Reducing Cancellations and Broken Appointments: A Practical Approach to Dealing with Chronic Offenders

Use these simple strategies to help you reduce the stress of no-shows in your schedule.

Updated 6/30/20

It’s 10:10 a.m. Dr. Smith marches resolutely to the front desk to see if anyone knows why her 10 a.m. patient has not arrived. The business assistant assures the doctor that she left the patient a confirmation on her voicemail yesterday. The problem is that this patient is notorious for breaking appointments. Over the past five years, five of his appointments have either been no-shows or late cancellations.

Downtime is a serious problem in many dental practices today. It is the great destroyer of profit. Without a patient in the chair, the dentist is temporarily unemployed. If we are honest, we must accept part of the blame, especially with the pesky two to three percent of our patients that are chronic offenders. If we want different results and are serious about reducing the stress that no-shows cause, it is imperative that we employ some different strategies aimed at avoiding the problem.

Defining the Problem and Developing Solutions

Start by finding and flagging your chronic offenders. Discovering that Mr. Davis has broken several previous appointments after he is ten minutes late for today’s appointment is too late! You must be proactive in identifying patients with a history of disappointment. You can use Dentrix to help you keep track of these patients. When you break an appointment for a patient, Dentrix automatically notes the date of the missed appointment and counts the number of appointments the patient has broken. You can view this information in the patient information block in the Family File.

When a patient has begun to show a pattern of missed or late arrivals, flag them with a patient alert that appears when a staff member tries to create a new appointment for the patient.

To create a patient alert, select the patient in the Family File and then click the Patient Alerts button. Click New…. Enter the description and text for the alert and then specify who the alert applies to and when you want it to expire. Finally, select Create New Appointment to display the alert when a staff member schedules a new appointment for that patient.

You’ll need to create new protocols and train your staff to use them when they see the “Missed Appt” alert appear. Your protocols might include the following three ideas:

1. The chronic offender must be informed in a tactful manner that his or her failure to show up for appointments is a problem. For example, when the patient comes in for preventive care and needs to come back for some restorative work, the scheduler could say, “Mr. Davis, we’ve reserved time with Dr. Smith for your needed dentistry. Do you know of any reason why you would not be able to keep this appointment?” The patient will usually reply that the appointment looks fine. The scheduler would then offer, “The reason I ask is that we’ve had a few problems coordinating your busy schedule and ours in the past. I trust that won’t be a problem in the future.”

2. Patients with questionable dependability should not be allowed to pre-schedule hygiene appointments six months into the future. Such patients should be sent a reminder card when it is almost time for their visit with instructions to call the office for an appointment. These patients provide a ready source of patients to fill openings in the immediate schedule.

3. It is unacceptable to leave reminder messages for any patient with a history of cancellations. Office staff must speak with these patients directly, even if it requires a call after regular business hours. To help manage these patients you can create a new appointment status in the Office Manager. From the Maintenance menu, point to Practice Setup, and then click Definitions. Under Definition Type, select Appointment Status, and then in the two fields under Definition Text, type “DIRECT” and “Contact Directly.” When you schedule the appointment for the chronic offender, set the status to your new type.

Staff making confirmation calls will see the appointment status and be reminded that they must speak to the patient directly. Keep in mind that about a third of patients don’t want a reminder call. Another third won’t come without it, and the final third are ambivalent about the call. When you schedule an appointment, ask the patient if he or she would like a “courtesy reminder call.”

If the patient says no, you should say, “Great — I’ll make a note of that. Thank you for being dependable.” You should then change the status on the new appointment to Confirmed. If the patient says a call would be appreciated, you can respond with something like, “Certainly, I’ll be happy to give you a courtesy reminder call. Tell me which phone number to call.” Enter the preferred contact number in the Appointment Notes field so that it is accessible during the confirmation process. This prevents the business assistant from having to call home, work, and cell numbers, leaving the same message over and over.

Finally, you might consider alternative ways to communicate with patients about their scheduled appointments. If you haven’t already done so, begin building a database of patient email addresses and offer email and/or text message reminders. Dentrix makes this kind of communication simple through the Communication Manager, which allows you to automatically generate email and text message reminders.

While it is impossible to eliminate no-shows from our schedules, these strategies can help offices keep downtime to a minimum.

Learn More

For more information about keeping patients engaged with your practice, visit

Read 5 Ways to Keep Your Patients Coming Back for more information about keeping your schedule full.

By Dianne Glasscoe Watterson, MBA, CEO of Professional Dental Management

Dianne Glasscoe Watterson, MBA, is the CEO of Professional Dental Management based in Frederick, MD. Dianne is the author of two books, Manage Your Practice Well, and The Consummate Dental Hygienist. She is dedicated to making good dental practices better through customtailored solutions and practical onsite consulting. Visit the company website at Dianne can be reached at

Originally published in Dentrix Magazine Winter 2013