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Have you ever had your schedule disrupted by a patient who arrives late? I guess we all have.
And the early arriver is not much easier to deal with. Try as we might to keep a well designed
schedule, unexpected events that are not within the control of the practice can cause back-ups
of patients or wasted time. Here are some tips on how to improve the situation.
Assuming the usual efforts are made to tell patients the appointment time and confirm it one day
in advance, I just accept that some people generally run late. Tough measures to change people’s
habits can have a way of being perceived as too controlling for a high-service practice. Patients
can perceive it as a turn-off. When a patient does arrive late, I think it’s very important to
handle it well at the initial greeting by a staff member. My staff is trained to say something
like “Hello Mr. Smith! It’s so nice to see you again! I see you have a 1:30 appointment and
it’s now 1:50. We should be able to work you into our schedule with only a minimal delay. I’ll
let you know right away if there will be any problem.”
If the staff member feels too shy and passes the first chance to acknowledge the time situation,
the opportunity is lost. The same is true if there is no staff member available to greet Mr.
Smith because he or she had to leave the front desk (another pet peeve of mine that happens
all too often). Mr. Smith then conveniently forgets that he was late and he can begin to resent
any delay, even though he caused it! It seems fair to me that the latecomer should be the main
person inconvenienced by the action – not the other patients who were on time for appointments.
The Early Bird
The patient who arrives early can also cause problems with the schedule, because a well-meaning
assistant will frequently start the exam for this patient ahead of another one who should have
gone first. This is fine for the early arriver – but the next patient (who was on time) may be
I recommend similar staff training for an immediate acknowledgment, just as above for the late
patient. “Good morning, Mrs. Jones! I see you have a 10:30 appointment and it is now about
10:05. We will try to take you in a little early if our schedule permits, but I’m not sure
about that just yet. In the meantime, please help yourself to a cup of coffee or tea at the
beverage counter, and feel free to browse for frames while you wait.”
An office manager or senior staff member should evaluate the schedule and make a decision about
when the best time will be to begin the early or late arriver.
A Cut-off Policy?
My staff occasionally asks me if we have an official number of minutes, after which we turn away
a late-arriving patient. They would like it to be a little more cut and dry than I think it
should be, so I decline to have a specific number of minutes. While it would make things easy
on the staff to just say “if a patient arrives more than 20 minutes late for an appointment,
they will be turned away and rescheduled for another day.” I won’t do that. It’s a good way
to lose a patient and his family and to build a bad reputation. One could argue that those late
arrivers are not desirable anyway and they deserve to be taught a lesson, but I don’t agree.
Patients are too valuable, and the patient very likely will teach the practice a lesson by going
elsewhere. Most of these latecomers are good people who had something unexpected happen in their
I prefer to be flexible enough to handle things that throw off my office schedule. We should be
good enough to manage those inconveniences well. I will generally see any patient who arrives
late, unless it is right at closing time and would require staff members to stay extremely late.
What about the wrong day?
Here is another great example of challenges that can upset the schedule. By now, you probably can
infer that my office is going to handle the patient who shows up at the front desk saying he has
a 2:00 appointment, only for the receptionist to finally find him in the schedule one week in the
future. My staff is trained to accept the blame for this mishap, and apologize for apparently
recording it wrong. We then do our best to work this patient into the schedule today, which is
usually no big deal. What we avoid is the confrontation of trying to prove that the patient
made the mistake and should just go home and come back next week. The patient, realizing that
the situation could have been his error, is always very understanding. And let’s not forget
that it really could have been our fault!
Flexibility and Efficiency
This customer-friendly appointment policy works if your practice is flexible and efficient with
clinical procedures. Here are some factors that make that possible.
A larger staff
Shorter appointment slots for exams
Doctors and staff who are aware of the schedule and can change the sequence of testing
A supervisor to direct patient flow
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.