Airlines, Medical Practices, And Teaching People A Lesson

Yesterday I called Continental Airlines to see what I could do with an unused ticket. They told me there was going to be $150 change fee, plus the difference in fare.

The new ticket was less than the old ticket (thank goodness), so after paying the fee, they told me there was another “booking service fee” of $15. Huh? That is like paying for gas and then paying extra for using the pump.

Thank you sir, may I have another…

Later the agent explained that the ticket was non-refundable, non-transferable, blah, blah, blah. They also mentioned I could only fly on certain days of the week, blah, blah, blah again. The agent’s list of restriction was so long, I basically started tuning out and all I heard was Charlie Brown’s teacher.

PenaltyIt was as if they were saying “… Oh, well, you didn’t fly when you told us you would fly so you are going to have to pay an outrages penalty. Don’t think you can fly whenever you want. You fly when WE say you can fly. And yeah, you bought a ticket, but it’s not like it is yours to give to anyone. And don’t think you are going to ever get your money back if you are dissatisfied, had a bad flight or simply decided not to go.”

But that is not enough “… because you are talking  to an agent and making a reservation over the phone, we are going to charge you another $15.”

Was I being punished?


What does this have to do with managing a practice?

It got me thinking… do medical practices punish patients, our customers? Do medical practices impose ridiculous rules and penalties on patients?

What about charging for No Shows? Is that a penalty similar to the airlines’ infamous change fee? What about when a patient leaves the medical practice, are we penalizing the patient by charging them to make a copy of their medical record?


My View

This is how I see it and you can tell me if I’m crazy. Let’s start with no-shows.

Yes, no-shows are a loss. But what is the real intention of imposing the no-show charge? Trying to teach the person a lesson by punishing them with a fee? 

Seems to me that if you have no-show problem, no-shows are not the problem. In other words, your problem is that too many people are missing appointments. Why? Instead of focusing efforts on collecting for no-shows, focus on finding out why patients are missing appointments.  

Besides, is one really recuperating the loss of the no-show by collecting a fee? Is it worth the effort?

It seems to me educating patients the importance of keeping appointments is more valuable than collecting for no-shows. 


Let’s tackle copying charts

I conclude there are two reasons why a patient leaves a practice:

  1. Patients leave because they have to. They have a change of insurance, they move, they found something more convenient, closer, better, etc.
  2. Patients leave because they are dissatisfied. In essence the practice has done something to piss them off, so they’ve decided to move on.

If a patient leaves because they have to, then why should they have to pay for their records? It is not really their fault. After all, it is their records. And even if they refuse to pay, one can’t withhold the records. Yes, I know it takes time to prepare the records, copy them etc. But how much more time is spent trying to collect the $25 bucks? 

If a patient leaves because they are dissatisfied, why do I want to piss them off even more by telling them they have to pay for their records? I suggest cut our losses and move on. We can’t win them all.

Besides, how often does one prepare records? If copying records is taking too much of my staff’s time, then again, there are bigger problems. Instead of trying to collect for my staff’s time to prepare records, I ought to spend that energy and time figuring out why there are so many requests for records.


I know…

I  understand some times there are good reasons, good explanations, good excuses to charge. But the challenge here is not to criticize people that charge for no-shows (I’m merely giving you reason why in our practice I don’t think it is a good idea), but rather look at our practices differently in order to provide a better service to our patients. Ask yourself, is there good reason for this charge? What is the real intention? I’m I doing this because it is necessary or do I just want to teach people a lesson?  



What are your thoughts on this? Do you agree? Are there other ways you’ve seen others punish patients? Maybe filling out forms that truly are not necessary? Charging them for school physical forms?

I’m I wrong? Am I looking at this the wrong way?

What are your thoughts?


  1. A while back a patient I was seeing for breast cancer missed her appointment. When she came for followup next week I asked her why she had missed her prior appointment. She said “I was able to get in with my hairdresser, and it’s a lot easier to reschedule with you [the surgeon] than it is to get in with my hairdresser.”

    I thanked her for letting me know where I stand.


  2. Sometimes, however, these kinds of fees can be helpful. We have a huge pediatric practice of 24 pediatricians. We give patients a PE form at their checkup. For decades, we were re-doing them for patients who lost them or gave their only copy away. It cost us tens of thousands of dollars in staff and doctor time. We decided that patients would get one form. If we had to redo it, there would be a $10 charge. Our volume of repeat forms dropped by 90% within a year. We posted the new policy a year in advance and warn people to make copies of the form when they get it. We still have a few hundred ask for new ones and they pay the charge or they don’t get the form. After a few initial complaints, almost none now. We can devote our time to more useful endeavors and patients make copies on their own.


    • Brandon says:

      Dr. Lessin,

      Thank you for stopping by and sharing your thoughts. I follow your comments on Pedsource and value your opinions.

      I agree there are circumstances’ where charging patients is pertinent. Especially when there is a need to change or curb an undesirable behavior. Similar to offering people an early bird special for example. You want to people to register sooner rather than later, thus one offers an incentive. For those that do not plan well, they are going to have to pay more.

      But what I’m suggesting is to understand why one is charging patient for certain things; because more often than not, I feel the decision makers tend to punish bad behavior instead of understanding why the bad behavior is occurring. In other words, it may be the practice’s fault.

      Thanks for stopping by and feel free comment anytime.



  3. Thought provoking and eminently readable, as always!

    I think the previous 2 commenters’ posts speak for themselves — and reveal an underlying mechanic that we’re going to see all throughout the coming healthcare reform years. People behave differently when they have so-called “skin in the game.”

    I agree with you, there’s another mechanic that definitely bears looking into, especially from the doctors’ side: Should we unstick our butts from our habitual thought patterns, so to speak, and consider that we can and should do things differently, as medical care becomes more of a commodity?

    But some financial penalties are clearly a dynamic that works. Both of the above mechanisms are manifestations of a deeper underlying one: taking more responsibility — not a bad thing.

    There may be many ways a practice can make keeping visits more appealing to patients. But there are many things competing for patient attention besides a doctor’s appointment, most of which are much more pleasurable, by their very nature (e.g. not even remotely critical).

    That last part — that docs periodically have to tell people things they’d rather not hear — is an unavoidable hitch in the giddyap. Folks won’t always want to ditch us, but there will always be folks who are going to.

    Doctors doing something different to prevent no-shows in the first place? The no-show penalty can actually be seen as “the something different” — a preventive measure, as much as a belated response. I’d be perfectly willing to charge a “reservation fee” up front, to make an appointment…but really, it’s the same idea.



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