An effective way to deal with patients who are chronically late for appointments is to:

By Karen Davis, RDH, BSDH

If you're reading this column because you're hoping to finally find a permanent solution for one of the biggest stressors for dental hygienists, I need to set your expectations straight. You will discover helpful tips that can substantially reduce the stress and improfve the outcome, but dealing with late patients is the "cost of doing business" by appointments. That said, let's dissect three running-late scenarios.

Scenario No. 1

The patient did not allow adequate time to arrive to his appointment on time, including any potential delays. I witnessed a similar scenario recently at the airport. Enter "very busy client" in the security line, loudly letting everyone around him know he was irritated with the delays due to the extra security checks that might make him late for his flight (his appointment). As I underwent the arduously slow pat-down and removal and examination of every item in my suitcase, I thought to myself, "Wow. I'm so glad I left my house with adequate time for this unexpectedly slow process of getting through security."

This is the same situation when our patients race into our parking lot and run through the door 15 minutes late, breathless, stressed, and apologizing. They didn't leave their home or office in time to allow for unexpected delays. But this scenario is an exception rather than the rule as this patient does not make a habit of arriving late. Let's call this scenario "poor planner."

Scenario No. 2

Some patients aren't just late to dental appointments; they're chronically late to all appointments-nail appointments, vet appointments, tee times, and dinner plans. It's almost as if their internal clock is broken and they operate with the mindset that they can get just one or two more tasks completed before breaking away for their scheduled appointment. They think everything they do is so important, and only they can do it! But inevitably, they misjudge how long those extra tasks will take and consistently arrive 10 to 15 minutes late for their appointment with you. Let's refer to this scenario as "oblivious."

Scenario No. 3

These patients are compliant with the intervals you recommend and the oral hygiene aids you ask them to use. They pay their bills on time and they follow your example. Through the years they've noticed they're generally seated 15 minutes late for their scheduled appointments with you, so whether conscious or unconscious, they now simply arrive 15 minutes later than their scheduled time. Let's refer to this scenario as "you are the problem."

The tips offered here vary depending on the scenario, but they all have a common theme. It is impossible to squeeze the same 60 minutes of services into the 45 remaining minutes of the appointment. Yes, we can socialize less and move a bit faster through necessary procedures, but either we run late with the next appointment or we leave procedures out. Let's examine tips to reduce stress and communicate through these late scenarios.

The answer to the "you are the problem" scenario seems pretty straightforward; simply commit to being on time! But as many of us can testify, it isn't often that simple. Here is a suggestion to help gain control of the problem.

• Be frank, and own it. If patients tend to run late because you run late, begin appointments by addressing the issue. "Tom, I know you've had to wait on me numerous times for your appointment. I apologize for that. How about both of us recommit to beginning and ending your dental visits on time? Is that OK with you?" Then do exactly that. Position clocks in various places in the room so you can glance at them throughout the appointment, and learn to manage the amount of time socializing with the amount of time necessary to provide comprehensive care. You have to value the importance of staying on time.

The answer to the "oblivious" scenario encompasses a different tactic, and that's realizing that the issue is a chronic behavior you are likely powerless to change. Instead, you want to prevent the innocent patients who follow "oblivious" from suffering because you run late as a result of "oblivious" being late.

• Be frank and address the obvious to "oblivious." For example, "Joe, you benefit most from your dental visits when we have the entire appointment time available. I'm really glad you're here, but let's get started by identifying the priorities for the time remaining today." What follows will vary depending on the person, but you want to approach the issue by identifying top priorities each visit, depending on the time. Sometimes that will include an update on radiographs, recording the periodontal screening, the doctor's examination, or fluoride varnish applied to exposed roots, but it likely will not include all of these. You'll need to be selective and document the time available each visit.

The answer for "poor planner" is similar to the strategy for "oblivious"; however, you need to seize an opportunity for important communication.

• Personally call patients when you notice they're five minutes late. This tells them you are on time and ready for them, but also that you are concerned. Often, you will find patients in their car racing to your appointment when you call. But, occasionally you find they simply forgot. Given how close they are when you call, sometimes patients can leave their home or office immediately and still salvage most of their appointment time. Even if you have to leave a message, hearing your voice on the other end really makes their reserved appointment time personal. One method to help "train" patients to arrive on time is to be ready for them when they arrive, and if for any reason they're not on time, they should expect a call from you within five minutes of their scheduled appointment. Depending on how late they arrive, you'll need to be selective about the priorities for that day's visit, just like the scenario with "oblivious."

A key to managing late patients is to respect everyone's time and to set a good example yourself. As much as possible, work hard not to seat a patient late because the previous patient arrived late. It will never be a perfect process when scheduling by appointments, but you can manage the stress with some forethought and strategies in place. RDH

Karen Davis, RDH, BSDH, is the founder of Cutting Edge Concepts, an international continuing education company, and practices dental hygiene in Dallas, Texas. She is an independent consultant to the Philips Corp., Periosciences, and Hu-Friedy/EMS. She can be reached at .