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Dynamic Chiropractic – April 19, 1999, Vol. 17, Issue 09

Scheduling (and Rescheduling) Patient Appointments

By Kiki Herfert

A doctor in California recently wrote me with an appointment book problem. Patients were scheduled up to a year in advance. Although he didn't give enough details, it feels as though new patients are typically put on a more intensive schedule and "maintenance patients" at an appropriate frequency for their problem for the rest of the year.

His frustration (and that of his staff) was that when patients changed one appointment and wanted to resume their frequency of care beginning again, from that day, it disrupted the preset schedule and they had to "change the rest of the year." He commented that his staff was "literally going insane" over the situation!

I'm kind of filling in the blanks here with what information I have, so some of these suggestions may be more helpful than others. I'm a firm believer in advance scheduling for most offices, but a year in advance is an unrealistic period to expect no changes in the patient's schedule. Possibly scheduling four weeks at a time for new people and three months at a time for established patients would be initially and eventually less time-consuming. As for the frustration the staff experiences, it is unavoidable and inevitable. At least the shorter time periods would mean less erasing and rewriting.

There are a number of computer systems I've seen that have appointment scheduling as a feature. I used to work with one that scheduled and rescheduled with a few keystrokes. Changing schedules -- even complicated ones -- was little or no trouble.

When scheduling for the first month or two of new patient care, tell patients during your recommendations if they reschedule, they're expected to resume as before with the next scheduled appointment. In other words, if a patient is scheduled for Monday, Wednesday and Friday and came in on Tuesday instead, the patient would still keep the Wednesday and Friday appointments. This isn't going to work for the two-week (or more) checkup patient.

I'm amazed how many patients think that when they reschedule they assume they can't come in that same day at another time. Tell patients that if 10:00 isn't convenient that particular day, you could see them at 11:30, for example. It's a rare office that can't find a slot someone in, particularly if it means that the patient will stick to their scheduled day.

Advance scheduling is certainly a plus for most offices. It keeps track of the patient for you. Patients are less likely to be lost in the shuffle if the daily missed appointment call fails to either reschedule or come to some agreement about their next appointment. Some problems could be avoided by asking patients to choose a time they feel would typically fit their schedule. I'd ask them to think this over after their report of findings rather than ask them to decide while they are still in the office. A more thoughtful choice might result in less scheduling conflicts and resulting changes of appointments.

Many doctors find that if patients with two-week to monthly frequency are called, preferably two days before their visit, even a message left "on the machine" will cut down on your missed visits. You may have to reschedule the time, but you should be able to get them in on the scheduled day. Dentists, with their large time blocks set aside per patient, have made this procedure routine. I don't like creating unnecessary things to do, but it could be well worth the effort for your situation. You might also experiment with reminder postcards, but this option requires careful attention to timing. You'll need to have a lead time of no more than 10 days and no less than a week. If the mail sits overnight in someone's car, misses a pickup, falls on a holiday, etc., you could be wasting time and postage.

We could wrestle around with this without ever hitting a perfect solution. The real solution is to get and keep patients scheduled no matter what method you choose to use. You might try keeping a master list of every active patient with a notation of their typical schedule frequency separate from the appointment book.

This list would be updated each time the doctor altered the patient's routine schedule. A regular review of this list would help catch the patients that just seem to slip away. I'd cross-check the list with the appointment book at least every two weeks.

Remember, if you can't get them into the office, you can't get them well!

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