Am I the only doctor with common sense? (Letters to the Editor).

Editor:

Many doctors in independent practice still can make policies and procedures that guide the workings of their practices. On one such issue, I sometimes wonder whether I am the only doctor in the country who has any common sense.

About 5 years ago, I posted a notice at the checkout desk at my office that states, "A charge will be made for all broken appointments unless a 24-hour notice is given." For me, this was a practice epiphany, and I am puzzled that more doctors--in fact, all doctors--do not post similar notices and include them in their office brochures. I would like to suggest most strongly that all doctors establish the above cancellation policy as a commonsense business practice and to promote ethical conduct on the part of patients. The reasons I say this are as follows:

1. In the AMA Code of Ethics, it states, "Patients generally have a responsibility to meet their financial obligations with regard to medical care," and, "Patients should be cognizant of the cost associated with using a limited resource like healthcare and try to use medical resources judiciously."

Around the country, doctor appointments are in short supply. Many patients have to wait weeks and sometimes months to obtain an appointment. Patients who are no-shows or late cancellations are not meeting their financial obligations regarding medical care and are clearly not using the medical resource of medical appointments judiciously. Patients, in these circumstances, are abusing the privilege of making an appointment and are abusing the limited medical resource of appointment slots needed to care for sick people. The widespread practice of medical offices' charging for no-shows or late cancellations would prompt patients to act ethically.

2. It is also clearly stated in the AMA Code of Ethics that "it is clearly ethical and appropriate to charge a patient for a missed appointment or for one

not cancelled 24 hours in advance."

3. It is commonplace for many businesses, such as hotels or airlines, to require payment if a person is a no-show for a reservation. As we are all aware, if you book a hotel room for late arrival, the hotel insists on having your credit card number and, in fact, charges you if you do not show up.

It is also commonplace in the dental profession for no-show patients or those making late cancellations to be charged if they abuse the appointment privilege. This even extends to masseuses, who will charge clients for missed appointments, because their lifeblood is having people show up for massages.

4. Establishing and enforcing a late-cancellation or no-show policy also helps the morale of the medical office staff. My office crew works hard when answering phone calls from patients for appointments. They make extraordinary efforts to accommodate patients' needs and determine who needs most or least urgently to be seen.

In addition, as we are all aware, when a patient calls in to make an appointment, the office staff exerts a lot of effort to find out what the patient's insurance is and whether that patient requires a referral, and to take care of all the little details involved in a single appointment. Therefore, a noshow or a late cancellation is not just a dollars-and-cents issue. In fact, it is almost an insult to the office personnel who have gone to great efforts to make an appointment.

I have had much better office morale since I instituted my policy of charging for no-shows or late cancellations. It lets the office personnel know that the patients are not going to abuse them or me.

When patients do not keep their appointments or cancel late, I have the office staff give me their charts for review. If these patients have reasonable or valid excuses, then I will consider not charging them. I do likewise for postoperative patients. I am cautious about this, but I almost routinely charge a nominal amount, such as $25. This informs patients that our time is valuable and that they are abusing the privilege of making an appointment and using a health resource.

This policy has virtually wiped out my chronic no-shows and late cancellations, permitting me to take care of patients who truly need my services by freeing up appointments for sick people.

I believe that doctors should not tolerate no-shows and late cancellations. By establishing a no-show policy across the country, physicians would encourage patients to act ethically and not inappropriately use the healthcare resource of patient appointments. I personally think it's the only logical and common-sense thing to do.

Thomas F. Gumprecht, MD, ABIM, ABO 

Diplomate, American Board of

Internal Medicine and Otolaryngology

Redmond, Washington