Sheri's Solutions: 'You upset the wrong person'

"Have you ever 'fired' a patient?" Interesting question. What would be the reasons to dismiss a patient from your practice?

Recently, we had a situation in which we had to send a patient a letter indicating the termination of our professional relationship. This woman had been a reluctant patient at the start, then an infrequent patient, at best. She was in the habit of canceling either the day of, or less than 24 hours before, her appointment. Appointments were rarely kept or canceled. Trying to reach her for follow-up care was impossible. We counted at least seven cancelations or no-shows in the past three years. This patient requested an appointment on a school holiday and she sent a text to cancel on Sunday at 6:28 p.m. for an appointment on Monday at 10:00. At that point, we decided our office was not the best place for this woman.

Sheri B. Doniger, DDS.

Sheri B. Doniger, DDS.

In most offices, there is a 24-hour window required for an appointment change. As a professional, we are respectful of our patient's precious time. We are appreciative of them allowing us to be a part of their healthcare, and do our best to be careful of scheduling appointments in times that will best serve their needs. But, there comes a point, when patients are not respectful of our time, that the discussion needs to be had if our office is the right fit for them.

We confirm our patients with a specific script, indicating time and length of appointment; we also remind them that the time is reserved exclusively for them. We request 48 hours if they have to change the schedule. We also remind them that a fee will be added for missed appointments. As we all know, there are unforeseen reasons that patients have to cancel --- a flat tire, illness, an employer who does not want them to take the scheduled time away --- we are flexible.

When encountering a patient who has consistently not shown respect for our schedule (and has already paid a "failed confirmed appointment" fee), we have to decide whether to cut our losses. At some point, constant no-shows do affect the practice. It is not fair to other patients who are waiting to be scheduled or the office team who may be idle for the hour. (As a reminder, it is always important to document no-shows or last-minute cancelations. Some offices document patient tardiness.)

We sent this patient a letter, explaining the reason of dissolving our professional relationship, stating we will serve as their emergency dentist for a period of several months, along with the final statement. We also included a radiograph transfer form for the patient to complete when she finds a new dentist.

Although the patient requested to be billed for the missed appointment time, she was not a happy camper when she finally received the bill. We heard from one of her co-workers that we "upset the wrong person," and she is not saying pleasant things about our practice. As her place of work is a potential source of new patients for our practice, she is possibly ruining our chances of garnering any new patients from this workplace. The co-worker is aware of the no-show history and does not believe this woman will have a great impact on others. It is still a source of bad publicity for our practice.

The bottom line is, however, that when you let a patient "go," they will tell others their side of the story. They will not say that they didn't show up for several appointments, or they did not make their oral care a priority. Only, that we charged her and don't want her back in because she canceled this one time, for what she felt was a perfectly plausible reason. You can't control the spin from one individual, but be aware that it will be there. Some may have let this patient go earlier, but, as she was working in a place where a cluster of our patients are also employed, we kept hoping her punctuality and her commitment to her own oral care would improve.

I am curious what others do in this situation. There are no hard and fast rules. Nothing is written in stone for repeat no-shows. Every practitioner is different. Is the aggravation of the no-show worse than the former patient bad-mouthing the practice? Remember the saying: Satisfied patients tell three friends; angry patients tell many.

Sheri B. Doniger, DDS, practices clinical dentistry in Lincolnwood, IL. She is currently vice president and president-elect of the American Association of Women Dentists and editor of the American Association of Women Dentists "Chronicle" newsletter. She has served as an educator in several dental and dental hygiene programs, has been a consultant for a major dental benefits company, and has written for several dental publications. You can reach her at [email protected].