# Is it so hard to call your doctor if you are going to miss your appointment?



## Overread (Mar 7, 2015)

I don't know if you do so already but a reminder service automated by email might be a help. If its automated and setup right it shouldn't cost you any more admin time (beyond setting it up and any additional software to use) and it could mean that people are reminded of their appointments. 

I know that I wish the dentist I go to did this; although granted the 6months or so between general check-ups is a bit on the extreme side; but still even if its only a handful of days things do get in the way; at least an email reminder might at least get them to send a reply if they know they won't be there and might mean that they stave off making plans that will get in the way. 


The other option is to impose a fine for missed appointments without prior notice; although I know that this practice has to be handled rather more carefully with medical situations depending upon the nature of your clients (esp in the USA where medical care is paid for or at least an insurance situation - least far as I know).


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## beau159 (Oct 4, 2010)

Overread said:


> I don't know if you do so already but a reminder service automated by email might be a help.


This is a company I've looked into that does this, along with text reminders. However, it costs a substantial FEE to me in order to have that service. And I'm not about to embark on something new in the office when we have ICD-10 looming over our heads in just a few short weeks. 

I think for some patients it would help. However, I've had people in the call for an eye exam (let's say they call at 10 AM) and we have an opening at 11 AM and they say they'll take it. Then 11 AM comes and goes and low and behold, no patient. 

So for patients that were going to stand you up anyway, a text or an email isn't going to help. 



Overread said:


> The other option is to impose a fine for missed appointments without prior notice


I've considered it. But most of those patients that no show you, a fee like that is going to get sent to collections and I'll never see it anyway. So is it worth the money (paper, postage, phone calls, etc) to try to collect that fee? Probably not. 

Half the time people can't even give you a phone number that works; I doubt they'd give a credit card (ahead of time) that works. 

It's just frustrating.


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## Corporal (Jul 29, 2010)

Been there, done that--SOOO SORRY!!
I would keep track of people that don't do you the common courtesy to even call to cancel. THEY get a higher rate, next time they call. Let them ASK you why.
For those that do communicate, knock some $ off of THEIR bill, and Tell Them Why.
It sounds like you have a word of mouth business, so let the word get around.
There may be some other good suggestions out there, too. =D


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## Overread (Mar 7, 2015)

Beau I don't do this but I would think that automated emails shouldn't be too expensive to setup. Textmessages might be more tricky, but a pure email based system shouldn't be an arm and a leg I would think. 

That said I agree with corporal that a system of monitoring your patients and getting a handle on those who are repeat offenders would be important. It's hard when its dicing with peoples health and well-being; but if you're going to get those who do fail to turn up repeatedly then a black-list of some form might be in order. 

You could simply charge the black-list people before any work is done.


Another option is booking-fees or a returnable deposit paid upon booking. Of course this really depends a lot on your client base and the market you're in; if you're near the bottom such tactics might just turn away what business you do get since many might not be able to afford such costs anyway.


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## beau159 (Oct 4, 2010)

Wow. Another no show. That makes 5 for the day. And another cancellation for a sick kid. This is unbelievable. 

We get our share of no shows and cancellations. I understand stuff happens. But today and Thursday have been out of the norm and it is just CRAZY. I'm pretty much sitting here with my jaw on the floor. I have no idea what is going on all of a sudden. 

Oh believe me, I keep track of repeat offenders. In my book, 3 no-shows and you are out. You can seek medical care elsewhere and not waste my time. I think 3 chances is very lenient. 

Corporal: That would be bending the rules. Legally, we need to charge all patients the same fee, regardless of insurance or other factors. You can, however, charge a no-show fee if you like, but then you do have to apply it to everyone that meets that criteria and not pick and choose. 

I can, however, refuse service to someone if they fail to come for their appointments or if they are rude to my staff, etc. I'm not an emergency room. I'm not obligated to see them. 

I do enjoy my job. I really do. 90% of my patients make me love coming to work. It's the other percent .... heck, today and Thursday make them the main majority, that makes me beat my head against the wall.


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## Jan1975 (Sep 7, 2015)

So rude! I hate it when people completely disrespect your time in that way. That being said, I HAVE forgotten about an appointment before, but I always apologize profusely and often bring in a little treat as a token to ask for forgiveness. It also drives me crazy when people are late for their appointments, because then the Dr. gets behind and I end up waiting for the appointment I was ON TIME for.


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## Missy May (Feb 18, 2012)

DD goes to college out of state, and her dentist there charges $50 for a no show. Food for thought.


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## Kay Armstrong (Jun 28, 2015)

I feel for you. I'm a realtor and we get no better communication from people who call us to make appointments. Maybe tomorrow will be better.


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## RegalCharm (Jul 24, 2008)

beau159 said:


> ....So a reminder to everyone that if you make an appointment ... keep the darn thing!! It's just courteous. Vent over.


That is a two way street. I had an appointment for Sept 10 at my outpatient clinic for a 6 month checkup. the 7th I was on the VA dot gov site refilling my Rx's checked my appoints calender, it said cancelled, called the clinic and they said yea it is and we rescheduled for today the 14th. they called about 9:30 saying they had to cancel cause the dr. called off. So now it is scheduled for the 24th, and I have one for the 21st but just to see the nurse 

I will have to say this is a first for the clinic. They seem to have a hard time keeping Drs. My last PCP was a nurse practioner she lasted 2yrs. Drs. only work 8hrs a day 5days a week, and no emergencys. For around a hundred thousand a yr. plus liability insurance and benefits, not to bad of a deal.

also the VA has an automated reminder service that calls by phone 2 days before to remind you
press 1 to confirm appointment, press 2 to cancel.


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## boots (Jan 16, 2012)

I work at one clinic with a 50% no show rate. 30-40% at another. 

It does make providing the service tough because your own dependable employees are there even during the down times and have to be paid. Along with keeping the lights on, the water running, the insurance on everyone...

I don't understand not showing up. 

As a patient, though, I don't understand the whole "hospitalist" racket or docs that disappear frequently. The latter probably led to the former.

I found a clinic that has primary care physicians. You can have a family doctor! Wow. A luxury.


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## beau159 (Oct 4, 2010)

RegalCharm said:


> That is a two way street. I had an appointment for Sept 10 at my outpatient clinic for a 6 month checkup. the 7th
> 
> *VA*


Unfortunately, the VA is a disasterous mess, so that doesn't surprise me. 




RegalCharm said:


> also the VA has an automated reminder service that calls by phone 2 days before to remind you
> press 1 to confirm appointment, press 2 to cancel.


We personally call each and every patient the day before. We like having that "personal" touch where people can speak to a real person instead of an automated machine.


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## Skyseternalangel (Jul 23, 2011)

I usually get nervous calling off an appointment, especially one I've fought so hard for BUT I always do it. It's just courtesy


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## Rainaisabelle (Jan 2, 2015)

I always call to cancel ahead of time but if I do forget I call the person and apologise profusely and reschedule


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## ChitChatChet (Sep 9, 2013)

People now days seems to only think of themselves.


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## BarrelracingArabian (Mar 31, 2010)

That goes for employees as well. I have worked at a deli since march, since then we have almost an entirely new staff because we mass hire and 98% do back to back no call/no show or call off every other shift. Why go out take the time to get 2 interviews, separate orientation and then NOT go to work, I don't get it. Makes it very hard on the rest of us when we don't even have enough trustworthy people to promote anyone. My friend and I were promoted a few weeks ago and shows that we carried front of the house as, as soon as we weren't able to be scheduled regularly they started to tank. People just don't follow through anymore on anything.


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## david in md (Jun 13, 2013)

There is no excuse for no showing an appointment or not calling to cancel well in advance. Some of those patients would be former patients. It's not easy to get a Dr. appointment so there must be plenty of patients to go around.

That being said please respect your patient's time. I hate sitting in a waiting room 45 minutes before being called back and the another 15-30 minutes to see the Dr. That's time away from my business. I try to make early appointments before the practice has had a chance to get too backed up.

The only profession I've found to have less regard for a person's time than the medical profession is the court system when on jury duty.
_Posted via Mobile Device_


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## Missy May (Feb 18, 2012)

I have never not shown up for an appointment in my life, or even been late. The one time I thought I _might_ be late I called on my way there and said so, but as it turned out I managed to get there on time. I have cancelled appointments - _way _in advance.

But, like Regal said - it works both ways. A doctor/dentist/whatnot can be the best there ever was, but if their office management can't manage time - or is instructed "not" to properly manage time, it reflects really poorly on them. I mean, if someone shows up at 2 for a 2 o'clock appointment, and is seen at 2:45...? It is just unsat.

Likewise, if a doctor/health professional is excellent, and the office staff has "excellent" time management skills - they literally can name their price.


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## beau159 (Oct 4, 2010)

david in md said:


> That being said please respect your patient's time. I hate sitting in a waiting room 45 minutes before being called back and the another 15-30 minutes to see the Dr. That's time away from my business. I try to make early appointments before the practice has had a chance to get too backed up.


I agree completely and I hate making people wait. 

However, I can't help it if a person shows up late for their appointment and then makes me run behind. I try the best I can to "catch up" and get the schedule back on track but it just doesn't always happen. 

Or if I had an emergency retinal detachment patient that needs a referral immediately to the surgeon. I have to take care of it. 

I agree; I hate waiting when I go for appointments too. But sometimes stuff happens that is out of my control.


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## Woodhaven (Jan 21, 2014)

Beau if you have some patients that you know have trouble keeping appointments can you flag them in your computer and call them just before their appointment and check to be sure they are coming? I know this is extra work for you and your staff but if it means they actually show up, that is a plus.
For my eye and dental appointments they are made a year in advance and I do get a reminder call which I appreciate altho' I have the appointment marked on the calender.
I can understand your frustration. It is really rude to not keep appointments.


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## PaintHorseMares (Apr 19, 2008)

Missy May said:


> But, like Regal said - it works both ways. A doctor/dentist/whatnot can be the best there ever was, but if their office management can't manage time - or is instructed "not" to properly manage time, it reflects really poorly on them. I mean, if someone shows up at 2 for a 2 o'clock appointment, and is seen at 2:45...? It is just unsat.


I agree...one of my few pet peeves. Sadly, I have been told (off the record) by a couple doctors in our area that to "solve" the no-show/last minute cancellation problem, they actually over book their appointments (like the airlines) assuming that they will have cancellations. VERY frustrating.


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## Saddlebag (Jan 17, 2011)

When people make appts, do you write them in ink? A doctor's wife/clerk always does this. If the apt is changed, she finds space to write in a new name but never erased the first one. One pregnant lady cancelled her appt. A few weeks later she had a miscarriage and tried to sue the doctor. There it was on the schedule sheet, that she had cancelled her appt. End of law suit.


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## beau159 (Oct 4, 2010)

Woodhaven said:


> Beau if you have some patients that you know have trouble keeping appointments can you flag them in your computer and call them just before their appointment and check to be sure they are  coming?


Habitual no-show'ers literally have a flag in their electronic chart. It's a little icon that appears next to their name. Or any other important thing we want to make a note of and visible to all the staff.

I wish it were as simple as that. Many of these patients either don't answer their phone, don't have voicemail, or their message box is full. Some of them even have those little pay-as-you-go phones where the number is active when they give it to us, but by the time we try to confirm, it is disconnected. So even if we try to reach them, they often don't answer or have a way for us to leave a message. 

Best I can describe it: _"Some people."_




Saddlebag said:


> When people make appts, do you write them in ink? A doctor's wife/clerk always does this. If the apt is changed, she finds space to write in a new name but never erased the first one. One pregnant lady cancelled her appt. A few weeks later she had a miscarriage and tried to sue the doctor. There it was on the schedule sheet, that she had cancelled her appt. End of law suit.


We have electronic medical records. Therefore ANYTHING you do in the system (literally every keystroke you make) is documented. Date, time, person logged in who did it, if it was edited, etc. It is very easy for us to track something like that.


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## gunslinger (Sep 17, 2011)

On the other hand, if my appointment is a 9 why do I not see the Dr till 930 or 10?
_Posted via Mobile Device_


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## boots (Jan 16, 2012)

gunslinger said:


> On the other hand, if my appointment is a 9 why do I not see the Dr till 930 or 10?
> _Posted via Mobile Device_


You can blame lots of things, but be sure to include:

The information the patient gives the receptionist aids her best guess on how much time to schedule for that patient. But, if Joe Schmoe calls and says "I have an itchy rash on my leg" and then comes in and it is actually venous stasis ulcers and it's been going on for two weeks, your doc is going to be tied up longer than planned.

I don't like waiting. But, I kind of figure the doctor is giving who ever he is with the time that person needs and the doctor will do the same for me.


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## Foxhunter (Feb 5, 2012)

In all honesty if I miss an appointment it is because I forgot it! 

Times have changed - one GP never had an appointment system, this was some years ago, his attitude was that you arrived and waited. If Mrs Brown needed twenty minutes to talk something through then that is the time it took, if you were ill you waited, if it wasn't important you went home!


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## beau159 (Oct 4, 2010)

gunslinger said:


> On the other hand, if my appointment is a 9 why do I not see the Dr till 930 or 10?
> _Posted via Mobile Device_


In our office, my "standard" is that if my patient is booked for 9:00 then they should be in my exam chair by 9:20. No, it doesn't always go that way, but we try. 

It takes a few minutes when you arrive for my staff to scan insurance cards, double check benefits, and confirm contact information (address, phone number, etc). Then my tech takes over and finds out what problems the patient is having, go over their medical history and any medications they may be taking (yes, your eyes are connected to your body so I need a full case history), and various pre-testing that our techs know we are going to want. When all that is gathered, then we see them. 

Sure, I could do all that myself. But to make the business survive (while patients are my #1 priority, this IS a business and I have bills to pay), I need to see more than 1 patient an hour. So I need staff to help me do that and gather information for me. 


But let's say your appt is at 9:00. But what you don't know if that my 8:20 appt didn't show up until 8:35. Or that the other two doctors in the practice had a 8:00 and an 8:10 that we are also working through the office. And then I had a patient walk in the door with extreme pain in one eye that we are trying to work into my schedule. Or that my main tech called in sick today and we are short-staffed. Etc. Etc. 

Things happen. We make every effort to stay on schedule. But some days it just doesn't happen. I am very aware of how the schedule is going and I will be the first one to apologize to a patient if they have had to wait longer than I would like. 

Unfortunately, you have to remember that you aren't the only one being seen that day by the doctor.


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## DuffyDuck (Sep 27, 2011)

I am fortunate that I have "private" medical care as I work for the military. If I can't get an appointment within a week, I phone a call centre thing run by local nurses who assess the condition and make a call as to whether a routine appointment is required, emergency appointment or advise me to go to A&E.

Same with A&E. We get treated as private patients and will be seen within 4 hours whilst others wait up to 8. They tend to be very efficient, however, and I'd much rather wait my turn for an x-ray and let someone else with more visibly serious injuries in to that machine first.

I have a colleague who works but is not entitled to the same treatment as he is on the "German net". He has to go to the doctors at 0800 and sit in a line and wait to be called up. Unless it's a specialist appointment, there is no appointment time give- first come first served. 

I'd much rather wait an extra half hour than have to use a system like that where you can spend (and lose wage) for an entire work day. It happened to me once when I had to go for an MRI that had been sourced outside the usual routes.

Also, if we miss three appointments you're hauled up in front of your chain of command and given a right earful- the reprocussions are just not worth missing it!


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## gunslinger (Sep 17, 2011)

Well then, if I'm going to be late I call. If the doctor is running late why can't they call?

Is my time less important than his?
_Posted via Mobile Device_


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## beau159 (Oct 4, 2010)

gunslinger said:


> Well then, if I'm going to be late I call. If the doctor is running late why can't they call?
> 
> Is my time less important than his?
> _Posted via Mobile Device_


My goal is to get the schedule back on track. If I call every patient thereafter and tell them to come late because we're running late, I'll NEVER get back on track, and we'll all be here 2 hours after we were supposed to be closed. 

It's not every day we run late. But it does sometimes happen.


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## beau159 (Oct 4, 2010)

I'll use yesterday as an example. In the afternoon, I had an 84-year-old patient who was brand new. After we got going with the exam, turns out she has glaucoma, macular degeneration, and a slew of other things. I had to do extra testing on her, and I had to take some extra time to go over all the findings with her and answer her questions. 

Yes. Taking the extra time with that older patient made my following patient have to sit and wait for me. There's no way I could have known ahead of time that my 84-yo patient would have needed extra time, so there's no way I could have called the following patient to tell her she was going to have to wait. 

I was able to get my next patient done quickly enough that my following patient did not have to wait and I was back on schedule. 

But if YOU were the one with the complicated diagnosis, wouldn't you want your doctor to _take the time_ to go over everything with you and answer your questions? I like to think so.


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## PaintHorseMares (Apr 19, 2008)

Some doctors schedule longer appointments for new patients to review history, etc. Is that a viable option?
_Posted via Mobile Device_


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## beau159 (Oct 4, 2010)

PaintHorseMares said:


> Some doctors schedule longer appointments for new patients to review history, etc. Is that a viable option?
> _Posted via Mobile Device_


Problem with that is not all new patients need extra time. From a business perspective, I don't want to have "wasted time" where there isn't anyone in my chair. It's not cost effective. 

And sometimes existing patients end up taking more time than they did before if they have a new condition. It makes scheduling too complicated for the staff to try to do that; plus many times we don't know until my technician starts their case history with the patient and we find they have a new condition, or when I start the exam and realize something is not right that requires extra testing. 

You can't predict what an individual patient is going to need. That's the purpose of the exam!


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## bkylem (Sep 21, 2013)

beau159 said:


> I couldn't even make this up if I tried.
> 
> Last week on Thursday, I had 11 patients scheduled for exams (plus a few in-between for other stuff). By the time I left, 7 of those 11 patients had either no-show'ed or cancelled very close to their appointment time (making it impossible to fill the spot on such short notice).
> 
> ...


I fully understand and agree with your position as it is irresponsible on the part of a patient to cavalierly ignore a preset appointment. I will say however that it is equally disrespectful and unprofessional for a doctor to over book their appointments which often can result in a patient reading every outdated magazine in the holding area as they wait 30-45 minutes to finally have their name called. A total waste of time and both scenarios are insulting.


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## gunslinger (Sep 17, 2011)

bkylem said:


> I fully understand and agree with your position as it is irresponsible on the part of a patient to cavalierly ignore a preset appointment. I will say however that it is equally disrespectful and unprofessional for a doctor to over book their appointments which often can result in a patient reading every outdated magazine in the holding area as they wait 30-45 minutes to finally have their name called. A total waste of time and both scenarios are insulting.


Absolutely correct IMO.
_Posted via Mobile Device_


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## Missy May (Feb 18, 2012)

It still all comes down to time management. 

I have gone to doctors that emphasize to new patients that for their first appointment they need to be there 20 minutes early to fill out necessary documentation, and repeat it in their phone messages, and again when they call with a courteously reminder. That (getting their early) seems a bit obvious, but apparently not to everyone. 

If I were me, I would want accurate data collected for the time of appointments, what time they actually arrived, and when I actually saw the patient, if they were new, return, whatnot. Simply b/c a lot of the parameters are out of a doctor's control (e.g., when a patient shows up, if at all) does not mean that no part of time management is in their office's control. 

The last doctor I went to I really liked b/c when I saw him he got right down to it, no small talk - but he was very attentive to detail, listen well, and did not rush or seem rushed. I do not provide a doctor with superfluous info. Very oddly, he had several bad reviews on-line b/c of his bedside manner. I don't know what people want out of a doctor - but the best use of time is all they should expect. Another thing that is out of their control. I imagine it is no picnic.


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## PaintHorseMares (Apr 19, 2008)

bkylem said:


> I fully understand and agree with your position as it is irresponsible on the part of a patient to cavalierly ignore a preset appointment. I will say however that it is equally disrespectful and unprofessional for a doctor to over book their appointments which often can result in a patient reading every outdated magazine in the holding area as they wait 30-45 minutes to finally have their name called. A total waste of time and both scenarios are insulting.


I guess I've become a lot less patient in my old age as I refuse to wait more than 30 minutes past my appointment time before seeing the doctor. I inform them when I check in, and I've walked out of exam rooms without being seen.... and I cringe at the "the doctor will be in to see you in a _minute_" line. UGH!


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## gypsygirl (Oct 15, 2009)

Sorry you have to wait because we are telling someone they have cancer or reviving a person from a cardiac event. When it's you in that position, I'm sure the doctor would be happy to leave the room as not to be late for the next patient. It's not as if we are sitting on our bums not giving a sh!t
_Posted via Mobile Device_


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## bkylem (Sep 21, 2013)

gypsygirl said:


> Sorry you have to wait because we are telling someone they have cancer or reviving a person from a cardiac event. When it's you in that position, I'm sure the doctor would be happy to leave the room as not to be late for the next patient. It's not as if we are sitting on our bums not giving a sh!t
> _Posted via Mobile Device_


Could you possibly be a bit more dramatic ? If must be exceedingly difficult to tell every patient that they have cancer or revive them from a cardiac arrest. I can only hope that you occasionally see an individual who simply needs a follow up visit or a check up. No one sitting on their bums in your claustrophobic "waiting" room is expecting the almighty doctor to pander to us, but if an individual on staff could at least note our existence would be nice. Being a physician certainly deserves respect, but no more than a truck driver, farmer or a factory worker. Time is important to us all.


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## Missy May (Feb 18, 2012)

Worse than waiting in a germ infested waiting room is finally being shown to an examination room, where a tech takes your bp, and then leaves you there .... ...waiting, waiting, staring at the walls, sink, q-tips, and icky posters. You start wondering if you should call the front desk and ask if they forgot you, or something. Ugh!!!!


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## gypsygirl (Oct 15, 2009)

Actually, where I work, we spend most of the day telling people they have cancer. It's mostly the healthy (lucky) individuals that are mad that they've had to wait. Of course we have some quick patients, but we never know who is going to need a procedure or who is going to need extra time. You just can't plan for that, people are too variable. 

That being said, we run mostly on time, but being an hour behind does happen, and no one likes it.
_Posted via Mobile Device_


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## gypsygirl (Oct 15, 2009)

Ps- we always estimate a wait time and check on patients every few minutes if we have the opportunity.
_Posted via Mobile Device_


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## beau159 (Oct 4, 2010)

bkylem said:


> I will say however that it is equally disrespectful and unprofessional for a doctor to over book their appointments


Maybe you aren't directly referring to me, as there was another comment speaking about this, but you did quote me directly...

We don't overbook our patients in our office. We have a specific schedule set in place for both exams and "in-between" office visits. But it sometimes happens where we need to squeeze in an extra office visit, for example someone with a piece of metal in their eye that needs to be removed today. Priorities are priorities. The longer that metal sits in the eye, the more it rusts and creates an bigger issue. I'd rather my healthy patient wait 10 minutes while I get the metal out, than to have my painful-metal-rusting-in-eye patient have to wait any longer. If you were in that situation (with the metal in your eye), I'm sure you'd appreciate it too.




PaintHorseMares said:


> I guess I've become a lot less patient in my old age as I refuse to wait more than 30 minutes past my appointment time before seeing the doctor. I inform them when I check in, and* I've walked out of exam rooms without being seen*.... and I cringe at the "the doctor will be in to see you in a _minute_" line. UGH!


So you allow the technician to begin a workup on you ... and then you just leave if things don't go your way? 

I agree with you that I don't like to wait (as a patient myself) and I don't like to make my patients wait (as a doctor), but this is just blatantly *disrespectful.* You've taken a piece of the office and staff's time, their expertise, and then you just walk out? Legally, they CAN send you a bill for that; even if you didn't actually see the doctor.

I can compare that to a child throwing a temper tantrum and storming out of the room.

Not to mention your OWN time that you've wasted driving to the doctor's office, going through a workup, and then having the repeat the same thing the next time you get an appointment (if they will even give you another one, after that behavior).


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## bkylem (Sep 21, 2013)

beau159 said:


> Maybe you aren't directly referring to me, as there was another comment speaking about this, but you did quote me directly...
> 
> We don't overbook our patients in our office. We have a specific schedule set in place for both exams and "in-between" office visits. But it sometimes happens where we need to squeeze in an extra office visit, for example someone with a piece of metal in their eye that needs to be removed today. Priorities are priorities. The longer that metal sits in the eye, the more it rusts and creates an bigger issue. I'd rather my healthy patient wait 10 minutes while I get the metal out, than to have my painful-metal-rusting-in-eye patient have to wait any longer. If you were in that situation (with the metal in your eye), I'm sure you'd appreciate it too
> 
> ...


I was not referring to you and apologize if my statement was misdirected. I do agree with your eye analogy as unexpected situations arise in all professions. Your response was one of caring and didn't suggest that your day is filled with one dramatic event after another (as implied by the other individual), nor was it condescending or elitist in nature.
It sounds like you work within a very professional environment.


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## PaintHorseMares (Apr 19, 2008)

beau159 said:


> So you allow the technician to begin a workup on you ... and then you just leave if things don't go your way?
> 
> I agree with you that I don't like to wait (as a patient myself) and I don't like to make my patients wait (as a doctor), but this is just blatantly *disrespectful.* You've taken a piece of the office and staff's time, their expertise, and then you just walk out? Legally, they CAN send you a bill for that; even if you didn't actually see the doctor.
> 
> ...


Sigh. When I arrive for my appointment, the staff has ample opportunity to let me know if the doctor is running more than 30 minutes behind. If they say the doctor is, I'm more than happy to reschedule my appointment before anyone provides any service to me, let's me continue on to other appointments, and makes the wait for people following me less. If I'm already in an exam room and something urgent comes up, it only takes a minute from someone on the staff to inform everyone waiting and let them decide if they want (or can) wait longer.
I'm sorry, but if my horse vet, working alone, can effectively communicate changes in his schedule during the day due to emergencies that come up, a doctor's office with staff certainly should be able to.


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## gypsygirl (Oct 15, 2009)

bkylem said:


> I was not referring to you and apologize if my statement was misdirected. I do agree with your eye analogy as unexpected situations arise in all professions. Your response was one of caring and didn't suggest that your day is filled with one dramatic event after another (as implied by the other individual), nor was it condescending or elitist in nature.
> It sounds like you work within a very professional environment.


Hmm
_Posted via Mobile Device_


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## beau159 (Oct 4, 2010)

PaintHorseMares said:


> Sigh. When I arrive for my appointment, the staff has ample opportunity to let me know if the doctor is running more than 30 minutes behind.


What you don't seem to understand is that this cannot always be predicted. 

It could be that when you arrived, everything was flowing smoothly and on schedule. But then the nurse takes you back, begins your workup, and maybe the patient that the doctor is working with in the room next to you (who was the appointment directly before you) and just discovered the patient has brain cancer (as an example). Now the doctor has to take extra time with that patient to explain the complicated diagnosis and go over questions the patient may have.

Should the doctor LEAVE that patient, because you told the front desk when you checked in that you absolutely _cannot_ wait?

Would you want the doctor to walk out of the room halfway through YOUR appointment, to go take care of the patient that absolutely cannot wait longer than 30 minutes?



PaintHorseMares said:


> If I'm already in an exam room and something urgent comes up, it only takes a minute from someone on the staff to inform everyone waiting and let them decide if they want (or can) wait longer.


So again, you are thinking only of yourself here. That means the doctor will have to leave the room of the brain cancer patient, or call a nurse in (who will interrupt their dialogue), just so the nurse can walk around to ALL the exam rooms to tell people the doctor needs to spend extra time in another room. Maybe you have 3 people who end up walking out because they have a similar mentality that you do, they flood the front desk and all have to be rescheduled. And now the person who needs to check in has to WAIT because 3 people need to be rescheduled. And in the mean time the doctor has just lost several appointments for the afternoon and now is losing "chair time."

From a business standpoint, that makes zero sense.


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## BarrelracingArabian (Mar 31, 2010)

I see both sides to that, yes it would be nice and respectful to be let know when it occurs that the dr is behind. I usually have to completely clear my day atleast 2-3 hours at my old dr because it would take an hour, everytime not just occasionally, to finally see my dr. I understand things come up but it would be nice to be told so. 
You are worried about losing appointments for being behind however I know many who leave for the long run because of a dr regularly being behind. Would you rather lose the appointment for that day and be seen in a respectful light or lose the customer completely for leaving them sitting for an extended period of time. 
Just a thought, like I said things happen but I would much rather be informed in case I did have something else going on then sitting forever. 
I usually see atleast 2 people at the front desks so to have one reschedule appointments while the other continues to check current people in would be a simple and quick fix. 
I won't walk out, but it is very irritating to not atleast be informed on how much longer approximately it should be considering I have been sitting for 40 mins past my appointment, if dental, eye, vets, etc can handle it so should other offices. Just a thought.


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## Missy May (Feb 18, 2012)

Well, in this age of specialization, not all doctors are neurologists. So, the odds of all doctors having an emergency cancer "like" setting with a patient right before every appointment is - slim to none. 

I rarely go to the doctor. My family members are generally healthy, and they don't need to run to the doctor, often - either. So, the types of doctors and the times we have gone to the doctor have been -random. Very rarely have I or a family member been seen within 10 minutes of the scheduled doctor's appointment, and often it was in the 30 - 45 minute range.

From this rather small set of data, I would have to say that doctors, in general, could easily improve their scheduling methods. If it consistently requires more time than one "wishes" it would take to see a patient from a business standpoint, then one either adjust their scheduling to reflect that or they don't on the basis they don't have to or want to worry about how long anyone has to wait - b/c people will wait.


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## beau159 (Oct 4, 2010)

Missy May said:


> Well, in this age of specialization, not all doctors are neurologists. So, the odds of all doctors having an emergency cancer "like" setting with a patient right before every appointment is - slim to none.


I simply used cancer as an _example_; don't take it literal. 

But there are many other scenarios besides cancer that would also cause the doctor to have to take extra time with a patient. Or it simply could be a "routine" diagnosis but the patient happens to have a lot of extra questions. I think most people would be angry with the doctor if the doctor walked out before you were done with your questions, because you went over your "allotted time limit."


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## gypsygirl (Oct 15, 2009)

Beau, I used cancer as an example because I work with a lot of cancer patients and that is often why we get behind.
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## Missy May (Feb 18, 2012)

beau159 said:


> I simply used cancer as an _example_; don't take it literal.
> 
> But there are many other scenarios besides cancer that would also cause the doctor to have to take extra time with a patient. Or it simply could be a "routine" diagnosis but the patient happens to have a lot of extra questions. I think most people would be angry with the doctor if the doctor walked out before you were done with your questions, because you went over your "allotted time limit."


I didn't take it literal, which is why I said "like", meaning a scenario that requires immediate, uninterrupted, and focused attention.

Yes, I imagine there are many, many scenarios not involving cancer - or the like - conditions that would warrant delay in attending to the next patient. And, there would be combinations and permutations of same. However, in no scenario that I can think of is the element of time removed. Like I said, if the allotted time is consistently insufficient, then most reasonable thinking people wouldn't conclude that scheduling couldn't be a factor.


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## gypsygirl (Oct 15, 2009)

But it can only take one patient to set back your whole day. When you are booking appointments 2+ months out, how do you justify sitting on your butt for chunks of time when you could be seeing patients? 

Also, every day you will have same day add ons and potentially patients that just walk in.
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## Missy May (Feb 18, 2012)

gypsygirl said:


> But it can only take one patient to set back your whole day. When you are booking appointments 2+ months out, how do you justify sitting on your butt for chunks of time when you could be seeing patients?
> 
> Also, every day you will have same day add ons and potentially patients that just walk in.
> _Posted via Mobile Device_


Where you introduce "walk ins" into the equation, do they get an appointment that day b/c they walked in (as opposed to calling), regardless of available time?? 

Yes, there could be a domino effect. However, the odds are that for every patient that takes extra time there is one that takes less.

I don't understand your "When you are booking appointments 2+ ...." question.

Like I said in the beginning, there are many parameters that are completely out of an offices control, but the scheduled amount of time for an appointment is not one of them. If you believe time management can never be improved for any doctor's office in the US with respect to wait time for the patience, then you do. I don't.


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## gypsygirl (Oct 15, 2009)

Some walkins can be scheduled out. Some need immediate attention. For example, active bleeding, fever, infection. 

If you called the office today and asked for the first available appointment, it would be in 2 months. If people actually call and cancel we will fill the spot. I used to work for a primary doc that was booked 6 months out. No joke.
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## Missy May (Feb 18, 2012)

It would be unusual for many specialists to have bleeding "walk ins". A clinic type setting, yes - I can see that. 

You can throw in all kinds of "what ifs" b/c the possibilities are endless , but it will never translate to "there is no room for improvement in the area of time management at any doctor's office".


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## gypsygirl (Oct 15, 2009)

Many specialists do surgery and clinic, so not all that uncommon. Not saying we're perfect, just trying to explain how many variables there are. All we can do is our best.
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## Bombproof (May 20, 2015)

gunslinger said:


> On the other hand, if my appointment is a 9 why do I not see the Dr till 930 or 10?
> _Posted via Mobile Device_


The time for a standard appointment is based upon one or two relatively straightforward problems, but a high percentage of the time that's not what we get. I understand that when a patient has gotten that precious appointment they want to get everything addressed, but when they pull out a list with eight (8!) significant issues on it, I know the day has just been screwed. I can't win. If I don't make some attempt to address everything the patient had on their mind, they'll be mad but if I do I just shoved all the other patients back and lost my chance to have lunch. If every patient came in with one or two straightforward problems OR made a longer appointment, I would see you on time. It ain't gonna happen. It's just the reality of human behavior.


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## Bombproof (May 20, 2015)

Missy May said:


> Where you introduce "walk ins" into the equation, do they get an appointment that day b/c they walked in (as opposed to calling), regardless of available time??


Different offices do it differently. In my office, they get an appointment if one is available, otherwise they wait until they can be worked in. Ideally, they would be screened and if it isn't urgent they would be given an appointment for another day. The problem is that in the patient's mind it is always urgent or they wouldn't have come in.



> Yes, there could be a domino effect. However, the odds are that for every patient that takes extra time there is one that takes less.


No. There is almost never one that takes less. The length of time for an appointment is already scaled to one relatively simple complaint. You can't shorten that. People don't have 1/2 of a simple complaint. On the very rare occasion I look at the vitals, check the heart and lungs, and refill a prescription. That happens maybe three times a week. More often we use an entire standard appointment just getting the story.



> Like I said in the beginning, there are many parameters that are completely out of an offices control, but the scheduled amount of time for an appointment is not one of them. If you believe time management can never be improved for any doctor's office in the US with respect to wait time for the patience, then you do. I don't.


I don't know what to tell you except that you're wrong. It's one of those things that you have to see in action to understand. It's about human behavior. I could stay on time if I walked out of the room when the patient's "time was up" but how would you feel about that? If you haven't done it, you don't understand it.


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## ChitChatChet (Sep 9, 2013)

We rarely go to the dr.

The times we do makes me want to start charging the dr for my time. I can understand a reasonable wait but an hour+ is a bit crazy.

And we dont even get that much time with the dr. We usually end up sitting for a quite some time in the exam room too.

Somebody else brought up a good point. Vets are much more efficient with their time. I have an appointment, I walk in and usually head straight back to the exam room. Or I'll get a call telling me there has been en emergency can I come in at such and such a time instead.


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## Missy May (Feb 18, 2012)

Bombproof said:


> Different offices do it differently. In my office, they get an appointment if one is available, otherwise they wait until they can be worked in. Ideally, they would be screened and if it isn't urgent they would be given an appointment for another day. The problem is that in the patient's mind it is always urgent or they wouldn't have come in.
> 
> 
> No. There is almost never one that takes less. The length of time for an appointment is already scaled to one relatively simple complaint. You can't shorten that. People don't have 1/2 of a simple complaint. On the very rare occasion I look at the vitals, check the heart and lungs, and refill a prescription. That happens maybe three times a week. More often we use an entire standard appointment just getting the story.
> ...


Lets see, if all patients take more time than the amount that was scheduled for them to be seen, then time management cannot possibly be a factor?


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## Bombproof (May 20, 2015)

Missy May said:


> Lets see, if all patients take more time than the amount that was scheduled for them to be seen, then time management cannot possibly be a factor?


It almost never happens that there are enough shorter cases to make up for the ones that take longer. Yes, I could schedule fewer appointments, but then if a patient doesn't show, there will be more wasted time. I could then overbook to make up for that but we're back to square one. Every wasted minute means that your per-minute cost goes up and nobody wants that. If I schedule longer appointments I'll see fewer patients so your appointment will be more expensive. I can set it up so that you'll absolutely, positively be seen on time. Heck, I can even come to your house whenever you want. But that's gonna cost ya.

It isn't possible to plan for all contingencies. The best we can do is try to set up a schedule with a reasonable compromise between patient waiting and wasted time. The two are diametrically opposed and as one goes up the other goes down. The other factor is wait time for the appointment. You can wait 25 minutes today or 5 months to get an appointment you won't have to wait for -- but then if you need to be seen urgently I won't see you because that would deprive the people who waited 5 months. Then there are the human factors. This morning we worked in a patient who just had to be seen right now for "ankle pain." Turned out his "ankle pain" was fluid overload due to congestive heart failure and the morning was screwed. In the afternoon a patient leaving the dental clinic collapsed in front of the elevator and I had to resuscitate him and stay with him until the ambulance came and the afternoon was screwed. We know those things will happen _but we don't know which day they will happen on._ I could leave an open hour in the morning and the evening in case it does but that's gonna cost ya.

I understand your frustration. I even admit it's legitimate. However, scheduling medical appointments is unlike any other sort of scheduling because every single encounter, every single nuance is at the mercy of human behavior. There's really nothing else we schedule routinely for which that's true to the same extent. This started with the OP's frustration at patients not calling to cancel. Guess what? If they had called she could have put another patient in that slot or seen another one earlier. It's the human factor and it keeps us from making everything neat and pretty. That doesn't mean we don't care. We monitor wait times constantly and are always analyzing ways to make it better. Some do it better than others but we all end up compromising to some extent. I'm truly not trying to be mean or condescending, but your idea that it can be scheduled so nobody waits and there is no wasted time is naive and unrealistic. In the real world it just can't be done within the the constraints which exist.


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## Missy May (Feb 18, 2012)

I've never implied, inferred, or otherwise that "it" can be scheduled so nobody waits and no time is wasted. I'm not trying to be condescending, but it is always a waste of time to read meaning into something that is not there. I think that it is naïve and unrealistic of you to believe that all doctors offices are standardized to one system, i.e., what you do in your practice probably doesn't apply to every doctors office in the US.

I acknowledged the multiple variables would exists in a medical office. I simply pointed out that time management is one of the factors that would affect wait times, and it is my opinion that some offices could improve in that arena. If you interpret the word "improve" to mean "eliminate wait times", then you do.


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