Compassionately Letting Go of Non-Ideal Patients for Long-Term Success (S1E7)

Continuing the discussion of ideal clients, In 1960 Niel Sadaka wrote a song called “Breaking Up Is Hard to Do”, and man, it’s one of the hardest things that I experience in practice. Especially when you’re working on creating relationships, discontinuing relationships is difficult. Letting go of patients who aren’t a good fit – is a necessary part of the process. You’ve got to get good at it. Discharging patients who don’t align with your practice is hard.  But, when you do, it opens the door to create space for the people who are a better match. It allows you, the practitioner, to be available to the type of patient you desire without being tired and burned out. I know what you’re thinking, “What about the duty to the patient”? A doctor-patient relationship is critical to good care – you have a duty to discontinue relationships that aren’t profitable (and not just financially).  It’s your duty. You should know that if you can’t really relate to this patient, and they can’t work with you because of: compliance issues, attitude, your skill set, or a trust level, that it’s your duty to move that patient on and get them to somebody who can help them and work with them. To give you some context, discharging a patient isn’t casting them into outer darkness with wailing and gnashing of teeth. It’s about recognizing that every relationship isn’t meant to last. Consider being in a relationship with somebody long distance, and neither of you likes to get on a plane. That relationship will just not work. There’s just certain things that don’t work. It doesn’t need to be a disaster or a horrible situation, it’s just not a good fit. It is good to recognize these relationships and end them as soon as possible. Here are few signs that it might be time to consider parting ways with a patient. (This is somebody who is not your ICP – they’re not your ideal client or ideal patient.) 

Breakup Reason 1 – The Patient Lacks Engagement. 

1. If they have a lot of no-shows, or late-cancel appointments. 
2. On a repeat visit you ask, “Hey, how’s that working? We talked about your treatment with doing stretches, or that medicine”, and they reply, “Well, I just haven’t really been able to get to it yet”. That’s a sign they’re not really fully invested, and that’s okay. You can coach them through it, and it may help (because not everybody’s ready for commitment).

I have a patient (this example will be helpful).  She was diagnosed with diabetes. We talked about the need to shift diet and make changes with eating habits. Generally, I’m pretty relaxed about dietary control (I know it helps, but I also know it’s one of the hardest things for people to change). I generally don’t say, “Never eat sugar”, or “Never eat cake, cookies, pasta, bread, etc.”. I usually recommend limiting them. Her response to me was, “Don’t you tell me I can’t continue to eat sandwiches!” My response to her was, “I’m not going to argue with you. I’m just trying to help you to go down this path”. Clearly this could have been an opportunity to discharge her or break up the relationship. But coaching did work with her. And she was willing to change her mind. She’s done great, with peptides and other treatments. She’s doing really well.  

Breakup Reason 2 – A Patient With a Negative Attitude.

If they always come in – it drains your energy and you hate seeing their name on the schedule, this is a patient you should discontinue a relationship with. You want to work with patients who are open (and at least somewhat hopeful that you can help them), not those who bring the rain cloud into the office. This will not only affect you but [will affect] your entire staff. In our office, we look at the schedule in the morning and do a morning report. When every staff member’s response is “Oh no, there’s that patient.” Those are the patients where the conversation is important to have. We ask the question, “Do you really want to be here? Is this really working for you?” If they have a positive response and do want to be a patient, then we set boundaries for them to adhere to with guidelines and timelines. If the patient can do this, they are able to remain a patient. At this point, some will self-select to leave.

Breakup Reason 3 – Mismatch of Values. 

If you find your approach to care is in direct conflict with the patient’s beliefs or values (they don’t think that it’s really good to take medicine or whatever type of treatment you are recommending), this patient is not a good fit. If they have conscious issues with the treatment you believe would be best for them, they should not remain in your care. As an integrative practitioner, I believe in doing exercise, nutrition, and medication when the patient needs it. I also believe in the full spectrum of care, including oncology and surgery. We cover many types of treatment and we’re willing to work with patients along all different spectrums, but if the patient refuses what we believe would be most beneficial, it’s probably not going to be a good fit. It would be similar to being a “steak and potatoes guy” at a vegan joint. You can’t do it. They’re not gonna be able to do the work that I need them to do, in order to get the results that I’m experienced with and that they desire. It’s generally easy to know within that first visit or two, – “This is a really good fit”.

How to Release a Non-Ideal Patient

So, how do you release the non-ideal patient? With professionalism and kindness. Be direct, but compassionate when you talk to the patient. Be really clear about your decision before you go into it. Then, express your understanding and say, “I think you would benefit from a different approach”. I have many patients who believe that they are doing well enough, they don’t need to have lab work, or they don’t need to take a certain course of action. I can say to them very directly, “You know what? If you’re not comfortable with this form of treatment, I think it would probably be better to see somebody else because I want you to have the best care you are comfortable with. I can’t do a good job for you if you can’t follow this protocol.” Just be direct and compassionate. Offer alternatives. We have many good doctors around us, and there are plenty of patients. You don’t have to hold on to those that are not a good fit for your style of practice.  I have people who I work with (other primary care physicians and health-oriented people), who are great. Some are more formal than me. They’re just more traditional in their demeanor; and there are people who are way more alternative, and some patients like that. Having these relationships, I’m able to provide referrals to other practitioners who might be a better fit. That really goes a long way compared to, “This isn’t working, sorry”, or as one patient told us, he was told, “We can’t help you, we wish you well”. Neither one of these is helpful to the patient or kind. Taking the time to help them understand why the relationship isn’t a good fit shows that you care. They don’t feel like they’re just abandoned. Because this is my personality, I like to keep it light. It doesn’t have to be heavy. Like the Neil Sadakis song – “Breaking Up is Hard to Do”. But I think if you can say something like, “You know, we’re like oil and water. Both are good, but when you put them together, it’s not a great mix. They don’t mix.” Keep it light. It doesn’t have to be horrible. Parting ways doesn’t have to be a negative experience. It can be an opportunity for both you and the patient to find a better fit in the journey. Discharging patients who don’t align with your practice opens the door for those who do fit with your practice. Making this part of your practice management makes a huge difference. Your staff’s happier. Your days are better. You might get to leave early once in a while because you don’t have a totally busy day every day. You don’t want patients that don’t fit.  Putting it all together, if you want your practice to thrive and your compensation to reflect your expertise, you have to take the time to define your ideal patient profile ICP.  This strategic focus will transform your practice from a job (like urgent care), into a really rewarding journey. (But if you want to be an urgent care provider, then you can define your practice this way.) The connections you build last a lifetime and they lead to a really great patient base; which grows, and grows, to the point where you can actually start to say, “You know, I need to limit the number of patients I’m seeing because I have too many to manage well”.  Thanks for joining me today on the Cash Practice Solution Podcast. Don’t forget to check out our cash practice scorecard at cashpracticesolution.com. This scorecard will help you guide your decisions and really do a great job of making that transition. If you found this episode helpful and hopeful, please share it with your colleagues who could benefit from it.  Until next time, remember the keys to your success – Apply to the ideal patient. Listen to your patients, learn their stories, and love them with your whole heart; and it’s true, you will be unstoppable.