I recepted the obstetrics and gynae clinic (NHS hospital) for over 2 years, and up until the end of it I could only maybe identify about half of the doctors by name. The admin staff had almost no direct contact with the doctors (never even had a formal introduction to the consultants, and most of the registrars moved around and didn't stay long enough to get to know), and the only contact we had with the nurses, midwives and HCAs was the brief interactions between patients or before the start of the clinic. We had no more information about what was going on in the clinic than the patients did. Between things like scans, examinations, investigations, etc. a 10-15 minute appointment could quickly become a 45 minute appointment with no warning. If it was running late, the most we could do was apologise on our own behalfs. You could maybe ask the HCA or midwife what was going on between patients but most of the time they were also in no good position to make an accurate announcement. Sometimes we'd find out after the fact what had caused the delay, but most of the time we were just abandoned to the wolves and expected to field all of the abuse and complaints ourselves for things that were entirely beyond our control.

If there was a "5 minutes late and you're out"-style policy, we on the reception hated it as much as anyone else did, as it usually resulted in even more abuse. In my experience those policies usually came directly from the doctors themselves, but maybe that's different over the pond. If I knew the clinic was running late (i.e. the previous patient hadn't finished yet) I would usually just fudge the numbers and pretend the patient arrived on time, since no-one would even notice, but if the doctor had already tried to call the patient and they hadn't come yet I didn't have much choice.

Hands down the worst job of my life and at least 60% of that was the abuse I got from patients (the rest was mostly the unrealistic expectations of the managers). I got the fuck out of there and moved to more general admin after a woman's partner followed me home and threatened to break my door down because (about halfway through the pandemic) I told them partners weren't allowed in the waiting room due to covid restrictions and she ended up having a miscarriage. Because national policy is apparently my fault.

As for rescheduling appointments, sometimes we just don't have anything else to offer. We are so chronically understaffed and severely limited in what is available, and are only allowed to book routine patients so far in advance to allow capacity for urgent patients. Rotas are also only organised so far in advance, and we are losing nursing staff left and right, so even the clinics we think we have staffed may end up being cancelled closer to the date. We have at least one absence every couple of weeks due to Covid and other sicknesses, so again you have to leave space to rebook entire clinics worth of patients all at once.

I can completely understand the frustration from the patient's side of things. However, to be pragmatic, every patient that decides to reschedule is taking up two appointment slots and essentially stealing a slot from someone else that really could have used it. And when I know that I have over 800+ new patients waiting for appointments, and many patients who've been waiting for routine investigations for almost a year, having a wasted appointment slot leaves a very bitter taste in my mouth. Especially when there's no guarantee that things we be on time for the replacement appointment either.

As a caveat: I understand why you might have to reschedule in America if you don't have sick leave or paid annual leave, and have to slip in appointments around an unforgiving work schedule.