Showing Mercy to No Shows

Q. In my medical practice, patients often fail to show up for an appointment, show up too late for a complete treatment to be given, or cancel at very short notice. What am I entitled to do? 

A. No-shows and late cancellations can be a very frustrating as well as expensive experience for professionals. Yet for ethical as well as practical considerations, it is important not to over-react.

For instance, it would be wrong to turn this phenomenon into a source of income. If a missed appointment doesn't lead to any lost income, because you overbook or are able to find another patient who can come in on short notice, it's wrong to "double dip" and also collect a fee from the no-show.

It's also inappropriate to penalize people for circumstances beyond their control. If a particular patient took the same steps as others do to arrive on time but was unexpectedly delayed, for instance because of a late train (in an area where the trains are usually on time) or due to illness, it's unfair to charge them even though their tardiness caused a loss for the clinic.

But when patients miss appointments due to negligence and their absence or tardiness result in lost income, it is permissible to charge them. Even in this case, it's not fair to charge the full amount, because the idle time of the staff is usually exploited in some way. The practitioner and any support staff usually take advantage of "dead time" for paperwork, phone calls, or for some much-needed rest, and this needs to be taken into account. Remember also that the poor client didn't receive any service. Rabbi Aaron Levine has suggested that charging half the usual fee is an equitable solution in this case.

The same principle applies to a "late show" that enables partial completion of the work. If the tardiness is due to negligence and causes a loss of income, then you are entitled to recover some of the loss.

Of course, you should be sure your clients are notified that they may be charged for missed appointments. Some clinics announce a uniform fine for any appointment that is missed without giving advance notice; but given the importance of the criteria we have just mentioned, such a policy is likely to be unfair in many cases.

Consider also that charging for no-shows can be problematic for both ethical and commercial reasons. This policy can lead to significant ill will and could harm your business. If you apply the policy uniformly, then you will inevitably end up alienating some loyal but occasionally careless patients; if you apply it unevenly, you will open yourself up to charges of partiality.

I would suggest trying to think of some non-monetary sanction you could apply. Perhaps you could sentence latecomers to less desirable appointment times; or you could offer incentives and discounts to patients with exemplary on-time records. Another solution is to give discounts to patients who are willing to come in on short notice to substitute for a no-show; this could reduce the loss in income due to this phenomenon, especially if there are a fair number of patients who live or work nearby and have flexible schedules.

One more thought: if your practice has an unusual number of cancellations, try and find out the reason. Perhaps your patients are ambivalent about the effectiveness of the treatment you provide, or find it unpleasant or painful. Perhaps it is your conduct, and not that of your patients, which requires modification!

SOURCES: Shulchan Arukh Choshen Mishpat 333; Case Studies in Jewish Business Ethics by Rabbi Aaron Levine.