Editor—When a patient does not attend a scheduled appointment, or cancels so late that a replacement cannot be found, there is a cost to the health care system in terms of personnel time, extended waiting lists, and the loss of potentially beneficial services to patients who miss their visit. These costs are particularly important for genetics clinics because a great deal of preparation is often required before a clinic visit. Preparation may include sending out a family history questionnaire from which a pedigree diagram is constructed, and a review of the medical reports and charts of the patient and other family members. In the case of rare genetic conditions, a preliminary review of publications/computer database search may be conducted and research laboratories may be sought which would be willing to receive patient samples. Furthermore, genetics departments typically set aside at least an hour for each new patient visit.

Failed appointment rates at community and university medical clinics have been reported to range between 10 and 30%.1 2Studies involving hospital clinics set in low socioeconomic status populations have shown no show rates in the upper end of this range, whereas family practice clinics have reported fail rates as low as 5%.3

There is some evidence to suggest that missed appointments may be more likely among certain demographic groups, such as young adults and adults with young children,3 patients with lower socioeconomic and educational status, and those with larger families.1 Moreover, geographical distance from the clinic or the inability to obtain transport or both have been found to impede appointment keeping.1 Sex and race have not been associated with compliance.1

Problems with communicating to patients about the timing or nature of an appointment and in providing them with information about their diagnosis may …