What are the best ways to deal with chronically late and repeat no-show patients?

Knee jerk reaction: Dismiss them from the practice.
Long answer: Read on...

In my experience, 23 years this summer, I can't recall having worked in an office where patients are NEVER late, or NEVER miss their appointments. It's foolish to think that ALL people are conscientious and keep their appointments; events happen in people's lives that prevent them from following through on their commitments.
For instance, haven't we heard of the patient who is scheduled, and confirmed, for an appointment that doesn't show up? The nerve… Only to find out that they were detained unavoidably at work for a meeting that may have more severe consequences than a tooth going south; like losing their job. Something may have occurred that we didn't hear about. Let's take a listen…

Patient's Boss: "Mary, we have an emergency meeting this afternoon, it starts in five minutes; grab your things, let's go."
Patient: "Gee, boss, I have a dental appointment, and it's real important that I go, I promised; and they already confirmed my appointment yesterday."
Patient's Boss: "Mary, what part of "emergency meeting which starts in five minutes; grab your things, let's go" did you not understand? I'll make it real simple, you choose: Meeting - keep job, Dental appointment - lose job."

Okay, all kidding aside, there are things we can control in this process, and things we cannot. When offices focus on the things they can control, kept appointment rates increase, failed appointments decrease, and patients by and large will arrive on time; sure, not always, but improvement is the idea here.

Before I lunge into providing some quick and useful ideas for integration into existing systems to improve kept appointment rates, here is another quick case study as an example of what not to do. During the first few weeks of a consulting engagement in an office I worked with a few years ago, the team showed me the following letter, received recently in the mail:

"I am sending this letter expressing my disagreement with your current policy of charging $45 for a patient that has missed an appointment.
On several occasions my daughter waited past the originated appointment time to receive your services. Additionally, we have never been past due on an account for your services.
Enclosed is the payment that you have requested. However, you are at a great loss, for my daughter will never return for your services nor will we recommend your services simply because I feel you have little value for a good customer.
Recently, my family moved to a new home. Apparently, the original appointment card was lost in the move. However, this letter is not intended to make excuses. It is simply to voice my opinion on your policy and my perception of your lack of appreciation for a good customer."

The team asked me what they should do in response to this letter from a patient of record. We pulled the chart to look into past events and discovered the mother and daughter had been patients for around 19 months. During the first six months, a chart entry indicated that they failed an appointment without notice. An entry on a later date indicated the mother called apologizing for not keeping the appointment due to car trouble. Okay, apology accepted, onward to better health.

A year passes with multiple entries indicating treatment for the daughter and mother; kept appointments; low or no balance due on the account. A chart entry was made about a month prior to receiving the above letter, about 18 months from the date of their first appointment. The entry indicated: "Failed appointment without notice - second occurrence, failed appointment charge issued, $45."

It gets better. When I asked if the reference in the letter about running late was true, the team members acknowledged they run late, constantly. Even though the reminder card was lost in the move, the family had mentioned that buying a better car was secondary to their children's dental health.

Uh, oh.

Seemed to me the office violated one of the fundamental principles of good appointment scheduling: Respect other people's time before you expect them to respect yours.
So, lesson number one: Be on time; don't make people wait. Also, avoid, as much as humanly possible, changing an appointment to make the day better for the office.
Gone are the days, I certainly hope, where we try to move people around because of holes in the schedule, due to cancelled appointments on short notice, or try to move patients up in the day so that we can leave early! This may backfire. There's nothing wrong with trying to make the most of your day and be as productive as possible, but when one takes the point of view of the patients, it may be an inconvenience to them to change the day or time of their appointment; we're all busy!

Okay. Let's be proactive and manage this situation so that we reduce the number of people that are chronically late and those that fail their appointments.

  1. Respect other people's time. Stay on schedule, and make every effort to run the office in an orderly, professional manner so that appointment times are in line with the clinical treatment and skills of the providers.
  2. Be polite and flexible, but firm and businesslike. Patients learn quickly if a receptionist handles the issue with tact and diplomacy. Example, "We missed you at your appointment, but it's good to know you'd like to make another appointment and complete your treatment. Let's find a date and time that you know won't conflict with anything else and that you'll be able to keep."
  3. Listen to the patient's side of the story. There may be a very good reason why the patient didn't attend the appointment; hear it out. Then, decide based on your philosophy and what you've decided as an office if the reason is acceptable. If it is, move forward and re-appoint; properly. If it isn't, make the decision to dismiss the patient instead of facing the inevitable - chronic no-shows and cancellations!
  4. Be nice. Patients may feel uncomfortable canceling during the confirmation call to avoid confrontation with an abrupt receptionist. Result: No Show.
  5. Treat each case individually. Is there a clear-cut answer? No, but you can work within guidelines. Establish a foundation of good patient services and communication skills.

Dealing with patients who are late for their appointment:
When someone comes in late, have a conversation to let them know:
Team: "Mr. Herbert, hello, how are you?"
Wait for a response, knowing that they may provide you with all the ammunition you need.
Patient: "I'm fine, thanks."
No admission of guilt, even though they're 20 minutes late!
Team: "I noticed your appointment time was at 2:00, was that the time you had?"
Stop and wait for a response.
Patient: "Yeah, I got caught in traffic."
Team: "Boy that can happen around here, that's for sure. Let me see if we still have time to complete your treatment."
Leave the front; walk away. Check and see if in fact there is time to complete the treatment without inconveniencing the patients already scheduled.
Team: "We can still see you; but we'd like to stay on time as a courtesy to the patients later today. We may not be able to complete everything we had planned. In the future, if you'd be so kind as to do what you can to be here on time, we'd appreciate it very much."

Handle this professionally; but be direct. Let the patient know it's not okay for him/her to be late and try not to chastise or belittle him/her. If the patient could care less, and doesn't respect your time or other people's time, consider dismissing him/her as a patient. Standing firm on this is tough, but in my experience, there's a difference between letting patients run the office and you running the office.

Oh yes, and let's remember that delays happen, emergency appointments occur, and treatments may take longer than anticipated. Tips on putting out the fire when we may run behind:

When delays happen, talk to patients. Explain the delay, don't ignore it and behave as though it is a usual occurrence. Consider something like this.

"I'm sorry we're running late for your appointment. When our patients have a problem that needs immediate attention, we do our best to see them right away; hopefully without inconveniencing other patients. If the same thing were to happen to you, we'd do our best to see you immediately. Thanks for your patience."

A few final thoughts: Don't dismiss arbitrarily. Avoid patient abandonment issues by following this simple rule: do not dismiss a patient who has started but not yet completed treatment. In simple, what the dentist created must be completed. On the other hand, one may dismiss a patient who has a condition that must be treated, but has not started treatment. What nature created, you don't have to finish. You don't have to treat everyone.

Finally, be proactive. Work with the entire team to raise the bar on being on time, excelling in patient services, and enhancing communication skills. Put it all together to improve practice performance and rid the practice of patients who fail or are chronically late for their appointments.