Secrets of Success: Patient “no-shows”

“What happened to Mrs. Baker today?” asks the doctor. “She had a two o’clock appointment and didn’t show up.”

Patient no shows…a daily scheduling occurrence that is more common than any of us would care to admit. Why do they happen? What do we do about them? And finally….how can we prevent them?

Let’s start with “why?” The reason for no shows from a patient perspective could revolve around many things. Of course the possibility exists that their absence could have been the result of an unavoidable last minute conflict or an unfortunate mishap…and in those particularly rare cases, you find it easy to empathize.  More likely, however, one of the following occurred…they were too busy, they forgot, didn’t feel it was a priority, or just didn’t understand the value of going. Then there are those who make a habit out of not showing and you can predict two weeks out, (thanks to the roadmap of red markings in their charts), exactly who they will be. What do we do about these patients?

By intentionally disregarding their actions, we are irresponsibly allowing these patients to diminish the value of our time. Except for those offices who have a rigid policy when dealing with patients who don’t show (e.g. charging a fee or inconveniently re-scheduling them), there is, often times, little to no consequence to a patient who fails to show for this appointment or the last one…or the one before that….or the one, well, you get the picture. Sometimes without our realizing it, we allow our patients to sit in the driver’s seat of our practice, instead of taking control of the wheel ourselves and the only way to avoid unwanted future wrecks is to realize that we need to reposition ourselves.

So how do we do that? First, by attaching value to our time and once we do, make the patient aware that we do. Unfortunately, some patients who have been told by the doctor to reschedule a follow-up appointment do so without fully understanding the reason why. Without proper doctor-patient communication, the patient is at a loss to associate any “value” to the appointment, and so if they happen to miss it, it is of no real significance. It is up to each one in the office – beginning with the doctor – to impress upon the patient that a follow up appointment is suggested for THEIR benefit, not ours. If the patient fails to appreciate that by the time they leave the office, there is a hole in the protocol/system somewhere that needs to be fixed.

It is important for the receptionist to be proactive when making the patient’s follow up appointment. Again, reinforce the importance. Next, emphasize to the patient the courtesy of a call if he/she cannot keep the appointment and then also explain to them that their failure to keep the appointment scheduled for them could severely limit their chances for rescheduling at a convenient time. The strategy in this case should be, “Mrs. Baker, if you cannot keep this appointment, we would appreciate the courtesy of a call to us so that we can then make it available to someone else who’s been waiting to get in. We realize your time is important and should the situation ever arise where YOU would need to be seen, we would like to be able to offer you the same consideration.”

Remember, when we speak in terms of appointments to the patient, they only translate that into “increments of time.” 15 minutes, 30 minutes, 45 minutes…they are merely time slots in your book to them. So, in addition to conveying the message that our time is valuable, we need to take the extra step to prove it and make them believe it. Think for a minute of the mixed message we send when scheduling two or more appointments in the same time period. (And don’t be so naïve to think that they don’t compare appointment notes while they are sitting in your reception room!) You cannot expect a patient to understand the value of that appointment knowing that you double booked them with someone else and forcing them to wait 40 minutes (or more)! Maybe the next time they are scheduled, they’ll think it is “no big deal” if they don’t show, with the notion that you already have someone else penned in to fill that “valuable” time slot anyway!

And so, we come to our final question….what can we do to prevent them? Without starting a debate on the pros and cons of calling patients to remind them of their scheduled appointment, I can only tell you that if you do (call), from a patient’s perspective, you continue to live your philosophy by example…showing them that you assign importance to the time you have set aside for them.

In addition, calling your patients to confirm a day or so prior to their appointment allows for two very important things to occur:

  1. You can verify your schedule for the next day;
  2. You have an opportunity to fill newly vacant appointments with other patients who may be waiting for an opening.

Make your call count! Inform your patient that you will call to remind them of their appointment and be sure to ask where they can best be reached. Rather than just leaving a message on their machine, you want to call them at a place where you are sure to make a live connection. Some prefer home or cellphone, while others, their office phone or email. It can be argued that there are still the occasional no-shows even with a reminder call, but the truth is there are far less than without it. However you choose to deal with those patients who repetitively cancel, change or break their appointments, it’s important to first follow up with a phone call for completeness of care. Document your call, their response and reason for not showing, and their rescheduled date (if they choose to make one). At every available opportunity stress the value of the time you are setting aside for them. It’s up to you to teach them. If you don’t…who will?

(reprinted from 2010)

By: Lynn Homisak, SOS Healthcare Management Solutions, LLC –

Ms. Homisak, President of SOS Healthcare Management Solutions, has a Certificate in Human Resource Studies from Cornell University School of Industry and Labor Relations. She is the 2010 recipient of Podiatry Management’s Lifetime Achievement Award and recently inducted into the PM Hall of Fame. She has also recently been named as an Editorial Advisor for Podiatry Management Magazine and is recognized nationwide as a speaker, writer and expert in staff and human resource management.

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