveniencing other patients. If a patient arrives late and there are no other patients scheduled or ready to be seen, we will see the late patient when he or she arrives. However, if a patient arrives more than 5 minutes late and other patients are waiting, we assess how accommodating that patient will affect other patients. Patients who arrive on time are prioritized over those who arrive late. We also take into account the reason for the appointment. Sick patients always take priority over routine appointments.

We often cannot predict how long a late arrival may wait. Sometimes late arrivals can be accommodated if another patient fails to show up for an appointment. We may suggest returning at a later time to minimize your waiting time in the office, but we cannot guarantee a later appointment time. Emergencies often interrupt our plans. We also might suggest you see another provider who is available. On very busy days, as a last resort, we may have to ask a late patient to reschedule their appointment to another day. Calling to notify us that you are running late helps us accommodate a late arrival better, but does not alter the late arrival policy.

All of us at ENT Consultants wish that every patient could be seen promptly at his or her scheduled appointment time. We dislike keeping our patients and families waiting, just as we dislike being kept waiting ourselves. We believe that everyone’s time is valuable, and we are constantly revising our schedule to improve patient flow and to be as accommodating as possible to all.

Why do I have to arrive on time if the provider doesn’t always run on time?

We ask patients to arrive on time, and enforce our late policy, as late arrivals affect the entire schedule. For example, if our first patient of the day arrives 15 minutes late, it is impossible to get back on schedule for the remainder of the clinical session. We certainly cannot make up that time by short-changing subsequent patients.

Emergencies also affect schedules. We are medical providers and surgeons, and some emergencies require us to perform procedures, or even to leave the office urgently for a hospital. A patient who is seriously ill, bleeding, or complicated requires a much longer visit, and can absorb more office resources, including the physician’s assistant, surgical scheduler, nurses, medical assistants, and front-desk staff. This almost always causes a provider to run behind. Whenever possible, we will call ahead to notify patients if a provider is running more than an hour behind schedule.

It is our policy to accommodate, on a same-day basis, all patients who require an emergency visit. We never know exactly how many patients are going to need to be seen. On any given day, anywhere from 3 to 30 patients may call each physician requiring a same-day visit. We have created a dynamic schedule that allows for most variations. However, when there are more than expected, it becomes increasingly challenging to keep all of the clinicians’ schedules running punctually.

When there are no emergency spots available, we will advise that those with urgent, but not emergent, care issues of a scheduled time when s/he can come in to be seen after hours, early the next day, or we may suggest coming in and waiting until there is a break in the schedule. We cannot predict when such a break will occur. We may alternatively suggest going to your PCP, a walk-in clinic, or the ER, depending on the nature of the emergency.

How can you help?

You can help us greatly improve our ability to see you on time by arriving on time yourself for a scheduled visit. Please call us if you think that you will arrive more than 10 minutes late. If possible, we will try to adjust our schedule. However, it is possible that we will ask you to reschedule your visit to another day. We would also appreciate a call ahead of time if you hope to have an additional child or family member seen for a visit. Your call will help us to adjust for the “squeeze-in” appropriately.

In order to improve office flow, we typically suggest both an “arrival time” for you as well as an “appointment time.” By coming a few minutes earlier than your appointment, at your suggested “arrival time,” you enable our office staff to update your medical and demographic information, collect any necessary copay, check insurance and referral data, assess vital signs, and prepare an exam room with any equipment necessary for your visit. This enables everyone to be seen more promptly and efficiently.

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