The Clinical Entrepreneur Podcast — Episode 304
Transcript
[INTERVIEW]
Ronda Nelson: You know, I fired a patient. Actually, I had to fire her twice. And if you’ve ever had a patient who ignores your recommendations, pushes your boundaries, price shops your plan, no shows, and then somehow makes you think the problem is you — that’s exactly what we’re gonna talk about today. Because sometimes it’s not the protocol or what you’re doing. It’s that the patient is not a good fit.
Ronda Nelson: Well, hello, welcome back. It’s gonna get saucy today. I’ve got — you know, I’m gonna spill a little tea on something that I think has been — it continues to be an issue for so many practitioners, and it doesn’t really matter whether you’re a wellness practitioner or you’re a dentist, or you’re an MD. There are just sometimes people who just are not a good fit. Doesn’t matter which way you slice it, they’re just not a good fit. And so today I wanna talk about that.
Ronda Nelson: You heard me say I really truly did fire this patient twice. I’ll give you more of the info in a bit. But you know, the relationship always starts out good. And you think, oh, of course I can help you. Of course I can. I’m gonna help you. Yes, no problem. And then it goes south, and sometimes the relationship between the practitioner and the patient starts to take on a — I say like a different flavor, shall we say — and that flavor starts to taint the relationship. Like it didn’t start out that way. And I didn’t sign up for this, and I didn’t expect this out of you.
Ronda Nelson: And I think where we get into trouble is this: we wanna help everybody with all the things. And there’s nothing bad about that — I am not faulting you or me or anyone else for wanting to do that. Like we really wanna do the right thing by the person. But the problem is that not everybody’s invested at the same level. And if I could really be honest, I don’t know about you, but I have noticed that there is so much more entitlement happening these days. People, patients aren’t just entitled — and I hate to kind of throw that word around, but I think it’s really true.
Ronda Nelson: We see more and more — I see it in the hiring pool. That’s why in the last year and a half — well, that’s not true. I’ve had a really solid person in my practice for over a year now. But before that, in the 14 months or so before that, I hired and fired — I lost count. I think it was nine people just in the span of a year and a half, and almost all of it was because of entitlement. And so I think patients sometimes come in the same way. Well, why aren’t you gonna do that for me? Well, that’s what I deserve. Well, that’s what I’m paying you for. Well, why can’t you call me back at 9:00 PM if it’s an emergency on my part? Sometimes the boundaries just get crossed.
Ronda Nelson: But of no fault of our own, honestly — genuinely, we really, really do wanna help. We don’t wanna seem unprofessional. We wanna help them get results. We wanna make sure that they’re happy. We don’t want the conflict. And sometimes, honestly, we don’t wanna get a bad review. Like I just got my first two-star review from a bot. And okay, fine, I’ll take that, I can dispute it and all of that. But sometimes you get a two-star or a three-star review from someone who’s just disgruntled. We wanna do everything we can to make them happy, but sometimes there’s just no more happy that can happen. You can try every supplement in the world and it’s just not gonna fix the problem. Because sometimes you’re not dealing with a clinical problem. You’re dealing with a fit problem — a patient fit problem.
Ronda Nelson: So here’s what happened to me. This woman comes to me. She was a referral, and that’s the only way that I will take on someone new — by referral. You can’t find it on my website. You can’t find anything about anything, anywhere, ever. I only take patients by referral. So this lady came to me and she had really high anxiety — fairly young, I mean, in her upper twenties, recently married. And she just had so many digestive issues. Well, right away I’m like, well, that’s a no-brainer. Of course, if you have high cortisol, you’re going to have digestive issues for sure. So she has all these digestive issues — reflux, heartburn, pressure in that epigastric area, pain in the mid back.
Ronda Nelson: And so I start her on the normal things. I do what I’m gonna do, and the first thing I know is I’m never gonna make any progress with her digestion until I fix the stress — we all know this. So I go after the stress and I give her everything. I mean, I know I’m gonna have to really settle that nervous system down in order to even begin to make headway. There’s no amount of digestive bitters or hydrochloric acid that’s gonna fix this. I have to get the stress and anxiety down. So I start doing that, and then she says, well, I’m too scared to take the pills. I’m just too scared to take them.
Ronda Nelson: Okay, well then — I said, listen, let’s start with some vagus nerve work. Let’s start with some deep breathing. And I’m like, well, if you won’t take the supplements, the herbs — I know they’ll work — but if you aren’t willing to take them or you can’t, then let’s do some other things. So she couldn’t really do that either. Her family — her husband and her family — was pressuring her to go to an MD because they were sure something really, really bad was wrong. Well, when you say that to someone who has anxiety, yeah, that’s not gonna go over well. And indeed it did not. Now her anxiety just went five degrees higher because now she’s panicked that something’s serious.
Ronda Nelson: So she’s had all the imaging — endoscopy, colonoscopy, CT, x-rays, labs, specialists, all the things. And she kind of ghosts me. She’s not really talking to me and I’m following up: how are you feeling? How are you feeling? And she says, well, I’m going to the doctor for this next thing. Going to the doctor for this next thing. Well, I’d already had the conversation with her about some of her medications — she was on four or five at this point, including a couple of anxiety medications. And of course, what does the doctor do? Gives her a PPI. So now that’s messing things up further.
Ronda Nelson: And someone told her, oh, well you can’t work with someone like Ronda because she’s gonna give you stuff that’s gonna interfere with the medication. So then she’s off spiraling. Do you see how this is becoming a not-good fit? At the end of the day, she gets through all these medical tests. She comes back and she says, well, the doctor prescribed me some enzymes and I think they’re helping. I said, great. I love that they’re helping for you and I think you should keep doing it — because at this point, I’m looking for an off ramp. I mean, I’m being honest. I want off this crazy train.
Ronda Nelson: So I told her to keep taking it. And then she says, well, yeah, but you told me some of the medications are a problem. And what if I take this and it makes it more of a problem — is that gonna interfere with what you’ve given me? By this time she’d taken a few things but not much. I felt like my foot was nailed to the ground. It didn’t matter what I said — nothing was gonna be the right thing. So I just said, those enzymes aren’t gonna interfere with anything. You just keep taking what you feel comfortable taking. Keep taking the enzymes and let’s just see how you do. Reach back out to me in a couple of months.
Ronda Nelson: A couple months later we get back on the phone. She’s talking about her hormones — and of course they’re all screwed up, because when cortisol’s a mess, the pregnenolone steal happens and everything downstream gets affected. So I said, well, when you’re ready, we can start to make sure your digestion is working — which it sounds like your doctor has under control — and once we get your stress better, then we can start working on your hormones. Well, what does that look like? I said, the first thing I’m gonna do is have you do some liver work, because the liver and bile are super, super important.
Ronda Nelson: And then she says to me — get this — what I need you to do is create a custom list for me of the cheaper things I can take, along with dietary recommendations and what I need to eat. My husband and I are gonna do this together, so I need you to do it for both of us. And I need to make sure there are foods on there that are gonna be really good for my fertility and also for my digestion. And could you just please write that up? Because we can’t really afford the supplements you’re recommending, so I just need you to go find other supplements I can buy online for cheaper and then create the protocol.
Ronda Nelson: Wait — what? What is happening right now? And I thought, I’m done. That’s it. You just crossed my line. I’m done. I’m never mad. Ever. But I’m done. You crossed my line.
Ronda Nelson: So I sent her an email and just said, listen, I think we might need to part ways. And part of the agreement she signed is that if you’re going to work with me, all of your supplements have to be purchased through me — because if they’re not, I can’t tell if she’s taking what she needs to take. I know by the dosing and the reorder schedule what’s happening. And she hadn’t been. I went and looked and she’d ordered one bottle from me. That tells me she’s ordering her stuff on Amazon. I didn’t have her on a program — I know it’s what I teach, but I did not do it with her, and it bit me in the butt. I’ve lost money on supplements, she’s becoming a problem, and I’ve spent all this extra time.
Ronda Nelson: Anyway, at the end of the day, I send the email. Very kind. No one could ever say it was over the line. I said, moving forward, this is how it’s gonna be. If you need to order anything, those supplements have to come through me. If that’s a financial difficulty, then you’re welcome to do it on your own, but I won’t be able to provide any support for that. And I never heard back from her. I thought, oh, this is perfect. Sweet. She got the message. It was kind. And then about a month later I get a message from her — super excited, ready to start the liver cleanse.
Ronda Nelson: I don’t think she ever got the email. Now what do I do? So I just had to have the conversation. I said, I don’t know that this is gonna work. And that was a super hard conversation because she needs help. I tried to refer her to someone in the area who came highly recommended, and she was just too anxious to even do that. So I had to let her go.
Ronda Nelson: So looking back — what would I have looked for? Here are some of the things that, if you’ve got a patient who’s gonna potentially encroach on your boundaries and maybe take advantage of you, that might signal they’re not going to be a good fit.
Ronda Nelson: One is practitioner hopping. I’ve talked about this before, but someone who says, oh, I’ve been to everyone and no one can help me. Well, why do you think I’m gonna be able to help then? That tells me either they’ve been to very poor practitioners — which I find hard to believe — or they just aren’t coachable. That’s one.
Ronda Nelson: Another big red flag is someone who’s trying to control the process before I ever get started. I just had someone email me a week or so ago and she said, oh, I heard about you from so-and-so, another patient — which was nice, great referral. And then she sent a list of like ten questions. Excuse me. That’s not how this works. You either want what I have or you don’t. I don’t mind providing a little more information about what I’ve done for the last 20 years — I have enough street cred, I can stand on my own two feet. But I’m not going to go justify what I’m doing so that you can feel better about it. I just said back to her, you should probably talk to the patient who referred you and get her opinion. She can fill you in. I’m not doing that.
Ronda Nelson: So someone who wants to know all the things — what tests are you gonna order, when are they gonna come back, what order do they come in, can I go through my insurance — you know the drill, right? These are those people. Red flag, warning, warning, warning. Do not say yes to those people.
Ronda Nelson: Another one — I’ve now started asking people how comfortable they are with taking supplements they’ve never taken before. I had a lady who was in an MLM — I won’t name which one — and she said, oh, those are the only supplements I take. And I said, okay, well then I’m not gonna be a good fit for you. I told her, listen, I’m not familiar with those. You’re probably better to get support from the company on how those are gonna work in the body. I’m not gonna be the right fit for you. And I let her go.
Ronda Nelson: Sometimes if they’re too medically oriented, that can be a problem — they’re thinking, well, I gotta check with my doctor before I take your supplements. No-shows. Disappearing — drifting away and then coming back wanting you to fix things, then drifting away again. Those people are just not committed. Not committed to the outcome, not committed to the process. And then they want you to do all the work and then go off and do their own thing. No. And also when someone starts to kind of twist the truth a little bit — well, I’ve been really, really good with my diet — and their triglycerides are going up and their weight is up. What? You’re lying to me. I don’t like that either.
Ronda Nelson: And really, at the end of the day, if there’s constant friction instead of a partnership from the very beginning — if they don’t trust your process, they are going to drain your practice. It’s not that they have questions. The issue is that they are not looking for a partnership. They’re looking to stay in control. And that doesn’t work for you and me.
Ronda Nelson: So how do we get rid of these people — in the nicest kind of way? I would never be unkind. My favorite, especially because I work virtually on Zoom — is to say, you know, listen, I’ve been thinking about this, and I know you’ve had some struggles feeling like what we’re doing is working. I really honestly think I would love to continue working with you. However, I really think at this point you’ll be much better served if you have someone in person that you can connect with — they can see your face, they can see your body, they can actually meet with you. I think that type of provider is going to be more in alignment. I don’t think what I do is the right fit for you, and I wanna honor your needs and how my practice works. But I think we need to find someone locally who will be a better fit. Because I don’t feel right with you continuing to make appointments when we’re not making progress. That’s not fair to you. You’re paying for something and not getting value from it, and I want to make sure you’re really getting the value for what you pay.
Ronda Nelson: See, I just made it all about them. I didn’t have to point out all the things — well, you this and you didn’t show up and you — no. None of that. And my friend, I promise you: your life will become so much more peaceful.
Ronda Nelson: You know how sometimes you look at your calendar and you’re thinking, oh, that person’s coming in today — ugh? You know what I’m talking about. That’s just what happens. So I don’t want you to feel like you can’t do anything about it. These are your monkeys, your circus. You have to make sure the patient is working within the guidelines of your practice. You get to decide what those parameters are. You’re not abandoning anyone — you’re just recognizing who’s the right fit for you.
Ronda Nelson: Like me — I don’t like to work with weight loss people. But I have someone in Clinical Business Academy who loves it more than anything and she is so good at it. She will fix weight loss for anybody. I, on the other hand, would rather never see a patient again if I had to only do weight loss. There are just things I don’t want to do. I don’t wanna do cancer patients because — it’s hard for me. Having my daughter go through cancer, it just brings all of that back up. My heart hurts because I understand. I just emotionally can’t do it. So there are boundaries. What are yours?
Ronda Nelson: Sometimes you meet with someone and you’re like, oh yeah, no — right away. You know: I’m not qualified for this, it’s out of my league, they need medical help, or it’s just not a personality fit. I had a guy who was a bully one time and he threatened to sue me because I wouldn’t see him at 7:00 AM. Because that was what was convenient for him. And it was patient abandonment, apparently. Whatever. But sometimes they’re just bullies. Helping them see that there’s a better opportunity for them somewhere else is the kindest thing you can do.
Ronda Nelson: And please — don’t let money be the driver. Like, well I really need the money, so I really need to take the patient. Is the aggravation really worth it? I would argue no.
Ronda Nelson: So first, I want you to think about what are your own standards. What does a good-fit patient look like for you? Obviously someone who has some disposable income for the work you’re doing together. But what kinds of behaviors do you want? Obviously we want them to be kind, respectful, a team player — working together as a partnership. What are your non-negotiables? I call ’em the no-fly zone. What are the things that are just not tolerable for you? You’ve gotta get really clear about that. Because when you’re clear about what you want and what you don’t want, filtering out a poor-fit patient becomes so much easier.
Ronda Nelson: When the relationship doesn’t work between you and the patient, it is no longer therapeutic. Not for you, not for them. Good-fit patients will be a little hesitant, they might need some reassurance, but they have a genuine desire to follow through. They have questions but they’re coachable. They may not understand something, but they’re willing to learn. They follow the guidelines. They order their supplements. They show up for their appointments. They’re kind. They don’t mistreat you or your staff.
Ronda Nelson: If you don’t define your standards, the most demanding patient will define them for you — and by the standards by which you operate your practice. Do you really want to give up that control to someone? I don’t. I’m not willing to audition for people. If you’ve already decided that I am auditioning for you, wait — no. That’s not gonna work. I choose who I want in my practice. We are flipping the tables on that. You don’t choose. I get to choose. Because this is my circus, my monkeys, my practice, and I’m paying the bills.
Ronda Nelson: So as I’m talking, I’m pretty sure a few names popped into your mind and you’re thinking, oh yes, I need to let go of them. Listen to this episode again. Write down the things I said that you’re like, oh, that’s good, I can say that. Say it in your own words — you don’t have to do it like me. But be kind, and make it about them, not about you.
Ronda Nelson: What I want you to think about is: are we really working together? Are we on the same page — or am I working harder than they are? Because I’ve always said, I can’t care about this more than you do. I can’t. And as soon as that line gets crossed, where I’m caring about it more than they are, I pause and I think: is this a good-fit patient? Like the young woman I was describing earlier — she was more heavily invested in the influence and opinions of her family, the opinions of her doctor. I completely respect financial constraints. I completely respect that. But she kept asking and wanting from me in ways that just aren’t how my practice works. Let’s find someone who can do that. I can’t do all the heavy lifting and then have you get all the benefit. We have to be a team here.
Ronda Nelson: So I think the takeaway for you, my friend, is this: you are never, ever going to build a practice that’s the right fit for everyone. As much as you might want to think that, it’s never gonna happen. The goal is to build a practice that’s filled with people you really enjoy, who want what you have to offer, and who are willing to do the work and pay for it. Because you cannot care about it more than they do. That’s all. And if there’s an imbalance in that relationship, it might be time to get a little thoughtful about whether that patient is the right fit for your practice.
Ronda Nelson: And when you can relieve that emotional turmoil and angst, and you can help them find someone who’s going to be a better fit — my gosh. It’s just so much more freeing. So much more freeing. And you’ll have more energy to bring in the right people. Because every action has an equal and opposite reaction. If your action says, these are the people I want — and therefore I’m going to make room by releasing the people I don’t — you just created space for more of what you do want. But spend some time. Think about it. Who’s a good fit? Who’s not? What are your rules and boundaries of engagement? What are the non-negotiables?
Ronda Nelson: When you look at your calendar and you feel that sinking feeling, that’s your signal. Things happen — I’ve missed appointments too. But I clean up my mess, I follow up, I apologize, I make it right. But people who consistently disrespect your time? Get rid of them. Because now you’re leaving room for the right people to come in. Don’t be offended too fast — give people a chance or two. But when they show you who they are, believe them. That’s all.
[CLOSING]
Ronda Nelson: Alright friends, see you next time. Listen, if this episode hit a little too close to home for you and you realize that you’ve been tolerating — right, tolerating — those patients that are giving you trouble in your practice, you have got to stop. You don’t need any more chaos in your world. There’s enough chaos in life the way it is. All you really need is a better system. You need a system around your intake. You need a system around how to qualify those patients. You need a system for how you’re going to integrate them, and you also need some kind of marker or checklist to evaluate when things start to go awry — and where the line is that, if they cross it, we move into plan B, which is how to kindly and warmly remove them from your practice.
Ronda Nelson: These types of systems are exactly what I help practitioners do inside Clinical Business Academy. If you are ready to start building a business that’s built on a solid foundation — not waffling around trying to change things at the last minute, having documents scattered everywhere with no organization and no structure — if you’re tired of that, then I have got the solution for you.
Ronda Nelson: Schedule a practice strategy call with me and let’s talk. I’m here to help you, and I want to help you grow a business that helps you serve more people — but do it in a way that feels easy and light, and most importantly, really helps you generate the revenue you deserve for the transformational work you’re doing.
Ronda Nelson: So schedule a call with me. Go to rondanelson.com/practicestrategy. That will give you access to my calendar. We can schedule a time to talk and let me just find out what’s going on in your business. What are your big pain points, and I’ll tell you if Clinical Business Academy is a good fit or not. If it’s not, I will tell you. And if it is, we can talk further about that. But get on a call with me — I would really love to know where you’re stuck, what is the biggest problem you’re facing, and let me see if I can help. So go to rondanelson.com/practicestrategy, and I can’t wait to talk to you.
[END]