[INTERVIEW]
Ronda Nelson: Can I ask you something? When did your patients get unlimited access to your brain? Because somewhere in between answering a quick supplement question to responding to messages at 9:00 at night, you may have accidentally created a monster where your expertise is available 24/7 for free. And the worst part is that your patients don’t even realize they’re taking advantage of it because you’ve taught them that it’s okay, but it’s not.
Let’s dive in.
Well, we are gonna talk about boundaries today. Patient boundaries as it has to do with their access to you, and it’s such a slippery slope. This is such a slippery slope because I’ve done it, and you just… You know, we’re just nice. We don’t intentionally give an open door access to our knowledge and our time, but it just happens.
You know, the patient asks a question like, “Oh, I gotta ask you a quick question.” But is there really ever such a thing? There is no such thing as a quick question. And you answer, though. I answer because I feel bad. I wanna help. I don’t wanna be a jerk. But then over time, they start emailing, and they text, and they’re asking all kinds of questions.
“Can you take a look at this supplement? What do you think about… Well, my mom has hemorrhoids. What can I do about that?” And it just snowballs from there, and as like a runaway train. And how do you even begin to get that thing back? So no one ever opened their practice and said, “Come on in. I will help you for free, for unlimited, whenever.”
But I catch myself doing this. You probably do the same thing, where I’ll say, “You know, listen, let me know. Ask any questions. I’m happy to help. I’m here for you.” Yeah. I say that and then they do it, and then I think, “Wait a minute. How did this, how did this monster get created?” But I didn’t really mean that, I just said that, but I didn’t really mean it, but I meant it.
So where is that middle line? Like, how do we not have an open door policy where they get to ask us anything or interact with us about anything and everything, and there isn’t a clear boundary about what gets paid and what doesn’t get paid. So, you know, they ask these super simple questions, and that’s where I think we get into trouble fast.
So when we give our time away, we have to think about what’s happening on the other side. What’s happening with the patient? The patient doesn’t realize it. They don’t know. They just have a question, and you’re their go-to person, so they’re going to ask, and they’re relying on your judgment and your knowledge and, you know, what you know about supplements and whether they can take ashwagandha with their blood pressure medication.
You know, they’re asking questions, and you should answer those questions. You have a responsibility to answer those questions. But those answers came, the knowledge to be able to answer that came with years and years and years and untold amounts of time to get that information. And so when that guidance or information is routinely provided outside of appointments, the patients start to look at the access that’s included with their service.
And that’s where I get myself into trouble, because I don’t carry those boundaries as well. And then they just think that it’s all included, even when I really didn’t want to structure it that way. I didn’t want that. The problem becomes I just keep answering and clarifying questions. I keep allowing them to reach out and ask me and… Like, I use Practice Better, and Practice Better has a chat function. And so the patients are in there, and they’ll ask questions. And right now I have a couple of patients that literally will message twice a day.
And I have someone that helps me with that, but she doesn’t know how to answer those questions, so guess what? They come to me. And then I’m nice, and so I just type out an answer. But I can’t just give a cryptic answer because that doesn’t solve anyone’s problem. And then I just feel like it’s a sinkhole. It’s just a big sinkhole. And, you know, I’ve spent how many hundreds of thousands of dollars on training and time and all of that, but yet somebody sends a message and says, “Hey, could you look at these labs real quick for me?”
It sometimes doesn’t feel real good when we’re being a… I don’t know, I was gonna say another word, I won’t say it, but when we’re being that way, we’ll say jerk. And saying, “No, I’m sorry, I can’t look at your labs because you’re not paying me for it,” that’s not cool either. How do we work, how do we get around that? What is your expertise worth to you — in an appointment, dollar-wise, what is it worth that you get paid, but suddenly it doesn’t have any worth when it’s outside of an appointment?
It’s the same information, it’s the same brain, it’s the same clinical judgment call on your part. The only thing that changed was the environment that the question was asked in. So your clinical knowledge doesn’t become less valuable just because somebody asked for it in a text message. It should still be paid for, but there’s a cost that comes with being constantly available because we don’t get paid.
So every time there is a message that comes through, think about this: you’re busy, you’re right in the middle of dealing with patients, you’ve got back-to-back-to-back patients in the morning, and then you’ve got a school conference for your first grader or teenager or something in the middle of the day, and your front desk person comes to you, or you just happen to check your email or your text messages, and there’s three messages in there from patients who have questions.
Now, you’re down that mental rabbit hole. We can’t multitask well. We already know this. It’s proven fact. So you’re down that rabbit hole, and now it’s taking you off your game. Now you’re not focused on what you need to be focused on, which is asking questions of the teacher at the conference or prepping for your two new patient appointments in the afternoon, and now there’s just this chaos.
Do you guys track with me here? It’s just all these open loops in your brain. You got somebody that needs this over here and somebody that needs this over here, and you’ve got the kid at school, and then you’ve got these two new patients, and there’s a supplement that you really needed to look up, and actually you need to call your rep because the rep was the one that needed to give you the information ’cause the brand-new supplement, but you think it might be kind of working, so you’re not really sure if that’s the right one you need to do, but you need to ask about…
Oh my gosh, you got your kid over here, and then you got these two people that… You get this, and it just starts snowballing out of control, and all of a sudden, to make all of the crazy noise go away, what do we do? We just start answering questions. We just start answering. “Okay, you, solve the problem. I’m gonna close the loop. You, here’s what you need to do. Here’s the supplements you need. There you go. You, over here, here’s what you need.” And then somewhere in there, the parent-teacher conference is thrown in.
But you understand what happens is we don’t have good guardrails, and so because we don’t have good guardrails, we start giving away, giving away, giving away information and not maintaining the integrity of the business and keeping the cost down because there’s a cost. There is a cost for your lost time, and potentially lost revenue because the patients just keep wanting to ask questions in email or text or Practice Better or wherever they’re asking.
So let’s just say that you have 15 patients a week that send you questions, and let’s say each one of those is five to 10 minutes. That’s a couple hours of time. You don’t think about it when it’s just five, 10 minutes. You’re like, “Oh, yeah, I can answer that real quick.” But that happens week over week over week, and in one year, it’s essentially about 120 hours you’ve given away of your time for free. That’s three weeks of time, three 40-hour work weeks, and that doesn’t account for the mental interruption, right? The multitasking thing where I’ve got one problem over here and another problem over here, and everybody’s pulling at me.
This happens to me all the time. I think you guys gotta know. I gotta let you in on my secret. You ready? Just don’t tell anyone. I talk to you guys about what I’m dealing with, if you hadn’t figured that out yet. Like, this is a struggle for me, so then I have to start thinking about, “Okay, this is a problem for me. I need to talk about this,” because if it’s a problem for me, I’m just like you. I’m in practice just like all y’all are. If it’s a problem for me, I’m pretty sure it’s probably gonna be an issue for you because we are all cut from the same cloth.
We are cut from the same cloth. So it’s hard for me to… I want the noise to go away. I just need the noise to go away. I need the chaos to go away. You know, somebody who needs this, and another person needs this, another person… And then I end up being very ineffective. I go home at night and my brain hurts because I feel like I didn’t get anything done all day because all I did was answer questions.
Whether — and, you know, we could lump in staff questions or online questions. Like here on the podcast, sometimes people will ask questions, and so I get in and I respond to them once in a while. And it’s just like all those little things that get, they’re just distractions. So at the end of the day, this really is a boundary problem that you and I have created.
I mean, we have to own that. I have to own that. I have created the monster. I’m the one that didn’t draw the boundaries. Why? This was my question. This is what kind of led me down this rabbit hole, and that’s why I wanted to talk to you about it today, about why did I not set the boundary? Because for me, I think, and I would bet this is the same for you, but just being vulnerable, for me, I think it makes me feel like I’m more valuable to them.
Like I’m different from the medical doctor or I’m different from your, you know, whatever other medical professional. I do it different. My patients can call me and get me whenever they need me. And on one hand, I don’t hate that. I want to do that on one hand. But on the other hand, what is the cost to me?
Nobody else that I know of lets you do that. You can’t just call your doctor and talk to the doctor. I’m always shocked how many new patient inquiries come in, as I get a lot of them, and they’ll call and say, “Oh, I just need to talk to Ronda.” My staff is like, “Yeah, I don’t think so. Doesn’t work that way. Sorry.” But they just think that they’re gonna call and just… well, if you call a medical doctor, you’re gonna maybe talk to his nurse or you’re gonna talk to a front desk person, and you’re gonna ask your question.
What’s gonna happen is they’re gonna take it to the doctor, right? And the doctor is either gonna answer it or not answer it, and it’s like a yes or no question. And what do they usually say? “Oh, you need to come in. You need to come in. You need to come in and see the doctor.” What about your attorney? Can you just call your attorney with a quick question? Maybe once in a while. Probably could, you know, phone a friend kind of deal. But that can’t happen every day.
Your attorney’s gonna be like, “I don’t think this is working. We need a $10,000 retainer for you, my friend, because this is not working.” It’s not sustainable. It’s nice in the beginning when you’re first starting out, but it isn’t sustainable. And if you keep doing it for months and months and years and years, you get overwhelmed, you get frustrated, your brain hurts, and you start dreading your inbox, dreading the responses, or even worse, just ignoring them altogether.
But they’re just following the rules that you set or didn’t set. So how do we fix this when this constant need — I don’t wanna say need, I wanna say when my ego, I’ll say that. When my ego is wrapped up in being super helpful, it becomes a part of my identity. And when it becomes a part of my identity, that’s when I struggle with the boundaries because I think, “Well, it makes me look like a good person.”
I mean, I’m being honest. It’s just really true. But it’s not that I’m not a good person. I’m a good person, but I have to have boundaries. I think the patients deserve the boundaries, and I deserve the boundaries. So I don’t want to need to be needed. I want to respect myself enough to draw the line and say, “I can be helpful. However, when you ask these kinds of questions, this is where we need to be with this. This is what I need to have happen. First, I need you to come in. Let’s just schedule a quick 15 minutes, and we’ll get this all sorted out.”
That sometimes I struggle with that because I just wanna be helpful, but if I don’t do something, then the five minutes turns into 10 minutes, turns into 15 minutes, and then pretty soon I’m down the rabbit hole researching some supplement and trying to find an alternative for their grandmother’s hemorrhoids, and that’s not helpful for anyone.
So I don’t know about you, but here’s my question to you: Are you responding because you believe that your patients genuinely 100% need that kind of access to you, or is it because you wanna be seen as the practitioner who always comes through? And it’s not gonna be true for all of you, but I would bet that some of you it probably is.
I don’t think your patients need you to be indispensable. What they need you to be is effective. They need you to solve the problem, and they’re very different things. Being indispensable and constantly available is one thing, but actually fixing the problem, that is the difference.
So when we can improve those boundaries, we’re gonna actually improve the care because what I have found, and you’ve probably found the same thing, is that when there’s a question on the fly, I’m not in that zone of that patient. So if I’m in the zone, I have their notes up, I’m reviewing them, I’m looking at them. I’m going, “Okay, what’s happening? What have I done? What have I recommended? Where are we at? What is it that I need to do next? What kind of questions am I anticipating?” And now I can take their question in context with the whole picture because I have it in front of me.
But when it’s a question on the fly, that takes me a few minutes — I gotta go kind of read through my notes and see where I’m at. But what happens is if it’s on the fly like that, that becomes a problem because now I don’t have all that context. I don’t have the historical context of what we talked about the last time, what are the exact supplements you’re taking.
Like, I just had this happen. Someone said, “I’m gonna go overseas for a couple of weeks, and I’m taking so many supplements,” of which she is adamant about taking all of them, but that’s another story when the patient drives the care. But anyway, another story, another podcast topic for another day. And so she said, “Well, which ones are the minimum that I need to take?”
Valid question. Valid. But I have to stop what I’m doing, go into Practice Better, pull up her notes, look at her notes, look at the protocol, see what she’s taking, take that into consideration. What kind of country is she going to? Is she going to Europe or is she going to, like, India? What is the risk? What is the parasite risk? What is the risk of her getting ill? Is she going to Mexico or is she gonna go do a missions trip in the, you know, rough part of Mexico City, and what do I need to do? So now I’m 10 minutes looking at her supplements and trying to make a recommendation.
I don’t know how to handle that. I don’t wanna say, “Oh, that’s a 15-minute appointment.” But maybe what I need to do is increase my fees a little bit to adjust or compensate for these questions that I know are gonna come through. Yes, I want to take care of her, but I didn’t expect to spend 15 minutes answering a really simple question — what is the absolute minimum that I can take on my trip overseas? And it ended up being a 15-minute rabbit hole for me.
So how can we do this? Well, I would say that being available all the time doesn’t necessarily make either one of us great practitioners because we are making those clinical decisions in between appointments. What I want to leave you with today is I want you to be thinking about what is the cost to you. What is the cost in revenue to your business?
Remember I said last week we have two hats, right? We wear the clinical hat as the employee of the business, and then we wear the CEO hat as the boss of the business. What is your response costing you in efficiency? So now as the clinician, I’ve got my clinician hat on, and my boss, the CEO, is over here looking at me like, “How are you driving the bottom line of the business? ‘Cause we’re running a business here. It’s not a charity. It’s a business.”
So what am I doing? Am I being efficient or inefficient? If you had an employee that was really inefficient and was dropping things and forgetting things, and then having to go back and having to redo it again, and then they went back, and then we ran out of stock, and then we had to cancel somebody’s appointment because we didn’t have enough needles — so now if I was a CEO, I’d be having that in my office and say, “We need to talk about this. Tell me what’s going on. We need to find out what’s happening here.”
You don’t wanna have to do that with yourself. So what is the cost to the business? Is it loss of revenue? Is it loss of your productivity or even loss of your wellbeing? It might be all three. So instead of eliminating access — the patient access to you — I don’t think that’s necessarily the answer.
But instead of eliminating the access altogether, what if you said, “Okay, well, I’m gonna consider that maybe there is some leeway, and if you can answer the question in less than five minutes, no problem. But if it’s gonna require more than five minutes, then I need to talk to you.” Because typically that’s gonna mean you’re gonna have more questions.
Like my patient that was going overseas, I could’ve said, “Okay, where are you going? Where are you staying? How’s your digestion been? Have you ever been here before? What do we need to take?” Like this particular patient keeps having some recurrent UTIs, so we’re working on it and it’s getting better. So I knew that I needed to send her with the UTI stuff, but I also knew that probably I need to send her with some Zypan.
And then to make matters worse, just as a side note, when I emailed her, I said, “I would take Zypan. I would take what I’ve given you for the UTIs.” And she emailed back, she goes, “Oh, I had to quit the Zypan because it bothered my stomach.” Wow, I didn’t even know that. There we go. Thank you so much. Appreciate that. So there’s landmines all over this conversation, but how do we recreate those boundaries?
And I don’t know what the right answer is for you. I think for me, if it’s a fast question, I’m happy to respond. But if it takes any amount of thinking on my part or I have to go in and look at the notes, then there’s gonna be a fee. What I have decided to do is I’m not gonna charge them for an appointment, I’m just gonna charge them for time. For me to really go dig in and answer your question, there’s a fee for that.
Because you would be surprised how many times they’ll ask you, “Hey, would you take a look at this supplement for me and tell me what you think and what you would recommend?” All of a sudden, when there’s a $45 fee to answer a question… I’m not saying that’s what you should do, I’m just saying, though. I’m throwing it out there as a possibility. Pick it up if it’s yours. If it’s not, let it lay. But what if there was a $45 fee for that question? All of a sudden, what do you know? That supplement question just became a lot less important because they don’t wanna pay.
So you know then where the priority is. But I think I am just tired of being the go-to person, and it’s making me less efficient because I can’t focus on what I need to be doing because I’ve got all these open loops. And so because of my availability, I can’t focus on what I have because everybody’s coming at me.
Your expertise and my expertise, it deserves a boundary. So again, this week, I don’t know, I’m kind of in the giving you homework mood. Last week, your homework was to just kind of look at your business and see what you wanted to fix first. What is the thing that might be draining your revenue? Where’s the problem?
This week, I want you to think about where your time maybe and your mental sanity is getting compromised because you’re sort of on call all the time. How much of that communication that you’re having with these patients is something that really should be an appointment, and how much of it is just truly just being a good human and just answering a simple question?
Your patients can’t expect you to be on call all the time. It’s just not reasonable. You can still have boundaries, and they can still respect you. And it’s not that you’re a jerk, it just is that you are respecting your time, and you wanna make sure that you’re giving them the absolute best care possible by making sure that you are in the right state of mind.
You have all their facts in front of you. You have their protocol in front of you. You have all the notes. You have everything there. So then at that point, you can say, “Okay, I’m good. Now let’s have this conversation.” And I think that’s such a better way to protect yourself, protect the patient, and also to protect the business.
[CLOSING]
Ronda Nelson: So that’s your homework for this week. If you’re thinking, “Oh my gosh, I don’t even know where to start,” of course you know I’m gonna tell you that you need to schedule a call with me, schedule a practice strategy call, and let’s talk about your business. Let’s talk about what’s going on in your business because I may be able to help you inside Clinical Business Academy. I don’t know if I can or not, but that’s the point of the call, is to find out what’s going on and if Clinical Business Academy will help you.
Because what we focus on is helping practitioners turn what they do and what they know into a very profitable, thriving practice that will support them, give them a retirement, and allow you to have that, “Ah,” in your world because you’re making enough revenue, you’re creating that revenue stream that allows you to take a vacation. It allows you to enjoy a weekend away without having to worry about what you’re coming back to on Monday morning.
So go to rondanelson.com/cba and click the link and schedule a call with me. I’d love to chat with you. But your homework is think about how can you make a little bit better boundaries. What will work for you? What can you put in place so that patients don’t have as much access to you and you can protect your time, your mental space, and also the needs of the business?
All right. Thanks for hanging out with me this week. I’ll see you next week on the podcast.
[END]