In our clinic at St. Christopher's Hospital for Children, we attach a fluorescent golden, 8½-by-11-inch piece of paper to the top of the chart, with the omnipresent title "Missed Appointment" in large bold letters and the options of "send letter to have parent reschedule," "call parent to reschedule," or "doctor will arrange."
A colleague in a private suburban practice told me that she and her staff are surprised when a family doesn't show up for a well-visit appointment. Their anxiety escalates until they make sure the child and family are safe. No-show rates in her practice are in the single digits. By contrast, in larger, inner-city practices, the no-show rate ranges from 20 to 40 percent. In our practice, the no-show rate is close to 30 percent. That's 100 children every day. Almost 24,000 appointments missed yearly. All missed opportunities to discuss and promote health.
The adverse effects of no-shows are staggering. The missed visits put more work on staff who make the appointment, pull the chart, refile it (or record it in an electronic medical record), and reschedule the patient. The no-shows consume valuable slots that other families could use. They reduce a practice's revenue, which is extremely important to inner-city practices, whose payments are already low, due to Medicaid and the State Children's Insurance Program (SCHIP).
It is even more important to the child. Recently I saw a 2-year-old boy for what his parents thought was dandruff. When I told them he had ringworm of the scalp (the ubiquitous tinea capitis), his mother got defensive, insisting that he "doesn't play in dirt" (most ringworm is by direct contact with another child, not dirt).
