[INTERVIEW]
Ronda Nelson: Your patients don’t drop off because they’re non-compliant. The problem is that they didn’t get the message from the very beginning that they actually need you. Let’s talk about it.
Hey friends, welcome back to the podcast. I hope you loved last week’s interview — it was so great. So today though, we are going to be talking about patient compliance. But before we do, I wanna remind you again that starting May 1st, all of the podcast episodes are going to now live on YouTube, so that will be our primary home. I’m not changing anything, it’s just moving to YouTube. I was already posting there, and we’re just gonna make that our primary home instead of having to do duplicate work and put things in two places. Smart business decision, less work for Ronda, better content for you. So if you haven’t already, head over to YouTube and subscribe so that you know when new podcast episodes go up. It also gives me the opportunity to create bonus episodes and bonus videos for you, which is a little bit harder to do on a podcast platform. So there you go. Things are changing, but it’s all super good.
All right, let’s get into today’s topic. You know, sometimes one of the most common things that I hear from practitioners is they’re frustrated. Especially now, I think, because patient compliance seems to be going down. And we say, well, they stop booking, they stop scheduling, they’re not ordering, they’re ghosting me. They’re just not responding. They go quiet. They quit returning phone calls. They just don’t show up. And you’re left thinking, what the heck happened? Is it my breath? Did someone offend them? Like, what happened?
And so then we go into — listen, if this is you, do not feel bad. I’m just saying this is how our brains work. We tend to make excuses. We don’t wanna say justify, but we make up a story that makes the situation make sense to us. So we think, oh, well, people are just too busy, or they’re just not compliant. They want help, but they just don’t wanna do the work. Or it just got too expensive. Or even more self-deprecating: well, my fees must be too high. Or the supplements — oh, I talked about that two weeks ago when I was talking about Standard Process — the supplements are just too expensive. And we start making excuses about why they stopped, why they’re not compliant.
But I would offer something different. I think the reason that patients don’t comply is not so much a problem with them — it’s more of a problem with you. And here’s — I’m gonna talk about that today. Don’t hang up on me. Don’t hit stop. Here’s why. I think it’s a communication problem. It’s a value problem. It’s a leadership problem. It’s a structure problem — like a business structure problem. And I know that doesn’t feel real good, but that’s okay. We’re gonna get through this together.
So let me walk through this with you. We tend to wanna make it their fault, and I understand that because it’s a lot easier to make it someone else’s fault than to own it myself. And we wanna think that they only care about price, or they found it cheaper online, or whatever. But what I think is really happening is we don’t give them enough evidence that staying compliant with the protocol we’re giving them — or continuing to work with us — is where the transformation is gonna happen.
Because we don’t go over with them. We don’t anchor them into a conversation about the seriousness of the issue, or the expected timeline, or the phases of care. Maybe there are going to be three different phases or three different stages or steps. And we don’t anchor them into what progress looks like. Like, the first month, this is what you’re gonna experience. The second month, this is what you’re gonna experience. And the third month is when we’re really going to see the transformation. We don’t spend time doing that. Most practitioners don’t.
We don’t anchor them into why stopping early matters — in the wrong kind of way. Kind of like when you have to go on an antibiotic and they’ll say, always complete the full course. Why? Because if you stop partway, it’s not enough. You’ll feel better — that strep throat will clear up and you’ll feel better after 24, 48 hours — but there’s still one or two days left on the antibiotic and you’re thinking, well, why am I still taking this? I’m gonna stop. And then you stop. And then what happens? It comes back. Maybe not as bad, but maybe. And then you just screwed up your microbiome for nothing. So we don’t anchor them into why you wanna finish the antibiotic. I know — really bad example, isn’t it? But you get my point.
We don’t anchor them into why the follow-ups matter, or why buying elsewhere disrupts the plan. Because they could get cheap products — Amazon’s full of knockoff products. Some of them they’re not really at risk with now, but there are still a lot of bad ones on there. So the question I think you have to ask yourself — and I have to ask myself — is: did I create this relationship with this patient and build a protocol that made follow-through the next obvious step? Did I do that? And if the answer is no — and usually it’s no — then the patient is just going to drift.
They’ll drift because we did not anchor them into the reason that they want to stay. We wanna say they’re non-compliant, but really what it means is we gave them a loose recommendation. We hoped — just assumed, zoomed — that they would understand the importance of staying the course. And then we’re frustrated when they treat it like an optional suggestion. It’s true. It’s a hundred percent true.
So most of the time they’ll drop off when they feel about 30% better. That’s my experience anyway. Maybe you guys don’t have that, but my experience is that it’s about 30 to 40% better and they’re like, I’m done. Their bloating is better, their energy is up, their skin is clearer, they’re pooping better, their sleep is a little bit better, their cycles are better.
Like I have a lady right now, and she came to me and said, I bleed all but five days a month. And I’m thinking, bleeding — she keeps saying, I’m bleeding, I’m bleeding. I’m like, oh my gosh, you’ve gotta be anemic. She’s not anemic. And I come back to her and I say, could you tell me what bleeding means? I said, is this like spotting or is this like tampon material? She goes, oh, no, no, it’s just bleeding. Just like when I go to the bathroom and wipe, I’m bleeding. I wanna bang my head against the wall. My own fault, because I assumed.
My point is we just assume that we’ve communicated with them. We assume that they know what bleeding means. We assume that we’re on the same page with the language, and sometimes we’re not. So she gets better — I do what I do for her hormones and I get her better, and she’s so happy. She ghosts me. Ghosts me because she’s better. My fault. Completely my fault. I cannot blame it on her. I did not anchor her into the why soon enough. Because the patients are not dumb. They’re thinking, how are you gonna solve my problem? And if I’m not clear about how I’m gonna solve that problem, they’re going to drift.
So we can’t call it non-compliance. They call it, I’m done. But we can’t call it non-compliance. We have to call it for what it is, and that is that we dropped the ball.
So from the patient’s perspective, they come in, they have an appointment, they get their stuff, they go home. And then you call ’em, they come back, they get — you just talk about it. You’re just talking about it. Talking about it. Maybe you’re muscle testing and you’re talking about it, talking about it. And then they go home. After two or three of those visits they’ll be saying, I don’t know when I’m coming back, what’s next? What am I supposed to be working for? How long is this going to take? What should I expect? Because we did not anchor them into the importance and the value of the process.
So it’s not about selling them. I’m not telling you that you should be really salesy or high pressure or anything like that. It’s about — think of it like creating architecture around your visits. Maybe that’s a better way to say it. If you don’t have structure around how you’re gonna deliver your care, then the follow-up is gonna be poor and the drop-off is gonna be high. And it’s not because you as a clinician are bad. You could be fabulous. It’s not because you’re bad — it’s because you’ve got loosey-goosey screws and your house is all topsy-turvy. That’s not going to help you.
So you might say, well, I don’t want the patient to feel obligated. I don’t want them to feel pressure. I don’t want them to feel trapped. Okay, but listen — there’s a difference between putting someone inside a container where they can be safe and get better, versus having them feel trapped. You’re putting them in a container so that you can lead them, so that you can ensure that they’re getting the outcome that they want.
The supplements that we leak — and I’ll say leak because we’re really leaking that revenue from the product sales — is big. And they fight it too. I just had to fire a patient about a week ago. Felt really bad about it. She was kind of a high-maintenance patient. She had been down the medical road. She had so much anxiety. And I made a recommendation for her, and then she pushed back on me and said, well, we can find it online for this much. It was like $20 or $30 less or something like that.
And I’m usually pretty gracious about the whole thing, but her anxiety was just getting the best of her. So I sent her an email and I said, listen, I’m happy to support you, but I do need to know — and I have them sign something that says, if you choose to buy your supplements elsewhere, it’s fine, but if you do that, the consultation cost is going to double. Because it makes more work for me to try and understand what you’re taking, whether you went and found something cheaper and what’s in that thing. I can’t support that. I know how to get you better with the tools that I have. So I need you to work with me and make sure that you use my tools. If you don’t use my tools and you’re gonna use tools somewhere else, then that plan has to change, because it creates more work for me.
So I had to send her an email. And I had AI kind of help me write it, because I can be direct — I’m always kind, but I can be direct. So I love AI for that, because it helps me say what my heart wants to say, but I don’t always type it right. And so I sent a really nice email to her, and I never heard back. I just said, this is how it’s gonna be. And she probably feels like I kicked her to the curb. So it’s easy for me to blame her. Easy for me to blame her. But if I’m gonna be honest, it’s totally my fault. Because I did not anchor her from the very beginning into what this looks like when you work with me. When we do this together, this is what it looks like. All of your supplements will be ordered through this. This is how we’re gonna follow up. This is what you’re gonna experience.
She probably did wanna save some money, and I can work with that if it’s a financial concern. But we have to take responsibility for when they drop off. I know this is — I’ve kind of been on a not-so-fun topic list lately. But it’s just our fault. It’s a hundred percent our fault. So we have to make sure they understand why it matters.
They may say, you know, I already know what to do. I’ve been doing it for two months and I feel better, so I’m just gonna reorder and keep going. I have people on my Fullscript account that just keep ordering and ordering, and I just gave up. I’m like, well, at least I’m making a little bit of money on the supplements. But they won’t call me back. They just keep taking stuff and I look at what they’re ordering and I’m thinking, you don’t need that. Still. You don’t need that. That’s old news. You should never be taking that for this long. It’s not gonna hurt them, but you don’t still need that. And if they don’t call me back and don’t schedule an appointment, then I cannot help them. The patient doesn’t understand that. So these are the things that we have to anchor. We have to value-anchor them from the very beginning — not emotionally, we’re not manipulating — but very, very strategically.
So I think the value comes when we think about how to anchor them. It comes in how we sequence the treatment. In other words, we give them an overview of what this is gonna look like, and then we give them an interpretation — here’s what you’re gonna experience along the way. And we let them know there may be some need for adjusting. Because who wants to take a supplement not knowing whether that’s still gonna be good for you? If you said that from the beginning and you said, listen, we might get to a point where these supplements are no longer needed and we can go work on the next thing — or after a certain time, like Artemisinin, for example, you don’t wanna give that long-term, over 30 days. So I tell them, listen, we have to do this short-term. You don’t wanna take this long-term, and that’s why we’ve got to follow up, so I can protect you and your health by making those navigational changes with your protocol. That’s anchoring them into the conversation so that they don’t drift.
And some of that is just accountability. So how else are you holding them accountable? Are you sending follow-up emails in between? Do you have a little SMS text that goes out saying, hey, just checking on you, seeing how you’re doing, your supplements should be running out about now — would you like me to place that order for you? How are you holding them? Are you holding them accountable, or are you just kind of letting them drift and then tossing out the life ring when they show back up? Like, yeah, come on in, let’s talk about it.
They have to know the importance of relying on your clinical judgment. They have to know that your clinical judgment is the key. And sometimes I think we just make it so lackadaisical. Like, lowey-dody-do-do, come on back in and we’ll talk about it and we’ll just see. Maybe I’ll muscle test you. We’ll see what we do next. That does not anchor anybody to anything. I mean, some people will keep coming back because they love you and they’ll show up no matter what. But I think often we’re just too soft.
We’ll even say things like, well, let’s try this and see how it works. Even if I don’t know whether something’s gonna work, I will say with confidence, this is what we’re going to do and this is what’s going to change. If it doesn’t, I’ll say, huh, interesting — all right, let’s reevaluate and see what we need to do differently. But none of this: well, let’s maybe start with this. Well, if you want, we could do da-da-da. Let’s see how it goes. Whenever you’re ready, let me know. All of that soft language is your code for: I’m not confident about the next steps, so I’m letting you know I’m kind of in charge, but I kind of don’t know what I’m doing and I’m not really sure this is the right direction.
Look, my friend — if you have to just fake it till you make it, then that’s what you’ve gotta do. You have to be able to say with confidence, this is what I’m recommending. Even if in the back of your mind you’re like, hmm, A or B — I’m gonna go with A because I think A is the right choice. That’s what I’m choosing. So we have to stop with the soft language.
Being authoritative is not being aggressive. It’s not aggressive. You’re just saying what you know. It’s your clinical judgment. And being clear with someone is not being pushy — it’s just being clear. When you’re leading, you’re not manipulating someone. You’re not making them go left or right. You’re just leading them with confidence. You’re being clinically confident and you’re not using wishy-washy soft language. Because patients will leave when they don’t feel like you’ve got the reins under control. If they feel like they can take the reins back — and they’re gonna go buy it online, or just find whatever they need — they will.
If they don’t have clear follow-through — like I said, refill reminders, a clear timeline, a duration of care — what does rescheduling look like? How do you make it really easy? Is there built-in accountability? Do you call and check on people on Saturdays? I often will send text messages to some of my patients just to check in on them on a Saturday morning because I know they’re working and busy during the week. And it’s outside of hours for me, but I don’t care. Because they always say, thank you so much for checking on me. And it feels like I’ve kind of gone over and above. Now — it’s not my cell phone. I’m not texting from my cell phone. So if they text me back, I don’t respond until Monday. But I will do that very often on a Saturday morning because it’s me holding that gentle accountability. How are you doing? How are you feeling? How’s your back? Have you been back to the doctor? Just following up with them just a little bit.
When patients drop off, I’m just telling you — it’s not their fault. I love you so much, but it’s not their fault. It’s yours. It’s mine. Because we did not lead. We did not hold them accountable. And that’s on us.
Sometimes we also have practices full of people who really aren’t invested, and that part’s not very fun to talk about either. They’re kind of like tire kickers. They’re information shoppers. Sometimes they’ll come in and be like, oh, well, what can you do for me? Oh, okay. Well, I’ll do that. And then they’re in it to not win it. They’re in it to get the supplements. Or even worse, if you’re doing any kind of discounting, they’re just gonna come and take you for what they can, and then move on. Practitioner shopping. They don’t wanna stick with the process. They’re just gonna go try this, and that didn’t work, so I’m gonna go over here to this person. That didn’t work, so I’ll go over here to that.
Warning. Warning, warning. Always say no to those people. If you’re attracting those kinds of people, you may wanna be asking more questions. Because if you ask them a lot of questions and you start getting back a lot of hesitation, or yeah, I’ve been to everybody, no one can help — those are clear signs that this is not going to be a good fit at all.
Another thing that we often do — and I fall into this a lot — is I give free information. And I do it because I care. And you guys do the same thing. I know you. We all have the same kind of heart. We just wanna give, we just wanna share. But there’s a difference between being generous and having holes in the bucket where all of your information just comes flowing out — blah, blah, blah, blah, blah. Tell them a little bit of what they need. Just hold back the how.
You can teach them the why. Why is your digestive system a problem? What is happening? Why did it happen? Here’s how your digestive system works, and when you’re under stress, this is what happened, and this is what we’re gonna need to fix — because if we don’t, X, Y, and Z are gonna happen. Here are the consequences. That is good leadership. That’s good management. That supports them, that allows them to have a transformation. It’s got structure. It has sequence. It has timing. It has accountability. You’re saying, this is what we’re going to do. And that’s going to make the patient feel so much safer.
So when you’re following up and you’re thinking about these patients — they’ve ghosted you, they’ve abandoned you — I would really encourage you to think about what it is that you are doing, because it’s not them. It’s not because they just decided to drift away. The truth is, in most cases — not every case, I would be wrong to say a hundred percent — but I really believe in most cases it’s a failure of leadership on our part. It’s a failure of us holding the line, holding the space for them, creating expectations, and anchoring them in the value and the transformation of what we do.
So we wanna give them: here’s what the flow is gonna look like, here’s what your care is gonna look like, here’s how the supplement reorder process works. Not just, well, let’s try it out and we’ll see. I’ll see you back in four weeks. I sometimes still do this after all these years. It’s just so my heart. I don’t know why I do it. I know better. And when I do, almost always, it never ever works out. It’s like the patient I just had — I had to say, sorry, if you want me to help you, I’m happy to help you, but this is how it has to go at my house. And she’ll never come back. And she’s probably mad at me and won’t say nice things about me, and that’s okay. I can’t be everybody’s best friend. But I lost that one, and that’s on me.
I wanna blame her. I totally do. I wanna say, well, did you hear me earlier in this podcast? Yeah, well, she had high anxiety. Do you see how easy it is to justify? Well, she was going down the medical route. She wanted to do all the doctor stuff. Her anxiety was really high and she was out price shopping. Do you see how easy it is? I just wanna make a story up about why it’s her fault. But if I get quiet and I just sit with it — it’s a hundred percent my fault. A hundred percent my fault. Because I didn’t anchor her in the value of what we’re doing together, and I didn’t act right away when I saw that she wasn’t ordering supplements from me. I should have been right on it. And I just got all passive and went, eh, it’ll be fine. She’ll be fine. And she’s now fine. So there you go.
[CLOSING]
Ronda Nelson: Friends, that’s what I got for you this week. I know — not a very fun topic. Maybe next week will be better. I’ll have to decide what I’m gonna talk to you about next week. I’ll try and find a happier subject, although last week was great, right? I hope you all put your order in for your Real Mushrooms products. Amazing. So anyway, have a magnificent week.
If you’d like to know more about how to run your business, how to be a leader with your patients and in your business, you know where to find me. rondanelson.com/cba. Set up a practice strategy call with me and let’s talk about your business. I will tell you the truth — if you are a good fit, great. And if you’re not, I will tell you that too. No high pressure. I just really do wanna help you. So take care, friends. Have an amazing week. See you next week.
Hey, hang on. Before you go — don’t forget, starting next week — well, no. Next week is our last actual streaming podcast episode. After the end of this month, at the end of April, everything is gonna be over on YouTube. So make sure you hop on over to YouTube. You can find me — just search Ronda Nelson and you’ll find the channel. Subscribe, turn on the notifications, and make sure you get the ding-ding when the new podcast episode goes live. So if you are watching this podcast and you’re like, wait, why is there only one more — which is next week — you’ll know why. They’re all gonna be over on YouTube. So don’t forget, we’re moving over to YouTube exclusively. Have a great week. See you then.
[END]