The Late Patient
Mrs. Smith's appointment is at 2:00 and she called the office after receiving a message to call, confirming that she will be there. It is now a little after 2:00 and the hygienist is on the telephone trying to contact Mrs. Smith to make sure she is on her way. Nobody answers the cell phone or home number, so she tries the work number. They tell the hygienist that Mrs. Smith has stepped out of the office. It is now 25 minutes into the appointment and Mrs. Smith walks into the office.
Now what? Many people will be quick to scold the patient for being late. “You are too late, we need to cancel your appointment and reschedule.” Or, “The doctor is waiting” with some very negative non-verbal communication. The hygienist is standing or pacing in wait, tapping her foot with a scowl across her face, and the first words out of her mouth are, “well come on back and we will see what I can do. I am not going to be able to probe, or get the x-rays. I will just do the cleaning.” Of course the voice she is using has just a little attitude also.
We have all seen this scenario. Maybe it has happened to us the one time in our life we were late to an appointment. This is not a good way to encourage patients to return for future appointments. This may even be a reason that patient retention is not as good as it should be in your practice. Nobody knows what is going on in this patient's life that made her late. It may not even be our business. Whatever happened, she has done whatever she needed to in order to make the appointment.
There are many things to consider when patients show up late. Here are the two to always keep in the front of your mind.
This is one way we would have liked to see this scenario play out.
The hygienist did perfect by calling the patient even a couple minutes after the confirmed time was missed. The sooner she gets the phone call made, the more likely you are to save the appointment. Even if the patient has not left their house, they may only live five minutes away and the appointment is saved. If the hygienist waits 10 or 15 minutes after the appointment is originally scheduled, it may be too late to save the appointment.
When Mrs. Smith walks in the door already looking like a truck has run her over, the last thing she needs is to have the staff jump into another truck and back up over her. Greet her as you normally would. Have her come back to the chair. Most patients at this time are already profusely apologizing. You're not going to say it is all right, because really it is not. You are going to say nothing at this time. Continue to guide them to the operatory.
Once the patient is in the chair, ask them to take a deep breath, they are here now. This will lift the entire world off of their shoulders. Giving a patient just a minute to stop, breathe, and relax will make a difference in the rest of the appointment. If the hygienist were to get the patient in the chair and start hurriedly, then you would have two people dealing with an unnecessary stress for the remainder of the appointment.
Go ahead and review the health history, and begin the appointment as if you would any - do blood pressure, ask the patient what problems, concerns, or changes they have. Make the notes in the computer, look in the mouth to check for decay, and evaluate the work that needs to be done. Once you have actually evaluated the patient's mouth, this is the time to decide what will and will not be done during that appointment. Even if you have seen this patient for years and you know they have a trash mouth, at least look in the mouth.
You always want to provide the quality of care that is in your vision. With this particular patient, you may be able to complete the hygiene appointment in the time remaining. This is where teamwork will make a difference. The assistants may be available to do the x-rays, the doctor or another hygienist may be available to do the probings.
During the 20 minutes the patient was late, the hygienist should be looking at the appointment book with another staff member, determining how the appointment may be saved. Arrangements made with the individual staff members or doctor should be set up during this time - rather than standing, pacing, and lying in wait to pounce on the patient when they walk in the door, risking lost production (and possibly a lost patient).
If the patient does have a concern, and if time permits, at least address their concern - get x-rays, and even probe if that is all you have time for, and reschedule them for the specific time required to complete the cleaning.
If there is no way at all to save the appointment, after the hygienist has looked in the mouth, inform the patient by saying something like, “Mrs. Smith, in looking at the work that you require and the quality of work we like to provide, it would be in your best interest if we reschedule your appointment.” Now you are canceling the appointment with the patient in mind, in private.
You may also want to have Mrs. Smith stay in the office long enough to make sure the next patient is going to show.
Of course we would prefer that our patients never be late and always make their appointments. However, life happens even to the best of us that are “NEVER late.” Try to consider the patient first and what they may have gone through to get to you at the time they did, instead of thinking only of your schedule.
Interested in improving your hygiene department? Email firstname.lastname@example.org and ask us about our 1-Day Hygiene Training Program.
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