Dental hygiene schedules: On with the show, RE: no-shows

Oct. 1, 2012
One of the biggest frustrations in dental practices is the patients who fail to show up for their dental hygiene appointments.


One of the biggest frustrations in dental practices is the patients who fail to show up for their dental hygiene appointments. It happens in my office, and while we use strategies to try to prevent it, nothing appears to be foolproof. Today I will share ideas I have picked up in my seminar and consulting travels that have worked for some practices.

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As much as I love them, members of the millennial generation seem to be our worst offenders. Those in their late teens and 20s simply do not seem to grasp the value of the chair time we’ve set aside for them. In particular, teenagers who are driving themselves to the office are frequently late. This we can live with, but it is the failures that drive us crazy.

To help this group remember to show up, it’s probably a good idea to confirm verbally with a parent, and then follow with a text to the teen or 20-something. Remember that texting is their addiction. We know that at least we’ll reach them, and we can hope that they’ll follow through.

I’m a firm believer in confirming all appointments, and in doing so two days ahead. This gives you 24 hours to refill the chair should you lose the person after you’ve made phone contact. If you are leaving a message (this applies to every generation), why not ask for a call back to confirm receipt of that message? If you get one call back for every three messages you leave, you can have 33% peace of mind. When you text, ask for a text back. Finally, send along an email to finish it all up. I appreciate that this consumes time, but there are systems out there you can invest in to do the job for you.

Do I think this is overkill? No. If a patient complains, we can explain that we understand the overwhelming demands on everyone in today’s busy world, and we do everything possible to help our patients remember their appointments. If a person has a proven track record of keeping appointments and asks us to stop sending so many messages, I believe this should be respected. Conversely, those who have failed appointments can be gently shown their dental record, where all missed appointments are highlighted in red so as to glean an understanding of why the office does what it does.

An excellent telephone confirmation should state the name of the clinician the client will see, with the theory being that it is more difficult to cancel with an actual name and face. Another tip is to make patients aware of how long they will be in the office. Remember, it’s not just “a cleaning and a checkup.” Professional verbiage creates a positive impression.

I’ve started to think that in an ideal world, I should confirm my own hygiene appointments. My batting average is very high when it comes to overdue recall phone reminders because I’m the clinician, and I can personalize. That theory carries over well to phone confirmations, although finding time to call is an issue. Bottom line — whoever confirms should not ever invite the patient to cancel by saying, “If you can’t keep the appointment, please let us know as soon as possible.” Don’t go there. Remember, it is your intent to convey an expectation that the person will keep that appointment.

Having said this, it’s hard not to get upset at those who confirm, call back to say they will be there, and then do not show up because they “forgot.” (When my administrator bangs her head against the wall, I enjoy teasing her and asking why she failed to pick up the patient at his house.)

To charge or not to charge when a patient does not show? My employer individualizes that decision based on patient history. I believe that charging and not allowing the person another appointment until the account is cleared can be effective. Most patients in the practice value our services and will not leave us when we try to recoup something for that appointment time. (Disclaimer: I said most, not all.)

Patients who fail prime-time appointments, such as early morning or late afternoon slots, should not be rewarded for their irresponsibility by being granted additional prime-time appointments. I know of an office in Boston that will only dispense a prime-time appointment after a failure if the patient provides a credit card number and understands they will be charged if they fail to show.

I have three stories to share that are real-world scenarios. First is a story about a New Jersey dentist who was stood up by a particular patient so many times for hygiene and restorative that he no longer cared if the person was in his practice. The next time the patient came in, the doctor was ready with chart in hand. He had a face-to-face confrontation that included red highlights of years of cancellations and missed appointments. The patient was horrified and promised to change, and said he did not realize how frequently it had happened. He vowed to change, and he did so. Confrontation is fearful to many practitioners, but it can work.

The second story is about a dentist in Massachusetts who decided when he started his practice that his administrative staff would not spend time on confirmations. He set a clear expectation at the new patient visit that his office stayed on schedule and provided excellent dentistry and service. In return, he expected patients to show up on time, and to remember their appointments without confirmation. If a patient “forgot” an appointment once, he or she was forgiven. But if that patient “forgot” again, they were asked to leave the practice, and there were no exceptions to the rule. Word spread quickly through the small dental community that this man walked his talk. As a result, he has a practice that runs exactly as he intended, and it is 20 years later. All I can say is WOW!

A hygienist who attended one of my lectures told me this final story I’ll share with you. At the close of each workday, her doctor personally contacts patients by phone who do not show up for their hygiene or restorative appointments. The dialogue goes like this — “Susan, this is Dr. Assertman. I hope you are doing all right. The reason I’m calling is that we reserved time for you today at my office, and for whatever reason you did not come in. Please call the office tomorrow to reschedule, but I’m going to ask that you to not do this to me again. I’m a small business man, and I simply cannot afford it.” He then stops talking!

The hygienist told our seminar group that the impact was amazing. Why? She believes that because it came from the doctor personally, and in such a humbling fashion, that patients were mortified beyond belief. There is no delegation of this task to the front desk administrator. The no-show rate for this practice is astoundingly low. The doctor makes these calls, as needed, on his way home in the car. He refuses to get caught up in a conversation about why or how, and he will leave a message on a machine. It’s short, sweet, and cuts to the chase. Bravo to this man! Here’s a hint. Your tone and your ability to be firm, not accommodating, are supremely important. Why? Because these no-show folks will slither through any available crack.

For the record, I have yet to meet another dentist willing to try this. Would it be as powerful coming from the hygienist? Food for thought, as we continue with this ongoing challenge in our practices. Onward we go; it is in our hearts’ core. RDH

EILEEN MORRISSEY, RDH, MS, is a practicing clinician, speaker, and writer. She is an adjunct dental hygiene faculty member at Burlington County College. Eileen offers CE forums to doctors, hygienists, and their teams. Reach her at [email protected] or 609-259-8008. Visit her website at www.eileenmorrissey. com.

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