Boundaries and Policies

by Pat Rosenzweig

When a patient repeatedly cancels or no shows, what's your policy? While that may sound like an easy question to some of you, in many offices I get pitiful looks from the front desk staff when a patient – who has repeatedly missed appointments – insists on another 4 P.M. or Saturday time slot. The pitiful look is because the office has no real policy regarding these instances, and they have many other patients wanting those prime time appointments. I'm completely aware that we never want to upset our patients because we don't want them to leave or speak poorly of the practice. We do however, in all aspects of our life, need to set boundaries. These boundaries in an office not only keep your schedule running properly, but also show your staff you respect them as much as you do your patients. Because I know how much doctors dislike setting these boundaries and making these policies, let me suggest some and you can blame the evil consultants.

If a normally good patient misses a prime appointment, we can overlook the first infraction with no need for a warning. If a new patient does the same, we can reschedule with a gentle warning that we do have a policy in place, so let’s be sure this appointment fits well with their schedule, as we cannot give them a third prime appointment if they miss the second.

If a patient of record is a repeat offender (in my mind that's two no shows or last minute cancellations of prime time appointments) it's time for a gentle warning that we need to be sure this is a good time for them because, as a matter of office policy, we will only be able to put them on a call list for a prime time appointment. We can present this as a plus. We'll call them the day of the available appointment so they'll be sure to know if they can make it.

The same verbiage applies to a patient who misses any appointments three times, not just prime time ones. We can put them on a call list ONLY and give them a call when we need to fill a slot. I’ve found this method works much better than charging for missed appointments. Your patients are likely to respond in a much better fashion to a hit to their conscience, rather than a hit to their wallet.

Another boundary we need to set is regarding a family with multiple children. Our office policy should allow for only two children in a family to be scheduled together. If we feel strongly that we need to bend this rule because of many big families in our area, we give them one opportunity to schedule all the children together. If they miss this appointment, we go back to our policy with a gentle apology explaining we need this policy because of the amount of time lost when they miss these family appointments.

While I am an advocate of warnings and boundaries, some doctors prefer a softer approach. Instead of saying "it's our policy" you could also use “you were lucky this time that I have a 4 P.M. appointment next week, but please try to keep it, as it could be months before I have another." They have been warned, and if they do it again, make it an internal policy to have nothing available for at least 6 weeks. Then get them on the short call list and fill a slot that doesn’t get taken with them. They'll feel like you've been looking out for them and you stop them from wasting valuable time.


Also keep in mind your Ortho2 software has all the tools you need to help set good policies and healthy boundaries. You can not only create templates with different colored areas as a warning to staff that these are the prime time appointments, but you can also track missed appointments, keep an open list of available "day of" patients to call, and flag these patients so we all immediately see their status when they call. Obviously, our desk staff has permission to overlook one, or even two infractions when there are mitigating circumstances such as ongoing family illness. With a solid policy in place, they will be able to use that permission when needed, but will now also be able to be kind but firm with patients who show no respect for them, the doctor, or the practice.

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