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Better late than never

Dear Dianne,
My coworkers and I are having an ongoing discussion about what to do when a patient arrives late for an appointment. My opinion is that if the patient is 10 minutes late or more, he or she should be rescheduled. I don't think it is fair to me or the patient to have to do a "rush job" in order to finish on time. I refuse to cut corners on care or on infection control measures. However, our front desk assistant disagrees. She thinks I should still see the patient. It's obvious that she does not understand the predicament or stress that I am under when I am expected to still see patients who arrive late. We're not sure how the doctor feels about the issue, as he has chosen not to give his opinion. We all think you are a pretty smart cookie, so what do you say?
Texas RDH

Dear Texas,
I haven't been called a "smart cookie" in a while, but I like it -- thanks! I hope you will still think I'm a smart cookie when you read my advice on this matter.

As a practicing hygienist for many years, I distinctly remember the dilemma of the late patient. Here's the image -- I'm standing over by the filing cabinet frustrated and aggravated by a patient who rushes in the front door 20 minutes late for a 40-minute appointment. The patient cannot see me. The patient speaks to the business assistant in sheer breathlessness from running from his car to the office. "I'm so sorry for being late … there was an awful car accident that tied up traffic and caused me to be late!"

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The business assistant graciously smiles and says, "Oh, I'm sorry to hear that. We were worried about you." She then looks in my direction, and I'm vigorously shaking my head NO. This guy is ruining my day! How on earth can I be expected to see him and do everything I had planned to do in half the time? Nope, the best thing to do is to send this guy packing. We have to teach him a lesson -- there are no acceptable excuses for arriving late!

The business assistant is caught in the middle between a patient who has arrived late through no fault of his own and a hygienist who is unwilling to seat him because he is late. What a terrible place to find oneself! So the only thing she can do is to say to the patient, "I'm sorry, but we will need to reschedule you." The patient is visibly upset, but I'm satisfied. Who is the real winner here?

Consider if you were this patient. You got off work, got in your car, fought through horrendous traffic, and arrived late. You did all this, only to be told that your efforts were wasted, because the hygienist would not see you. Would you be happy? If I were this patient, I'm pretty sure I'd change dental homes.

It gets worse. After the late-arriving patient is sent out the door with no treatment, the next patient on the schedule is a no-show.

Now, let me ask you a question. Do you ever run late? Do you ever keep patients waiting? I expect every hygienist on the planet has kept patients waiting for various reasons. Some hygienists run late consistently every working day. Is this acceptable? Is the statement being made that our time is more important than the patient's time when we refuse to see someone because he or she is late? Is this fair? I think not.

The answer to the dilemma of the late-arriving patient can be found in prioritizing. Seat the patient and decide what can be accomplished with the time that is left. In fact, if there are only 10 minutes remaining, that still gives enough time to do bitewings and a tour of the mouth. Say to the patient, "I'm so glad you made it -- we were worried about you! Come on back and let's get as much done as we can with the time we have left." Any reasonable patient will not expect you to do everything you had planned to do originally. Prioritizing means that you don't have to rush through anything or compromise your standards, but that you use the time you have to its best purpose.

You have to decide what is most expedient. Your "Plan B" for this patient might involve scaling only half the mouth instead of the whole mouth, or maybe delaying X-rays until the next visit, or simply updating X-rays and reviewing home care with a patient with gingivitis, or any number of possibilities. Believe it or not, it will not "harm" your patient if you do not polish. I might say to my patient, "Well, the good news is that you have little if any stain, so we can dispense with the polishing today." That will save time. Will you charge the same fee? Of course. If you decide that you have enough time to scale half the mouth, you would say, "Well, the good news is that I was able to make wise use of the time we had, but I'll need you to return for completion." Then I would reschedule the patient for a shortened visit and complete whatever I didn't get to complete. If your next patient no-shows, you will have more than ample time to complete the patient in the chair.

My point is this -- take the warm body every time, even if he's late.

Consider that you are a bus driver, and the doctor owns the bus company. People are getting on and off your bus. You are the driver, so you decide what route is appropriate. Your riders do not tell you where to turn -- you make that decision.

Back a few years ago when many dental practices were slammed with high demand for services, we felt it was acceptable to be more dictatorial with patients regarding our office policies. Some felt it was necessary to make a strong statement that being late was not acceptable. The reality is that we do not live in a perfect world, and sometimes WE run late. Is it acceptable for us to run late but not our patients?

All practices have a few patients who are chronically late. The solution is quick identification first, which allows the appointment scheduler to be informed and proactive. Any chronically late behavior should pop up immediately when the chart is accessed. When the scheduler knows, she can manipulate the appointment time by telling the patient to come 10 to 15 minutes before the actual time in the schedule. For example, if the appointment is scheduled for 10 a.m., the chronically late patient would be told to come at 9:50. The appointment card would say 9:50. If you use automated reminder programs, the function would be disabled for such patients.

Today's business environment is challenging. More than ever, it is necessary to make it easy for our patients to do business with us. Turning patients away with no treatment when they arrive late hurts the practice financially and decreases goodwill.

My advice is to change your mental paradigm regarding late-arriving patients, and be glad they actually arrived. Prioritize and press forward with a smile! Remember, you are in the driver's seat.
All the best,
Dianne

DIANNE GLASSCOE WATTERSON, RDH, BS, MBA, is a professional speaker, writer, and consultant to dental practices across the United States. Dianne's new book, "The Consummate Dental Hygienist: Solutions for Challenging Workplace
Issues," is now available on her website. To contact her for speaking or consulting, call (301) 874-5240 or email dglass coe@northstate. net. Visit her website at www.professionaldentalmgmt.com.

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