Saturday, February 11, 2012

On Being Late

In an increasingly consumer minded era more and more patients, understandably upset with long office waits,  express the belief that their time is as valuable as the doctors and deeply resent having to, now running late themselves,  sprint out of the clinic to meet other needs, obligations or appointments.  When they are late for subsequent meetings or responsibilities a pile up, a chain reaction of tardiness,  can occur.

In addition to physicians chronically falling behind their appointment schedule, patient tardiness is a major factor, especially if despite arriving late  (beyond ten minutes), patients are immediately seen, pushing back appointment times for those who follow.

This is especially galling to patients who rightly feel a sense of ownership of their appointment times and believe their scheduled visit with the doctor should not be usurped, especially without their permission. (Mr. Jones may we delay your appointment fifteen minutes?)

There are numerous reasons why someone might show up late for their appointment.  The time on their appointment card was recorded incorrectly.  They are so sick or confused that they initially went to the wrong place.

For these reasons an accommodation needs to be made regardless of its effect on the schedule.  In my experience, these kind of reasons for being late are not as common as one might think.  But when they occurred, these patients were brought to the head of the  line.  I cannot recall a single objection raised to my either seeing an acutely ill patient immediately or spending a prolonged amount of time with them.  

Much more common are reasons falling into the categories of either late by choice or chance.  The patient was, for example, winning at cards and couldn't pull himself away while he had a hot hand.  After avidly exploring a frozen metal lamp post,  the families Doberman Pinscher, now mystified and irate, found himself tethered to the post by his tongue.  A group of firemen, were called in to defrost the post, carefully and slowly, hoping that when the tongue sprung loose the Doberman would show only gratitude.  The drama resulted in the patient arriving one hour late. 

Early in my career I began, after satisfying myself that there was no urgent problem afoot, to ask those late by choice or chance to either make a new appointment or take a later appointment that day should one be open, explaining that I could not, in good faith, give another persons appointment time away.  Moreover, I indicated that  I was not at my best when rushed and I believed they would have  a much more satisfying visit when I was not galloping to make up time.

These conversations generally did not go down very well with many patients who seemed to regard me as a small time dictator.  They reasoned, I feel certain, that since doctors were notoriously late, it was a  minor blemish to be, say, thirty minutes  late.

But when the vast majority understood that I meant to run on schedule, and that they could almost always count on being seen when scheduled, they warmed to my style and were rarely late.  A number of new patients came to me because they heard that I ran on time.  Over the years,  not a few patients thanked me for being prompt and guarding their appointment slots. 

Lesson?  Run like a Danish train (relentlessly on time) and doctors and patients get home less bruised and angry.  The occasionally clever and imaginative explanations for being late are sometimes hard to deflect, but making an earnest effort to keep on schedule is respectful of patient's time.  Moreover, it makes it far less likely that patients and doctors will feel as if they have been on a cattle drive.