A modest proposal on patient compliance

[DeusXM]

I had an interesting chat with my doctor last week about the number of her patients with diabetes who don't turn up for their appointments - apparently, it's quite a lot of them.

Today, I got my retinopathy appointment letter.

Here is my modest proposal for patient compliance. Instead of putting patients into appointment slots based on just throwing them into the first available slot that shows up on the computer and treating it like a court summons, why not actually get in touch with the patient and ask them when might be a convenient date and time?

My appointment letter feels like a summons - be here on the 1st July at 2pm. Unfortunately, I'm on holiday that day. I suspect when I phone up, I'll be told that now all the slots for a couple of days later are now booked and the earliest will be something like October. Yet I bet every single one of those now-booked slots are 'booked' purely by the computer system with no actual relationship to a patient's ability to attend, and if I'd been called a few days ago when all this was being planned, doubtless we could have found a mutually convenient date in a quicker time.

Seriously, this isn't rocket science. Why can't the NHS manage something as basic as arranging appointments in conjunction with their patients? And they wonder why so few people show up...

 

[Laura davies]

Very very true. I always feel like those letters are a summons!

 

[trophywench]

I always found when I was at work, that my apt in the mobile unit that came to my doctors surgery, was just after lunchtime. Bearing in mind you can't see to do anything too intricate especially in bright light for a couple of hours after, this wrote off the afternoon.

I always tried to change them, but was met with a straight 'can't do that we don't make the apts' from the doctors.

Turns out that is a downright lie. They do make the apts.

Anyway I roll em into my hospital visits now, the entire Retinopathy service for the CCG is based on the ground floor of a 2 storey building and the Diabetes Clinic occupies the upstairs. So when I get my clinic apt through around that time, I ring the R service and ask em if I can have it done that day - they normally say, Yeah no prob - somebody will be free to walk upstairs and sort you out! Otherwise I can make a separate apt with them, to have it done in the clinic on a different day and time AT MY CONVENIENCE.

WOW ! To suit ME !!! remember those days Deus? You must be well old (like me) if you do! LOL

 

[Northerner]

My dentist was telling me yesterday how frustrating it was when many people booked for appointments at his stints in the Dental Hospital don't turn up - I wonder if he has considered this aspect? In his practice you get to choose your appointment slot, so yes, why not for a hospital?

Also, it helps to tell the patient about the appointment - for my last eye appointment at the hospital I never received the original appointment letter, just a reminder text with the date, but no other info (like the time, would that be so difficult to include in a text?). When I called to find out more I asked for a confirmation letter, which also never arrived 🙄

 

[Lauren]

My clinic in Aberystwyth had a system like they one you propose. They would send out a letter reminding you that you were due an appointment and to get in touch to arrange a time. If you didn't get in touch within two weeks they would allocate you an appointment. It was a good system 🙂

 

[Northerner]

My clinic in Aberystwyth had a system like they one you propose. They would send out a letter reminding you that you were due an appointment and to get in touch to arrange a time. If you didn't get in touch within two weeks they would allocate you an appointment. It was a good system 🙂

That sounds sensible 🙂 As with so many of these things, if one place can do it, why not all? Isn't that what businesses call 'best practice'? Why do so many places fall short?

 

[Redkite]

"My appointment letter feels like a summons"

Ha ha, yes most of them do! We get a limited choice as to timings for diabetes clinic, but no choice for retinopathy, renal or other appointments. As we have to travel into London to get to the hospital, it's much more convenient for us to have appointments on the same day if possible (the consultants are willing, but the admin side lets them down!). Last year, the retinopathy screen was scheduled for 12pm and the diabetes clinic for 2pm, and the D consultant said he'd still fit us in if we were late running after the eye appt. However, when we presented ourselves at ophthalmology they had no record of our appt and said we were on record as "DNA's" for the week before. 😡 I was pretty cross and showed them our appointment letter - it transpired that this appointment had been cancelled and rearranged for a week earlier, but no letter had come out to us!! We had to come back another day, and were tacked onto the end of an old folks' clinic, which overran by two hours and made us have to travel home in peak hours at double the fare! What's more, despite it not being our fault, we have a DNA against us, and if you get two of those, you're struck off the list!

So yes, making appointments which are convenient for the patient would be marvellous!

 

[DeusXM]

On the plus side, my letter does seem to countenance the possibility that the randomly assigned appointment time might not be convenient and I'm invited to call them to rearrange if required - with apparently a choice of locations and even Saturday appointments.

So we'll see how we go on the phone.

As a side point, I was wondering why they don't do things the same way they do in Greenwich. There, you don't go to a hospital for your retinopathy check - they have a network of high-street opticians who can do the photography 7 days a week and then the hospital gets in touch afterwards. It surely can't be that expensive to do if they can manage it.

 

[everydayupsanddowns]

On the plus side, my letter does seem to countenance the possibility that the randomly assigned appointment time might not be convenient and I'm invited to call them to rearrange if required - with apparently a choice of locations and even Saturday appointments.

So we'll see how we go on the phone.

As a side point, I was wondering why they don't do things the same way they do in Greenwich. There, you don't go to a hospital for your retinopathy check - they have a network of high-street opticians who can do the photography 7 days a week and then the hospital gets in touch afterwards. It surely can't be that expensive to do if they can manage it.

In Bristol they have moved to a mobile screening service which tours around GP surgeries and takes the snaps as TW describes. Pretty convenient for me.

But the electronic noticeboard in our surgery continually loops around with stats on how many people miss appointments each month. It is LOADS. And knowing quite how hard it is to make an appointment at our surgery I alwats find that a bit of a surprise!

 

[Andy HB]

Personally I am quite happy with getting a letter once a year with the appointment date/time already suggested. It saves time for the patient if the appointment happens to be suitable. If it isn't suitable, then the patient has at least received a reminder!

If I can't make that particular date/time then, as DeusXM says, I can rearrange it. Normally, the letter arrives in plenty of time to arrange an alternative appointment quite easily.

Up to now it has worked very well for me.

Andy 🙂

 

[Northerner]

In Bristol they have moved to a mobile screening service which tours around GP surgeries and takes the snaps as TW describes. Pretty convenient for me.

But the electronic noticeboard in our surgery continually loops around with stats on how many people miss appointments each month. It is LOADS. And knowing quite how hard it is to make an appointment at our surgery I alwats find that a bit of a surprise!

A lot of surgeries have taken away those 'missed appointment' figures. Some research was done and found that it made people feel better about not attending if there were loads of other people doing it! People, eh? 🙄 It's that quandary of the fact it costs people nothing. I'm not in favour of charging for appointments, but some penalty where it can be proved it is down to the patient would be acceptable. Probably just create more bureaucracy though, so will cost more, and I suspect that appointment slots are 'overbooked' anyway in consideration of the levels likely to be missed. We probably wouldn't have enough doctors if everyone turned up! 😱

 

[yorksman]

Last year I got a list of opthalmologists to chose from and was asked to make an appointment with one of them. This year I got the same list but also got a letter from the one I chose last year reminding me that I was now entitled to another free test.

The sort of grandiose attitude you write of used to be common in GP practice. When our old GP retired and a new 'team' took over I got a letter saying that they were pleased to inform me that they had decided to accept responsibility for my welfare, as if I should feel humbled by their generosity. It wasn't long before I received a summons to an appointment, without my consent or knowledge, for a new health check scheme that they had come up with. I didn't turn up and was duly given a telling off for turning up later when I was actually ill.

Being used to the annual Doctors versus Dentists debates at university, no proposal, just a sort of verbal bun fight, I told the young doctor concerned that I didn't turn up because the dentist had told me that you were all c**p.

Didn't even have the wit to ask 'which dentist?'

 

[Sally71]

I was quietly minding my own business at home one day when it suddenly dawned on me that I was supposed to have gone to an asthma check up the day before 😱😱😱

I had completely forgotten about it, this is not like me at all. And what made it worse was that they had been nagging me for ages to make an appointment (my asthma is very mild and I don't particularly feel that I need a check up every year, but I always get called for one) and I had been looking forward to getting it behind me; I was not busy on that day so can't use the excuse that I was distracted by something; but the absolute killer is that the day before the appointment I called into the surgery to collect my daughter's prescription and saw the signboard flashing up how many people missed their appointments the previous month. How silly, thought I, why would you make an appointment end then not turn up - and then I did exactly that the very next day!! 😱

I was most apologetic when I phoned up to rebook the appointment, the receptionist's tone of voice sounded like she was thinking "yeah yeah, heard that one before..." . When I finally made it to the appointment a month later I was profusely apologetic to the nurse too and she told me not to worry, the signs are mainly aimed at repeat offenders not people who miss one appointment, and they seem to be working for them as the numbers have dropped drastically.

I would quite happily have paid a fine though, I deserved it! In fact I think dentists charge if you cancel an appointment without enough warning so why not doctors? That would force people to make sure they turned up!

When we have diabetes check ups at the hospital we book the next appointment before we leave, which means I get some say in the day and time. Sometimes I can manage to get a 4pm appointment which is just about doable if we go straight from school, so don't have to take her out of classes. The last time we had a late appointment but spent ages with the doctor and also had blood tests for annual review so the reception had closed when we left and they had to post an appointment. It came through very quickly and as luck would have it it falls on an inset day so I won't have to phone them to try to get a better time!

 

[Northerner]

...I would quite happily have paid a fine though, I deserved it! In fact I think dentists charge if you cancel an appointment without enough warning so why not doctors? That would force people to make sure they turned up!

My dentist charges £20 for a missed appointment without 24 hours cancellation. I have missed 1 in 15 years and it was totally my own fault, so I didn't mind paying. They're not NHS though, so not sure if NHS dentists can charge. Yesterday I had to go for a check up and didn't really feel like it, but the thought of the £20 fine made me make the effort! 🙂

 

[AlisonM]

Up here, they've only recently started sending out letters asking folk to call and make an appointment for whatever it is, foot checks, retinopathy, HbAs etc., but before that it was as Deus has said. I used to get letters telling me to "be here at" and the "or else" was implied. Now though, you call a central number to book your appointment at a date and time to suit you. They've started doing evening clinics as well, which is great for working folk, although I suspect that may merely be a way of clearing the backlog rather than fitting in with patient needs. It seems to be working too with a significant drop in missed appointments, or so the eye guy was telling me last year.

 

[Sally71]

My dentist charges £20 for a missed appointment without 24 hours cancellation. I have missed 1 in 15 years and it was totally my own fault, so I didn't mind paying. They're not NHS though, so not sure if NHS dentists can charge. Yesterday I had to go for a check up and didn't really feel like it, but the thought of the £20 fine made me make the effort! 🙂

Exactly, it would make people less likely to forget about their appointments, or at least encourage them to reschedule in plenty of time if the original time became unsuitable. People moan about it being unfair, but surely something like this would be a lot more fair to all those people who have to wait ages to get an appointment who could have had one of the missed ones!

 

[SimplesL]

Round here you phone to make your appointment. For the retinopathy you do get a letter reminding you a check is due with a list of local opthamologists (can't spell) to contact in the area. My hubby always goes to the 1 by our office so he walk there & back. I use it as an excuse to work at home that day & call my local health centre where they do the tests. The hospital send a team out to run them. I always go for early or late.

I've recently been referred by GP to the Breast clinic due to a concern I have. The next day I received a letter with the list of hospitals I could go to & the phone numbers. As I'm already under the local cancer place due to an early breast cancer diagnosed nearly 4 years ago (T2 picked up on pre-op tests) I opted for the 1 I already go to. I called them & have my appt next week on 25th. yesterday they confirmed appt in writting with details on where to go. Seems a pretty good system.

On some the intial letter will have a ref on it & you can log on & book on-line for a convenient slot such as local podiatry services or a local clinic tend to do this; the larger hospitals you normally get a list & choose where you want to go.

Wish me luck for the 25th & it is nothing more than a cyst since it is not far from area where they detected my early cancer last time.

Take care
Lynne

 

[Carmina]

I got a letter reminding me my 6-month review is due. It was actually due several weekds ago but I've played the waiting game just to see what my surgery defines as 6 months.

I rang to make an appointment and was told 11.30 next Wednesday. Now as I work an hour's journey away from home, this would have meant leaving work at around 10.15 which means working the morning would be ridiculous so I'd have to book a half-day holiday. I'm sick of my holidays being used up for appointments that I have no conrtol over. So I asked for one of the 'very early' ones between 8.30 and 9.30. No, I can't have one of those because 'they're only for people needing fasting blood tests'. Given that each appointment for blood tests is a 5-minute slot, that's 12 a morning, 5 days a week. So do my surgery really have 60 patients every week needing fasting BGs? Or is this just another manifestation of 'we're doing you a favour by being here and you must obey'? And of course, once I've had the blood taken I have to make an appointment to wring info out of the GP word by word, because he thinks 'everything's okay' is giving me the results of the tests. 'What's my HbA1c?' 'Why do you want to know?' ... repeat with every result he's got in front of him. I always take hubby into the consulting room with me. He thinks it's so he can see what a rubbish service we get - it's actually because I'm far less likely to lose it and strangle Doctor Smug with his own stethoscope if there's a witness in the room.

There's a notice in the waiting room that says anyone more than 5 minutes late for an appointment will not be seen and will have to re-book. Last time I went, we were sitting there for 45 minutes after my husband's appintment time.

And as for the retinal screening system - I got a list of places I could go, which said I could have a Saturday appointment. So I rang 9 of them and asked about Saturdays - no, madam, we don't do these on Saturdays. I was told that one only took retinal screenings on alternate Mondays between 3 and 4 pm. Another could offer me a Tuesday evening at 6 but it was 3 months away. So I rang the central office and asked what I was meant to do to get a screening at (quoting from their leaflet) 'a time that suited me' and told them about the quest so far. They said leave it with them and I'd be contacted again.

Strangely enough, 4 of the receptionists I'd already spoken to suddenly remembered that they could in fact offer me a Saturday appointment and rang me to say so. I got a 10am appointment the following Saturday.

I don't care if they think I'm a stubborn old battle-axe. They're right. But my time is not infinite and expendable.

 

[robert@fm]

[...]I suspect that appointment slots are 'overbooked' anyway in consideration of the levels likely to be missed. We probably wouldn't have enough doctors if everyone turned up! 😱

I seem to remember that Sick Notes by Tony Copperfield makes these two points. 🙂

 

[Northerner]

I seem to remember that Sick Notes by Tony Copperfield makes these two points. 🙂

That's probably what put the thought in my mind Robert! 🙂