Preventing Missed Appointments


Patients Don’t Have “Dental Amnesia!”

by Bruce Stephenson, DDS. FAGD

Missed appointments are expensive! The scheduled time is lost and additional time is also often lost attempting to reschedule the patient. But strategies to prevent missed appointments are often misguided. They are based on a misunderstanding of why our dental patients don’t show up.

There are many good “appointment confirmation services” such as DemandForce, Lighthouse, and many others. They do a good job of sending out reminders, especially for recare appointments made several months in the past. But, while appointment reminders are a good idea, they often only minimally decrease the missed appointment rate. This is because they are based on the mistaken idea that patients “forget” their dental appointments. Dental Amnesia is not the reason patients miss appointments!

Fear is the reason! If we want to decrease our missed appointment, we need to address the three real reasons patients fear … and avoid … our dental office.

The first type of fear is the most obvious. Patients fear dentists and dental procedures. Every dentist knows this. Nonetheless we often fail to alleviate this fear because we do not created sufficient trust. The establishing trust between patient and doctor is the single most important factor in reducing missed dental appointments!

If the patient relates a history of painful past treatment, we need to address it! We need to acknowledge the patient’s concerns. We need to provide reassurance that we will do everything we can to prevent that bad experience with us. “We have some much better anesthetics and techniques today. I can’t promise you I will never hurt you. But I can promise that I will always stop if something is hurting. I will never continue to work if I am hurting you.” This simple conversation recognizes the patient’s fear and assures them that we will treat them differently. Alternately, saying, “This doesn’t hurt” or “You’re not really feeling this,” makes in much less likely the patient will return for the next appointment.

We need to listen to the patient’s chief complaint! If the patient is concerned about the chip on #19, we need to address that concern before we discuss their 7 mm pockets and bone loss! Even though we know the small chip is not really of any consequence compared to the advanced perio, it’s the most important thing to the patient! We need to discuss it first! Acknowledging and addressing (and sometime treating) that patient’s primary concern first goes a long way to establishing trust and rapport. Patient acceptance of extensive, complex treatment is often enhanced by the small step of first dealing with the patient’s chief complaint.

There are many other ways to enhance patient trust, but there are also many ways to destroy that trust. I recently saw an office that refused to allow patients to pay by check. This is one of the clearest ways to signal the patient, “We don’t trust you so you probably shouldn’t trust us, either!” Not surprisingly, this office has a big problem with missed appointments! The patients don’t “forget.” They just do not wish to return to the doctor who does not trust them and whom they do not trust in return. Trust is a two-way street!

Keeping patients waiting is a betrayal of trust. We all run late occasionally and the doctor should personally apologize to the patient when this happens. But I sometimes see offices that double and triple book because they are plagued by missed appointments. So when patients do show up, they are punished by long waits. Those patients feel disrespected and tend to miss future appointments. The supposed “solution” of double and triple booking actually makes the problem of missed appointment even worse!

The second type of fear that prevents patients from keeping their appointment is fear about the benefits of the treatment. “Am I making the right decision to have this done?” “How will it look?” “Will it hurt afterwards?” “How long will this last?” These are often unspoken but of real concern to people when they are deciding about keeping their next appointment with us. What people really want to hear is, “This is the very best treatment, it will look wonderful, feel great and last forever!” But, of course, we can’t make those promises. However, we can say something like, “I think this is the best solution for you. I will try to make it look very natural and usually people do not have any problems after treatment other than a little temporary soreness. With just your normal brushing and flossing, it will probably last you many years.” We have reassured the patient but not made any guarantees or unreasonable promises. Nor have we failed to address the patient’s unspoken fears. We need to spend a little extra time talking “knee to knee” with the patient upright in the chair at eye level. This shows concern and caring. It builds trust. Incorporating a couple simple, reassuring sentences into a treatment discussion makes in much more likely the patient will return for the next appointment.

The third fear the patient has is also often unspoken. It concerns money. “How much will all this cost?” “How much will my insurance cover?” “How do they expect me to pay for this?” We are often too quick to simply give patient the printout from the practice management software. It shows all the excruciating details, line by line in dental-ese, of fees, co-pays, deductibles and insurance benefits. Using this overly detailed print out is a mistake! It distracts the patient with clutter rather than allowing them to focus on the real issue – how can they afford the treatment we are recommending. It’s a miracle if any patient ever returns!

The case presentation and informed consent discussion are done by the doctor (or hygienist) but should be separate from the discussion of the payment options. The payment options present how the patient can afford the treatment. Payment options are a separate focus, usually be handed by a staff person. This discussion covers how the patient can most comfortably fit the fee into a budget they can afford. Separating the treatment presentation from the payment options increases case acceptance and makes it more likely the patient will show up to have the treatment completed.

(There is more information on appropriate payment options presented here.)

In summary, remove the patient fears and reduce their missed appointments! Remember, the patient does not have “dental amnesia.” Sending frequent reminders by email, text messages or telephone calls are not the solution. When we understand and deal with the true reasons dental patients miss their appointments, our patient care is better and our practice is more profitable.


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