Dear Dianne,
My practice seems to have a lot of problems with patients who cancel at the last minute or just do not show up. My business assistant tries hard to make sure appointments are confirmed, but she ends up leaving lots of messages on answering machines. Our message asks patients to call us back and let us know they got the message. Nevertheless, my assistant estimates that only about 25 percent of patients call us back.
Do you think confirmation calls are effective at helping people remember their appointments? Is it appropriate to require business assistants to call patients after hours when they could not reach them during regular working hours?
Too Many No Shows
Dear Too Many,
Truthfully, I do not know of another profession that goes to the lengths we do to call patients and “confirm” appointments. It’s as though we expect our patients not to come. Is it possible that patients are living down to our expectations? Many practices lose thousands of dollars every year as a result of downtime from no-show patients. Often, we are to blame for setting a bad precedent and not holding our patients responsible for respecting the most precious commodity we have - our time.
Confirming an appointment that a patient scheduled sends the message that we are uncertain if he or she is actually coming. Our thinking should be that when the patient’s name goes in the schedule, that appointment is confirmed. Expect the patient to come, and there should be no necessity to confirm.
The patient population in many offices follows the bell curve. There is a segment (2 percent to 3 percent) of patients who are unreliable. Then there is a large number of good patients who are dependable. Finally, there is an additional segment (1 percent to 2 percent) who are so unreliable that if you schedule an appointment on the same day they call, they will disappoint. I don’t think it is appropriate or profitable to treat all of our patients as though they are unreliable.
There are three categories of patient attitudes regarding confirmation calls:
- Patients who do not need or appreciate confirmation calls. It actually annoys them by interrupting what they are doing or suggesting they are not competent enough to remember their appointments.
- Patients who will not come without the call.
- Patients who are ambivalent. They really don’t care if you call or not.
I have observed business assistants spend copious amounts of time attempting to confirm appointments, often calling three numbers to reach one patient. Most of the time, calls are answered by an answering machine or directed to voice mail. I imagine that some patients are annoyed to hear the same message on their home phone, their work voice mail, and their cell phone.
Instead, ask patients if they would like to receive a courtesy reminder call. If the patient answers “no,” your business assistant should say, “Great! I’m making a note of that. Thanks for being dependable,” or “We so appreciate your being reliable!” If the patient answers “yes,” then the business assistant should say, “Sure, I’ll be happy to give you a courtesy reminder call. Your appointment is Wednesday, May 10 at 3 p.m. I’ll be placing the call Tuesday, May 9 between 8 a.m. and 5 p.m. Which number would you prefer that I call? Will this call be going to voice mail?” This conversation stresses to the patient that:
- this is a courtesy we extend to them;
- this call is important; and
- the call should be expected during a particular time.
First, we need to improve our communication with patients by changing some of our standard verbiage. Let’s stop “booking appointments” and start “reserving time.” A call to a patient would go like this:
“Hi, Mrs. Jones. This is Mary from Dr. Hall’s office. This call is a courtesy reminder about your reserved time with Dr. Hall on Wednesday, May 10 at 3 p.m. We’re looking forward to seeing you then.”
Some business assistants ask patients to “call back to let us know you got this message.” Asking patients to call back seems punitive and unnecessary to your good, reliable patients, plus the extraneous telephone calls interrupt busy front desk assistants while they are assisting patients. As your assistant has noted, few people call back anyway.
Nevertheless, every rule has an exception. Patients who have historically demonstrated that they are unreliable should be treated differently. The key is early identification of such people. Chronic offenders should be called two business days before their appointments, and the message to an answering machine would go like this:
“Hi, Mrs. Jones. I’m calling regarding your reserved time with Dr. Hall on Wednesday. Would you please return this call within the next 24 hours so that I may speak with you directly? Our number is ________.” (Please say the number slowly, and repeat it.)
Chronic offenders have proven they are unreliable, so it is vitally important that someone speak with such patients one on one. Answering machine messages are not sufficient. If a patient does not call back, someone should take the patient’s phone number home and call after regular business hours. If the patient questions why he or she was asked to call the office, the business assistant should say, “Your record indicates that there have been past problems coordinating your busy schedule with ours, so that is why we needed to speak with you directly. We so appreciate your help with this.”
Consider this: People who prepay for their dentistry do not cancel. Asking for an amount of money ($200) or a credit card number to hold the time in the schedule is good business practice in scheduling patients with histories of no showing. Anytime I reserve a room in a hotel, I have to furnish a credit card number. If I do not show up, they will charge my card for a one-night stay because they held that room especially for me.
If you want to impress your tech-savvy patients, use e-mail and text message reminders. One of my favorite companies is Smile Reminder (www.smilereminder.com). You can go to the Web site to see a demonstration and get a free, 60-day trial. You can also send birthday greetings or announcements. It’s just one more way to communicate with your patients.
In closing, consider your time as the most valuable thing you have. Start holding people responsible for the appointments they schedule. Consider dismissing from your practice any patients who refuse to respect your time by being unreliable. Open up and expand the communication from the front desk when scheduling appointments. Remember, some disappointments are completely unavoidable. Nevertheless, these situations should be exceptions, not the rule. Accountability, strong verbal skills, and diligence are the keys to avoiding disappointments.
Best wishes, Dianne
Dianne Glasscoe
Glasscoe is a speaker, consultant, and writer for the dental industry with more than 30 years of experience. She is CEO of Professional Dental Management, Inc., in Frederick, Md. You may reach her at (301) 874-5240, [email protected], or visit www.professional dentalmgmt.com.
