The No-Show

Some time back, the parents of an 8-years old Indian-origin boy from Dubai came to me to get a bone tumor in the left hip treated.

A tentative date was fixed for the surgery after a detailed con-call with the parents who had returned to Dubai. My coordinator, S, took over and he was in touch with the father up to two days of the appointment date.

The evening before the procedure, the team normally interacts with the patient or relatives to go through the protocol one last time. S was unable to get in touch with the father, both on his Dubai as well as on his Indian cell number. Our standard policy in such situations is to cancel the appointment. In this case, since the patient was a child and was coming from Dubai only for this, I made a judgment call to keep the appointment. When I reached the center the next morning, I found the patient had not turned up. When the team tried to contact the father and he refused to pick up his phone, I canceled the procedure. I asked S to email the father one last time, just in case they were stuck or in some difficulty…there was no reply and there hasn’t been till date.

This happens with doctors all the time. The operation theatre (OT) is booked, the team is ready with if necessary, special instrumentation…and the patient just does not turn up.

Doctors are human as well and not immune from the emotional storm a “no-show” kicks up!

First, there is anger. What an a@@ole! How could the patient be such a *@&#*! If he was shopping around and checking rates and expertise levels, couldn’t he have had the decency to call or email and say that he was going somewhere else and spare us all this trouble?

It then raises self-doubts! Did I fail to create a congenial atmosphere where he could have trusted me to at least tell me he was going somewhere else? Am I not the best for this particular procedure?  What happened that changed his trust and faith in me? What did I do wrong? Do people now perceive that I am not good enough?

And then after some time, comes the acceptance of the fact that people are people, and especially as patients, and that too when the patient is a child, unpredictable and sometimes irrational as well.

It is a patient’s right to take multiple opinions especially in complicated situations or when the condition is uncommon or unusual and requires special expertise or experience that just a few possess. A patient then makes a choice to go with a particular physician or surgeon based on a combination of faith, personal comfort levels and some subjective assessment of the doctor’s abilities.

But if a patient has made multiple appointments or fixed dates for procedures or surgeries, it is common courtesy to inform all the others that he won’t be coming, once the treating doctor has been decided. And it’s not as if doctors work like Sicilian mafia cartels and will make a patient’s life miserable if he goes somewhere else.

In the days before cell-phones and email, people often had the excuse of not being able to communicate with doctors in time. Today, that is no longer an excuse.

Doctors are humans too! And common courtesies work both ways. If doctors are expected to be upfront, empathic and nice, patients also need to respond in a similar manner. Not being a “no-show” is a good place to start!

18 Comments

  • 100% agree. By booking the whole thing, he actually deprived someone else who needed it more just because the appointment was given. This is disgusting….. And then they come and complain that….. Forget it. Just rant, rant and more rant.

  • H.L. Chulani wrote:

    Sorry Bhavin, there is more to this- how come this has not happened to me! Not boasting, but most times doctors show undue eagerness in not losing a patient to another which (vibes?) the patient feels and decides to wait or choose another doctor. Maybe ‘S’ did the same on your behalf since he would also benefit if the patient did come! This is naivete at its best!

  • Bhavin Jankharia wrote:

    Seriously don’t understand what you are trying to say Dr Chulani. The only mistake was not taking an advance.

  • V.Subramanian wrote:

    This must be an “one-off” experience.While there is no excuse for non communication,it is difficult to visualise “no show” without communication as a routine occurance especially in a country with the ratio of 1 Doctor for 1700 patients.Juxtapose this with my experience of waiting for an ortho consultant,who after confirming the 3.45 appointment turned up after one hour and 10 mts and offered no apology.He had clarified that he was within Chembur and had no surgeriy scheduled.When I told him about this long wait and our time is equally precious he still had nothing to say.Every time I enquired with the receptionist,she would call him and report back he is on the way and would be there in 5- 10 mts.Yes he finally showed up.Though I cannot say that this is an “one off” experience.

  • Taral Nagda wrote:

    Bhavin I remember what Isha sharvani said in an interview with indian express once : whatever came to me was meant to me Whatever did not come was never mine
    It is about 80: 20 principle in life 80 percent patients respect our knowledge, commitment, time be good to them and enjoy their love and faith and be happy
    The other 20 percent are indecisive and do not have respect for what you can do be and be happy if they do not come to you

  • Bhavin Jankharia wrote:

    That Taral is fine but the problem occurs when someone from the 80% creates problems.

  • Bibhas DasGupta wrote:

    I agree. The “no show” has happened and will happen. That’s one of the reasons surgeons and some hospitals insist on admission the night before. In any case, there is absolutely no reason for not informing the doctor and wasting valuable lesson and scarce OR time and resources.

  • Sujata Morab wrote:

    In such cases do what a tailor, electronics storekeeper etc. will normally do. Ask for an advance as preparation fees. That way they will surely turn up.

  • Bhavin Jankharia wrote:

    Sujata. Have started doing that. For this patient it was just a logistical issue getting the advance done.

  • M R Sundaram wrote:

    There are ‘no show’s & ‘late show’s with or without apology/communication in each walk of life! Let us hope they are ‘exceptions’ and not the rule! Deterrants could be created to discourage it? Orelse, just grin & bear it?

  • dushyant bhatia wrote:

    i dont agree with most of the comments above. What ever the reason of a no show, basic courtsey demands that other party should be informed. I agree the solution given by Sujata. Infact airlines hotels & have started penalizing for no shows which ironically has also become a good source of alternate income and surely a deterrent to such people.

  • I agree with Mr,Chulani”s comments.Doctors are here today esp in Metros/cities/urban areas to fleece/suck blood of unsuspecting patients.Believe it or not I know of cases where patient after agreeing for major surgery has opted out for 2 reasons.second opinion /paucity of funds/no trust with the surgeon peroming surgery or defer for a future date.Doctors know one thing spin MONEY Let patient try/test h/h own destiny.In todays world one can count with fingers the number of Docs working with ethics/devotion for the patient”s wellbeing and permanent cure.Even in high end Hosp.there is outward glamour/parafernalia w/o any concern for rhe patient.All patients can not be at the mercy of these cunning/hungry Docs just for MONEY!

  • Only one”s good deeds and good time coupled with good luck can get/land to a good doctor for advice/treatment.Some doctors are doing trial and error method on patients.No wonder some pvt clinics/hospitals are rampaged by angry public/relatives/friends when their kin/relative lose their life when Docs do not assign any cogent reason for death of the patient.

  • Vaibhav Dedhia wrote:

    This happens frequently with me when I book my pts for cath. Just yesterday I booked a Yemeni national for an angiogram. After spending a fair time explaining the procedure, costs involved we confirmed a booking for 8 am. The patient simply didnt turn up and getting a cath slot on saturday is a pain because its a half working day. Plus my entire day was pre scheduled with other appointments till 3pm with no break. I was so put off because there was no way I could reach them, nor did they cal to say they were not coming. But losing my temper would be harmful to me…soI proceeded as planned for the day after waiting half an hour. Perhaps we should have a system in place like the hotel industry which blocks a certain percentage of the total cost to give a confirmed booking. But this would be perceived as in medicine as harsh , because we deal even at an emotional level with ourpatients.

  • I completely endorse Mr. Laxman’s comments, and fully agree with what he also states in the second one.
    I actually came on line to make this statement.
    Dr. Bhavin, I am surprised that the school which gave u your basic education, did not teach u to have a little bit of COMPASSION.
    Because I have a number of friends from the same school u attended(we were foes on the field, but once out were very good friends). They are very much different from your kind, even today. And mind u some are in top positions, but oh so humble.
    Guess u may have come from the later batches, where the standard did fall.So I guess I can’t blame U’
    One thing I give u credit that u have some sportsman’s spirit in U, as u still keep me on your list, in spite of me being critical of u at times.
    While I am not afraid of the little puppy who comes now and then wagging his tail when u come on Fridays, and barks (meows actually) at people like me, who calls a spade a spade. I am sure u have some backbone and don’t need anyone to defend u.
    And that u are not paying him to do so. So kindly advise him to do his bit, that is comment and keep his advice to himself.
    Or maybe I will have to note, that the cap suits him in a way and a nerve touched somewhere down the line.
    The others refrain from taking a stand, as they feel it is not worth the time, but I like to throw ……………….now and then to people who don’t mind their own business.
    U have graciously given us a platform to post our comments, so kindly take it in the right spirit.
    Thank U.

  • Bhavin Jankharia wrote:

    Honestly Norman I have no clue what you are trying to say.

  • Prakash Nanavati wrote:

    Bhavin – I agree with your last post of 6th Oct.

  • Prakash Nanavati wrote:

    …and also maturity shown by you in your reply.

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