Why We Don’t Come: Patient Perceptions on No-Shows
Open accessAbstract
PURPOSE: Patients who schedule clinic appointments and fail to keep them have a negative impact on the workflow of a clinic in many ways. This study was conducted to identify the reasons patients in an urban family practice setting give for not keeping scheduled appointments. METHODS: Semistructured interviews were conducted with 34 adult patients coming to the clinic for outpatient care. Interviews were audiotaped and transcribed verbatim. A multidisciplinary team used an immersion-crystallization organizing style to analyze the content of the qualitative interviews individually and in team meetings. RESULTS: Participants identified 3 types of issues related to missing appointments without notifying the clinic staff: emotions, perceived disrespect, and not understanding the scheduling system. Although they discussed logistical issues of appointment keeping, participants did not identify these issues as key reasons for nonattendance. Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants' lack of understanding of the scheduling system. CONCLUSIONS: The results of this study suggest that reducing no-show rates among patients who sometimes attend might be addressed by reviewing waiting times and participants' perspectives of personal respect.
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Patients who cancel appointments often have a history of psychosocial problems.
“They often have a history of psychosocial problems too [16,17].”
From The impact of the SARS-CoV-2 outbreak on the psychological flexibility and behaviour of cancelling medical appointments of italian patients with pre-existing medical condition: The “impact-COVID-19 for patients” multi-centre observational study (2021) · cites this paper as [16]
The introduction (section “P”; page not provided) reports that patients who miss appointments often have a history of psychosocial problems. The Abstract distinguishes those no-shows—patients who miss appointments without notifying staff—from patients who cancel, so the passage does not establish the claim for cancellations. (LLM, conf=0.86)
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Appointment scheduling algorithm considering routine and urgent patients
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“Lacy et al. (2004) reports that the probability of a no-show is anywhere from 28% to 45% in spite of reminder calls, emails, transport accommodations, and financial penalties.”
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“Although the overall difference of 11 days may not affect the clinical outcomes of ankle arthritis, longer waiting periods have been associated with more missed appointments and reduced patient satisfaction, contributing to the barriers to access that Medicaid patients face.(10) It is important to note that we assesse…”
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“Age Mean (SD) 46 (9) 45 (8) 47 (8) 45 (8) Range 23–78 23–67 28–64 23–67 Age 40 48 (24) 33 (24) 11 (25) 34 (24) 40–50 89 (45) 66 (48) 16 (36) 68 (47) 50 63 (31) 39 (28) 17 (39) 42 (29) Race Caucasian 21 (11) 14 (10) 4 (9) 15 (10) African American 169 (85) 119 (86) 39 (89) 124 (86) Other 8 (4) 5 (4) 1 (2) 5 (4) Educatio…”
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“We hypothesize that beyond the likely economic benefit, this outreach is an opportunity to engage our most vulnerable patients to build trust [20] and to avoid negative transference by providers with “frequent offenders” [6].”
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“Lacy et al. [26] identified three additional issues: emotional barriers (negative emotions about going to see the doctor were greater than the sensed benefit), perceived disrespect by the health care system, and lack of understanding of the scheduling system.”
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“Additionally, when patients are seen the same day, this eliminates other common reasons for no-show rates, including logistical issues such as trouble getting off work, child care, transportation, and cost.(17) Another reason for the low no-show/cancellation rate could be that patients are seen in a primary care clini…”
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- Authors
- Lacy, N. L.
- Affiliations
- Nebraska Medical Center (US)
- Corresponding author
- Lacy, N. L.
- ORCID
- Lacy, N. L.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2004-11-01
- Volume
- 2
- Issue
- 6
- Pages
- 541-545
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC1466756
- OpenAlex
- W2146444359
- Cited by
- 390
- References
- 25
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 25 · 2023: 21 · 2022: 24 · 2021: 25 · 2020: 32 · 2019: 21 · 2018: 26 · 2017: 17 · 2016: 22 · 2015: 22 · 2014: 26 · 2013: 19 · 2012: 18
- FWCI
- 9.56
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- other-oa
- Locations
- The Annals of Family Medicine (publishedVersion, other-oa)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (submittedVersion, cc-by)
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Healthcare Operations and Scheduling Optimization
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Keywords
- appointment no-shows, missed appointments, patient perspectives, general practice, outpatient care, anticipatory anxiety, waiting time, patient obligations, clinic workflow
- MeSH terms
- Adult, Aged, Ambulatory Care, Appointments and Schedules, Family Practice, Female, Humans, Male, Middle Aged, Outpatients, Surveys and Questionnaires, Urban Population, Qualitative Research
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