QUESTION:  How do you deal with a patient who regularly misses appointments?

ANSWER:  A successful chiropractic program is not only dependent upon the doctor's understanding of the patient's clinical needs and application of a sound care plan, but also on the patient's commitment to their own care schedule.  The easiest way to keep patients on schedule is to have them reschedule. The health needs of the patient are the basis for their schedule, and to keep the care plan on track, it is vitally important that missed appointments be made up.  It is best to re-schedule a missed appointment for the same day if possible. 

Be careful not to say that the patient "missed" their appointment as this is suggesting that the patient is in the wrong.  The patient is NEVER wrong!  There are some instances when the clinic schedule might be misleading.   It may be that the patient is in the appointment book more than once or came in for an unscheduled treatment earlier.  Always use caution in approaching this aspect of your relationship with the patient.  When patients do not appear for their scheduled appointments, be prepared to accept their excuses, and not argue in any way, but work to facilitate the most rapid rescheduling.  Remember, getting them back in is the point.

Your staff, not you as doctor, should be the contact point for all discussions regarding scheduling.  It is not necessary for you to get involved in the day to day scheduling issues as it takes up valuable time and can place you in a context that could, in some instances, detract from your clinical relationship and the healing process. You are, however, still the doctor and your intervention may be necessary sometimes, but do so with good sense and not as a matter of routine, as in cases where the patient seems to question the need for care, perhaps on the advice of another provider, or have some other clinical reservation.   Here are some points to consider and some possible responses on the part of the clinic staff:

Too Busy

The patient says he/she is too busy to take time to come in at all this week for a visit.  She says she will call when things slow down a bit.

CA:          "I understand (pause).  I know you are busy, but we would hate to see you lose the progress you've made so far.  The doctor made recommendations for your visits to give you the maximum amount of correction.  Why don't we schedule a consultation with the doctor? Maybe he can discuss a way to fit your visits with your schedule as to not interrupt your progress.  Can he call you at home tomorrow around noon?"

Sometimes the mere suggestion that the doctor will be calling them is enough to get the patient to come in.  Their hesitation may mean that the patient is trying to see if you really believe in the series of care as much as discussed, or that they simply need to be reminded of their responsibility to their health.  Being sincere but firm will get them back on track.  The doctor should be notified if a patient is indecisive about their care.

Refusal To Be Called

The patient says she missed her appointment because she needs to go to the beauty parlor to get her hair and nails done before her relatives come into town.  She says she'll try to come in later in the week.  She insists that your office NOT call her, she'll call you.

CA:       "Mrs. Jones, would it be alright if the doctor gives you a call?"

If she says no, tell her nicely that you will give the message to the doctor.  If this is the case, or if the doctor is unable to reach her by phone, you will need to release this patient by mail.

Forgot

Patient:         "Oh, I forgot that I had an appointment today.  There are too many things to keep track of!"

CA:        "I understand.  But don't forget how important it is to get your care.  We'll set you up for tomorrow to make up for that lost appointment today, unless you can come in later this afternoon.  If you do decide to come in today though, please don't forget."

No Transportation

Patient:  "I got a flat tire and it's just been a big ordeal."

CA:        "Well, we understand.  We'll set you up for tomorrow to make up for that lost appointment today, unless you can come in later this afternoon.  We don't want you to break down like your car did."

Discouraged Patient

Patient:  "I don't think it's working for me.  I don't feel any better than when I started."

 

CA:        "Well, we need to understand further as to why you are not improving as quickly as you feel you should.  Sometimes after long periods of having these types of problems, it takes longer than usual for you to see results.  We may further evaluate your care today when you come in for your adjustment.  I will let the doctor know that you are not improving as quickly as you would like."

These are just a few possible scenarios, but the excuses can be very diverse and range from genuine conflicts to the most incredible and frankly unbelievable excuses.  In the end, it is your educating the patient on the need for care, the nature of your care and the profound health implications of the chiropractic adjustment process that can help you cut through the excuse process by instilling a sound understanding of the powerful clinical relevance of your care.  In the end, like so many things in health care, education and understanding are your best tools to address scheduling problems and issues.