Cancel Culture. Enforcing your cancellation policy with compassion.
One of the most dreaded conversations in private practice is the one where a cancellation policy must be enforced. Admin team members will “rock-paper-scissors” over who has to let the patient know they are going to be charged for the missed or last-minute cancelled appointment. Despite the patient reading, re-reading, and stating their acceptance of your office’s policy on short-notice cancelled appointments with a signature when they become a patient, the moment they are informed that they (or their reason) aren’t an exception to this rule, it’s scorched earth retaliation. Few things ignite a one-star Google review like a poorly implemented or communicated cancellation policy.
At The Confident Clinician, we are believers in the value of your time as clinicians. We believe that for you to have sustainability in your practices and provide healthcare with longer appointments, in depth inquiry, and integration of healthcare, your time must be honoured. Further, the owner of the practice has overhead to cover. Patients that cancel last minute result in a loss for the clinic. Losses (whether they be emotional such as burnout from not feeling valued or financial, such as last-minute cancellations) negatively impact a practice’s sustainability. Period.
The issue, as I see it, isn’t IF you have a cancellation policy, nor is it WHAT the cancellation policy is (for the record, I believe appointments not honoured in a 24-hour window are billed at the full amount). The issue is HOW you manage the backlash.
As with everything else in behavioural medicine, communication is key. That communication starts with a clear understanding of your practice’s policy. Whenever possible, your admin team can communicate this policy verbally in addition to the written new patient intake forms the patient signs and accepts. If it’s a dreaded initial conversation, give your team some tools and permission to be honest with the patient pre-emptively: “We have a policy around cancellations and no shows. We really dread implementing it but it’s a hard line and we want you to be clear on the details so you can hopefully avoid it ever affecting you.”
When it comes to the patient who is scorching earth, it’s easy to back down to avoid conflict. But it’s also important to remember that a patient that no-shows or cancels last minute and expects to be rebooked at a time convenient to them isn’t showing up with the respect for you as a professional that I would argue is a mutual exchange of value. There are ways you can support patients with a pivot to virtual or phone calls in the event of an unforeseen circumstance. And if you have a patient that is known as a chronic no-show-er and dismissing them doesn’t feel like the right course of action, you can “B-list” them. Give them times that are typically hardest to fill in your schedule or put them on a last-minute list. Whatever you do, please protect your time, expertise, and reserve your clinical capability for the people who come to their appointment valuing the investment they are making and respecting what you are bringing to their lives.
If you’re feeling like this is a repetitive hurdle, headache, and dread in your practice, below is a script you can modify and provide to your admin team to support them in dealing with the backlash of a cancel culture patient.
“We understand that life happens and so much of what can happen is completely out of your control. Our goal is to deliver the best possible care to you and all of our patients. We do that by reserving a very large block of time relative to what is available in the publicly funded system. That time is also exclusive. No other patients get access to that time. When you book with us you purchase time with a highly qualified clinician who is dedicated to providing care to you and only to you during that time. They have researched for you, they are coming in prepared, and they are focussed on only you.
Because we know that life happens, we ensure that there are options for that time. You can come in person, you can pivot last minute to a virtual or phone appointment, or you can choose to cancel. Regardless of what you choose to do, in a 24 hour window that time is yours.
We cannot fill appointment times that are cancelled last minute. And we cannot continue to provide the quality of care with the clinicians that we have unless we honour your clinician’s time and create a mutual exchange of value. How can we run a practice and keep exceptional clinicians when their time is not honoured?
We hope you understand that our policy is in place to ensure we can continue to deliver the highest quality of care with some of the best clinicians we know.”