The term “no show” refers to an event when a patient who made an appointment to see the clinician, did not cancel, but simply did not come to the appointment, i.e, did not show up.
I think there are several separate questions to be answered with regard to a no show situation.
How can we reduced no shows in the first place?
If you have decided for your clinical practice that you charge for no shows, tell the person this as part of orienting them to the practice in the first or second meeting. Since not all clinicians charge for no shows, it is not fair to charge the person later without having first told them that you will.
What to do if a person is a no show?
Whenever a patient is a no show, briefly document this in the chart. All this needs is the words “No show” or even “NS.” This will allow you to keep track of how many times the person was a no show and also has medicolegal use in documenting that the person missed the appointment.
If the person who was a no show is known to be at higher risk for some type of bad outcome, it is prudent to proactively call the person to find out why s/he did not come, to check on how s/he is doing, and to offer another appointment.
In other cases, most clinicians wait for the person to call to reschedule. The reason given is that the person must take responsibility for his/her own care.
However, if the person does not call within a reasonable period of time, the clinician’s office has to either call or send a letter.
How can we reduce no shows in persons who have been a no show at least once?
1. At the next appointment, don’t start the session by asking what happened last time. The person may be worried that you are going to be angry. By bringing it up later in the session, you make it not about criticism, but about problem solving.
2. Figure out what the reason for the no show was. Did the person forget? Did s/he have something else to do and did not think that coming to your session was extremely important?
3. For persons who have difficulty remembering the appointments:
– When you provide the next appointment, ask if s/he wants it written on a card.
– Especially for person with ADHD, ask in a calm, non-judgmental way how s/he keeps track of appointments. In the smartphone? In a planner s/he carries around?
Encourage the person to put the appointment in the phone/planner right away.
Remember that for some persons (especially those with ADHD, helping them to have a system to remember and keep their appointments is part of the therapy!
4. For persons who don’t seem to understand that coming to the appointments is important
Calmly explain to the person that
What to do if a person is persistently is a no show?
Mago R, Mahajan, R, McFadden, R: Missed appointments: How to help patients to avoid them. Current Psychiatry 6(12):77-78, 2007.
Copyright 2016, Rajnish Mago, MD. All rights reserved. May not be reproduced in any form without express written permission.
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