Chapter 09
The hybrid day
A remote appointment does not need a room, and that single fact rearranges the whole day around it.
09.1Two kinds of turnover
An in-person appointment has a physical turnover: the room is reset, the previous person leaves, the next arrives. A remote one has an administrative turnover instead: a link, a check that the connection works, a short wait that cannot be filled with anything else.
The two turnovers are different lengths, and a calendar that treats them as identical will run late in one direction or waste time in the other. Timing each honestly, as with any other slot, is the whole of the fix.
09.2Interleaving is expensive
The most common hybrid arrangement — alternating remote and in-person appointments through the day — is also the most costly, because every switch carries a setup. Grouping remote appointments into a block removes most of that cost and has the additional benefit of freeing a room for the whole block.
The counter-argument is availability: a blocked arrangement offers fewer remote options on any given day. As with session blocking generally, the answer depends on volume, and it should be revisited once there is enough volume to answer it.
09.3The before and the after
A remote appointment moves work outward in both directions. Beforehand someone has to send joining details, and be reachable if they do not work. Afterwards there is no counter at which the next step can be arranged, so anything that would have been handled on the way out has to be handled deliberately.
Practices that adopted remote appointments quickly often kept their in-person process and simply removed the room. The parts that quietly depended on the room being there — the arrangement made at the desk, the form handed over — then went missing, and the gap showed up weeks later as confusion.
09.4Who is in the room at your end
A remote appointment happens in whatever space the practitioner is sitting in. Where that is not a consulting room, it becomes an operational question: whether the space is private, whether it will stay that way for the length of the session, and whether the person on the other end can tell.
This is worth deciding as a practice rather than individually, because it is one of the few aspects of a remote appointment that the other party notices immediately and remembers.
09.5What settled
The period in which many practices adopted remote appointments at speed was not a fair test of the format, and neither is the period immediately after, when some reverted on principle. What appears to have settled is a division of labour: some appointments genuinely do not need a room, some plainly do, and the useful work is deciding which is which for your own practice rather than in general.
That decision is operational and local. It depends on what the appointment involves, who the practice sees, and how far they travel — and it is worth writing down once it is made, because otherwise it is renegotiated at the desk, one caller at a time.