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How late is too late?

Discussion in 'Practice Management' started by Nat Smith, Jun 3, 2009.

  1. Nat Smith

    Nat Smith Active Member


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    I had a woman come in with her son today. He needs a new pair of orthotics. His previous podiatrist has moved on and the mother had to shop around for someone new to take him to. She had booked her son in to another clinic 2 suburbs away and due to traffic etc after school they were 7 mins late for their appt time. The receptionist told her that the pod was packing up for the day and that they were too late, they couldn't be seen. She was told they would have to re-book. The woman told them to forget it and then came and found me. I was a bit surprised really. 7 mins late? Now assuming her account of the time frame was accurate, I would still take a new patient in within 7 mins of their allotted time. For new patients my general rule is no later than 10-15mins for a 30min appt. Of course this all depends on your bookings for the rest of the day; patient due in next etc. whether you can run a little overtime or not. How strict are you all with time management? I think for the sake of 7mins this other pod has lost quite a bit of money; considering the patient is a 7yr old who will require ongoing care for possibly yrs to come. What say you all?
    Nat Smith
     
  2. wear84

    wear84 Member

    Harsh in my opinion...especially as it was the end of the day, no other patients waiting that your going to be putting out.

    Depending on what needs to be done just make it clear to the patient that you can still see them but may not be able to provide a full treatment and give them the option of if they want to do that or rebook for another time.

    I agree that it's a lot of money lost
     
  3. markleigh

    markleigh Active Member

    Interesting one. I try to be understanding & give 15 minutes. But I find people more & more just assuming they can turn up 5 minutes, 10, even 30 minutes late & expect to be fitted in. Often, they don't even give an apology or explanation - that really annoys me. Yes, I have run late many times, but I think there is a certain leeway there & I do apologise if I'm running late.
     
  4. wear84

    wear84 Member

    Yes that annoys me also Mark when they just turn and and don't even mention the fact that they are late or if you say something they don't give a reason. You can't predict what's going to happen in life and there are reasons for being late but an apology and a little common sense at times make things much easier.

    I'm currently 10 minutes in to a patient being late...what makes it worse is it's the last one of the day...how long to give before you shut up shop? I say up to half the appointment time is very reasonable depending on the patients needs.

    I guess a similar situation is the patients who turn up early and expect to jump the queue and then get annoyed if they have to sit and wait while others are seen
     
  5. markleigh

    markleigh Active Member

    That's funny, I'm waiting for my last one but only running 5 minutes late AT THE MOMENT :)
     
  6. 15 min is my golden rule any later and they have to rebook.

    Learnt this from a patinet who tuened up 20 min late, No " im sorry", explained to her that we did not have much time as I had another patient soon. Did what I could to help he in the 10 min we had. I then said we will have to rebook to continue. She then speeds 5 min getting very upset with me. When I could get a word in and explained that she had been on time I would have been able to give her the full tx, but thought It would be rude of me to keep the next patient waiting.

    She yelled some more walked out did not pay, refused to pay invoice sent to her home and buy now I was 10 min late for my next one...... at least when I said sorry she smiled and said the walls are thin enough to hear through so no problems.

    Michael Weber
     
  7. Nat Smith

    Nat Smith Active Member

    15 mins is pretty much my cut off too. I would give more leeway for an existing patient rather than a new one. I try to explain to a new patient that I don't want to rush through their first appt, we need time to go through history etc. If you explain to them that you can't be as thorough as you would like to be in a short time frame, I think people respect your professionalism & that you're going to be attentive to their needs. Even if it was my fault for being late, I would hate to be squeezed in and rushed through. I think they still expect their full appt regardless if they're late, even if you tell them they can only have a reduced appt time. I find that with a lot of the elderly around my area they sometimes get held up waiting for taxis and public transport...I agree an explanation and apology is all that's needed for some mutual courtesy. I hate to run late and keep patients waiting. Thankfully the GP's have a far worse reputation for keeping them waiting...I have patients that need to allow 3hrs to see their GP! They love me for taking them in on time.
     
  8. Jbwheele

    Jbwheele Active Member

    Was the Pod employed by by someone, If so May get payed hourly rate /wage. perhaps the Pod had to go and pick up Kids / house calls etc..... goes both ways
     
  9. Nat Smith

    Nat Smith Active Member

    I know the clinic, but the patient didn't mention any names, so I'm not sure of the circumstances of whether the pod was the chief pod or an associate getting paid hourly. If she was being paid hourly, you'd think she'd be happy to wait a bit longer. However, if she was packing up getting ready to leave, she was hoping to obviously just take advantage of being able to get away early. If the parent & patient had of turned up on time and been seen, they would have been in treatment for at least another 20mins, if not longer. I don't see any legitimate reason for the patient not to have been taken in...If the pod had some kind of situation that had of arisen, such as picking up kids, emergency, sudden illness etc, you would think the reception would have apologized and explained that the pod had to leave early for personal reasons. The parent was just basically told, "You're too late..." I know I'm sometimes glad when there are some no-shows at the end of the day and you can knock off early...but if it was within a reasonable time, I'd feel like I should still take them in...
     
  10. AdminMan

    AdminMan Member

    When deciding ‘how late is too late’ it's important to take into consideration a few factors. It's not simply a matter of time management, but also involves looking at your whole approach and attitude to your podiatry practice.

    But first I have to warn some of you that you might not agree with everything I’ve written in this post because it will challenge some of your personal beliefs about yourself and your own worth. I make no apologies, that’s because I know, and you probably do deep down, that you are worth more.

    If you are a podiatry practice owner, this post really applies to you, because you are the leader in your business. If you are an employee or locum, you'll learn some valuable information about how your behavior can affect your patients.

    To answer 'how late is too late’ you have to look at how you run your podiatry practice:

    Are you ever late?
    For example, how often do you run late? How late are you when you do run late? These questions are important to answer because the behaviour you display to your patients and staff is the behaviour you are telling them is acceptable.

    If you've gotten into a habit of running late and not doing anything about it then you've probably already unconsciously taught your patients and staff that it's ok to be late too! Even if you are late once per week, it's probably too much!

    If you are offering 30 minute appointments and you're running late from time to time then you should take a very close look at what you are actually doing in your consults that causes you to run late. When you have identified the cause, eliminate it.

    Having a clock in a prominent spot where you will see it is a great idea, having a countdown timer is even better. You can explain it to your patients by saying something like "I’ve got the timer because I was letting some patients down by running late. Don’t you hate it when you’re waiting for someone’s who’s running late? Now I use it to make sure I don’t run late anymore. I’ll do my best to make sure you receive all the care and attention during your appointment with me. In the unlikely event that it looks like we are going to run over time we’ll have to schedule another appointment if it’s necessary. Is that OK with you?

    By doing this you are being honest to your patients and getting their permission to look at the timer. They will respect you for it and you've set the guidelines for the management of your time. By setting clear expectations about how valuable your time is you are educating your patients and staff on how you expect them to behave in your practice. It clears up confusion and sets a great standard.

    If you start doing this today in your practice, in 6 months time you will notice that patients don't run late and if they do they will call you to give you plenty of advance notice. You must do the same for them if you are running late too!

    I’m not going to take up any more space here in this post because I know your time is valuable, but there are other factors that every good podiatrist must consider, for example how much do you value yourself?, what is you time worth? and what message do you send you patients about your self worth?

    I’ll write more in another post about these critical factors. But there is more to ‘how late is too late’ than simply is it ok or not ok to be late.

    May you have the success you desire and deserve.
    Michael Shaw
    If you want more info on this and other practice management topics read my blog at
    www.SmartPracticeSystems.com/blog
     
    Last edited: Jun 4, 2009
  11. markleigh

    markleigh Active Member

    We all have our ways of dealing with late patients I guess. I find I run generally to time & while I might run late on one patient, I might then run quicker on another & it generally works out OK. The timer is not something I would choose to use but that's obviously a personal choice.

    No offence but the previous post had a feeling of self promotion in it IMHO.
     
  12. TedJed

    TedJed Active Member

    Hi All,

    It's been fascinating to read all of the various versions of 'late'. The fact is, 1 minute late is 1 minute late. I think the key issue here (that no one has mentioned yet) is: 'What is your practice policy when a patient is late?'

    If you have a clear policy on 'lateness', the matter is easily handled.

    E.g. In our practice, patients are advised of their appointment time and we recommend that (new) patients arrive 5 mins early to complete their paperwork so that that their appointment can 'begin on time'. They are also advised that if they are late (hey, sh!t happens) they will need to be re-scheduled.

    This way, the patient is forewarned of the consequences of being late and won't argue. In this case, they just about always say '...I know I'm late, can I still be seen or will I have to reschedule?' If they protest, we advise them that 'their health is too important to rush, so let's make another time so that their case can be attended to thoroughly and carefully'. When the patient's best interest is your objective, you will quash any ill-feeling.

    We allocate 15 mins for New Pats (5 mins pre consult, 15 mins with pod, 10 mins with assistant). This makes it very efficient for the practitioner/business and not such a big issue for lates or no-shows.

    It all comes down to clearly outlining your practice policy AND training all staff in the implementation of the policy.

    Remember, if you don't establish the rules, people (staff, owners and patients) will make up their own.

    Policies have been a godsend for a smoother running business.

    Cheers,
    Ted.
     
  13. AdminMan

    AdminMan Member

    Each person and business is unique and run differently as you say.

    No offence taken, my post is simply a suggestion to help solve a problem. It may not be something for everyone, that's why it starts with "But first I have to warn some of you that you might not agree with everything I’ve written in this post because it will challenge some of your personal beliefs about yourself and your own worth. I make no apologies, that’s because I know, and you probably do deep down, that you are worth more."

    You're spot on, I want to promote that I love helping people solve problems. The most important message in my post is that we are often responsible for the behaviour of our patients and that there are some strategies that we can use to help improve things we don't like in our business. As highlighted by TedJed above.

    Wouldn't it be great if patients did value you more?
     
    Last edited: Jun 4, 2009
  14. markleigh

    markleigh Active Member

    Thanks for your response Mick & Ted. I am just wary of "marketing gurus" who promise a lot & seem to really achieve very little. And I will be honest too say I feel a bit "battle scarred" from running 2 full-time practices & do feel often less than enthusiastic about what I do & so maybe do not value what I do.

    Ted makes a good point about policies. My wonderful wife has been spending a huge amount of time writing up new policies & procedures. I am not the most organsied of persons & so that has been confronting at times (that might sound silly).
     
  15. Sammo

    Sammo Active Member

    Sounds like language that only sales men and "lifestyle gurus" use.

    NB I don't think any one ever agrees with all of anyones post on this forum.. sometimes I don't even agree with myself!

    Some of them really really do value us.. I had an old lady trying to take me and my colleagues out to dinner with her last night.. She was mad as a hatter, in a good way.

    One quote I chuckle at regularly is "this job would be great if it wasn't for all the patients".

    For me, when I was working on the NHS we had 20 minute appointments, saw 19-20 patients a day.. 30 min lunch. It always seemed that I was chasing the clock.. We had a policy that if a patient was 10 minutes late they may not be seen.

    It always seemed to me the patients that ran 9 1/2 minutes late were the really old, poor mobility ones that then took 5 minutes to tell me about their journey/holiday/grandson and then another 5 minutes to take their tights off.. kinda frustrating, but kinda cute, but they mean well, normally coming in with "sorry I'm late!"

    The ones I think we all hate are the ones that never apologise for being late... but just come not-quite-late-enough to send away.
     
  16. AdminMan

    AdminMan Member

    Thanks for helping this post generate discussion on a topic that we are probably a little sensitive about, giving patients excellent service that goes beyond the consult room, marketing and the ugly word 'sales'. Mark you're absolutely right, it's very confronting, it's not silly at all, because podiatrists are taught how to be excellent with peoples feet and not taught much about how to run an excellent business. My wife and i realised that we weren't taught anything useful about these things in University and realsied that if we wanted to have our own children and still keep our practice that we needed to learn more to keep our podiatry clinics viable and affordable.

    Thanks for the complement, but I'm not a marketing guru. My wife and I have been through the pain of spending money on marketing gurus and lifestyle gurus, some great and some were a complete waste of time and money. But the reason we did that was because we realised that if we didn't learn how to market our clinic and provide excellent customer service that our business and our income would not keep up with inflation and might even drop.

    After spending three and half years learning as much as we could about how to run a successful and profitable practice while giving our patients excellent value for money I am now at the point where I don't need to be as hands on in the management of the clinic.

    It took a long time, effort and sometimes frustration to learn the things we learnt. Now that I have more free time I want to share that with others who want to have a successful and financially viable podiatry practice. I'm not selling you anything, my words and suggestions here are free of charge. There's no obligation as you know. I'd love to feel welcome here to keep sharing some of the lessons that we learnt here in this forum, so others don't have to make the same costly mistakes we made and maybe some of it might be useful to someone.
     
    Last edited: Jun 5, 2009
  17. markleigh

    markleigh Active Member

    Thanks Mick for your comments. My father-in-law always has the saying to pick the meat from the bones so I am still keen to hear more of your thoughts. I am keen to hear & learn from yourself & others in private practice who are doing things sucessfully.
     
  18. Heather J Bassett

    Heather J Bassett Well-Known Member

    Nat there are always 2 sides to the story, without being there at the time you can not know how late is late. If the Podiatrist has an outside committment, then 7 minutes late, register details etc then we are talking 10 minutes.
    If one has to pick up children or have appointments yourself then, late is late.
    30 years later I have heard many stories, and many do not gel.
    We often have clients telling us things that we did or when we saw them etc that varies from the actuality of the notes.
    There are times I jsut love my notes when I quote the client or us pods and tell them a date and what was advised anything up to 27 years ago.
    Recent chap booked, wanted to see the boss as he was not happy with his last consultation some approx don't quote me 5 years ago.
    The reason he wanted the boss was so if he was not happy this time he oculd tell the boss directly.
    I advised him this time the same as he was advised at his previous consultation that if he was to resolve his symptoms he would need to change his footwear and possibly look at cushioning insoles. I asked if he remembered this, no he didn't, I asked if he remembered the 5mm felt pad that wasz applied to his foot he didn't.
    Then asked why he was not happy with last consultation whcich was the same as this one.......NO REPLY!
    I am sure we all have these stories to tell
    SOOOOOOOOOOO
    7 minutes?????????

    Cheers

    Cheers
     
  19. Nat Smith

    Nat Smith Active Member

    Hi Heather,
    I agree, there's always two sides to the story...in my first post I questioned whether or not the patient's recounting of the time frame was actually accurate...and just assuming it was accurate, I still personally think 7 mins late was a reasonable time frame to be expected to get seen. Of course, looking from the pod's perspective...7 mins late may be too late for many...which is why I posed the question as to what people felt was a reasonable timeframe. Everyone has their cut-off rule, their bad mood days, their personal emergencies etc. Some pods may feel that 1 min late is too late. Others will take someone in and keep the next one waiting. Whatever the real reason for not taking the patient in is irrelevant really...I would think that in private practice you don't want to send away a patient without at least offering even a fake apology or reason and getting them to re-book. As for your story about accurate note taking...I couldn't agree more with the pleasure of being able to recount back to someone the previous advice they were given which they have chosen to ignore..."Oh, I thought these shoes were ok..."
    cheers,
    Nat Smith
     
  20. jambutty

    jambutty Member

    Hi
    Wasn't quite sure where to place this question - hope someone can offer help & guidance...
    I've been offered a room in multi-disc clinic (UK) - on a fee-sharing basis. I will have to equip this myself and advertise my services. There is full receptionist cover. The location is good and I have a large and significant client base to transfer to this new location.
    The question is considering 'everything' expenditure-wise and the long term - what is decent fee split - and any other advise?
    Many thanks
     
  21. Heather J Bassett

    Heather J Bassett Well-Known Member

    Hi Jam Butty, might be worthwhile adding a more formal name at some time??
    I would recommend that you start a new thread for this as it is a new topic.
    You are then more likely to get replies.
    Also if you search the tags you will find that there a similiar discussion threads there.
    Sometimes country specific forums can also be off benefit.

    One word of advice I heard regarding joing others, is think about what happens when you want to leave and work back form the worst case scenarios to the present and then there are no surprises.
    Good Luck
     
  22. jambutty

    jambutty Member

    Many thanx for the advise Heather.
    For now - JB
     
  23. Lauren84

    Lauren84 Member

    I hate running late for appointments and I hate it when patients are late!
    Only having 20 min appointments, I have a cut off of 5 mins. I think this is fair, especially if the next patient has arrived on time, I dont want to punish them and make them wait for the patient before them who arrived late. Also I find not being able to get everything done in time if the patient is late, especially if they are diabetic. Having long waiting periods, a patient who turns up late (more than 5 mins) will have to re-book and may have to wait 2-3 months before getting in next...they soon learn not to be late again!
    I also have a sign in my clinic room about patients that are late will need to re-book. Its amazing how fast word travels around small country towns!!
    I think its important to remember, we are here to do a job, and its our time as well. Tardiness and lateness should not be accepted...call is harsh if you wish, but to provide optimum care patients have to be willing to arrive on time for their appointments if they are serious about taking care of their feet.
     
  24. beekez

    beekez Active Member

    I think this is each to their own, what they are willing to put their patients through and what they are not willing to accept.
    It comes back to the question about our the status of our profession and how the patients regard us.

    I think personally 7 mins can be too late doesn't matter the reason (stuff ups do happen), but I think that in the case from nat, if the practice had a sign or policy or let the patients know at the time of booking it may have been resolved much easier.
    Rather than saying your too late the podiatrist is already packing up the reception staff could just simply point out the policy and that the patient will nee to be re-booked, they do not need to know they are the last for the day or any other information just the policy is "if you are late you may not be seen". I will still see people late if they call ahead or have come from a distance or I know I can stick to time reasonable with that client. The other side of the stick is if you take someone in late early on in the day and run late all day as a result you have a full day of patients upset with YOU for running even though it wasn't your fault!

    The reason I think 7 mins is too late is that I prefer to have the full time with the patient and the full attention to their care, I also hate keeping people waiting. If you do take that person in and you know you are then going to be 10-20 mins late leaving to pick up kids etc you most likely will not have you full attention on the patient.

    I also think its preferable to re-schedule, my partner is in another health profession with on going clients and she is just able to cut the session short by the amount of time the clients were late and they still pay for the consult time (they do not do it again). In our cases for example you cant leave an ulcer not dressed and point at the timer and send them off til next week etc so it is easier to re-book.

    Just my thoughts.

    BK
     
  25. Dr. Len Schwartz

    Dr. Len Schwartz Welcome New Poster

    I saw this down the page a ways, but still felt compelled to comment. To be 7 minutes late, I'm sure happens every day for a patient or two. And to be packed up and ready to leave just 7 minutes after your last scheduled appointment, also seems a bit extreme. Who hasn't been late before due to unforseen and extrenuating circumstances, especially in this case when it's a child that is the actual patient? I can understand wanting to stay true to your schedule, and stressing the importance of being on time, especially for more busier practices; but there should be a line somewhere in there. Perhaps a little bit more empathy and understanding was in order there. Look at it from the patient's perspective, as long as it's rational.
     
  26. RobinP

    RobinP Well-Known Member

    In clinic, my time management is far from exemplary and bearing in mind what I am about to say, then I should practice what I preach. AdminMan is absolutely right.

    If your working day is 8 hours long split into 20 min intervals, you should see 24 patients per day(I know this means no lunch break but stick with it for simplicity's sake). If 3 patients over the course of the day are 7 mins late, which is perfectly plausible, that is one extra patient you could have seen every day.

    Over a 42 working week calender year, this equates to over 200 extra patients per year. Privately, this is potentially £6000 per annum in income or, publically, 10 days of annual leave which don't require locum cover at the cost of £350 per day(£3500).

    Does 7 mins matter?

    Robin
     
  27. TedJed

    TedJed Active Member

    I like the objective analysis of this situation Robin. If only humans, their emotions, needs, experiences and demands didn't get in the way!!

    Ted.
     
  28. RobinP

    RobinP Well-Known Member

    I couldn't agree more Ted which is why I preceeded the objective analysis by saying that my own time management was poor. A review of today's patients showed 3 people being late, 2 by10 mins and 1 by 20 mins. I saw them because I am too soft and am habitually late myself so would feel hippocritical refusing to see someone on the grounds of being late.

    I see AdminMan's analysis as being ideal practice management and I aspire to being that good at managing my time. As my practice gets bigger, I am having to make more and more of an effort to run on time.

    It does, however, raise another question. I think that my success rates for treatment of patients is reasonably good. I am not, however, anywhere near as good a technical clinician as, I suspect, most of the people who post on this forum. In my opinion, it is because I listen to people's woes about how long the waiting list is, how poor their surgery was and how they are having to wear ugly shoes. This has a drastic effect on my time management.

    My question is this....how much of what we do is really psychological? We probably can all recount stories of patients coming in for review delighted by their reduction in pain from wearing their orthoses. When we remove them from the shoes we find that they are wearing them on the wrong feet.

    Interested to hear others views

    Robin

    EDIT: This may already have been talked about on another thread. If so - apologies
     
    Last edited: Jan 27, 2010
  29. PODKMM

    PODKMM Active Member

    The patient tells you 7 mins................. It was more likely 20 mins.
     
  30. perrypod

    perrypod Active Member

    If this had happened to me. My receptionist would probably have told me about the situation and I would have gone into the waiting room and discussed the problem with the them. I would try to be as flexible as possible and at least taken some preliminary notes and rebooked if there was insufficient time to assess the case properly that day. Remember, the podiatrist may have a dental appointment planned for themselves. They may also have unavoidable family commitments after work. Explaining this will probably not appease everyone but there again thats life!
     
    Last edited: Jan 29, 2010
  31. I am ready... Go!

    No it isn't.

    Eliminating flexibility might be one of the stupidest things I have ever heard. But please, continue.

    A clock! Genius.

    If you don't fully remove a spike from an OC because your buzzer goes off, then that patient will be back within days wanting the job done properly, preamble or not. The alternative is, they go elsewhere and mention to friends/colleagues/relatives that you only did half a job, damaging your reputation in the process.

    Patients will contact you after being told that you are thorough, not punctual.

    Impractical. New patients will have no idea of the inflexible time keeping that you have indoctrinated your patients with. Common sense and decency will provide punctuality, as it often does. How can you give a patient advance notice that you are running late, if you do not know you are running late until the patient before? A simple, 'I am sorry, the Podiatrist is running a bit late, would you like a brew?' will suffice.

    Well I wear a t-shirt saying 'I am the freakin best' when I attend work, so they know I think I am bloody fantastic.

    Please do, as my self worth is predicated on a daily dose of deconstructing nonsense.

    I stood in the mirror this morning and shouted

    'I am jimbob hear me roar!'

    I then meditated, and thought about how great I am for 15 minutes.

    Now everyone thinks I am an A-hole. :(

    Now, reverting back to topic.

    To err is human, to forgive divine. We work on 30 minute appointments, and will allow 10 minutes given the appropriate circumstances. A bit of give and take is much more valuable to the image of a practice than any self help rubbish, or created policy.

    We are human after all, aren't we?
     
  32. Airlie

    Airlie Active Member

    Interesting thread Nat

    I often find it difficult to understand why people cannot just pick up the phone, or dial you on their wireless blue tooth i phone to let you know they are running late.

    for the pensioners and not-techno savvy I ask people how they get to their appointments, if I know someone catches a bus i document it with their apointment, saves the rage when they are 15 minutes late and counting. I discuss this with patients and find an appointment that best suits their timetable, they will often then book up those appt for the next 6 months :)

    And of course expecting grace when you happen to run late yourself, I have found that good receptionists are absolutely the key here, someone who will readily offer a coffee or suggest that your patients go to the shops when you are running late I have found make patients more content than the treatment itself. I work in with a GP where the magazines and music are so good that the patients come 10 minutes early just to relax!!
     
  33. TedJed

    TedJed Active Member

    Nice touch; our latest Grand Designs DVD works the same treat. See, even downunder we appreciate quality Brit TV (except when its us losing the Ashes!) ;(
     
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