Dealing with clients who are late, or who do not show up for a scheduled appointment, are two of the most common issues raised for discussion in my ethics workshops. Because these situations present us with the awkwardness of confrontation, and the challenges of effective communication and limit-setting, we may choose to "let it go," say nothing to our clients, and hope the problem will go away in time. Eventually, if the problem continues, we can become frustrated, resentful and feel taken advantage of by the client. And if we are not effectively dealing with the situation, we may even grow to dread seeing the client's name in our appointment book.

The recommendations offered here are ideas and solutions that I have compiled from the experiences of my own practice, and from those of many massage therapists I have met over the years. They can help you be more effective in ethically managing clients who push your scheduling and time management limits.

Establish A Reasonable Policy
It's easier to start fresh with healthy habits than to change old ones that don't work. So, if you are a new graduate setting up your business, this is an ideal time to establish and begin enforcing your policies. It's also easier to implement a policy with a new client you hardly know than to confront a client who has been coming to you for many years. However, even if you are a seasoned practitioner or are working with a well-known client, it's never too late to set limits by implementing a new policy for lates and no shows.

To determine what parameters are reasonable for your practice, consider the policies of other business professionals who operate on an appointment-only basis, and ask yourself if you would be willing to abide by those same policies. Twenty-four-hours notice seems to be a typical requirement for cancellations, but if you would be unwilling to pay for a missed appointment that you canceled within 12 hours, that may not be the best policy to adopt as your own. It's unfair to expect clients to do something that you would find unreasonable if you were in their position.

The reverse is also true: It is fair and reasonable to request that clients do what you are amenable to. For example, if you are willing to forfeit the amount of time you were late out of the appointment time, offer the same option to your clients instead of making them reschedule, even if they arrive 30 minutes late.

Another characteristic of a reasonable policy is that it would be practical for you to enforce. A no-show client who doesn't call to reschedule isn't likely to pay a bill you send them for the missed appointment, so billing for no shows in these instances can be costly and futile. A more effective policy may be to keep a record of clients who miss their appointments. Inform them when they call to reschedule that, if they wish to make any future appointments with you, they must pay your cancellation fee. Don't waste your time or postage expenses chasing after a lost cause.

Your policy may be that the amount a client must pay you for late cancellations or no shows is the same amount you charge for a treatment. Or, you may decide that half your fee or another rate is more acceptable for your practice. There are no set rules for this aspect of ethical business practices, but it is important that you are realistic, reasonable and willing to follow the policy yourself.

In my own practice, I require a minimum of five hours for cancellations. It seems reasonable and practical for my clients, since I usually see them in the evening hours, and they may not know they aren't feeling well enough to come to the appointment until they wake up that morning. This still gives me enough time to fill appointments that become available from my waiting list, and even if I can't fill the slot, I have enough notice about the unexpected free time in my schedule to plan other things. For lateness, I offer clients the options of being worked on for the remaining time of the appointment for my regular fee, or they may pay me for additional time to make their treatment last the full hour, providing that I have the extra time available for them.

Displaying your policy is important. Put it on your business and appointment cards, post it in your office, and include it in your welcome packets for new clients. Simple wording, such as, "To avoid paying for missed appointments, a cancellation notice of ___ hours is required for all clients" works well to inform clients that you are a conscientious businessperson, and that no client is exempt from having to take responsibility for appointments he or she can't keep. For your lateness policy, it is usually sufficient to include the information in your introduction literature or welcome packet. Verbalizing both policies to first-time clients also is recommended, in case they aren't information readers.

Make Reminder Contacts
Taking a few minutes to contact your clients a day or two before your scheduled workday can save many hours that might be lost due to client lateness or no shows. You might say, "I'm calling to confirm your appointment at ___ tomorrow," and, if they aren't home, leave a message on their answering machine along with a request that they call you if they can't make it. Adding, "To avoid paying a cancellation fee, please give a minimum of ___ hours notice if you can't make it," will reinforce your policy with clients each time you call to confirm.
Also, now that many people have cell phones, they have more ways to be reached. E-mailing a reminder is another option. To make the most out of this, ask the client which method of reaching him or her is most convenient and effective.

Handle Situations As Soon As They Arise
The longer you leave unacceptable situations unresolved, the more difficult it can be to address them appropriately. Even if you eventually confront them, your actions may come from a place of anger and frustration and not from a clear, grounded practice of professionalism.

If clients are late, as soon as they arrive for the appointment, an appropriate response is to kindly inform them that the session time has been reduced by the amount of late time; ask them where you should focus your work for the time they have left; and charge them your normal fee for a full appointment. A simple statement, such as, "Unfortunately, we only have ___ minutes left to the session. What areas would you like the focus to be on?" To try to absorb the client's lateness by running behind in your schedule is to work at your own expense, not to mention the expense of the clients who may have to wait for you because you are now late for subsequent appointments.

In cases where clients do not show for an appointment, calling them 15 minutes after the expected arrival time may help you know if they are delayed or not showing up at all. If your attempts to reach them fail, leave a message for them to contact you and remind them that if they want to reschedule with you, a cancellation fee must be paid.

With these suggestions, you can avoid carrying around the stressful baggage of unresolved issues throughout your day, and you have fewer messes to clean up when the day is done.

Have A "Flexible Backbone" When Enforcing Your Policy
Policies for lates and no shows are useless if they aren't enforced. Under "Suggestions for future workshops" on a recent ethics course evaluation, one participant wrote, "Please have a course on how to grow a backbone!"

Having a backbone in business affairs means being able to set limits, make boundaries, and act in our own best interest when dealing with our clients. Just as our anatomical spine needs both stability and mobility, we must be both strong and bendable when dealing with lates and no shows.

A flexible backbone gives us the courage, strength and ability to speak up and carry out our policies without being rigid, harsh or close-minded. It allows us to be simultaneously forthright and compassionate, to know when to persist to take care of ourselves, and when to accept the client's explanation and not charge the cancellation fee. It may take practice, but we usually can find a comfortable middle ground somewhere between the extremes of being a cold, impersonal businessperson and a doormat who can't act on his or her own behalf.

One way that I have found to stay flexible is to offer a client options, as noted above in how I deal with clients who show up late. Another example of this is if a client calls to cancel with less than five hours notice, I offer him or her the opportunity to find a client who is appropriate (both medically and ethically) for massage to take his or her place instead of paying my cancellation fee. This hasn't always worked out, but when it does, I have made a new client, the canceling client doesn't pay anything and everyone wins.

Summary
Handling business affairs can be tricky. It's never easier in the long run, though, to deal with lates and no shows by not dealing with them, thereby enabling our clients to act without due care and attention to their commitments to us.

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Dianne Polseno, former chair of the National Ethics Subcommittee, is a practicing massage therapist, practical nurse, academic director and teacher at the Bancroft School of Massage Therapy. She is the author and publisher of Comprehensive Review Manual for Massage Therapists. She can be reached at: 1 Raymond St., North Smithfield, RI 20896-8215, or at: dipol@aol.com