 "Not
only did he not apologize," fumes a solo GP from Medicine
Hat about a patient who had missed three appointments
in a row, "this nervy fellow actually thought he was
doing me a favour and 'giving me a deserved break' by
not showing up." Such an attitude is sadly common these
days — and that's why practices with high no-show
rates need to teach truants a lesson.
Apart from the obvious harm they're
doing to themselves and your bottom line, no-shows contribute
to the wider problem of extended wait times.
GET
TOUGH
The first step to remedying the situation is establishing
a formal written policy that explains why showing up
is so important and that the office will not tolerate
repeat offenders. Get your reception staff to hand it
out to all your patients.
The next step is trying to understand
just who these no-shows are. There's a paucity of research
on the subject, and none of those few studies conducted
give us a clear profile of who's missing all these appointments.
That's why it's a great idea to look at your own patient
roster, flag the serial no-shows and deal with them.
Though it won't win you any popularity
contests, many practices have seen their no-show rates
plummet by fining patients for missing appointments.
Typically in such schemes patients can avoid the charge
if they cancel 24 hours in advance. Fines are tough
to collect, but can be an effective deterrent.
FORGET-ME-NOT
The most common reason patients miss appointments is
plain old forgetfulness. That's why it's important for
practices with serious no-show problems to come up with
an effective appointment reminder system. Patients are
most likely to miss appointments booked far in advance.
Here are some reminder systems to consider:
- Having a staffer call to
confirm appointments is the most effective
- Automated phone reminder messages
have one big advantage — they can call after
business hours
- Email reminders work well too
— but only for web-savvy patients (and practices)
No matter which reminder method
you choose, you should always make sure your office
attempts to confirm the appointment a couple of days
in advance. This gives the patient enough time to make
arrangements to attend, but isn't so far off that they'll
forget about it.
OTHER
OPTIONS
While it's certainly not for everyone, switching to
a same-day booking scheme virtually eliminates no-shows
(see "Same-day
booking makes the grade").
Be wary of an oft-prescribed solution
that might actually make matters worse: over-booking.
If you opt for this trick to compensate for no-shows,
chances are it will seriously backfire on you. By filling
the waiting room you're upping wait times for everyone,
effectively punishing your most compliant patients.
And by making visits to your practice longer you're
increasing the chances of busy patients not showing
up — they'll assume you don't value their time,
so why should they value yours?
FIRE
THE TRUANT
If you're dealing with a patient who skips appointments
time and time again without a valid excuse, 'firing'
may be the best solution. This isn't a decision you
should take lightly. But it's generally within your
rights provided you take the proper steps. The College
of Physicians and Surgeons of Alberta recommends you
follow this protocol (check with your provincial College
for local regulations):
- Give adequate written
notice to the patient, stating the date you wish to
end the relationship, and clearly state the reason
- Reassure the patient in writing
that you'll continue to care for them, or refer them
to someone who will, until the termination date
- Be ready to transfer their
medical records
- Try to help them find another
doctor, either by giving them the names of physicians
accepting patients or pointing them to a referral
agency.
Make no mistake, terminating patients
is a tricky business. It's always a good idea to talk
about the specifics of your problematic patient with
a lawyer or someone from the Canadian Medical Protective
Agency before you go ahead and fire that no-show.
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