012: 10 Signs That Your Patient Isn’t a Good Fit and How to Let Them Go
As you build your practice, you want to make sure that you’re finding and connecting with the right patients. But what do you do when you have patients in your practice that aren’t a good fit? How do you let them go, so they can find another practitioner that’s right for them?
I used to lose sleep about how to have these conversations with patients, but I’ve figured out a way to do it gracefully and ensure that everyone wins in the end.
Today’s episode is about more than just how to identify great patients. It’s also about what to do when you have one that isn’t right for you – and how to let them go gracefully, to find the care they need without compromising your integrity.
- How to tell if you have a strong connection or relationship with a patient – and signs that you’re not set up for a good long-term relationship.
- Why your patients need to trust in your ability to help them get better – and why communication with both you and your staff needs to be mutually respectful.
- Why patients that rely on Google for their prognosis and then ask you for support are almost always a bad fit.
- How to be honest when you let a patient go, helping them feel listened to and valued as you end the relationship – and even turn some of these patients into your best referrers.
When you've got that feeling and something just doesn't feel right, you're better to end the relationship sooner than later. Because it's not going to end well for either one of you. – @DrRondaNelson Click To Tweet
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Welcome to The Clinical Entrepreneur, a business podcast that’s dedicated to health care practitioners just like you who are hustling every day to build a business and a life you’re proud of. Join me, Ronda Nelson, as I share my own experiences and extract actionable advice from industry experts about what it takes to build and scale a profitable wellness practice.
Well, hello, my friends. Welcome to The Clinical Entrepreneur Podcast. I am your host, Ronda Nelson, and I’m so glad that you joined me today. Whether you’re watching on YouTube or you’re listening on your favorite device, I’m just so happy that you’re here. I want to talk to you today about something that, sadly, I’ve had to get kind of good at over the years. It’s something that I never wanted to be good at, but I’m going to give you a few tips today about how to make sure that you’re finding and connecting with the right kind of patient. I also want to share what do you do with the patients that aren’t a good fit and how do you gracefully let them go, and let them go find another practitioner that’s a better fit for them. It’s a tough conversation to have and it’s never easy to do. I have lost sleep and have been in angst about having to have these kinds of conversations with patients. However, over the years, I’ve kind of figured out a way to do it and do it gracefully so that everybody wins in the end. That’s the goal. I want to maintain my integrity and I want to make sure that the patient gets taken care of.
Before I get into how to let them go, let’s talk about how to make sure that you are finding the right ones. I’ve talked about this in prior lectures and podcasts but I wanted to dive a little bit deeper today. This is something that I think we can all do a better job of looking for those little clues that might give us an inkling that the patient may not be the right fit for us. The first one is how do you know if you’ve got a good connection or relationship with the patient? Decide whether you connect with them. Do you feel that kind of jive or energy when you meet with them? It doesn’t mean that you have to be besties, but it does mean that you have to feel that rapport. There has to be some kind of connection. That’s number one. You want to make sure that there’s something there that you can work from. That’s the foundation from which the relationship is built. So, is there a connection?
I’ll give you an example. I had a patient come in one time and the minute that the patient started talking, I was just irritated. Now, I don’t know why I was so irritated, I just was. I don’t know if it was the sound of their voice or maybe it was just a bad day but I was just like, “Whoa, err, irritated.” That is not going to set up for a great long-term relationship. I don’t know what happened there and I’m not making the other person wrong, I’m taking full responsibility for it. When you’ve got that feeling and something just doesn’t feel right, you’re better to end the relationship sooner than later. Don’t let that type of foundation start because it’s not going to end well for either one of you. So again, number one, make sure that you have a good connection.
Number two. Do they trust you? Do they have reason to trust you? Have you delivered on what you’ve promised? Have you set good boundaries and good expectations in the very beginning so that they know that they can trust you and you’re going to come through? You want to know that they’re coming in and they’re not trying to always outsmart you or one-up you. You need to have a relationship with a patient where there’s complete trust. They trust you and your ability to get results for them to help them get better. If they don’t believe that or if they don’t have trust in you, it’s going to be an uphill battle. It’s always going to be a “me against you” situation. I’m trying to convince you that I can help you and we don’t want that.
Number three. Does communication between the two of you happen and occur very naturally and very easily? Are there any issues when you’re trying to have a conversation? A good example is a person who interrupts all the time, constantly cuts you off, and never let you finish a sentence. I don’t know about you but that is one of the things that just irritates me. I will go from zero to mad in a New York second when I get interrupted. I hate it. It makes me so mad. So when I have someone in my office and they’re talking to me or I’m on the phone with a patient and they’re cutting me off mid-sentence, for me, that’s not going to work. You might be totally groovy with it. Good on you. But for me, that’s a deal-breaker. So, does communication happen? Is there mutual respect as you’re having communication back and forth?
Number four. This is a biggie right here. I have let someone abuse this particular one and I regretted it later. Do your patients respect your staff? Do they treat your staff kindly? Are they considerate? Are they respectful? If they call and they’re rude on the phone or demanding, insisting that they talk to you, insisting that they have a certain appointment, insisting that you show up early to meet their needs? If they don’t treat my staff, my team well, they’re not a good fit for me. Again, that’s just me, you might have a different tolerance for that, but I might challenge you to rethink that a little. I want patients that are going to be respectful, not only to me but my team because my team is an extension of me.
Number five. Are you patients demanding special treatment? Like showing up early, asking for you to hand-deliver their supplements, expecting you to only see them at this time on this day of the week every time no matter what, or they want to be able to access you all the time on the weekends asking for your cell phone number? If they’re demanding and almost making themselves a very special case, that’s not going to be a good fit. Those are the people that never pans out well in the end.
Number six. Are their expectations higher than what you’ve promised to deliver? If you set clear boundaries and established those guidelines right from the very beginning, you know exactly what you expect of them and you’ve been clear with them about what they can expect from you. You’re going to show up on time, you’re going to respect their time, you’re going to do your best, to be honest, deliver a good service, etc. You’ve lined out your expectations. They have to match. And if they don’t match, you’re going to have a problem. Because if the patient has expectations that are higher than what you promise to deliver, you will always be a failure, never reaching their level of expectation. You’re always going to come up short. That’s never a good relationship between a practitioner and a patient.
Number seven. Do they run to Dr. Google for their medical advice? This one’s a deal-breaker. I am not going to co-manage with Dr. Google. I won’t do it. I’m out. Hard no. I will not co-manage the case with Dr. Google. I don’t have a lot of faith in Dr. Google. I think the information that Dr. Google gives is not medically sound much of the time. So if the patient comes back in and says, “Well, I was doing online research and I found XYZ, what do you think about this? And can we do that? And oh, I found this supplement. And oh, I found these probiotics. And what do you think about this therapy? And how about this?” I’m out. Not a good fit for me. There can only be one cook in the kitchen. For the record, I’m very clear about that upfront. If the patient comes back in and says, “Hey, I’m working with another practitioner who’s doing this and I’m working with another one who’s doing this,” I very respectfully step out of that circle. I just step out and say, “You know, I think there are too many cooks in the kitchen. I don’t want to be that other cook that’s trying to go in and say one thing and they’re saying something different. Then you’re saying something different as well,” and that is a lose, lose, lose all the way around. If they’re going to Dr. Google or they’re working with other practitioners, I will step out. That’s not a good fit patient-wise for me.
Number eight. Do they need a fully detailed, fully referenced, verified, certified, notarized, double-blind placebo-controlled study that’s been 10 times repeated over and over? Do they need all that kind of verification before they believe you? If so, I’m out and you should be out too. I’m all for making sure that what we promised, what we deliver, and how we communicate with the patients is medically sound. It is clinically sound and we’re giving them good advice. Completely, I’m all over that but when the patient comes back and says, “Well, what’s your proof? Well, where’s the study? Well, where can I go? How do I find that?” I do not have time to prove to you that what I’m saying is correct. I’ll send you to PubMed and I might reference a textbook. What happens is, and I’ve had this happen, all of these things I’m telling you, these are all things that have happened to me. That’s how I know all this because this all happened to me. I’ve had every single one of these patients come into my office and some of them just ended badly. Some of them as I’ve been in practice long enough, I recognize this isn’t going to be a good fit and I can let them go sooner than later. But when they need lots and lots and lots of proof, why is an apple good for you, an apple a day? Why is it good for you? Can you show me where the study shows that? That’s really just not a good patient for me. Those kinds of clients are not right for me.
Number nine. Are they continually challenging my suggestions and stating, “Well, this won’t work for me. I tried this and it never works. I don’t know why you would ever do this because it never works every time. Every time I take that it never works. I’ve been to so many other practitioners, it never works. I’ve tried it. It never works.” Those are the people that often are so attached to their own outcome that they need to be ill in order to prove that the outcome will be the way that they think it needs to be. It’s sad. It’s sad to me but when patients start not wanting to try or work with me, then I’m just not a good fit for them. And it’s okay. I’ll make a referral and I’ll send them somewhere else. If they aren’t willing to work with me, then I don’t know how this relationship is going to pan out to be productive. I honestly don’t know.
The last one, number ten. Do they have a history of being a practitioner hopper? I can see on an intake form that they have seen four doctors and three of this, five chiropractors, this many functional medicine practitioners, so many acupuncturists, and they are hopping all over the place. They will often say on an intake form, “No one has ever helped me. No one never knows what they’re doing.” Now, there are some that have been to several practitioners. I usually have a good idea whether they’ve been to someone who would know how to take care of those health issues or they’re just looking for someone who maybe isn’t as qualified. Sometimes you can see through that and you can weed that out. I don’t want to draw too much of a hard-line here, but if it feels like they are just going from practitioner to practitioner, practitioner, practitioner always in the back of their mind saying, “I’m never going to get better. I’m never going to get better. No one’s ever going to help me. I’m just going to be sick all the time,” practitioner hoppers will always be practitioner hoppers. Pay attention and watch for that.
Those are 10 things that I always look for that raises the hair on the back of my neck, the alarm bells start to go off, and I think, “Oh, I don’t know about this. This might not be a good fit for me.” Now if you know that it’s not a good fit, how do you let them go? How do you do that in a way that preserves your integrity, their relationship, and lets them leave feeling fully respected and honored and valued? Because that’s important. We don’t want to just fire someone and say, “I’m sorry, I’m not going to work with you anymore. Bye-bye. Here are your records. You’re out.” That doesn’t feel right to me. I wouldn’t do that. What I’ve learned to do, is just to be honest, and sometimes being honest is hard, but honesty is also very refreshing. In our society today, honesty is a little bit hard to come by. For those of you that are listening, watching, or reading, I am sure you are all honest and you want to be honest to the best of your ability. But remember what the patient or client experience has probably left them feeling disappointed. They probably felt lied to, duped, scammed, false promises, “Oh, sure, I can help you,” and then they’re in it $2,000 or $3,000, $5,000 and they still feel the same.
So remember, what’s their perspective when they come to the table? Pay attention to see if they are a practitioner hopper, if they believe that they’re always going to be ill, or if they need every kind of notarized receipt of everything you’re going to say. There’s some wound, hurt, or disappointment that they’ve experienced. What I want to do is try and bridge that gap. I will sit down with them either in person or over the phone, I now work virtually so most of my conversations are over the phone or even better, on a Zoom call (or some other secure conferencing platform). I’d love to talk to them face-to-face because I want them to see my face. I don’t want them to just hear my voice. The first thing that I do is I ask them how they’re feeling about how things are going. I let them talk first. Always get them to talk and they will often say, “Well, I don’t think that it’s working and I’m just frustrated,” or, “I told you, it’s never going to work and your staff, they just are rude. They’re just rude.” Whatever it is that comes up and you can bet that’s going to come out of their mouth because if you’re even thinking about having to have the conversation with them, there’s already been some issues going on, right? So I let them talk first.
Now they feel listened to and they feel valued. Sometimes I’ll even ask more probing questions just to make sure that they really feel like I’ve listened. I just need to let them go and send them on their way, but what I want to do is make sure that they feel like I really listened to them. So sometimes I’ll ask them, “Well, what happened? You know, how did you not feel valued when you interacted with Mary? What happened when you called to make an appointment and that didn’t work out? Tell me about that. What happened?” And rah, rah, rah, rah, they’ll start in and they’ll be complaining and griping about it, but they need to be heard. Once all that’s out on the table I then say, “You know, I get it. I am so sorry that we have not been able to meet your expectations. That was not intentional on my part but I don’t believe that I’m going to be able to meet your expectations. I don’t think that I’m the best person for you but what I want to do is I want to find someone that I believe can help you. Because I just don’t think I’m the right person. I may not know enough or I may not be skilled enough in dealing with what you’re dealing with. It’s important to me that you feel valued and you feel like you’re really being taken care of. If this isn’t the right space for you, it’s okay. I’m not mad or upset at all. My goal is to make sure that you are taken care of because this is about you. It’s not about me. There’s no ego on the table here. This is about you. I want to make sure you are well taken care of. So, if it’s alright with you, I’m going to get back with you. I’m going to find a few people that I think you might do better with that have more skill to be able to handle what it is that you’re dealing with.”
Then, almost always, the phone, the room, the call, it just goes kind of silent because they don’t know what to say. They’ve never had anyone that’s really cared for them enough, listen, and then make them feel important. And then to basically fire them, but do it in a way that makes it about them, you wanting to help them, not wanting to get rid of them. I’ve had so many people back up. I’ve had so many clients and patients that I have let go like this, that have been some of my best referrers because I let them go in a way that honored and respected them. I didn’t do it in a way that made them, you know, I just sent him a Dear John letter. I don’t want to do that. If you have those relationships with patients or clients that aren’t working, let them go sooner than later. Don’t wait because when you wait, it only makes it harder later. My dad always used to say to me, “Hire slow. Fire fast.” I think the same thing is true when we’re working with people and we’re serving them. We bring them on, we work through what they’re presenting with, we don’t get in and do a bunch of protocols, tests, and all the themes, just going at it slowly because that gives you the opportunity to see whether it’s going to be a good fit. When you recognize that it’s not a good fit, do it right away. Don’t wait because it isn’t good for anyone.
So, I hope that was helpful for you today. It’s been on my mind to share this. I get this question often from practitioners who asked me, “What do I do when I have a patient that’s driving me crazy? I don’t know what to do with them.” It’s really simple. You let them go but you make it about them, not about you. When you do that, the relationship ends very nicely. It’s really pretty awesome and you get to go to sleep at night and know that you did the right thing and they kind of think you’re a superhero too.
That’s it for today. I am so glad that you joined me. I love doing the podcast. I love being with you. I love knowing that we’re having a little conversation, even though we’re not having a conversation, but I know you’re listening. And I’m so thankful for that. So, all you have to do if you want more of The Clinical Entrepreneur Podcast, subscribe to the podcast on whatever device you’re listening on, leave a review if you love what you hear, and otherwise, you can find me on Facebook and on Instagram as Dr. Ronda Nelson. The link is in the show notes. I will see you next week for more of The Clinical Entrepreneur Podcast, but head on over to social media and say hello. I’d love to hear from you. Take care, my friends. Talk soon. Bye.
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