How Do Clinicians Respond to Patients Who Miss Appointments?

Background: Although patients miss up to 60% ofscheduled outpatient appointments, little is known about howclinicians respond to “no-shows.” In an effort todetermine how clinicians customarily handle missed appointments,we surveyed mental health clinicians and internists at 2 academichospitals: a private psychiatric hospital and an urban generalhospital.

Method: An anonymous questionnaire survey wasmailed to psychiatrists, psychologists, and social workers atboth hospitals and to internists at the general hospital.Clinicians were surveyed about their usual response topsychotherapy, psychopharmacology, and internal medicine patientswho miss appointments.

Results: Among the 356 responses (39.5%) to 902mailed questionnaires, there was substantial variability inclinicians’ reported handling of “no-show” patients,although psychiatrists tended to be initially less active inpursuing patients than were nonphysician therapists andinternists. A number of clinical variables were associated withclinicians’ responses including the perceived risk of a badoutcome, hospital site, support staff availability, and billingpractices.

Conclusion: The results suggest that clinicians’responses to missed appointments are determined by a complexmixture of influences rather than adherence to a readilydefinable “standard of care.”