“No, that won’t work Mrs. Jones, I’m sorry I cant help you.”
Recently, I had a patient return to the office after a hiatus of about 3 years. Nice lady, but as my staff recalled, she had initially challenged us on almost everything in our patient policies from co-pays on time to compliance with professional advice.
Well, of course she got better which is why she called us again.
This past week though, my staff quickly reminded me how tough she was on them.
Her return was as my staff anticipated.
But for some reason, I really like this lady, just can’t put my finger on exactly what it is that intrigues me about her approach to the world.
Her exam went well, and then the challenges began to fly. “I can’t possibly be here next week. Co-pays are how much? You’re not here Fridays?….”
So, I walked her to the front desk, and asked my receptionist Julia to schedule a second visit appointment. Then, within earshot of the entire waiting room, she says, “Is that when he tries to convince me to come three times a week?” Julia was aghast. “Did she really say that to me? Why did she even bother coming back?”
I asked Mrs. Jones to consider carefully her comments before scheduling again.
Well, she came back Thursday, I asked her to sign an informed consent after a brief report. She asked, “So, when do I come back?”
I said, “You just will not get better if you can’t follow advice. I am sorry, I can’t help you. I’ll tell my staff I’ll see you on an as needed basis-just call or walk-in. I wish you all the best”.
Next, I’m down back with patients, then I walk back to my office for the next patient, and guess who is scheduling a treatment plan with the front desk?
Doctor, I can’t tell you how many times this low stress. Low-key approach to patient care planning has worked for me, and still does, even as I train new doctors.
There are of course some caveats.
The patient must know, non-compliance usually means you’ll be forced to refer the patient on. I tell every patient that non-compliance means a higher liability risk for me and a likely discharge from my care, right up front.
You and your assistants must document exactly what’s going on. If it’s poor insurance, finances, time, willful non-compliance.
Whatever it is, you can’t write it often enough. Have your staff do an entry too if the patient becomes belligerent or disrespectful.
But, strive to train your staff to screen prospective patients better.
Lets face it. People are stressed, confused enough about healthcare benefits as is.
I have really seen the value in this while treating so many elderly patients with neuropathy. Most are sweet, and grateful. But more than one in ten in this age group has been tough on my team, some downright nasty, when they find out what exactly non-covered services like the first exam are.
So, now we have the business office call new patients before the first visit to review the ABN.
Then at the front desk, before any other paperwork on their first day, Julia reviews the ABN and non-covered services. And you know what? two or three every month still walk out.
Then, rather than making Julia feel bad because of a walkout, I compliment her on eliminating a trouble case up front, and keeping the office peace.
Tough approach? You bet.
But, you see, the doctor must set the ground rules. It’s the doctor’s license, liability, and reputation.
Some patients will just never get better, no fault of ours. Seems some even pride in trying to make you wrong, or as miserable as them.
Most however are sweet, kind and very appreciative. Supportive, and continuously refer their friends and family. In fact, in my waning days of practice I appreciate them more and more.
Some of my sickest patients have overcome extreme adversity, yet every visit still smile and pay their bills. The sheer human impact of this inspires me to do all I can for them.
And I know it’s the same for you too. But only if you lovingly but firmly run the office.
Remember, the real power is in the continued improvement of your systems.
Make sure you take the time to meet with your team, and really go through these encounters step by step.
You’ll be happier, busier, and more prosperous too.
Related posts:
- Are your patients getting mixed messages?
- Doctors as Effective Executives
- Something so very simple.
- Staff.
- The War of Art* and getting unstuck…
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{ 2 comments… read them below or add one }
Great post, Dr. Hayes!
As healthcare professions (and a future one, in my case), we need to coney to patients the importance of treatment, life style changes, and compliance. I know I’ll deal with this in my lifetime when I’m out in practice, but it gives a casual technique to handle those situations. I also appreciated the portion of making it a positive for your staff–eliminating trouble cases.
Hopefully those particular patients still end up finding treatment someway because we all do deserve to at least try to be healthy.
Jim, I am passing the torch to you, there is tons of this stuff you guys and gals will need to deal with. All the best!