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Patients who fail to show up for appointments are a reality in every eye care practice, but the
amount of disruption it causes can vary widely. Here are some tips to reduce the frequency of
no-shows and to minimize the inconvenience caused by them.
Make it your standard practice that staff members confirm all appointments the day before
with a reminder phone call. Since each phone call is short, this task can be worked in throughout
the day during brief slow periods. A check-off list should be kept as a record of who was called
with staff initials. Many of these calls will result in leaving a short message on the patient’s
answering machine. Patients perceive the call as an excellent touch of service.
Consider using an automated voice system for the reminder calls, like 4patientcare.com or other
similar service. I’m usually not big on non-human phone communication, but this system is so well
done that it’s actually impressive to patients. An outbound reminder call is different than answering
an incoming call with a phone menu. The service integrates with your office management computer
Be sure that the confirmation procedure is really occurring. Some staff can view the reminder
calls as a job that only makes tomorrow busier – good for the practice, but more work for them.
The confirmation calls can simply fall by the wayside one busy day and may never be revived. An
office manager should supervise administrative tasks like this to be sure they are being done. If
your no-show rate is still high even though your office confirms, ask a few patients if they
received a reminder call and if they liked it.
If you use a pre-appoint system for patient recall, even more reminder effort is needed.
Many practices send a post card indicating the appointment date and time two to three weeks in
advance (pre-addressed in the patient’s own handwriting for recognition). The patient is asked to
call the office and reschedule if the time is not convenient. Additional phone confirmation is
still needed as the date gets closer, but even with all the effort, pre-appointed patients have a
greater incidence of last minute problems than those who actively call for appointments on their
Some doctors become very upset by no-shows, and some simply take it in stride. One of the biggest
factors relating to this is the number of patients seen per day. Doctors who book appointments
closer together don’t feel a disruption in the schedule like doctors who spread the appointments
out. This is a good reason to review your exam process and consider increasing your clinical
delegation and decreasing the appointment time slot. A no-show in a schedule with 10 patients is
a waste of your time; a no show in a 25-patient day is hardly noticed and might even be welcome.
Many doctors think they simply don’t have enough patients to warrant a busier schedule, but all
they have to do is compress the patients they do have during any given week into fewer days.
Missed appointment charge?
The technique of charging the patient a fee for a missed appointment is occasionally used (we hear
of this frequently with dentists), but I don’t recommend it. Whether the fee is real or simply an
empty threat used to discourage no-shows, I think it’s very hard on the good will we want to
establish. It may reduce no-shows, but it will also reduce the size of your practice. The position
I take with a patient who misses an appointment is to be very understanding and supportive. I’ve
missed appointments on occasion and that is how I’d want to be treated. It happens.
The chronic repeat offender is the bigger concern, of course, but I instruct my staff to be very
patient and tolerant with this group also. It’s part of the nature of working with the public.
If pushed to our limit, we will simply double-book the chronic no-show patient (no need to inform
the person about this – keep it invisible). With an efficient clinical process, it’s not difficult
to work in an extra exam if and when he shows up.
Best wishes for continued success,
Neil B. Gailmard, OD, MBA, FAAO
Editor, Optometric Management Tip of the Week
Dr. Gailmard's new book, Practice Management in Optometry: A Blueprint for Success Based on the Optometric Management Tip of the Week, is now available on Amazon.