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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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“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]
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“Reasons for missing traditional clinic visits have been previously established and include emotional barriers, a perceived disrespect of one’s beliefs and time by the healthcare system, and a lack of understanding of the scheduling system.(13) However, a lack of data exists regarding why patients miss their telehealth…”
BackgroundQuality deviations in cancer diagnosis: prevalence and time to diagnosis in general practice
Jensen, H., Nissen, A., & Vedsted, P. (2014) · British Journal of General Practice · doi:10.3399/bjgp14x677149 · Cited by 35
Lenzi, H., Ben, Â. J., & Stein, A. T. (2019) · PLoS ONE · doi:10.1371/journal.pone.0214869 · Cited by 35
Virtual Versus In-Person Visits and Appointment No-Show Rates in Heart Failure Care Transitions
Gorodeski, E. Z., Moennich, L. A., Riaz, H., Jehi, L. E., Young, J. B., & Tang, W. H. W. (2020) · Circulation Heart Failure · doi:10.1161/circheartfailure.120.007119 · Cited by 35
Predicting no-show appointments in a pediatric hospital in Chile using machine learning
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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.”
BackgroundFactors of missed appointments at an academic medical center in Taiwan
Tsai, W.-C., Lee, W., Chiang, S., Chen, Y., & Chen, T. (2019) · Journal of the Chinese Medical Association · doi:10.1097/jcma.0000000000000068 · Cited by 34
Janssen, A. L., Fletcher, J., Keep, M., Ahmadpour, N., Rouf, A. S., Marthick, M., & Booth, R. (2021) · JMIR Serious Games · doi:10.2196/29579 · Cited by 34
“Nonattendance at scheduled appointments is a known burden on health care organizations [41].”
Using outreach to involve the hard-to-reach in a health check: What difference does it make?
Sinclair, A., & Alexander, H. A. (2011) · Public Health · doi:10.1016/j.puhe.2011.11.004 · Cited by 34
Developing a Performance Data Suite to Facilitate Lean Improvement in a Chemotherapy Day Unit
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Zonneveld, L. N. L., van Rood, Y. R., Timman, R., Kooiman, C. G., Spijker, A. V., & Busschbach, J. J. V. (2012) · PLoS ONE · doi:10.1371/journal.pone.0042629 · Cited by 34
“Feeling disrespected is a factor that is known to influence un-notified no-shows [75].”
BackgroundDesign-Led Service Improvement for Older People
Wolstenholme, D. (2010) · Australasian Medical Journal · doi:10.4066/amj.2010.377 · Cited by 33
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Qu, X., Peng, Y., Shi, J., & LaGanga, L. R. (2015) · International Journal of Production Economics · doi:10.1016/j.ijpe.2015.06.022 · Cited by 33
Gromisch, E. S., Turner, A. P., Leipertz, S. L., Beauvais, J. E., & Haselkorn, J. K. (2019) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2019.101513 · Cited by 32
Health Provider Determinants of Nonattendance in Pediatric Otolaryngology Patients
Cohen, A. D., Kaplan, D. M., Shapiro, J., Levi, I., & Vardy, D. (2005) · The Laryngoscope · doi:10.1097/01.mlg.0000175202.50499.63 · Cited by 32
Embedding a Psychologist Into Primary Care Increases Access to Behavioral Health Services
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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…”
BackgroundBriatore, A., Tarsetti, E. V., Latorre, A., de Quirós, F. G. B., Luna, D. R., Fuentes, N. A., Elizondo, C. M., Baum, A., Serena, M. A., & Giunta, D. H. (2019) · The International Journal of Health Planning and Management · doi:10.1002/hpm.2890 · Cited by 31
Stratifying no-show patients into multiple risk groups via a holistic data analytics-based framework
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Patient-perceived health service needs in inflammatory arthritis: A systematic scoping review
Segan, J., Briggs, A. M., Chou, L., Connelly, K., Seneviwickrama, M., Sullivan, K., Cicuttini, F., & Wluka, A. E. (2017) · Seminars in Arthritis and Rheumatism · doi:10.1016/j.semarthrit.2017.10.019 · Cited by 31
“(18-27) A key question is why should these patient-centred components of care and outcomes be any different in the context of inflammatory arthritis? Relative to the vast majority of chronic health conditions that are more prevalent with ageing, inflammatory arthritis typically affects younger people, most often when…”
BackgroundNo-Show Modeling for Adult Ambulatory Clinics
Türkcan, A., Nuti, L., DeLaurentis, P.-C. C., Tian, Z., Daggy, J., Zhang, L., Lawley, M., & Sands, L. P. (2013) · International series in management science/operations research/International series in operations research & management science · doi:10.1007/978-1-4614-5885-2_10 · Cited by 31
“Reasons related to patient health status include being physically or mentally ill (Bowser et al. 2010; Collins et al. 2003; Defife et al. 2010; Gany et al. 2011; Lacy et al. 2004; Peeters and Bayer 1999; Potamitis et al. 1994; Sarnquist et al. 2011) and feeling better and not needing the appointment any more (Corfield…”
BackgroundOverbooked and Overlooked: Machine Learning and Racial Bias in Medical Appointment SchedulingPreprint
Samorani, M., Harris, S. L., Blount, L., Lu, H.-B., & Santoro, M. (2020) · Manufacturing & Service Operations Management · doi:10.2139/ssrn.3467047 · Cited by 97
Understanding the causes of missingness in primary care: a realist review
Lindsay, C., Baruffati, D., Mackenzie, M., Ellis, D. A., Major, M., O’Donnell, C. A., Simpson, S. A., Williamson, A. E., & Wong, G. (2024) · BMC Medicine · doi:10.1186/s12916-024-03456-2 · Cited by 35
“…beneficial, or provider and patient are “misaligned” ([11], p.4) in their understanding of the causes or solutions to health problems, or of the format or purpose of appointments, this might increase the sense that future attendance is of limited value [11, 50, 62, 64, 71, 83, 86, 93, 102, 103].”
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Alhamad, Z. (2013) · International Journal of Medical Science and Public Health · doi:10.5455/ijmsph.2013.2.256-265 · Cited by 30
“misused resources such as ward capacity and possible misuse of patients’ time.[5-8,10,11] This puts an extra load on the health care system and costs”
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Moscrop, A., Siskind, D., & Stevens, R. (2012) · Family Practice · doi:10.1093/fampra/cmr053 · Cited by 30
A dynamic approach for outpatient scheduling
Creps, J. R., & Lotfi, V. (2017) · Journal of Medical Economics · doi:10.1080/13696998.2017.1318755 · Cited by 30
Crable, E. L., Biancarelli, D. L., Aurora, M. N., Drainoni, M., & Walkey, A. J. (2020) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.13496 · Cited by 29
Closing the gap: addressing telehealth disparities across specialties in the sustained pandemic era
Amagai, S., Vonesh, E. F., Adams, J. G., & Luo, Y. (2024) · npj Digital Medicine · doi:10.1038/s41746-024-01201-w · Cited by 30
“Previous research has identi fi ed common reasons for no-shows, including access barriers such as cost and transportation, and other factorslikeforgettingappointments,workcon fl icts,childcare,andlongwait times 6,7 .”
Toward a better understanding of dental appointment‐keeping behavior
Lapidos, A., Shaefer, H. L., & Gwozdek, A. E. (2015) · Community Dentistry And Oral Epidemiology · doi:10.1111/cdoe.12193 · Cited by 29
Metadata
- 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
- Social Sciences › Decision Sciences › Management Science and Operations Research › 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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