Chiropractic + Naturopathic Doctor

The missed appointment

Angelo Santin   

Features Business Management annex

Four steps to managing patient absence

Photo: Fotolia

Chiropractors either dread missed appointments or bury their heads in the sand and ignore them. I believe missed appointments provide us with a great deal of information.

When patients miss appointments they are giving us a sign, or a clue as to how they interpret their chiropractic care. If we ignore these messages it will lead to frustration not only with the patient, but also with the entire office setting.

Let us take a look at a four-step process to reducing missed appointments and managing them with more ease.


Step one: Acknowledge the people that show up
Mother Theresa’s answer to why she doesn’t attend an anti-war rally was simple. She said, “I will never do that, but as soon as you have a pro-peace rally, I’ll be there.” If you focus on the negative you are subconsciously giving energy to it and will, one hundred per cent of the time, create more negativity. This applies not only to you but your staff, as well. Instead, you want to focus on the positive.  

One way to start is by acknowledging the patients that do not miss their appointments and are always on time. Simple compliments would do. We used to have a star system where if they got 24 stars in a row for good attendance they got a high-five or hug.  Make it fun and create some positivity around it.

Step two: Acknowledge the no-show
It doesn’t do you or the patient any good to ignore when they miss an appointment. If you don’t bring it up you are basically saying you don’t care about their care, their results, and your time. It’s a deadly silent message.

All you need to do after they miss an appointment is say “we missed you at your last appointment,” and wait for their response. Let them tell you why. Often, if you truly listen, you will gain a great deal of knowledge about how they perceive their care. For example, if they are running around driving their kids or loved ones around for their appointments and honestly forget, then a simple acknowledgement like, “I understand,” is all you need to do. If there are consistent multiple appointments missed in a row or in series, however, then the patient is sending you a message. That message can be one of many: they can’t afford care; they don’t value their care; they are out of pain and don’t want to be there; or there are scheduling or personality differences. Either way, you want to deal with it promptly before it becomes a bigger problem.

The easiest way to do that is to acknowledge the series of missed appointments with, “I see you have had difficulty keeping your schedule. Any reason for this?” At this point stay quiet and try to listen to what they are truly saying. Sometimes it’s just as simple as they need an end-of-day appointment schedule versus rushing to your office in the mornings. Sometimes it can be more complicated. Either way, don’t downplay it. Acknowledge it by saying you understand and try to rectify the situation.

Step three: Paint the big picture
Often chiropractors focus too much on the missed appointments versus the big picture.  The big picture is really how being off schedule affects their health and their goals.  Whether their goal was to get in shape, run a marathon, play with their grandchildren, or be able to get into a fishing boat again, you must relate the inconsistency of care back to not fully reaching their goals. This has to be done in a caring manner as holding them accountable is really an act of love.

Step four: Be prepared to let go
Some people will just not be the right fit for you or chiropractic. Multiple missed appointments with disregard for your time or your staff’s require firing. At times, I will mention to a patient who is chronically missing appointments that I think we should stop care due to their lack of commitment. For some, this was a wake-up call, as people only value what they sometimes cannot have. For others, it made no difference. Be prepared to have the conversation – your patients will appreciate it.

By following this four-step process, you will find more ease with managing missed appointments and should have to address it far less frequently. This will increase your efficiency and energy in the office, which will let you focus on serving more people in the community. Ultimately that is what personal growth is about – helping you help more people. Good luck!

Dr. Angelo Santin operates a busy subluxation-based family practice in Thunder Bay, Ont., and is president of the Thunder Bay Chiropractic Society. Santin is also a Carter Universal proficiency-rated chiropractic coach. He can be reached at or 807-344-4606.

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