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Come Back Soon

The Text That Failed the Right Way

Behavioural science's most famous no-show text didn't get people through the door when Denmark retested it, but it did get them to cancel in time, and for anyone who can refill a slot that may be the result that matters.

Priya and Hector · 19 min · 21 Oct 2026

FactUnion VerifiedEvery fact on the episode's fact sheet was checked against its sources. Wrong facts were corrected. What this meansFacts checked 20 Oct 2026

Chapters (8)

About this episode

In 2013 and 2014, two London hospital trials found that a reminder text naming what a missed appointment costs the NHS, about a hundred and sixty pounds, cut no-shows. It became one of the best-known findings in behavioural science. In April 2026 an independent Danish team tested the same idea on more than twenty thousand appointments, and the headline on their blog was "We did not replicate." The no-show rate didn't move. What did move was the number of people who cancelled ahead of time.

Priya and Hector go through how strong each piece of evidence really is: two trials by the original team, one large independent trial with a weaker design, a review, and a before-and-after count from one Welsh GP surgery. Then they look at what that means behind the chair and at the counter, where a cancellation two days out is a slot you can sell again and a silent no-show is gone for good. Hector turns it into one reminder text you can try this week, no fee and no new policy. Nobody has tested it yet, and they say so.

Hosted by Priya and Hector, performed by synthetic voices. Supported by Lynqly.

Facts and sources

Every fact used in this episode, with the sources it was checked against. Download as data

167 of 167 recorded lines matched the checked script.

  1. The Behavioural Insights Team’s blog of 22 Oct 2015 says it worked with the Department of Health and Imperial College London, testing reminder messages on patients at five clinics at Barts NHS Trust.

    Kept on a lower-weight source (bi.team); nothing we found says otherwise.

  2. The clear winner was a message that pointed out the approximate cost of the missed appointment to the NHS (£160).

    Kept on a lower-weight source (bi.team); nothing we found says otherwise.

  3. BIT’s blog says a more general version of the cost message, without a specific cost, was less effective.

    Kept on a lower-weight source (bi.team); nothing we found says otherwise.

  4. The project reduced missed appointments from 11.1% to 8.4%, a relative reduction of 23%.

    Reworded to match its sources. Wrong: 25% reduction, 8.5% figure, and no-extra-cost claim. Right: government and academic sources report 11.1% to 8.4%, a 23% relative reduction.

  5. The PLOS ONE paper reports two randomised trials: Trial One with 10,111 participants (November 2013 to January 2014) and Trial Two with 9,848 participants (March to May 2014), each testing four reminder messages sent five days before the appointment.

Show all 22 factsShow fewer facts

  1. In Trial One, 8.4% of patients sent the specific-cost message missed their appointment, against 11.1% sent the existing reminder (odds ratio 0.74, 95% CI 0.61 to 0.89).

  2. In Trial Two, 8.2% of patients sent the specific-cost message missed their appointment, against 9.9% sent a message describing costs in general terms (odds ratio 1.22).

  3. A Danish team including Pelle Guldborg Hansen retested the idea at South-western Jutland Hospital across 20,867 appointments in cardiology, endocrinology and pulmonology, published online in Behavioural Public Policy on 23 April 2026.

  4. The Danish trial was a quasi-experimental, time-blocked design that rotated a standard SMS, a descriptive social norm SMS and a specific institutional cost SMS every two months.

  5. The Danish social-norm message told patients that more than nine in ten patients turn up or cancel in good time.

    Kept on a lower-weight source (inudgeyou.com); nothing we found says otherwise.

  6. Neither DSN nor SIC reduced DNAs overall.

    Reworded to match its sources. The original omits the qualifier "overall." The evidence supports only that neither DSN nor SIC reduced DNAs overall, not in every case.

  7. In the Danish trial, the specific-cost message increased advance cancellations (OR = 1.41, p < 0.001) but not attendance.

  8. In endocrinology the specific-cost message increased missed appointments (OR = 1.31, p = 0.021), while the social-norm message reduced them in cardiology (OR = 0.76, p = 0.027).

  9. subsequent similar interventions have reported heterogeneous findings

  10. We did not replicate

    Kept on a lower-weight source (inudgeyou.com); nothing we found says otherwise.

  11. Neither message moved the no-show rate.

  12. A 2016 systematic review by McLean et al. found that all reminder types improve attendance and that reminder systems may also increase cancellation and rescheduling of unwanted appointments.

  13. At a Wrexham GP surgery of about 15,000 patients, missed appointments fell from 5,848 before SMS reminders to 3,343 after (a 43% drop the authors call significant), out of 572,794 booked between 2010 and 2020; the authors say SMS let patients cancel in good time, and the counts are not adjusted for volume.

  14. Kim (2025) writes that many restaurants hesitate to apply cancellation policies due to customer dissatisfaction and perceived unfairness, and that research on how such policies affect no-shows remains limited.

  15. Kim (2025) notes earlier research finding fine-dining guests consider non-refundable reservation fees fair, and warns that policies may lead guests to not book at all or to book while still searching for an alternative.

  16. No-show customers, who were running above ten percent under the traditional reservation systems, dropped to less than one percent.

  17. A 2014 randomised trial at a Geneva youth clinic found plain SMS reminders made no significant difference to missed appointments (16.4% vs 20.0%, p=0.346).

Removed during checking (5)

  • We got the same result when we ran the trial again, which makes us confident it's a real result.

    Why it was removed: Only one source states this: bi.team.

  • A 2025 restaurant study cites OpenTable data showing 28% of US restaurant reservations made in the past year were not honored.

    Why it was removed: Reliable sources disagree about this.

  • A June 2014 MassLive column describes Chicago restaurateur Nick Kokonas replacing reservations with prepaid tickets, first at Next (opened 2011), with the payment serving as a deposit against the final check.

    Why it was removed: Sources only partly back this: Chicago Tribune.

  • The column reports revenue and customer counts each rose about 20 percent, while noting the results came from three high-end, high demand operations.

    Why it was removed: Couldn't be checked: a key record would not open.

  • RepuClinic, citing Mangomint 2025 data, reports that 77.49% of barbershop appointments are booked online.

    Why it was removed: Only one source states this: repuclinic.com.

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