Tips from a fellow traveler

March 1, 2000
It is financial and psychological suicide to have the doctor and the staff ready and waiting ... and no patient in the chair! The appointment book is one of the pillars of success and one of the criteria by which I evaluate my front desk people. You run the appointment book ... it does not run you!

Part 2

Tips on scheduling appointments and managing the appointment book ensure you`re the one in control!

Marvin H. Berman, DDS

It is financial and psychological suicide to have the doctor and the staff ready and waiting ... and no patient in the chair! The appointment book is one of the pillars of success and one of the criteria by which I evaluate my front desk people. You run the appointment book ... it does not run you!

How do you get patients to make appointments at their convenience, and yet still fit your schedule? For starters, don`t ask "When would you like to come in?" Every parent would like an after-school appointment or to come in on a Saturday. You can give a dozen reasons for appointing patients at a certain time. Do you want to start prepping teeth for an eight-unit bridge at 5 p.m.? Do you want to manage a difficult 3-year-old at 4 p.m.? Neither do I! Does an orthodontist want to be strapping up new cases on a Saturday morning? Then don`t! By directing the patient to a couple of choices, you can fill your mornings and afternoons. Guide the patient to the best time for you.

There should be a firmness about the appointment. It`s like a promise: "I`m putting you down for 10 a.m. on Tuesday, Feb. 23, Mrs. Wilson. We look forward to meeting you." In some cases, you might add, "Please write it down on your calendar. You don`t want to incur a charge for a missed appointment." All this is said matter of factly ... with a smile, of course.

If the patient is standing in front of you, you have the advantage of eye contact. Use it! Don`t keep your eyes focused on the computer or the appointment book. Look the patient in the eye and say, "I`m putting you down for 10 a.m. on Tuesday, Feb. 23, and here`s an appointment card so you won`t forget, Mrs. Wilson. We`ll see you then."

The more firm you are and the better the eye contact, the less chance there will be for a cancelled or failed appointment. You are creating what I call appointment respect. If you don`t create appointment respect, you are raising the odds for a cancellation.

Charging for a failed appointment is just an "attention getter." I have patients who fail appointments and are quite willing to pay the charge. We usually say, "Just please don`t let it happen again, because we were all here waiting for you and we felt stood up." (Smile ... smile!)

For the patients who are upset when they receive the statement with the penalty charge, we smile sweetly and again say: "Gosh, we were all here waiting for you! Several people wanted that appointment time, but it was too late to call any of them. You put us in a bad position. We`ll waive the charge this time, but please don`t do that again." Inject a little guilt, but don`t take away their dignity. Patients that are downright rude - the ones who call with an insulting attitude as if you did something wrong - should be politely sent on their way. Mutual respect is everything in a relationship. Caution: The doctor should never override the front-desk staff if these employees have clearly conformed to the office policy. If you do, it undermines the respect the patient should have for the front-desk staff.

The appointment book

Let` s look at the appointment book itself. Everybody has a different way of booking, depending on the nature of the practice. Whether you`re using a paper system or a computer system, the principles are the same. Double-booking, overbooking, and just plain bad booking can happen with either system. The people at the front desk have to possess good common sense, and they have to know something about dentistry. The front-desk staff has to recognize the difference between a preventive visit and a treatment visit.

Front-desk employees know that a try-in visit for a crown does not take as long as a delivery and cementation or a preparation and temporization. In our practice, we have to know the difference between a difficult-to-manage patient and one that is very cooperative. In an orthodontic practice, staff must know the difference between the time needed for a full-banding visit and an adjustment. There also is a definite difference in the time required for a first visit with a new patient and a recall or check-up.

An example of bad booking in my office is putting two difficult-to-manage children side by side or putting two new child patients whose behavior is an unknown in the same time slot. What makes such a situation worse is that I will have to spend a considerable amount of time talking to the parents, as well as caring for the children.

It`s a mystery to me - even after almost 40 years in practice - how front-desk personnel, confronted with the question, "How could this happen?" or "Who booked these patients?" can look you straight in the face and reply, "It wasn`t me!" Don`t think you won`t have to worry about overbooking problems if you use a computerized appointment-book system. Although the computer can be set not to accept any more entries in a certain spot, this monitor can be over-ridden manually, creating the possibility of human error.

An important rule of thumb: No patient leaves the office without an appointment of some kind. If a patient is finished with immediate dental treatment, but will be due for a recall visit in six months, that patient`s name should be entered into a slot in that particular month. If the next visit is a continuation of treatment, the appointment day and time should be entered in the computer scheduler or the appointment book.

If the patient says, "I`ll have to call you," the name should still be entered in at some particular appointment time. You do this because, frequently, the patient doesn`t call and you have a dead record sitting in the files. If the patient takes offense at your "aggressiveness," respond by saying, "We keep careful track of the status of all our patients. Rather than have a record sitting on the desk waiting for the patient to get back to us, we assign you a time at the appropriate interval so we have you in our computer system. This serves as a more definitive reminder for all of us here and for you."

Confirming appointments

To confirm or not to confirm? That is the question! Do patients appreciate the reminder? "Oh, thank you for calling - I completely forgot!" Do they resent the call? "I`m not stupid. I`ll be there." Do they depend on receiving the call? "Well, I didn`t hear from you, so I figured it was next week."

At the time the appointment is made, all patients are told, "We try to call and remind you about your appointment, but, regardless, you are responsible for keeping it." Despite that qualifier, the overwhelming number of people do rely on receiving that call. Some prominent practice-management experts believe that you shouldn`t call, because it gives the patient an open invitation to cancel. "I`m so glad you called. Maria isn`t feeling well, so we won`t be there." What would they have done if we hadn`t called?!

In the same vein, our off day in our office is Wednesday. Invariably, we used to find the greatest number of cancellation or appointment-change messages left on our answering machine when we arrived at the office on Thursday. It`s much less pressure leaving the bad message on a machine than to talk to a live person at the office. You don`t get any argument!

We have a 48-hour cancellation policy which we attempt to enforce. Our answering machine only accepts emergencies. In other words, we now take a harder line by not accepting appointment changes or bookings or discussing finances when the office is closed. Patients have to call during business hours unless it is an emergency situation. If it is an emergency, a doctor can be beeped immediately. The key here is to reach the patient on the same day to reschedule. The computer tells you who cancelled. Don`t just file away the records. Allow these records to accumulate and you`ve created another task called "purging of your files." We hate that job!

Note: The mere mention of pain, discomfort, or just being very worried is enough to warrant jumping a current or potential patient to the head of the line. Control of the appointment book and the schedule is important, but remember: We`re in the "caring about people" business. Anybody in trouble is treated that same day.

Company is here!

Patients in your office are guests in your home. Make them feel welcome. Your physical facility should be people-friendly, clean, attractive, with comfortable seating, and up-to date reading material. (If the headline reads, "Beethoven Dies," you probably need some new magazines). Some of the literature available should be information about your office. The people-friendly part is the most important and it starts with the people at the front desk. There is this person standing in front of you ... a stranger ... sometimes a nervous, ill-at-ease stranger. So, how about looking right at him with a big smile and give him a big "Hi Mr. Austin! I`m Cathy ... welcome to our office!" It is so disconcerting as a customer to walk into a new place and say, "Here I am," and then have the hotel clerk or receptionist or restaurant hostess say, "Let me see, I can`t seem to find your ... name! Oh yes, there you are!"

Bring a new patient into the routine of your office immediately. For example: "Mr. Austin, please fill out this information card and medical-history form. Let me know when you`re finished or if you need any help with the questions." If the person is not proficient in English, you may want to sit down with him or her and glean the information directly. Ask the questions verbally ... especially the ones concerning the medical history, present complaints, and financial details. Make certain that any personal questions are posed in relative privacy and not asked out in the open for everyone in your waiting room to hear.

If the patient hasn`t received a copy of your office policy (we sometimes mail a copy prior to the appointment, if time allows), then give him or her your office packet that talks about what you do and how and why you do it. The patient then can browse through it while waiting.

Make eye contact!

Don`t fixate on the computer screen. Look at the people while you are asking the questions. You can chew gum and walk at the same time. Observe the patient`s behavior as he or she answers the questions. Is the patient pleasant or unpleasant? Is the person downright angrywith that "chip on the shoulder" look? Don`t be afraid to address the issue by asking something like, "You seem so upset ... is there a problem?" Listen carefully to the patient`s story. Often, you`ll get an earful about some previous "bad" dental experience. Don`t be too quick to buy into the negative story. Just say, "I understand. We`ll let Dr. Berman know about your concerns and he will discuss them with you." Then, make sure your doctor is aware of what`s going on.

All the material you`ve compiled from the patient questionnaire and medical history - as well as your personal observations - are put into the computer, on the paper record, and on the "care slip" which goes into the operatory with the patient. At the beginning of each day, a care slip is printed for every patient who has an appointment that day.

Certain items are not put prominently on the record for privacy reasons. In my practice, parents are sometimes sensitive about such things as adoption and mental and physical handicaps. Allergies, medications, and clinical conditions which bear directly on dental treatment are marked with a red "Medical Alert" sign that is difficult to overlook. If a condition requires previsit medication, such as an antibiotic, it is marked on the front of the record and noted in the computer. Then, when the appointment is verified, we automatically remind the patient about the medication.

About that waiting room

Note: The waiting room is for waiting, hence the term "waiting room." We all have to wait, whether it be at the airport, at the supermarket checkout, or at a doctor`s office. Situations arise that cause delays. It`s not the delay or waiting that`s frustrating. It`s not knowing why and not knowing how long the delay will be. To consistently run late, of course, is wrong. The important thing is that the people at the front desk are aware enough to alleviate the patient`s anxiety by saying, "It`ll just be a couple of minutes" or "We`re running a few minutes late. Would you like to make a phone call?" "We had an emergency ... that`s why we`re running a little late." Say something! If you don`t, the patient comes into the operatory on the warpath.

For more information about this or to order his latest videotape course on "Winning Friends and Influencing Patients," contact the author at (773) 764-0007.

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