Challenges and solutions to broken appointments

Sept. 1, 2005
Recently while online, I visited my dental hygiene Internet discussion group. One of the hygienists posted her views on the confirmation of dental appointments.

Recently while online, I visited my dental hygiene Internet discussion group. One of the hygienists posted her views on the confirmation of dental appointments. She was opposed to it, contending that when we confirm, we are baby sitting. She said we are encouraging irresponsible behavior in our patients and providing them an opportunity to cancel. Instead, she insisted that we must instill in them the importance of keeping their appointments without us having to remind them.

I disagree with this view. I’ll explain my reasons as well as discuss broken appointments and potential solutions to this challenge. As a consultant as well as a dental hygienist who temps, I am constantly in different practices observing their operations. Broken dental appointments are headaches for everyone in the practice, and no practice appears to be exempt. It accounts for decreased production and profitability. Losing two simple hygiene appointments per day can result in a significant loss of annual practice revenue.

So, we know there’s a problem. What’s the solution? I wholeheartedly disagree with those who say we should not confirm. If we are service-oriented, then we should recognize that confirming appointments is part of good service. The rationale that confirming an appointment is going to give the patient an incentive to cancel is pure hogwash. If your patient is going to cancel, he or she will do it anyway, and your phone call has nothing whatsoever to do with it. To stop confirming and effectively penalize those patients who appreciate this service is downright dopey.

Today’s world is hectic. Whether your patient is a mother, a busy executive, or both, everybody has a lot going on. As a single working mom with numerous obligations, I very much appreciate the phone call a couple of days ahead reminding me about my appointments. Why? Because despite my appreciation for the importance of all my health care services, my crazy life sometimes gets in the way of my best intentions. Reminding patients about their appointments will increase the likelihood of them showing up. But take it a few steps further -

Get a cell number and an e-mail address, and use both to confirm the appointment if you are unable to reach the patient in the traditional way.

Ask for a return phone call to let your office know that the message has been received.

Make the confirmation phone call a couple of days in advance so you have a day to get someone else scheduled should the patient have to cancel.

Above all, do not “invite” the patient to cancel when you confirm. It always amazes me when I hear front office staff members confirming appointments like this: “Mrs. Smith, this is Mary from Dr. Murray’s office calling to remind you of your appointment tomorrow at 3 p.m. If you have to cancel, please call us as soon as possible.”

Another thing I see repeatedly is when a patient cancels an appointment (frequently the day before or the day of), he is immediately rescheduled into an opening within the same week. What’s wrong with that? Simply this - in the effort to fill or refill the schedule, we’re sending a message to the patient that it’s OK to cancel or break the appointment because we’ll find him another one right away. I believe this is what encourages irresponsible behavior in patients, not confirmation phone calls.

What are some other strategies? One practice in western Massachusetts gives a patient a prime-time appointment after a breakage only if the patient is willing to reserve it with a credit card number. The conversation goes like this: “Mrs. Smith, I see you have had some trouble in the past keeping this 4 p.m. appointment time. Patients wait months for these. Because of this, I must ask you for a credit card number to reserve that appointment slot for you. We hope you understand.” This message is delivered firmly, but with a smile. If the patient wants that appointment time badly enough, he or she complies. It may be hard-nosed, but it works for that practice.

Practices frequently ask me if they should charge patients for broken appointments. I don’t have a problem with that except I don’t think you are necessarily going to get such patients to pay. The balance is reflected and continually carried month to month in monies owed. Unless you are determined not to reappoint until the patient pays the balance, you defeat your purposes and send mixed messages. If you are going to take a hard line, go all the way like the doctor on the south shore (see sidebar).

As a hygienist, at recall visits I make an effort to praise patients for coming in and being in compliance with their recall schedules. The hope is that patients who are praised for being regular will perpetuate that behavior. I also try to leave patients with a reason for return, or RFR, in whatever recall frequency has been determined. The reason is something very specific that I am monitoring on that individual. I explain it in layperson’s terminology and try to leave them with a graphic vision of the specific area of concern. I know a practice where the RDH makes recall appointments and actually references the RFR in the recall phone call as well as on the recall appointment card - enclosed in an envelope in compliance with HIPAA privacy mandates. These strategies help validate and reinforce the importance of returning.

I have one last potential solution that I encourage all of you to try. I have used it as a consultant when doctors have canceled appointments with me on short notice. It takes chutzpah. The next time you’re face to face with the patient who has burned you, look him straight in the eye and say, “John, I set aside two hours for you on your last visit, and you didn’t show for the appointment. I am a small business owner. I’m asking you to please not do this to me again.”

How would you react if your health care provider said this to you in a sincere, straightforward fashion? The doctor is not asking you to leave the practice or even to make good on the money lost that day. He’s simply asking you to please not let it happen again. I love this one and, as a consultant, I can tell you that it has proven effective for me.

Appointment breakages create headaches, but they don’t have to be chronic. Try some of these strategies and see if they help to make a difference.

Another option: Lay down the law

If you don’t call to confirm, what can be done to curb no-shows? A doctor I’ll call “Dr. Anonymous” on the south shore of Massachusetts does not confirm at all. The doctor decided when he opened his practice that he was not going to get involved with confirming patient appointments. Instead, he trains each patient on his or her very first visit that the appointment is important and that valuable time has been set aside. He warns that the practice will not call to confirm, and the patient is expected to not only remember the appointment, but also be on time.

This doctor takes it one step further. If the patient disappoints on one appointment, he is told that a second chance will be given, but only once. The rules of the practice with regard to broken appointments are repeated to the patient. If it happens again, the patient is asked to leave and find a new office.

This doctor takes a hard line, but he walks the walk. Word spread quickly through the practice that the doctor meant business. Does he lose patients? Yes, some; but most are there because they want to be. His strict philosophy works for him. Mission accomplished.

As a consultant, I have suggested this strategy to many dentists, but most are unwilling to try it.

Eileen Morrissey is a practice management consultant and coach, a speaker and writer, and a practicing dental hygienist in Clarksburg, N.J. Reach her at (609) 259-8008, e-mail [email protected], or visit her Web site at

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