037: How To Set Clear Boundaries with Your Patients





Ronda Nelson: Well, hello, friend. Welcome back to The Clinical Entrepreneur podcast. I am your host, Ronda Nelson. I’m glad you are with me today. I’m going to talk about something that happens to every single one of us, and that is what I like to call boundary creep. Now I learned this term from my business partner, Jeff. He talks about boundary creep or scope creep and it has to do with project management. It is when you’re providing service for someone, and then they just keep asking for a little bit more and a little bit more. That’s called boundary creep or scope creep, and it happens to the best of us.


What this looks like in your practice, is this – you bring a patient on, the patient’s super happy to work with you. And of course, you as the healer, the clinician, want to do everything you can to try and make sure that you serve them to the best of your ability. We form these relationships with our patients that are often very close, they’re sharing details with us that they may not share very many other places. We get to have a little bit more of an in-depth look at their life and their kids and their health and bowel habits. I mean, it gets personal when you’re having those conversations.


But here’s the problem, when that relationship starts to get so connected and personal, spending time together every month and you’re on the phone checking in or whatever your practice looks like. What happens is, sometimes for some patients, they can start to encroach a little bit and maybe expect you to turn around an email over a weekend. Or you happen to give them your cell phone number at one point in time, and now they’re texting you over the weekend or asking you to stay a little late or come in a little early. Do you see where I’m going here? Pretty soon, we have what we call boundary creep.


And now, because you and I didn’t set those really good boundaries upfront, the patient doesn’t have the guardrails to guide them in our relationship. And so, they are all over the road. They’re in the other guy’s lane and in your lane and bothering you at night and texting you on the weekend and expecting an email and calling and wanting free support. And we’ve all had that happen where a patient will send an email and they basically want information via email when they need to come in, but we answer because we’re nice, and we just want to help and pretty soon, it’s been an hour back and forth with an email, it could have been solved with a 15-minute appointment. And that’s boundary creep, my friends.


So, how do we keep this from happening? Well, first of all, you have to set the boundaries in the very beginning. Many practitioners are nervous about setting those boundaries, because what if I make them mad? What if they don’t come back? And, of course, I just want to serve, I want to help, I want to do my part, but you, my friend, have to establish those boundaries. And you do that by creating or giving them a document, and this document becomes kind of the guide, it sets the guideposts, or think of it like a guardrail on a bridge. If you have guardrails on either side of your bridge, you’re very comfortable staying in your own lane, you’re on the right side, the oncoming traffic is on the other side. We have a great relationship with each other because we have a dotted line in the middle and a guardrail on either side. However, when there are no guardrails, and when that patient isn’t sure where the boundaries are, they’ll stay in the middle, and they’ll start to kind of creep and they’re going to start encroaching on your personal space. Not every patient does this, but some will absolutely do this. So, how do we fix this?


Well, number one, we want to establish those boundaries, as I mentioned, in giving them something that’s in writing at their first appointment. If you already have patients that are boundary creeping on you, then you may want to go back and have a conversation with them, or you can just provide them with some updated documents. Now here are the things that I like to include in that document, whether it’s for your brand-new patient, which I recommend starting there, or it’s with an existing patient. The first thing you want to do is you want to set very clear boundaries about your hours of operation. State that you will answer the phone between this hour and this hour. You will respond to emails between this time and this time. If there is an emergency, call 911. You want to set those boundaries, when are you available to communicate? That’s number one.


Number two, never ever give your cell phone number out. I know lots of practitioners that do this, and they feel very comfortable doing it. I think from a business perspective, it’s not a good idea. If you want to have a number where they can text you, then opt-in for one of the texting services like Community or Simple Texting, where you can give a number out, that’s not your own personal number, but they actually have the ability to text what comes through on their phone, just like an SMS message, a normal text message, and they can communicate with you that way, if you want. But remember, anything that comes in outside those office hours then has to wait until the next day. Most patients are so respectful, but if you don’t set those boundaries upfront, you will have those patients that will encroach on it.


I’m going to tell you a story before I finished with the rest of my items on your checklist. Many years ago, I was in between a brick-and-mortar office, I was just first starting out, and I was working from home. I had a patient that was a person in the community, and she was fairly well known, but she didn’t have the best reputation, maybe a little bit disorganized in her thinking. And people kind of avoided her because she talked a lot, and she just was a little bit difficult to be around. And somehow, she landed on my doorstep, and I ended up taking her on as a patient.


So, this one night, it’s probably 9:30, quarter to 10 at night, I hear a knock on the door. Now, at the time, my husband and I lived out in the middle of the country, we had seven acres, lived out on this farm, had goats and chickens and cows, and did all that. And I hear a knock on the door. Well, you get a knock at quarter to 10 at night. And the only thing it can be is bad news, you think oh my gosh, what’s the problem? So, I go look through the little window in the door, and I see this lady standing on my doorstep at night. And our front window had no curtains on it because we lived out in the middle of nowhere. I look out, and she’s standing there. And I opened the door and I said, “Is everything okay?” I’m thinking, why are you at my house? And here was her question, she said, “I just had to come out and ask you, my daughter-in-law just had twins. And she just brought them home from the hospital, and they’re four and a half pounds. And they’re having trouble breathing. What should I do?” I said, you probably should call 911 on that because I don’t think I’m your girl to handle NICU-type preemie issues. You probably should call 911.


And how she even got my home address, I don’t even know, but she literally showed up on my doorstep at quarter to 10 at night. So, although she may not have been able to process information logically, she definitely had some boundary overstep there. These are the kinds of things you want to protect yourself from, by establishing clear boundaries upfront. So, don’t let the patients have the ability to be able to encroach on your personal life, because you’ll get that one, and it only takes one. She was my one. I said that’s it, from now on, I’m going to be very clear about this. Lesson learned. You want to make sure that your hours are well stated. 


So, number two, you want to make sure that you are clear about how you will respond to emails. Number three, if you’re going to offer texting, use a texting service, don’t give out your own cell phone number. 


Number four, let them know very clearly what your policies are around scheduling, cancellations, missed appointments, no-shows, that kind of thing. I recommend putting in a policy that states if you miss three appointments in a row, then we’re done, because you’ve blocked out that time for them, and if they just don’t show and don’t call, it’s disrespecting your time. Why would you keep scheduling them just because you don’t want to offend the patient, or you don’t want to hurt their feelings and you need the money and you don’t want to lose the patient blah, blah, blah? No, no, no, no, if that patient is not respecting you in the beginning, then we’re done. We’re all done. That’s all, but you have to be very, very clear about that in the very beginning. In the design of that procedure, that policy and procedure, it’s for your office, you’re very clear about what your expectations are there with a no-show, missed appointment, reschedules, that kind of thing.


I also put in there about cancellations. I understand that stuff happens, and they have to cancel, but be clear about what the window is for a cancellation, if they’re going to call and will there be a charge? Now, if it’s weather or a flood, or they were in a car accident or something like that, completely understandable, but when there are repeat offenders, and they just cancel, and then they reschedule, then they cancel at the last minute, that kind of falls in that same category and you want to set those boundaries. Now, as far as emailing questions that have to do with their health, be very clear about what is acceptable to you or not.


For me, I don’t let them email me anything that’s going to take me more than two sentences to answer. If it requires more than two sentences to explain, then they need an appointment. And my staff, they know that. If I have to write a book that’s three paragraphs to try and explain something, it takes me 10 times longer to write, to think about how I want to articulate it in an email because email is so one-directional, right? You can’t tell emotion. You have to be careful how you write a response, and you have to craft it with more intention, I suppose.


So, if you’re going to respond via email, let that just be, if it’s more than two sentences, it requires an appointment. In fact, I had a practitioner one time, who was adamant about not wanting to get on the phone with me. And he said I want you to respond to me via email. And I said, Okay, you understand this is going to cost you more, right? Because it’s going to take me more time. Yeah, no problem. It took me an hour to answer his five questions, and I charged him for an hour of my time. And I’ve never heard back from him ever since, never. I would have considered him a friend, but I probably made him mad because I charged him for my time. But it was on him because I offered. I said, “Listen, we can clear this up in a 10-minute phone call, or I can type it out in an hour. I can answer your questions much quicker on a phone call.” So, be very, very clear about that because otherwise, you’ll end up giving medical advice, whether you like it or not, you’re still giving them advice over an email or even a text, and you’re basically ripping yourself off. You’re not having them come in for that appointment. You’re decreasing your revenue, but you’re also not serving them very well.


All of these things to say, don’t let boundary creep happen. That way people don’t show up at your doorstep in the middle of the night, or email you question after question after question after question. Put a stop to that in the very beginning. In the show notes, I’ve linked to a sample document that I like to use. I’ve put some fill-in-the-blank places if you want to put in like the name of your clinic or your hours, etc., but you can download that, and you can use that as a template to create your own. It’s just a very basic office policy and procedure that will help you get started. And if there’s part of it that you don’t like, no problem, just delete it. You can do whatever you want with the document, but it’s yours to use freely, however, will work best for you in your practice.


So, make sure that you respect yourself, and you set those good boundaries for the patient so that we don’t have to deal with boundary creep, because it is a time sucker, my friend. Yes, it is. 




Ronda Nelson: Alright, friends, there you have it. I’m telling you, it makes such a big difference when you set those boundaries right in the very beginning, and that way moving forward, patients know exactly what to expect. You don’t get any pushback because you can say, hey, look, you signed it, here’s the document. And that way, everybody’s on the same page. So, if you want that resource, I’d love to share it with you. All you have to do is go to


So, I’ve laid it out as an office policy for you, you can cut and paste and use the sections that you want to use and don’t just use it to kind of fuel your engine, get your wheels rolling so you can create your own unique office policy just the way you want it and prevent that boundary creep from happening. I am Ronda Nelson with The Clinical Entrepreneur podcast. Thank you so much for hanging out with me, and I’ll see you next week.




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