Staff catering to patients during rush-hour at Aster Hospital in Al Qusais, Dubai. According to many hospitals, the main reasons that patients give for missing their appointments include difficulty in taking time off from work and child care. Image Credit: Ahmed Ramzan/ Gulf News

Dubai: Increasing no shows, late arrivals and long waits for a doctor’s appointment at clinics and hospitals across the UAE are raising concerns over their ripple effects and how they are dealt with.

Clinics and hospitals, which see around 20-30 patients a day, claim that no shows account for up to 30 per cent of their appointments, leading to losses and deprivation of slots to cases that need them most. But punctual patients on their part complain that they end up being punished as the health care facilities accommodate over-bookings and walk-ins to compensate for the no shows.

Ajith Singh Rathore, Operations Manager at RAK Hospital, which sees the maximum no shows in rehabilitation and physiotherapy, paediatric and internal medicine departments, said: “No shows cause difficulty for other patients who are forced to wait or push back appointments. Punctuality is a critical component of the entire service experience and if a patient gets delayed or cancels an appointment at the last moment, it has a ripple effect and impacts those who are waiting and could have been accommodated easily, or those whose appointments are deferred as no slots were available.”

He said the main reasons that patients give for missing their booked appointments include difficulty in taking time off from work and childcare. “Also, they tell us they don’t feel a sense of urgency after their first visit. Sometimes it could be a lack of seriousness on the part of the patient who does not understand the importance of the scheduling system and continuity of care. More importantly, many patients do not understand the significance of follow-up visits.”

Dr Tarek Fathey, Chief Operating Officer at Mediclinic Middle East, which runs 20-plus medical centres and seven hospitals across the UAE, said no shows typically peak during holidays. “The no show rate varies between 20-30 per cent across our facilities depending on seasonality. It is especially pronounced during the holidays as people go on vacation or get busy and forget to cancel their appointments. When we call them, we don’t get a response. We are forced to keep the appointments, but they are eventually not met.”

Some patients contend that doctors themselves are late at times. But hospitals say that this can be expected at times as doctors have to attend to emergencies and as far as possible, they do notify patients of possible delays.

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He said many patients have a tendency of booking appointments with more than one doctor, which also creates a problem. “Let’s say they call one doctor but don’t get a convenient slot. They will still reserve the slot and also approach another clinic for a more convenient appointment. That is fine, but they don’t cancel the first booking.”

Dr Fathey said many chronic patients who make appointments in the long-term also forget dates, making fresh appointments before the due dates.

Dr Sherbaz Bichu, Chief Executive Officer at Aster Hospitals (Mankhool and Al Ghusais), said, “Patients who don’t turn up often tell us that there was no one to bring them to the clinic as the spouse was out at work or that they had to attend to their children.”

He said latecomers also upset schedules. “We advise patients to come 15-20 minutes before an appointment to complete admin work. A typical appointment lasts for 15 to 20 minutes. But invariably three to four out of 10 patients come late. This has a domino effect and is unfair to other patients who come on time. We try to manage the situation but it can be challenging at times.”

Staff catering to patients during rush-hour at Aster Hospital in Al Qusais, Dubai. Image Credit: Ahmed Ramzan/ Gulf News

Patients also contend that doctors themselves are late at times, with specialities seeing a higher probability of this happening. But hospitals said that can be expected at times as these doctors have to attend to emergencies and as far as possible, they do notify patients of possible delays.

But whose responsibility is it to confirm or cancel an appointment?

Rathore said, “The appointment is the responsibility of the patient and we, as health care providers, help the patient take it seriously with strong communication. We maintain a very strict appointment reminder protocol. Personal calls are made to each patient who has fixed a time slot, followed by a reminder SMS with an option to cancel the appointment. Despite such a rigorous follow up, we’ve found that on an average 18 per cent of our appointments are a no-show, and that too without any prior intimation.”

It’s the same case with other health care facilities too.

As for walk-ins being accepted to compensate for no shows, hospitals claimed it has more to do with ensuring access to patients. As Dr Fathey said, “If there’s a walk-in, the patient must be sick enough to make the visit. So we try to accommodate the patient.”

Rampant no shows have also sparked a debate on whether patients should be charged a fee if they don’t turn up or are late. “That is not an option at all,” said Dr Bichu.

“By putting a no-show fee we can potentially alienate our patients, who may have justifiable reasons for turning up late for an appointment, or not turning up at all,” said Rathore.

Also, as Dr Fathey explained, with mandatory health insurance being implemented, levying a cancellation charge is not as simple as it may seem. “Awareness campaigns about the importance of people turning up on time are more effective,” he added.

Here’s what a cross section of the public feels when it comes to a doctor’s appointment:

James Mclean, British, 33

James Mclean

It would definitely frustrate me if someone didn’t show up for their appointment or arrived past their scheduled time. I always try and reach early for an appointment. Patients can at least make a courtesy call to doctors to inform them of their late arrival. People should manage their time more effectively to arrive on time.

Ritesh Gupta, Nepalese, 24

Ritesh Gupta

It is imperative that a person informs the doctor if they are going be late or if it’s a no show. People should keep in mind the inconvenience they might cause to others by coming in late. Personally, I have been made to wait for long for my appointment, despite arriving on time as the doctor was attending to a patient who arrived 30 minutes past his scheduled time. Doctors should give preference to people who come on time.

Sharwari Kale, Indian, 20

Sharwari Kale

Most people don’t show up because of some valid reason. It might be urgent work, last minute problems or even traffic. Hospitals should make an effort to remind patients of their appointments, especially senior citizens, as they have a tendency to forget. With improved technology and apps in play, it shouldn’t be difficult to send a reminder.

Thinely Wangchuk, Bhutanese, 29

Thinely Wangchuk

I always adhere to my doctor’s appointment. In fact, I try and reach at least 15 minutes early so that I can get my work done quickly and make others’ lives easier too. People should be charged every time they miss their appointment, this might ensure people stick to their appointment time. Doctors should also remind patients of their appointments via text or call.

Raunak Purty, Indian, 21

Raunak Purty

I generally arrive late for my doctor’s appointment. The prime reason being that the doctor usually arrives late to his clinic, so there’s no point in coming early. I have been made to wait several hours despite arriving on time, so I prefer going late to my appointment.

Mohammad Sultan, Afghan, 33

Mohammad Sultan

Most hospitals are overbooked, So I don’t think that cancelling my appointment is a big deal. In fact, I think I am doing hospitals and other patients a favour by not showing up. This way people who require more medical attention can be addressed more quickly. A ‘no- show’ here and there shouldn’t affect them.