Dealing with daily disruptions: Part 1

Daily disruptions in your schedule can be difficult to deal with. Learn now to deal with the unscheduled walk-in, canceled or changed appointments, habitual no-show or changed appointments, chronic lateness, emergency appointments, and challenging schedules.

Daily disruptions in your schedule can be difficult to deal with. Learn now to deal with the unscheduled walk-in, canceled or changed appointments, habitual no-show or changed appointments, chronic lateness, emergency appointments, and challenging schedules.

The unscheduled walk-in

When a patient enters the office and asks for an appointment that day, it should be scheduled if there is available time. The receptionist can evaluate the level of urgency.

Points to be addressed:

  1. Is the walk-in a new, established, or past patient?
  2. What level and duration is the pain?
  3. Is the pain the result of trauma?
  4. If an established or past patient, is the patient following your office policy to seek treatment within 24 hours after an accident?

If the walk-in patient’s need for non- emergency care is provided that day, explain your office policy concerning appointments in detail. Hopefully, in the future, the patient will be more considerate of other patients.

If the same individual enters the office a second time without an appointment, this shows inconsideration for others, and it would be advisable then to schedule the patient for a later date.

Once an office tolerates unscheduled appointments, complete disorganization can soon occur. A strong appointment policy builds a strong practice and allows you to spend more time at home.

Canceled or changed appointments

When a patient cancels their appointment or changes to another time, all effort should be made to meet the need for care. These missed or rescheduled appointments should be recorded in their personal file. Patient response to care can be hindered if the treatment plan is not followed.

Habitual no-show or changed appointments

Habitual no-show or changed appointments indicate the patient does not have a high regard for the chiropractor or office policies. Look for the root cause. It may be time to reevaluate all contact points made with the patient and try to correct any errors that might have occurred, so that they are not repeated.

Internal reflection

First, look at yourself and evaluate:

  1. Your ability to hear what the patient is
  2. Are the patient’s expectations understood?
  3. Was there a positive participation with the patient during their treatment?
  4. Are you and this patient still learning from each other?
  5. Did you use the best technique and delivery with the patient?

Staffing considerations

Then, look to your staff.

  1. Examine the way telephone contacts are being
  2. Review your reception room and make sure it has character and conveys good professional
  3. Observe and evaluate the interactions of your staff with your patients to ensure accountability at all levels.

Everyone, including you, should be cross-trained at each position. You can delegate the jobs you understand, but yield authority to jobs beyond your knowledge.

Chronic lateness

The patient who arrives late on a rare occasion should be pleasantly told that they are late for the appointment and may have to be worked in. Display a firmer attitude with patients who are habitually late. Even if the patient has a legitimate reason, it is best to make a new appointment.

Example script: “Mr. Smith, I am sorry you are late, but the doctor waited through your appointment and then had to see the patients who were on time. I’ll schedule an appointment for you at the earliest possible time. What day would you prefer? We have an opening later this week.”

Emergency appointments

When an emergency appointment is needed, every effort must be made to give the patient the required time. Your office should be prepared for this situation. When this happens, it may be necessary to infringe on the time allotted to other patients by delaying their scheduled appointments. The emergency patient may have to stay at the office until the doctor feels they are stable enough to go home.

If this occurs, it is important that the normally scheduled patients are called or, if present, the situation should be carefully explained to them in a manner that will elicit their sense of compassion and cooperation. Most people will be willing to wait briefly.

Challenging schedules

The details of scheduling an appointment should be delegated to the receptionist in charge. The responsibility for a free-flowing appointment schedule rests on their shoulders.

How to book for the busy lifestyle: If an extensive treatment schedule is called for, it is wise for the receptionist to check if the patient has irregular work hours. If so, it may be difficult to form a regular working schedule of appointments. It may take more time and ingenuity for appointment planning, but it can be done.

How to book the long-distance patient: Patients in rural areas may have difficult traveling arrangements. It is important that these conditions be discussed and some method for a logical appointment schedule worked out for the patient.

If a patient is going to attempt a round trip of three to six hours, you may want to treat them before lunch and recheck them after lunch. A long distance acute-care patient may need to spend the night or book one week a month until stable.


Gary A. Boring, DC, BCOA, LCP (Hon.), is a board member of the Sweat Foundation, practiced for 42 years at Boring Chiropractic, and is the author of Driven Towards Excellence 2014. He is also an extension faculty member at Cleveland Chiropractic College and president of the academy of Missouri Chiropractors. He can be contacted at