There is constant tension to remain on-time working in a primary care clinic, seeing patients every twenty minutes back-to-back. It takes an incredible ability for the front desk staff, medical assistants, and the physician to be able to keep this flow running smoothly only to have it be derailed by the late patient who does not understand how their actions affect everyone else after them.
I currently work in a system where a patient can walk in up to 16 minutes late for their twenty-minute appointment, and they will be seen per policy. No penalty. Very little conversation to help them change this behavior or understand its impact. I cannot refuse to see them. I am criticized for wanting to turn them away — ruining the on-time patients that come after — because now I am forced to fit this patient in. I am cited for my bad attitude when I complain that this is unjust and unprofessional.
I take my child to his 30-minute piano lesson that, too, is scheduled back to back with other students by the teacher to maximize her schedule. If I arrive 16 minutes late, my child gets a 14-minute lesson and is dismissed at the time his lesson was scheduled to end. My hairstylist states she will not take a late client if the time remaining in the appointment does not allow for her to be on time for her next customer. I am confused as to why this same courtesy is not acceptable or applicable in healthcare?
Patients need to understand we are stretched thin as is. Primary care has become factory line assembly work, and if you come late or disrupt the flow, the assembly line shuts down and clogs, and no one is happy. But in this current culture, it is the physician who is repeatedly blamed for not having compassion or empathy. I have plenty of empathy for those that now need to wait for me because I am forced to see the late patient.
I worked at an FQHC where the CEO believed that, despite transportation and housing insecurity in many of our patients, appointments were to be honored and respected in all aspects of life. He demanded no exception be made in clinic. Kids need to get to school on time. Adults need to be at work on time. Why should a patient not be expected to be on-time for a medical appointment? When a patient came late, it was up to the physician to decide if the person could be seen or needed to reschedule. Patients quickly learned, and behaviors changed.
Do I believe that things happen that sometimes are out of the patient’s control or mine to not be on-time? Absolutely—but ironically, these are never the patients that show up late. Those seniors that drive in a blizzard to keep their appointment with me somehow still arrive early — or call if they run into trouble. If I need to spend more time with a patient and go over the 20 minutes appt time arriving late to the next patient, I apologize profusely. My long-term patients know I work very hard to be on-time for them as much as humanly possible. I simply desire the same from them. For my colleagues that always run behind because it is a practice style issue- consider modifying the schedule so there is space built-in for catching up to keep you on-time. Without a doubt, it goes both ways.
Dear patients: Please show up on time. Maximize the twenty minutes you have with me and show up early. You will find me more attentive and responsive and less stressed watching the clock to get back on track for those patients that follow.
Katie Klingberg is a family physician.
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