Comments on: DNA

By: Shrinkwrapped

Shrinkwrapped — Wed, 07 May 2008 12:58:56 +0000

I have no doubt that there are issues around calling people. If you do it in a nice way, most don’t mind. If someone DNAs, I might call and say, “I’m just calling to check everything is ok” not “Where the hell where you, you waster of NHS resources.” I’ll also get them to agree to an appointment time that suits both of us. And of course you must have a policy about what to do if someone tells you about their difficulties over the phone. I would probably tell them that it sounds like they’re having a difficult time but in order for me to be of help to them, we’ll need to discuss it in person, not over the phone. Then I’d make a note in the file to remind me to ask at the appointment. I haven’t found that to be an issue.

However, opinion amongst psychologists on this is very divided. Some would say it is a boundary issue and that we shouldn’t be drumming up business. Others (and I am amongst them) think that we need to go the extra mile to make services more accessible for people who find it really difficult to come.

I think when you’re working with people who are intimidated by services, anything that helps to establish person to person contact and allows them to hear a friendly voice rather than an impersonal letter with an intimidating sounding name with Dr. is likely to make showing up to that first appointment a lot less frightening.

If I am working with someone who DNAs a lot, I don’t call, I make a therapy contract which says (in a nice way) that if one of us needs to cancel, we’ll let the other one know as soon as convenient and that if they miss, then I won’t call them or send an appointment, but they can call me and re-establish contact within 2 weeks. It is a nice way to give them responsibility and means I know what to do if they miss.

Then again, seeing a clinical psychologist is always optional. No-one has to see me – I imagine as a psychiatrist, there are more tricky issues to get around.

By: Nutty

Nutty — Tue, 06 May 2008 23:32:14 +0000

If you charge for appointments, won’t it just deter people from agreeing to see a psychiatrist in the first place? People that are unhappy about going to see a psychiatrist will find it an easy excuse not to go. I’ve only ever DNA’d once, and even then, I got as far as reception at the CMHT before doing a runner, but I have attended many, many appointments when I didn’t want to see a psychiatrist. If I’d had to pay, I’d have refused to co-operate at all.

By: Frontier Psychiatrist

Frontier Psychiatrist — Tue, 06 May 2008 22:29:27 +0000

That’s interesting. I thought about calling people, but then I thought it might intimidate people who would rather I left them alone. Also I had one or two experiences when I was a house officer where I called people who then started to ask me questions about their problems that were very difficult to deal without a face to face meeting; this put me off calling patients unless I had met them first. Perhaps it’s time to reconsider.

By: Shrinkwrapped

Shrinkwrapped — Tue, 06 May 2008 17:06:26 +0000

I have an impressively low DNA rate. In the last 6 months I only had one person DNA. The six months before that, zero. Not bad at all. I’d like to say it’s because I’m such a wonderful empathic clinician, but I think it is a combination of well selected referrals from my supervisors’ perspective and a good habit of making therapy contracts.

I don’t think it is a good idea to be too philosophical about it. Yes, DNAs are inevitable – perhaps much moreso for psychiatry, but I think that there’s a lot that can be done to make things easier for people. In a service I used to work in, well over 50% people were DNAing on first appointments. People didn’t tend to DNA after that – once they started coming, they seemed to like us. So we pulled all the stops out in making first appointments easier. We rang people beforehand to arrange an appointment at a mutually convenient time (no excuses) and we got a clinical team member to do it, not a secretary so they could establish contact and let the person realise that we’re pretty nice really and we were able to explain what would happen if the person was very anxious. Anything to make the initial appointment less intimidating. DNA rate dropped to about 5%.