John brings up an important issue I'd like to address in the larger context of how we can both achieve phenomenal service and highly efficient and effective practices.

A great study (Lacy et al, Ann Fam Med 2004;2:541-545  attached) describes patient reasons for not showing up.  The big two reasons for no-show: access delays and lack of respect.  Many other reasons come after (transportation, scheduling conflict, no longer sick).

Most practices suffer from horrendous access delays.  Removing those delays results in 50% or better reductions in no-show, a consistent finding in hundreds of practice implementations of open access across the nation.  Unsuccessful, incomplete, or flawed implementation of open access can create unintended consequences.  Open access means I have the capability of offering an appointment today to any of my patients, while maintaining the ability to offer future appointments

We never completely extinguish no-shows.  Even in my practice I know certain individuals who will likely not show and once in a while an unexpected pt (as in highly reliable) will mess up or have something come up.

I manage this by knowing the patients well.  Patients likely to no-show are highly predictable in behavior once you get to know them.  I schedule their appointments in ways that make their behavior less painful to the practice.  I will put them in the schedule at times that if they don't show, I can do other work.  I'll jump on the billing and get that done, make a few patient phone calls, write notes on a few labs to send out to patients, catch up on our listserv.

As you build this knowledge of your patients, keep track.  Put an alert on their file so that you can address it when they contact the office and/or so that you can use scheduling techniques that diminish the effect of their dysfunction.

If you have someone who consistently abuses your willingness to serve in spite of your respectful attempts to engage them as human beings, you could consider ending the relationship.

Ultimately, the burden on us is high.  We have decades (as a profession) of dumping our dysfunction on patients by making them wait for appointments, beg for appointments, then wait in our exam rooms.  We compound that by firing patients when they are 15 minutes late in spite of the fact that we kept them waiting 45 minutes at their last appointment.  We have a lot to atone for, but this doesn't have to exceed our practices' viability.

Once we are able to say:
I can see you today
I will see you on time
We'll have all the time you want and need
then we have the platform for a respectful conversation about no-show behavior. 

"Mr. Jones, I hear that you want an appointment for today.  In the past, you have failed to show up and gave me no notice.  The time I had reserved for you could have been offered to another patient with needs.  I need you to know that there are negative consequences to no-show behavior that extend to other patients in my practice.  What can we do to prevent this in the future?"

Phenomenal service can both delight those seeking care and make our work easier.
My recommendations:
Remove all access delays
Know your patients
Schedule chaotic or high risk no-show patients in ways that diminish the effects of their dysfunction
Have a respectful conversation with those few who consistently engage in bad behavior

Gordon