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Appointment No-Shows as a Symptom, Not a Diagnosis

May 4, 2023

Family Connections with Pediatrics Blog

In this month’s Pediatrics, “Reimagining No-shows as a Symptom and Not a Diagnosis: A Strength-based, Trauma-sensitive Approach,” by Brissett et al challenges us to look at a common practice policy in healthcare settings (10.1542/peds.2022-057590).

What is a “no-show?”

The authors write that “no-show” is a business label for a person who fails to attend an appointment, which results in lost income for the institution and longer wait times for other patients. While systems need to prevent no-shows, decrease loss, and increase efficiency, the authors point out that the approach of treating someone who cannot make their appointment as someone who should be punished for bad behavior can create a barrier and often creates harm for those who face the most healthcare inequities. The authors call on healthcare to move beyond this model and honor patients as people.

What is in the article?

“Another “no-show”? I wish Dee took her diabetes seriously. I can’t care more about her than she seems to care about herself.”

What if we stopped there and never asked the question- why was Dee a no-show? Then, as the authors tell us when they share about this patient in the article, we would miss that Dee is 18 and has been homeless since she aged out of foster care. There is a lot on her plate. She used to get help from case managers- with medicine, care, and appointments. Now she is on her own and must use the emergency department (the ER) for care. She used to have a place to live. Now she is on her own. She used to have stability and support. Now it is gone. Shelter staff tried to help make a new appointment but were told by the clinic that she had too many no-shows, so she needs to find a new doctor. 

The article explores ideas around:

  • How healthcare can use a patient and family-centered approach and remove barriers to building trust so as to ensure every visit is a “show”
  • The need to train healthcare providers on social and economic aspects of life, biases, and inequities that shape health and illness long before the patient enters the office
  • How to find out about, and then help with, the “because” behind the no-show

What can you do with this article?

  • The article is for all of us- patients, families, and providers, no matter the age. It reminds us how important it is to communicate. Ask a question that gets to the ‘why’; do not just label.
  • If you have a role as a family partner, family advisor, or family leader who works with healthcare facilities, share this article to talk about “no-shows” and other policies or practices that may create barriers.
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