Patients Cite Top Reasons for Not Showing Up

Approximately 40% of appointments become no shows. Why is that?

It’s a problem that plagues medical practices nationwide: Patients who schedule clinic appointments and fail to keep them. The practice has an entrenched, negative impact on medical clinics; many scramble to fill last minute cancellations with same-day appointments, but that method is inadequate for covering the cost of no-shows.

So why don’t people show up? Research in the Annals of Family Medicine shows the problem is about more than forgetfulness, logistics and healing. In the qualitative study, researchers interviewed 34 patients (32 women, 2 men) of a family practice clinic set in an urban, low-income area to explore issues related to failed appointments.

Three themes emerged from the interviews. A high number of patients (65%) had emotional barriers to keeping appointments, including fear of diagnosis or discomfort. A delay between making an appointment and seeing a physician allowed for a bigger window for emotions to play a role; study participants noted that a medical problem seemed less dire as time elapsed.

Study participants also acknowledged feeling disrespected by the healthcare system, with 44% critical of the inconveniences presented by the system such as referrals, wait times, and feeling like cattle being transferred from one holding pen (the waiting room) to another (the exam room).

Patients often know their complaint history better than the clinician, and this was another opening for discontent among participants. They were frustrated that they’d waited so long to get an appointment, by the time they were examined, the symptoms were less acute.

Considering the fiscal and mental duress caused by no-shows in medical clinics, one finding from the study is ironic: Participants felt that by not coming to appointments, they were doing the clinic a favor. Citing overloaded work schedules of clinicians and frazzled nerves of staff, participants felt that a no-show resulted in extra free time, and thought the clinic would likely be relieved of a time crunch.


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