How strict is your late policy?

[SpongeBob DoctorPants]

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We have a 15 minute grace period in our clinic, which I think is pretty standard. If someone arrives within 15 minutes of their appointment time, they will be seen; anything after this they will need to reschedule and they will be marked as a no show. Sometimes my staff will ask me if I want to see the patient when they arrive after the grace period, but the problem with this is that by the time they are checked in and vitals are performed, I would often be left with 5-10 minutes to see the patient if I want to stay on schedule.

Today I had a situation in which my 9:00 had not arrived by the 15 minute deadline. My 9:30 patient arrived early, and had been in the lobby since 9:10. At 9:16, I told my MA to get the 9:30 patient ready to be seen. Then, just a few seconds later, the 9:00 arrived. I was asked if I wanted to see the 9:00 or have them reschedule, and I decided it would be best to have them reschedule.

I felt kind of bad for having them marked as a no show due to their late arrival, because they were just one minute past the grace period. But there should not be a grace period for the grace period. Technically, a patient is late when it is one minute past their appointment time. In my opinion, it should not be acceptable to arrive even one minute past the 15 minute grace period; otherwise it would be a 16 minute grace period. Adhering to this policy, I feel, would promote patient responsibility and decrease the odds of them arriving late in the future. Allowing them to be seen would reinforce the behavior of arriving late.

I respect the time of my patients and I am almost always running on time. If I anticipate a patient will need extra time at future visits, I have them book for 60 minutes instead of 30. Late arrivals are a pet peeve of mine, and I always get nervous when someone hasn't shown up by the 10 minute mark, because most the time people arrive just before the deadline and I end up having to rush things. On occasion, I might allow someone to be seen if they arrived just a little past the grace period, but only if there is an empty slot after them so I don't run the risk of making someone wait; however, I also feel that this may not necessarily be a good practice if I want to reinforce the concept of arriving on time.

I'm wondering how others handle late arrivals in their practices. How strict are you if a patient arrives just a little later than you normally allow?

 

[Old&InTheWay]

Obviously I am not in practice but I have worked in a professional capacity prior to med school where I saw clients at specified times (many of whom were chronically late). I don't see any reason to be super-rigid, unless you think someone is taking advantage. I also think it's important to remember (especially in psych) that many patients' illnesses specifically affect their executive functioning and while it's ok to hold people accountable, lateness should not necessarily be seen as a disrespect for your time. Additionally, I think the idea that we can change someone's behavior by instituting negative consequences is instinctively logical (and perhaps satisfying on some level) but not always effective.

I feel like it's ok to have a policy, but then to override it when it works for you. Just be clear to say something like "our policy is to not see patients who arrive more than 15 minutes after their appointment, but my next patient cancelled so we can make an exception this time."

 

[wolfvgang22]

I'm quite strict. I do cut some slack to patients who are nearly always on time or early, and of course for actual urgent issues that if addressed, will keep the patient out of the hospital. 98% of the time what the patient thinks is urgent is not urgent, so I listen to our experienced triage nurse.

 

[TexasPhysician]

I’m in a different type of practice - cash only. I reserve 30 minutes for follow-up patients, but I allot them 25 minutes each. They can arrive at any time during their allotted time, but their time ends at the end of their slot. If we don’t finish what we need to get done, we reschedule soon to finish. They pay for my time.

 

[SpongeBob DoctorPants]

Thanks for the replies. I think it's also worth noting that I practice in a small city and traffic is never a problem. Parking is also right in front of our clinic door. The patient is an adolescent, and in our community all the kids have been out of school the last couple of days. Out of curiosity, I looked up the patient's address and found that they live 11 minutes away from the clinic. Therefore, if they were coming from home, they didn't even leave the house until 5 minutes after the scheduled appointment time!

As a matter of fact, in our city you can get pretty much anywhere in town in 15 minutes or less. So unless someone is traveling from another city to see me, I have to conclude that if they arrived after the 15 minute grace period, they probably didn't start driving to the clinic until after their appointment time.

I’m in a different type of practice - cash only. I reserve 30 minutes for follow-up patients, but I allot them 25 minutes each. They can arrive at any time during their allotted time, but their time ends at the end of their slot. If we don’t finish what we need to get done, we reschedule soon to finish. They pay for my time.

I like the idea of sticking to a 25-minute time limit for visits, but I don't know if I would be able to adequately discuss the patient's problems and go over treatment options in 5 minutes if that's what it ends up being. But, if they feel shorted because we only had enough time to quickly talk about one problem, perhaps that would encourage them to show up early next time.

 

[hamstergang]

I don't see any reason to be super-rigid, unless you think someone is taking advantage. ...lateness should not necessarily be seen as a disrespect for your time.

The problem is that lateness is disrespectful to our other patients' time. When someone shows up significantly late, me seeing them would either entail me providing substandard care by seeing them for only 5-10 minutes (which I won't do, and if the patient is in any sort of crisis or reports SI wouldn't be possible/ethical) or has me running late for all my subsequent patients that day. Not only would it make me late for others, but it also takes away my buffer time for responding to other patient phone calls, refills, and prior auths.

Often when people are late they start giving me their excuses. I end up explaining that the reason doesn't matter -- whether it was something legitimate or not it still ends up affecting all my other patients so they have to reschedule instead.

 

[Old&InTheWay]

The problem is that lateness is disrespectful to our other patients' time. When someone shows up significantly late, me seeing them would either entail me providing substandard care by seeing them for only 5-10 minutes (which I won't do, and if the patient is in any sort of crisis or reports SI wouldn't be possible/ethical) or has me running late for all my subsequent patients that day. Not only would it make me late for others, but it also takes away my buffer time for responding to other patient phone calls, refills, and prior auths.

Often when people are late they start giving me their excuses. I end up explaining that the reason doesn't matter -- whether it was something legitimate or not it still ends up affecting all my other patients so they have to reschedule instead.

I agree that the excuses really don't matter, and like I mentioned above, I think it's fine to hold people accountable. I would certainly not accomodate a late patient if it would make other patients late. I just wouldn't go out of my way to be a stickler. I have been in clinics where patient 1 shows up early and is able to be seen early, then patient 2 shows up late and is sent home on principal even though patient 1's time slot is now free.

On a side note, I'm not sure there's much of a difference ethically in turning away a late patient in crisis, than trying to see them in the 5 minutes you have.

 

[michaelrack]

On a side note, I'm not sure there's much of a difference ethically in turning away a late patient in crisis, than trying to see them in the 5 minutes you have.

Good point

 

[MedMan80]

Unfortunately in fellowship training there is no late policy. Patients even if hours late or early can be seen at the discretion of the fellow, nobody is turned away unless the fellow is contacted first and requests a reschedule...they do have a policy in which missing/late appointments lose favorable after hours spots but this is seldomly enforced, leading to a high no show/tardiness rate.