diff --git a/app/routes/pacientes.py b/app/routes/pacientes.py
index 9cf4a0c..6340f57 100644
--- a/app/routes/pacientes.py
+++ b/app/routes/pacientes.py
@@ -117,12 +117,12 @@ async def sync_all(
         return JSONResponse({"success": False, "message": "No se encontraron pacientes con esos criterios."})
 
     timeout = int(configs.get("api_timeout", 30))
-    resultado = await sync_todos(rows, ingest_url, wa_key, timeout)
+    resultado = await sync_todos(rows, ingest_url, wa_key, timeout, modo="insertar")
     resultado["success"] = True
     resultado["message"] = (
-        f"{resultado['total']} pacientes procesados — "
-        f"{resultado['created']} creados, "
-        f"{resultado['updated']} actualizados, "
+        f"{resultado['total']} procesados — "
+        f"{resultado['created']} nuevos, "
+        f"{resultado['skipped']} ya existían, "
         f"{resultado['errores']} errores."
     )
     return JSONResponse(resultado)
diff --git a/app/services/whatsapp_sync.py b/app/services/whatsapp_sync.py
index 156a81b..7853032 100644
--- a/app/services/whatsapp_sync.py
+++ b/app/services/whatsapp_sync.py
@@ -63,9 +63,16 @@ def mapear_paciente(row: dict) -> dict:
     }
 
 
-async def sync_paciente(row: dict, url: str, api_key: str, client: Optional[httpx.AsyncClient] = None) -> dict:
+async def sync_paciente(
+    row: dict,
+    url: str,
+    api_key: str,
+    client: Optional[httpx.AsyncClient] = None,
+    modo: str = "upsert",
+) -> dict:
     """Envía un paciente al endpoint de WhatsApp. Retorna {ok, action, message}."""
     payload = mapear_paciente(row)
+    payload["modo"] = modo
     headers = {
         "Content-Type": "application/json",
         "X-Lab-Key": api_key,
@@ -95,17 +102,19 @@ async def sync_paciente(row: dict, url: str, api_key: str, client: Optional[http
         }
 
 
-async def sync_todos(rows: list, url: str, api_key: str, timeout: int = 30) -> dict:
-    """Envía una lista de filas de pacientes. Retorna resumen {total, created, updated, errores}."""
-    resultado = {"total": len(rows), "created": 0, "updated": 0, "errores": 0, "detalle": []}
-    headers = {"Content-Type": "application/json", "X-Lab-Key": api_key}
+async def sync_todos(rows: list, url: str, api_key: str, timeout: int = 30, modo: str = "upsert") -> dict:
+    """Envía una lista de filas de pacientes. Retorna resumen {total, created, skipped, updated, errores}."""
+    resultado = {"total": len(rows), "created": 0, "skipped": 0, "updated": 0, "errores": 0, "detalle": []}
 
     async with httpx.AsyncClient(timeout=timeout) as client:
         for row in rows:
-            r = await sync_paciente(row, url, api_key, client)
+            r = await sync_paciente(row, url, api_key, client, modo)
             if r["ok"]:
-                if r["action"] == "created":
+                action = r["action"]
+                if action == "created":
                     resultado["created"] += 1
+                elif action == "skipped":
+                    resultado["skipped"] += 1
                 else:
                     resultado["updated"] += 1
             else:
diff --git a/app/templates/pacientes.html b/app/templates/pacientes.html
index 4504f5f..c3e26f6 100644
--- a/app/templates/pacientes.html
+++ b/app/templates/pacientes.html
@@ -135,7 +135,7 @@ async function runSync() {
             result.innerHTML = `
                 <div class="bg-green-50 border border-green-200 rounded-lg p-4 space-y-3">
                     <p class="font-medium text-green-800"><i class="fas fa-check-circle mr-2"></i>${json.message}</p>
-                    <div class="grid grid-cols-3 gap-3 text-center text-sm">
+                    <div class="grid grid-cols-4 gap-3 text-center text-sm">
                         <div class="bg-white rounded-lg p-3 border border-green-100">
                             <p class="text-2xl font-bold text-gray-800">${json.total}</p>
                             <p class="text-gray-500">Total</p>
@@ -145,8 +145,12 @@ async function runSync() {
                             <p class="text-gray-500">Nuevos</p>
                         </div>
                         <div class="bg-white rounded-lg p-3 border border-green-100">
-                            <p class="text-2xl font-bold text-green-600">${json.updated}</p>
-                            <p class="text-gray-500">Actualizados</p>
+                            <p class="text-2xl font-bold text-gray-400">${json.skipped ?? 0}</p>
+                            <p class="text-gray-500">Ya existían</p>
+                        </div>
+                        <div class="bg-white rounded-lg p-3 border border-green-100">
+                            <p class="text-2xl font-bold text-red-500">${json.errores}</p>
+                            <p class="text-gray-500">Errores</p>
                         </div>
                     </div>
                     ${json.errores > 0 ? `<p class="text-sm text-red-600"><i class="fas fa-exclamation-triangle mr-1"></i>${json.errores} errores — revisa los detalles abajo.</p>` : ''}