Shirah Vollmer MD

The Musings of Dr. Vollmer

Missing Appointments: What’s Up?

Posted by Dr. Vollmer on September 20, 2011


Diane, forty-four, like Zach,, “spaces out” on her monthly early morning appointment with me. I call her, fifteen minutes into our scheduled time and she is convinced that I have the wrong time. After a few minutes of discussion, she says “well, let’s schedule for next week.” I respond, with some irritation in my voice, and we make arrangements for our next visit. Diane comes in with obvious trepidation. She reports that her dating life is “messed up.” Her parents are “driving me crazy.” Work is good, “but way too busy.” Absent from this conversation is a recap of our last conversation where we both felt irritated with one another. “I notice that we are not talking about the missed appointment,” I say, wanting to discuss the large issue which seemed to be making us both uncomfortable. “Well, now that you mention it, I was quite irritated with you,” Diane reports, not surprisingly to me, as I could tell by the way she walked in that our relationship was bruised. “I know that I screwed up. I know that I did not look at my calendar. I accept that, but mistakes happen, and I did not understand why you were so irritated. Sure, it is your time, I understand that, but I am not perfect, and so it happened.” Diane reports in a defensive way, and yet she surprised me in that she took responsibility for the missed meeting. “That irritation with me must have made it hard to come in today,” I say, trying to talk about her body language of discomfort. “No, not at all. I am not married, so I am not used to talking about relationship issues, but I did figure that we would work it out.” She says, conveying a sense of hope in our relationship, but also conveying a sense of confusion about how to deal with her upset with my behavior. “I think we can work it out, also, but I know that we were both irritated when we spoke on the telephone, and so our relationship feels different to me than it used to.” I say, again trying to say how feelings impact  our interaction. “It sounds like you have had a hard few weeks,” I say, explaining to Diane that I understand that missing our appointment falls into a larger picture of stressful events in her life. Diane visibly relaxes after I say that. “Yes, it has been very hard for me,” Diane says, easing the initial tension, allowing us to return to feelings of mutual fondness.

2 Responses to “Missing Appointments: What’s Up?”

  1. Shelly said

    But you didn’t talk about the missed appointment and how that impacted your schedule. Do your patients not realize that you are a professional with commitments to others too? Is that not important? Or is there a sense that they “buy your time” and therefore it belongs to them?

    • I think it is obvious that a missed appointment impacts my schedule. The story with Diane was meant to illustrate that she needed me to understand that the missed appointment was part of a larger picture of a very stressful month for her. As soon as I showed understanding of that, we could move on to deepen our relationship. Again, she knows that she perturbed my schedule in that there are only so many hours in a day, but at the same time, she was communicating to me by missing the appointment that her life was in serious distress. Of course, it would be better if she could use words and not actions to communicate this, but at least we could figure out the meaning of the missed appointment.

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