Opinion: Attending to patients who do not attend - missed appointments deserve clinical attention

Responding negatively to patients who miss appointments is likely to further discourage attendance since their absence may be indicative of deeper challenges.

Dr Adam Polnay who is a consultant psychiatrist in psychotherapy and member of RCPsych in Scotland has written an article on this subject for the BMJ along with his colleague Adam Burley who is a consultant clinical psychologist.

Waiting rooms sometimes display posters tallying up the number of “Did Not Attends” each month, warning about the cost to the service. These signs might be intended to raise awareness, but instead they risk shaming patients. If staff rooms displayed posters listing every clinical detail we ourselves had failed to attend to in the past month, most of us would find this unhelpful, demoralising, and unlikely to improve our performance. Patients are equally unlikely to find this approach helpful or motivating.

Shame is a particularly aversive emotion. In healthcare settings, situations that evoke shame can discourage future attendance, especially among patients who already feel uncertain or mistrustful of services. Some might argue that posters referencing “wasted appointments” could motivate attendance by prompting patients to avoid the embarrassment of missing an appointment. But for patients with more complicated relationships with care, interventions such as posters that are designed generically and not tailored to individual patient differences could have the unintended outcome of deepening avoidance.

For a clinician who has set aside time and prepared for a consultation, it’s understandable that we might feel irritated or annoyed when the patient does not show up, especially if this happens multiple times. As clinicians working in outpatient mental health services, where non-attendance is particularly common, we often experience these responses. The task for health professionals is not to deny our personal reactions, but to process them and, where time and space allow, put them to productive use.

From a psychological perspective, absence can send a message. When someone repeatedly misses appointments they have booked, this might signal a range of problems—including conflicted feelings, fear, or shame around seeking care; a sense that the service is not suited to them; concerns about power imbalance; or limited resources and competing demands—rather than forgetfulness or disrespect. If our outward response is irritation, punitive messaging, or indifference, we risk reinforcing the dynamics that may have contributed to the patient missing appointments in the first place.

Non-attendance can be an indication of deeper difficulties in a patient’s health and in their relationship with healthcare. Rather than framing a patient’s absence as wasted time, we should recognise it as clinically relevant and respond outwardly in ways that keep the door open to care.

Research into “missingness” in healthcare suggests that patients who repeatedly miss appointments often have greater health needs than those who attend reliably. High rates of missed GP appointments are associated with increased premature mortality, a higher burden of illness (especially involving mental health), socioeconomic disadvantage, and adverse childhood experiences such as neglectful care. So this makes it even more important that we find ways to encourage these patients to attend.

It could help to reframe recurrent missed appointments as a meaningful clinical presentation. Instead of dismissing them as wasted slots, we might use that time to think about the patient in their absence and what support they might need.

Dr Adam Polnay, consultant psychiatrist in psychotherapy and member of RCPsych in Scotland, and Adam Burley, consultant clinical psychologist