Failed to attend and late cancellations: a different way of thinking
Across professional forums and WhatsApp groups, the same question appears again and again:
Should a self-employed clinician be paid when a patient fails to attend, cancels late, or was not brought?
It is an understandable question. Failed to attend (FTA) and late cancellation (LC) was not brought (WNB) appointments create frustration, lost income, diary stress, and tension between principals and clinicians.
But I would like to suggest that this may not be the most helpful question to start with.
A better question might be:
What is the patient communicating to us when they vote with their time
Because that is exactly what a missed appointment is. It is non-verbal communication.
If we improve the quality of the question we are asking, we are far more likely to improve the quality of the answer we receive.
When a missed appointment really is just life happening
Some FTAs, LCs and WNB are genuinely unavoidable. Patients are human, and life intervenes.
These can include:
- Genuine illness
- Adverse weather
- Unexpected traffic delays
- Emergencies or events that temporarily sit higher in the patient’s values hierarchy than their dental appointment
- “I forgot to put it in my diary”
- I am overwhelmed by texts and emails and did not properly read the reminders
In these situations, the behaviour is not personal, and it is not a reflection of dissatisfaction or disengagement. It is simply life colliding with dentistry.
Has there ever been a situation when you missed and appointment or cancelled at short notice?
When a missed appointment is saying something more
However, some FTAs, LCs, and WNBs are possibly an expression of something deeper.
They can be a patient’s non-verbal way of saying:
- I do not like or trust my dentist
- I am uncomfortable with what has been suggested
- I feel pushed into this and have not had enough time to think
- I have changed my mind
- I have a concern or hesitation I do not know how to articulate
- I am unhappy or dissatisfied with my care, the service, or the practice
- This treatment is not important to me right now
- I have other priorities for my time and money
- The treatment suggested does not address my wants or needs
- I do not feel listened to or understood
- I do not understand the treatment
- I do not understand the pricing or payment options
When we jump straight to assumptions, we miss the opportunity to learn.
Assumptions versus certainty
One of the most important questions to ask ourselves is this:
Do we really know why this patient did not attend
Or are we guessing?
Finding out the reason behind an FTA or LC is not about blame. It is about insight. Insight allows us to adapt our communication, our systems, and our patient journey in ways that reduce the likelihood of the same pattern repeating.
Every missed appointment contains data. The question is whether we choose to look at it.
Who should be doing the work to understand FTAs and LCs
It is clearly in the practice’s best interest to understand why patients miss appointments.
At the same time, every self-employed clinician is also a business owner. Often, they are the sole clinician, manager, and strategist within their own business. Reducing white space benefits them directly.
This is where collaboration becomes powerful.
Rather than positioning this as a principal versus clinician issue, FTAs, LCs and WNB can become a shared area of responsibility and learning.
When principals and clinicians work together to understand the causes, everyone benefits.
Patient behaviour is a mirror
Patient behaviour is often a reflection of their experience.
Missed appointments can be a mirror held up to:
- Communication style
- Case presentation
- Consent and thinking time
- The patient journey
- Systems and reminders
- Trust and rapport
- Alignment between what matters to the patient and what is being offered
The real question is whether we are prepared to look into that mirror with curiosity rather than defensiveness.
Working together to reduce FTAs, LCs, and WNBs
There are practical, collaborative ways practices and self-employed clinicians can work together, including:
- Joint engagement in collecting anonymous patient feedback around FTAs, LCs, and WNBs
- Shared, honest reflection on what that feedback is telling you
- Shared responsibility for identifying patterns and root causes
- Collaborative approaches to reducing white space
- Consistent and aligned patient communication across the practice
- Shared development and implementation of the patient journey
- Collaborative approaches to marketing and patient engagement
- Joint ownership of diary utilisation and appointment book health
When these conversations are open and non-judgemental, they strengthen relationships rather than strain them.
From conflict to collaboration
The ongoing debate about who should be paid for missed appointments risks perpetuating an unhelpful principal–clinician divide.
There is a more productive alternative.
By creating truly symbiotic relationships, where principals and self-employed clinicians work in close association, we can reduce white space, improve patient experience, and support both the practice business and the clinician’s individual business.
Better questions lead to better answers.
I would be genuinely interested to hear your thoughts and experiences on this.
