The Lost Patient Syndrome

Sept. 1, 1996
It amazes me how many dental patients get lost in the practice central file due to appointment cancellations, changes or no-shows. Several years may pass in this "lost stage." I call the central file "your golden egg that needs to be hatched."

Linda L. Miles, CSP, CMC

It amazes me how many dental patients get lost in the practice central file due to appointment cancellations, changes or no-shows. Several years may pass in this "lost stage." I call the central file "your golden egg that needs to be hatched."

Perhaps staff changes created a lack of understanding of the recare system in place or the easier method of mailing notices to patients is practiced. There also is the belief that it is the patient`s responsibility to keep track of his/her follow-up appointments.

Dentists see major declines in their hygiene departments, which result in major declines in the operative and restorative side of the practice. Within 90 days of this decline, panic sets in. The doctor and staff begin to sound and act desperate, which leads the patients to suspect that something is wrong.

To rectify this situation, you must review your present system of recalling patients. If you are on the "send a notice and have the patient call" system, you will find that only 20%-30% of patients call when they receive their notices. Mailing 300 cards per month results in needing someone to contact the non-responsive patients for appointments. This system is most ineffective as calls that do come in usually are received while the business staff cares for other patients.

Calling and recalling patients to fill the hygiene schedule is the second, least-effective recall system in dentistry. It takes 20 to 40 hours per month to complete this task in a single-doctor practice. After the first call, you begin to sound desperate. If a telephone call must transpire to schedule an appointment, it makes no sense to mail notices first. Because it takes extensive time to reach patients by phone, this system is very costly. By preappointing nine out of 10 patients daily, you reduce your recall time by 90%!

The doctor and staff should determine how many patient records and hygiene days are available vs. the number needed. A good rule of thumb is: one full-time hygienist (four to five days per week) for every 800 to 1,000 patient records. If patients aren`t being retained in hygiene, consider the causes. They often include:

1. The practice needs more patient education on the value of preventive care (short- and long-term benefits to patients).

2. The office constantly is moving hygiene patients around to accommodate the scheduling needs. NOTE: This is a major problem in many practices. If the office moves the appointments, the patients also move their own.

3. Staff or doctor need improved customer service skills and chairside manners.

4. Patients perceive the fees to be too high; fee rebuttals are weak.

5. The appointment is uncomfortable, clinically-speaking.

6. Patients constantly are reprimanded for poor home care.

7. There are frequent changes in staff.

8. The patients are kept waiting too long in the reception area or dental chair.

9. The office environment is stressful and disorganized.

10. The recare system isn`t supported by the doctor and entire team.

11. The practice needs verbal skills-training.

12. There`s no time to follow up on lost patients each week/month.


Using these 12 causes for non-retained patients, rank each cause in order of prevalence in your practice. Discover the weaknesses in your practice and create solutions.

The next question asked: What do we do when we learn more than half of our active patients haven`t been in for over 12 months?

Offices that realize the lost patient represents failing dental health for the patient and lost revenues for the practice usually have an active telemarketing campaign. All patients not seen in the past six to 12 months (or longer) should be called by the scheduling coordinator or one of the clinical staff. This person should be:

- Patient-centered

- Goal-oriented

- Enthusiastic

- Knowledgeable

A simple script might say:

"Mrs. Jones, this is Beth from Dr. Allen`s office. We are updating our patient records for 1996. Your last visit with our office was ____________________. Because preventive care is so important, I`m calling today to reserve a time for you before all our hygiene appointments are filled for the next few months."

Making the hygienist`s time seem valuable is often the key to appointment acceptance. Until the office values hygiene time, the patients will not.

Each telemarketing call takes approximately three minutes. If 20 to 25 calls are made each hour, with at least 15 contacts, you should expect to schedule at least four to eight of these patients an hour. If someone is committed to placing calls four hours weekly, this should result in 16 to 32 patients reactivated each week, or 64 to 128 monthly, which is 10 to 14 days of additional hygiene time.

The best hours to make telemarketing calls are Monday through Friday, 4 p.m. - 7 p.m., or Saturday mornings, 9 a.m. - 12 noon. Those making these calls should keep a progress log in the computer or on a legal pad with the following information:

- Date

- Reason for not scheduling

- Number of calls

- Family members appointed

- Number of contacts

- Date of last appointment

- Names of scheduled patients

- Date of scheduled appointment

- Names of non-scheduled patients

Normally, in every practice we consult, there is a practice within a practice of patients who are inactive and stay that way. Patients must realize, as we in dentistry know: Preventive dentistry is not expensive or painful, but emergency care can be. Taking care of small dental concerns before they become major dental problems is the name of the game.

Set a goal in your practice to immediately increase patient retention. Until the staff become accountable for this important task, patients will continue to be lost and practices will never reach their full potential.

The author is an internationally-recognized consultant and speaker on practice and staff development. She is founder and chief executive officer of Miles and Associates in Virginia Beach, VA, and can be reached at 800-922-0866.

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