From a Psychiatric Times article dated October 8, 2013:

Doctoring to the No-Shows
 
I’ve discovered that perhaps the best measure of how well we’re caring for a population of patients—how effective our system is, and I am, at delivering community medicine—is the answer to one simple gut-wrenching question: “How relieved am I with a no-show?”
 
http://tinyurl.com/ks2apy2
 
Gut reaction?…relief? One less note. Opportunity to catch a break. Catch up on work. etc.
 
But do you know what happened to the no-show? Why he or she was a no-show?
 
The article suggested to me that in this particular context monitoring was somewhat remiss.
 
We’ve seen some references recently to “the good, the bad, and the ugly.” I suppose that patients fall on a continuum as to “good” v. “bad” reasons for not showing. There are those who are indifferent, ambivalent, feel pressured to attend, don’t pay or are behind or careless in making payments, and not getting along with the therapist or perceive no benefit to the treatment received.
 
There are many reasons for treatment noncompliance.
 
How do we monitor and reach out to these patients? And what do we do?
 
Matters pertaining to therapy and interruption and termination of therapy are covered in Standard 10 of the APA Ethics Code:
 
http://www.apa.org/ethics/code/index.aspx?item=13
 
See APA’s Termination and abandonment: A key ethical distinction:
 
http://www.apa.org/monitor/2009/09/ethics.aspx
 
More on abandonment and wrongful termination:
 
http://tinyurl.com/luwwpko
 
I can’t emphasize enough: keep accurate and detailed documentation!
 
The saddest case involving a “no-show” for me was a dear patient who lost his life in an accident late one night. It took about a month to learn what happened.
 
I also lost contact with several pursuant to the aftermath of Hurricane Sandy.  And it hasn’t escaped me that the one-year anniversary is around the corner (October 29). And people are still reeling from the devastation and aftermath.
 
Roy

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