Time to change?


One of the 6 ‘C’s is Courage. This refers to practitioners being prepared to raise their heads above the parapet to identify when things are less than satisfactory for patients, and to suggest a different way of doing things.
In our guest blog this week, WOMMeN practitioner member, Bev Hilton, mammographer at the East Lancs Breast Screening unit displays such courage. Here she calls for a more tolerant approach to patients who are late.

Late. When is late too late? When is a situation irredeemable? Can I get away with it this time?

These questions will be familiar to you if you’ve ever been late for a date, late for a meeting, or late for an appointment – and the majority of us will have been late for something, somewhere, sometime. But it’s what happens when you finally reach your destination that will make the occasion memorable; and whether it’s a bad or good memory.

If you’re late for a healthcare appointment, it’s likely that your stress levels are increased to start with – ‘white coat syndrome’ doesn’t improve anyone’s day. Then there’s the likelihood that you’re feeling under the weather or just damn dreadful; pretty likely if you’re using healthcare services. How about depression? A lot of people are depressed these days, almost one-fifth of the adult population, and that makes getting out of bed difficult, never mind getting somewhere to a strict time limit. And then we have plain old bad luck. The traffic jam, the unexpected childcare rearrangement, the lost car keys and the entire universe conspiring against you – admit it, you’re STRESSED.

So, you get there but you’re late. And then it goes one of a few ways: the receptionist greets you, reassures you that you can be seen, although there may be a small wait. Or, that you’ve missed your appointment and can’t be seen. Or, that you can be seen, but will have to wait till the end of the clinic. Alternatively, the receptionist greets you, reminds you that you are late, and says that they’ll check if you can be seen, returning to say that it was a close call, but the doctor/nurse agreed that you can be seen after waiting to see if another patient misses an appointment.

All but the first one is likely to get the blood fizzing, isn’t it? And it can be the way it’s said sometimes – some people just have no idea how to talk to other adults without sounding condescending. Ooh, it can really be infuriating!
What happens next? Well, I’m guessing a response ranging from mild irritation to full blown rage – it’s not as if you MEANT to be late! Where do we go from here? Sometimes, an argument ensues, upsetting both to you and to the receptionist; or just a short, abrupt nasty exchange – still upsetting to all concerned. Other times, you stay silent, appearing aloof and uncaring: there’s nothing you feel that you can say. In all these scenarios you feel powerless and hurt; you won’t be coming back here in a hurry to be treated like this.

How do we improve on this? I think that we improve by remembering the humanity of it all.


I think that in the rush to provide an efficient, time-pressured service, it’s easy for the staff to forget that everyone has a story. Progressive, modern Great Britain is still obsessed with manners, etiquette, class and rudeness – it’s long been held that to be late is to be rude; the old adage being that to be late is to assume that your time is more important than theirs, but that’s just not the whole story at all. A progressive, modern, healthcare provider isn’t there to judge; it’s to make sure that people get the healthcare they need: inclusive is the word we’re looking for here.

The section of society that needs the services the most are often the most vulnerable, and thus more likely to be late or to miss appointments, but to deny access to the services because of an ‘infringement of the etiquette rules’ is far from helpful, and could in the long run impact on people’s health in a major way. This is counterproductive from a healthcare provider’s point of view: that section of society ends up costing even more. If we look at the issue of missed appointments in breast screening, we’re looking at a missed opportunity to find that breast cancer at the earliest prospect.

Now, I can see that from the healthcare providers’ perspective, that when they’re delivering clinics to meet an endless demand, late or missed appointments cause significant disruption to the service, increase costs, and cause waiting times to increase. When we’re talking about breast screening, where the provider is attempting to invite everyone eligible for their mammos within a three yearly interval and accountable to several government bodies to do so, well, we can see that the pressure is on.

The mammographers and everyone staffing the breast screening service work hard within a time limit of six minutes per appointment to provide a high quality service, and all with a smile – but that sometimes doesn’t happen does it? I realize that most staff are pleasant and eager to help in the face of sometimes intolerable abuse, but I can never agree with turning people away from a health appointment just because they are late for it. There’s always six minutes in the day somewhere where someone can be squeezed in. I don’t agree with ‘politely’ reminding someone that they are late either – what’s the point, other than to make them feel bad? What is being achieved here, other than the satisfaction of seeing someone beg for forgiveness – and that’s not what anyone needs if they have struggled against several untold factors already just to get there. The likelihood of someone to return to use the health service diminishes with each time this happens; and the likelihood of staff facing an irritable client increases each time such passive aggressive tactics are used.

Healthcare staff, ironically, don’t often use the services they provide in the same way as the ‘(wo)man on the street’ as they are more likely to know ‘the system’; neither are they part of the vulnerable echelon of society, so it’s possible that the understanding of what it feels like to be powerless in the face of the big machine that is the NHS just isn’t there. It’s a deeper empathy that’s required, and one that can be difficult to grasp if you haven’t any experience of it.

Communication and conflict resolution skills are continually taught in the NHS – and they should be. It’s one of the most important skills required to make people feel valued and maintain a person’s dignity and co-operation – especially when delivering a well woman breast screening service.

So, I’m asking the staff, next time someone turns up late – let’s consider the whole story. They might have faced several health issues and sheer bad luck and timing just to get all the way across town for this; let’s respect the effort it took.


5 thoughts on “Time to change?”

  1. Good piece, but what happens when there are 50 attended a day booked at 4/5min intervals and other clients complain because they are now being seen late because we had to ‘find’ the extra minutes for someone who came an hour late or to the wrong site or on the wrong day and demanded to be seen? We all try our best to be caring and respectful to clients but it often feels as though we are the lowest of the low because we can’t please everyone including management.

    Liked by 1 person

  2. Agree. Bev!
    Health care services are under a lot of pressure and we’re often stretched. A few bumps in the road (like a late patient) can affect the day but that’s business as usual. Treating the patient with compassion should be the norm – as you say, we have no idea what they are facing.
    I’d only ask that patients show the same understanding when our services run late and the waiting room is full! We also do our very best to respect their time, but a machine breakdown or other unexpected delay can cause that dreaded “domino effect” where we’re running behind all day.

    Liked by 1 person

  3. Thanks for your comments all; I would only say that I stand by my original opinion Anne, I understand the pressures faced but I’ve found that if we always keep clients informed as to the length of delay then their tolerance of it increases. Feeling undervalued by your place of work concerns me; it’s my understanding that nowadays the NHS staff have a larger forum for their views in staff meetings and ‘suggestions boxes’ – make yours known.


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