Chronically late patients...

[tlackey]

How do you all handle late patients? I work in a peds clinic where there are a fair amount of chronically late patients, not 5 minutes late, but more like 15-20 minutes late. They never apologize, or acknowledge that they are late at all. The MDs don't really care - they think of it as income no matter what time the patient arrives, so we have no official late policy. Additionally, it is difficult to make them reschedule because sometimes the patients are there for a sick visit and have to be seen, or they are well-baby checks and we typically schedule 4-6 weeks out, especially in the summer. Lateness is my #1 pet peeve, and I hate the fact that people are entitled enough to think that their time is more precious than anybody else's. If one person is 15 minutes late for their sick visit and we have to see them, the next scheduled patient who shows up on time will not be seen until 15 minutes later. I wish there was a good way to indicate to these parents that they are late, and it is just plain rude and will now make everyone else behind.

Does anyone have a good zinger to lay on these patients?

[Julesmama28]

All the peds offices I've dealt with had a 15 minute late= rescheduled policy. They would also charge your account a no show fee of 25$.

[sharpeimom]

my husband (who was able to get two phds and become a member of pbk) has add, adhd, and ocd. he was born nearly one month late and i tell him he has never been on time, despite my best intentions, in the 30 years we've

known each other. ever! screech!

the doctors' offices (and other offices and businesses) all know his proclivity for tardiness and handle him about

the same way. if his appointment is really at 1:00, his appt. card says 12:30 instead. the receptionist then calls

me and tells me the real time, which i write down in my little secret pocket-sized calendar. the time on his card is the time that goes on the kitchen calendar... and ... miracle of miracles... he's on time and doesn't mess

up the morning or afternoon.

having to reschedule or pay for a missed appointment don't bother him. my threats to shake him until all his teeth rattle then fall out don't make any difference.for some reason though, he's never caught on to the time

adjustment thing and i hope he never does!

[GitanoRN, BSN, MSN, RN]

my husband (who was able to get two phds and become a member of pbk) has add, adhd, and ocd. he was born nearly one month late and i tell him he has never been on time, despite my best intentions, in the 30 years we've

known each other. ever! screech!

the doctors' offices (and other offices and businesses) all know his proclivity for tardiness and handle him about

the same way. if his appointment is really at 1:00, his appt. card says 12:30 instead. the receptionist then calls

me and tells me the real time, which i write down in my little secret pocket-sized calendar. the time on his card is the time that goes on the kitchen calendar... and ... miracle of miracles... he's on time and doesn't mess

up the morning or afternoon.

having to reschedule or pay for a missed appointment don't bother him. my threats to shake him until all his teeth rattle then fall out don't make any difference.for some reason though, he's never caught on to the time

adjustment thing and i hope he never does!

i use to have this trouble with my older son, then one week his doctors office called to confirm his appt. for 10:15am for the following mo. i told him it was for 9:15am. needless to say, he walked in to his appt. at 9:50am thinking that he was late, the front office staff was totally surprised

[classicdame, MSN, EdD]

some people just are not time sensitive, especially if they have waited to see the MD. They might then think the "rule" for tardiness goes both ways. When I worked in a clinical area we would tell the late person would not be put ahead of the on-time scheduled person. We also tried to see patients on time and not overbook. If we were running late we would announce to the reception area and allow people to reschedule if they desired. Being on time is a courtesy. Being chronically tardy is an ego thing, IMHO.

Had a SIL who was always late and would joke about it. Once we started Christmas dinner without her and she was PO!!Was not funny anymore.

[tewdles, RN]

I am not recommending zingers for your tardy patients.

I would recommend that you discover how the chronic tardiness impacts your workflow and then submit a proposal to remedy the impact.

If your docs don't mind then perhaps they need a dose of reality check to understand the financial ramiifications of running an office/practice in reaction mode rather than response mode.

[Ruthfarmer]

Offices are frequently overbooked, and sometimes patients have extended waits time and time again. Patients can feel that their time is important, too and they can become frustrated. I don't know if that's the case with your clinic. I do think that if the clinic goes with a policy to reschedule when the patient is 15 minutes late and to charge a $25 fee, then the clinic needs to extend some sort of courtesy or concession to the patients. If for whatever reason, the doctor is running 20 minutes or more behind, then the receptionist should notify the patients in the waiting room of the lengthy delay and afford them the option to reschedule.

Years ago, when my former spouse was undergoing chemo at his doctor's office, he had to be fasting before the blood work which was done prior to the office visit. We had a long commute to town for the blood work and visit, and some other logistical considerations that did not allow us to get a bite to eat between the blood work and the office visit. A terrible routine developed where the doctor was running behind an hour and half or more at each visit. I was concerned not only for my spouse, but also for some other patients who appeared more frail and weak. I wrote a letter to the doctor outlining my concerns about the discomfort caused by the overbooking delays.

The doctor called me and told me that from now on they would honor our appointment time and would not overbook. The doctor also opted to notify patients upon arrival that there would be a lengthy delay due to some emergent situation. Patients were afforded the opportunity to leave and get a bite to eat and return in an hour or so, or to reschedule.

Hurling a zinger or scathing comment will not engender good will or a pleasant interaction. It could bring down some mojo you'd rather not experience.

[sharpeimom]

while many cases of chronic lateness are due to ego issues, i feel, after living with someone who literally has no

sense of time whatsoever, that it's part of my otherwise wonderful husband's add, adhd, and ocd makeup that

time means absolutely nothing.

he can go to the kitchen during a commercial break during a tv show to make us tea, hear the dryer buzz, and

check it. he'll realize the load isn't quite dry but leave without restarting the dryer. he has completely forgotten about the tea brewing and goes up the back stairs to get a book from his nightstand, come back down the front stairs and sit down again. all before the last commercial ends!

i think a lot of chronically late people have scattered disorganized brains. he has written several books, a prize

winning produced play, won many national and international awards, gets outstanding teaching evaluations, yet i

check his backpack nightly to be sure everything that should be in it is in there and lay his clothes out for tomorrow. saves a lot of dithering the next day!

it used to drive me bonkers, but now i mostly just accept it and deal with it.

zingers? not the answer for most.

[grownuprosie]

I have worked front office for years. We ask that everyone comes 15 minutes early. For example, if the 1000 pt shows up at 9:45 and the 9:45 pt is not there yet, the 1000 pt gets puled back. The 9:45 pt is told that to stem any delays in care for other pts, the next pt was seen in their stead and they will have to wait an extra 15 minutes. Of the hundreds of people that i have said this to over the years, most don't take issue with it. A few go into a tirade to justify their lateness, but ultimately understand that we cannot allow their time management issues to make the clinic run behind. I think this is a facility policy issue that you should adress with the front staff and the MD. I find that when a response is well worded with a facility policy behind it, pts are less likely to feel they are being singled out for tardiness. Rather, they are adhering to an established policy.

[wooh, BSN, RN]

If you're going to have rules or especially zingers for patients that are late, you'd better be running your office like a Swiss watch. You give me a problem for being late, I'd better not be sitting in your waiting room for 5-45+ minutes when I'm on time.

[caliotter3]

Until your office adopts a reschedule and no show fee policy, you will encounter people who will take advantage of your lenient approach. They care nothing about who is inconvenienced by their thoughtlessness. Hit them with a $50 no show fee and they might change.

[SHGR, MSN, RN, CNS]

I'll admit. I am a chronically late person. And it doesn't bother me when patients are late. People walk in unscheduled with a glucometer problem, or weird issues they can't figure out, and if they need to see me for their chronic issues, they know they might have to wait. Or they say, I'm going to bring in this paperwork tomorrow. They can't give a time. Our patient population is just disorganized.

When I have an appointment, I bring a book. I've waited more than two hours to see a doc, this is pretty regular. I waited three hours once- that was excessive.

But, for the most part, I'm pretty casual about time, and this goes both ways.