The no-show syndrome

Sept. 1, 2000
We have a huge problem in our office with broken appointments and late cancellations. Usually, my schedule is full in the morning. However, I average two openings daily. I have had days where as many as five out of 10 patients do not show up, or else call too late to get another patient scheduled.

What can we do about broken or cancelled appointments in our office?

Dianne Glasscoe, RDH, BS

Dear Dianne,

We have a huge problem in our office with broken appointments and late cancellations. Usually, my schedule is full in the morning. However, I average two openings daily. I have had days where as many as five out of 10 patients do not show up, or else call too late to get another patient scheduled.

The worst offenders are periodontal patients. We give these patients a longer time slot because of anesthesia and the intensity of periodontal therapy. When periodontal patients break their appointments, it leaves huge gaps in the schedule.

We have two front desk assistants. Neither seems to consider the hygiene schedule a priority. They rarely go out of their way to fill a cancelled appointment.

I am paid a base salary plus commission. If my production exceeds a set amount, I receive 25 percent of the excess. Therefore, broken or cancelled appointments do affect my paycheck!

One of my friends is a hygienist in another practice. She rarely has any "down" time. In fact, she says that she often takes instruments home to sharpen them, because she does not have time to do this at the office.

What can we do about broken or cancelled appointments in our office?

Tired of no-shows in Texas

Dear Tired,

Disappointments are a problem in every dental office to some degree. It sounds like your office is approaching the critical level. Let`s examine why patients disappoint to get a better understanding of the problem.

* Ineffective communication.

Patients often minimize the importance of their preventive care appointments because we use terms that minimize the importance of proper oral hygiene. How many times have we heard, "It`s just a cleaning ..." We should never refer to the appointment as a "cleaning" or "check-up." The appointment should be referred to as a "preventive" or "continuing care"

appointment for healthy patients. For periodontal patients, the appointment should be referred to as a "disease control" or "periodontal maintenance" visit. While the patient is in the chair, reference should be made to particular areas that are stable and to those that require careful observation. Impress upon the patient that periodontal disease cannot be cured, but it can be controlled, as with diabetes. Additionally, we do not "book" an appointment. Rather, we "reserve time" especially for the patient.

Another noteworthy point is that we can trivialize the hygiene visit by whizzing through the visit and doing little more than exploring and polishing. (I think I just heard some of you gasp!) Many hygienists have been conditioned to work in an assembly-line fashion - get them in and get them out quickly!

Whatever happened to updating medical histories, taking blood pressures, doing a thorough intraoral exam, periodontal probing, and treating the patient as a whole person? While many hygienists protest that they do not have time, the problem of low value is exacerbated by assembly-line hygiene. Patients aren`t stupid! It would be advantageous to increase the prophylaxis fee and allow more time to be thorough.

On the other hand, I have visited offices that allow plenty of time for preventive visits, but the hygienist still neglects to do those procedures that patients perceive as valuable. The actual scaling is commenced as soon as the patient reclines, with little or no discussion pertaining to dentistry or good oral health. Could it be that some of us get lax after we get out of school?

You mentioned that periodontal patients often break appointments. One reason these patients fall into the "no-show syndrome" is that they do not understand the seriousness of their disease. For example, I have heard doctors say at the initial exam, "Mrs. Jones, it looks like you have a little gum problem. We`ll set you up with our hygienist to take care of that."

However, it does not seem so little when the patient goes out to the front desk and is told that the fee to treat her "little problem" will be $600! It`s easy for the patient to think, "What`s wrong with these people? Four times the cost of a cleaning? They just want my money!"

Periodontal therapy is not a "cleaning." Patients identify a cleaning as something simple. We need to use the correct jargon with patients so they comprehend the seriousness of the disease. Minimizing the problem does not make it go away and actually is detrimental to the patient.

* Fear.

Plenty of people are terrified to go to the dentist because of bad experiences in their pasts. It takes courage for some people to come in to see us.

This is especially true for our periodontal patients. We need to do everything possible to assure our patients that we will take good care of them and that their treatment will be pain-free. We have many good adjuncts (besides the needle) at our disposal to keep our patients comfortable during their visit.

* Financial problems.

Some offices adopt a tight financial policy in response to rising accounts receivable and defaults. The old tradition of patients strolling by the front desk and saying, "Just send me a bill," is virtually unheard of today. Patients are being retrained to pay at the time of their visit. Those with dental insurance are expected to co-pay immediately. Some offices opt out of insurance plans altogether and have the patient pay the full fee and file for benefits on their own.

While these financial considerations are justified, many people do not have the funds to pay for treatment when rendered. When this is the case, patients will often cancel "because of illness" - or some other excuse.

It is imperative that we build value into the appointment so

that patients realize the importance of their preventive visit.

* Patient irresponsibility.

Some people make no effort to remember their obligations. This irresponsibility affects many areas of their lives, not just dental appointments. When a patient proves him/herself to be irresponsible by missing two appointments, he or she should be dismissed from the practice.

* "I forgot!"

Every one of us forgets to do something or be somewhere at some time. Stuff happens. It is habitual "forgetting" that becomes problematic. It is akin to the issue of irresponsibility. Certainly, habitual "forgetters" should be dismissed from the practice. Those patients who have their preventive care appointments scheduled three. four, or six months in advance should receive a card in the mail two or three weeks before the appointment.

* Illness.

Unfortunately, people do get sick from time to time. Illnesses are unpredictable and unavoidable. When a patient calls to cancel an appointment due to illness, the front desk assistant should express "friendly disappointment" and immediately drop the patient a get well card in the mail. A card signed by several staff members and the doctor is a nice touch. If the patient is truly ill, this small gesture elevates the practice in the eyes of the receiver.

Now that we have outlined the causes for patient cancellations, let`s take a closer look at the front desk. In your office, it seems neither front-desk assistant has assumed responsibility for keeping the hygiene schedule full. If your office is a solo practice, one front-desk assistant should be dedicated to hygiene and the other to the doctor`s schedule.

You mentioned that you have an average of two unfilled appointments per day. If you work 200 days per year and the average hygiene visit costs $85, this adds up to a whopping $34,000 in one year of lost production! As you can see, broken appointments can be extremely costly to the practice.

Your friend who rarely has an opening obviously works with a competent front desk assistant, which can mean a huge difference in productivity. Assistants should be responsible for carefully monitoring patients with a history of cancellations and, if necessary, dismiss them from the practice. They should communicate professionally and be responsible for keeping the schedule filled.

Some cancellations are unavoidable. However, these situations should be the exception, not the rule. Accountability, strong communication skills, and diligence are the cure for the "no-show" syndrome.


Dianne Glasscoe, RDH, BS, is an adjunct instructor in clinical hygiene at Guilford Technical Community College. She holds a bachelor`s degree in human resource management and is a practice-management consultant, writer, and speaker. She may be contacted by e-mail at [email protected], phone (336) 472-3515, or fax (336) 472-5567. Visit her Web site at

Curing the no-show syndrome

1. Communicate more effectively with patients. Use vernacular that conveys the scope of their disease. Recognize the sharp line that divides healthy patients from those with periodontal disease.

2. Get off the prophy treadmill and build value into hygiene visits by treating the whole person.

3. Help your patients look forward to a pain-free visit by using whatever it takes to keep the patient comfortable.

4. Monitor and dismiss patients who habitually break appointments.

5. Establish accountability with the front desk assistant to ensure the schedule is filled and appointments are confirmed when necessary.