Interacting with and caring for our patients are some of the most enjoyable experiences of being a chiropractic assistant. Not only do we get to witness the impact of chiropractic care on their lives, but we also get to cheer them along in their health journey.
Occasionally, we have to deal with difficult patients, and that part of the job is not enjoyable. How we respond when handling these difficult patients can make or break the relationship they have with us and the practice. It's critical that all patients are handled with love, respect, and care, or we could risk losing them. We could sour the relationship they have with us and the doctor, and for some patients, it can affect their impression of chiropractic.
Before I go into how to handle difficult patients, let's first look at some common situations that cause a patient to express challenging behavior.
Inconsistent Expectations
Running a successful practice includes meeting or exceeding patient expectations. Patients need to have a consistent experience when they come in for care. For example, a patient comes in for the first visit and is greeted by a friendly CA who smiles and makes them feel welcomed.
The CA clearly outlines what the visit entails and reviews intake forms and fees, which helps put the patient at ease. The patient then meets with the doctor, and by the end of the visit, they feel like they're in the right place and leave hopeful that the doctor can help them.
On the patient's second visit, they're again greeted by a smiling CA and feel welcomed. The doctor has confirmed the patient is in the right place and outlines the treatment plan. The patient happily enrolls into care and receives their first adjustment.
The patient starts care and is coming in three times per week. Each visit, they're greeted with a warm welcome and a smile. They're in and out of the office in 20 minutes. The bedside manner of the doctor comforts them along their journey. They are happy with the care and starting to feel better.
Then something shifts. The consistent experience they had for the past couple of months begins to change. Sometimes when they arrive for their appointment, they're not greeted by anyone. The CA comes out of the back office, notices the patient sitting in the lobby, and assigns them to a room for treatment without the warm and friendly greeting the patient used to receive.
The doctor runs behind occasionally, so the patient has been late to work a few times because they're used to 20-minute appointments. Lately, they've been in the office for 30 to 45 minutes.
Then, the patient gets a phone call from the CA saying their last two monthly care plan payments were declined because their billing expired, and they have a balance due. This is the first time the patient hears about the declined payments. The patient becomes upset on the phone and snaps at the CA because that was the final straw for them. The CA perceives this outburst as the patient being difficult.
The patient feels a sense of frustration and disappointment and stops coming in for care.
No one calls the patient to ask what happened. The enjoyable and consistent expectations set at the beginning of care diminish and have now created an exit door to the practice. Sadly, the patient never returns.
When patients become accustomed to a standard that is met with each interaction, their chances of becoming loyal patients are much greater. Patients return because of certainty about what's going to happen throughout the course of care.
In the previous example, if the patient's experience had remained consistent and expectations were met or exceeded, they likely would have stayed the course of care. It's imperative that every team member in the practice trains on delivering the best care possible on a consistent basis. Each team member shares responsibility in clearly meeting the expectations patients have at each visit. A change in consistency causes some patients to behave in a way that is perceived as difficult.
If this resonates with you, I recommend you check out The E Myth by Michael E. Gerber. I first read about this concept in that book and made it a point to ensure every patient has a consistent and enjoyable experience in our practice.
Poor Communication
In any relationship, effective and clear communication is key. In today's world, we have a variety of tools that we can use to communicate with each other. Whether it's in-person, phone, video, text, or social media, the methods we select to communicate with carry some value. However, we must use the proper channels when communicating with patients to ensure patient satisfaction and build our relationship with them.
One of the biggest challenges in relationships that don't work is poor communication. You may perceive the patient as being difficult when you ask them to pay their balance due, and they get upset and believe they owe less, but the fact may be that no one clearly communicated the fees and the financial policy to them.
Perhaps the disgruntled patient who shows up late to every appointment and gets an attitude when you ask them why they're late was never clearly told their appointment time. Was their appointment time written on a card and given to them? Did you text or call them 24 hours before the appointment? Do you routinely call every patient who is 15 minutes late and communicate what time the appointment was scheduled?
We must give the patient the benefit of the doubt. In the previous example, we must look at our internal policies and procedures and make sure that all team members are aware of how we communicate scheduled appointments with patients.
A lot of business books talk about the 7 C's of Communication:
1. Clear: Use clear communication by avoiding complex words and phrases.
2. Concise: Keep it clear and to the point. Avoid slang, jargon, or filler words.
3. Concrete: Be specific. Use facts to support your message.
4. Correct: Use correct facts. Use the right level of language.
5. Coherent: Make sense. Avoid covering too much.
6. Complete: Include everything you need to communicate.
7. Courteous: Be polite and respectful.
When communicating with another person, be sure that you're actively listening. This means that you're looking at them, you're not distracted, and you're listening with intent, so pay attention to your body language too.
No matter the method of communication you're using, be sure to follow the seven Cs of communication, even if it's an email or text message.
Lack of Trust
As humans, we need to feel trust from others. This means we need to be honest, keep our word, and be authentic in how we communicate and interact with patients.
Every time you ask patients to repeat themselves, wait on hold for longer than you told them, or rush their time in the office, it can cause a breakdown in trust. Author Blake Morgan says, "Trust is the cornerstone of all customer experiences. It can't be built in a day, but it can be destroyed quickly."
Patients gain trust through the service that you provide them. Most of the time, their very first impression of the practice is through the CA on the first phone call. Exceptional phone skills demonstrate compassion and commitment to serve.
I have had the pleasure of training thousands of practices in my career. I can always tell a lot about the practice I'm working with when I call their office, and the CA answers the phone in a tone that does not sound happy and places me on hold without permission. If this were my first impression as a new patient, I would second-guess the decision I made to make an appointment with the doctor. That second guess is called a lack of trust.
However, let's say that the patient doesn't go with their gut even after the unwelcoming tone of the call and schedules an appointment anyway. They arrive at the office and check in, where they're given a mountain of paperwork, and at the end of the appointment, they're asked for money and are surprised that the visit costs more than what they were told over the phone.
The patient responds a bit annoyed and has a hard time scheduling their next appointment. The CA perceives this as the patient being difficult, when actually there has been a complete breakdown of trust.
Loyal patients need to feel they can trust your practice. They need to feel they can trust your business for them to stay, pay, and refer.
Handling Difficult Patients
First, there are offenses that immediately need to be addressed with firing a difficult patient. These situations are usually pretty obvious. Hostility, aggression, and offensiveness of a sexual or racial nature should not be tolerated.
It is your business owner's and/or leadership's responsibility to clearly identify and communicate to everyone on the team how to handle these situations. If anyone on your team were to encounter a difficult patient, they should know the procedure for handling it.
When a patient crosses the line, it's best to maintain your composure and respectfully address the situation right away.
• Provide the patient with an opportunity to say what's making them upset.
• If they're emotional, console them and give them time to collect themselves.
• Avoid communicating in a defensive way. Be mindful of your tone and body language.
• Show empathy. Make them feel like you genuinely care about why they're upset.
• Set boundaries if they're using profanities or yelling. "I want to help you, but I will not tolerate the way you're speaking to me."
• Get help with the situation. If you're unable to maintain professional composure, it's ok to ask for a co-worker or the doctor to step in.
There will always be difficult patients, but the key to reducing things that trigger people is to ensure clear policies and procedures internally as well as with your practice members. When you set the tone right from the beginning and deliver consistent expectations, clear communication, and trust, you will deal with a lot less drama.
Holly Jensen has served the chiropractic profession since 2002 as a CA and office manager, where she oversaw the operations of Dr. Miles Bodzin's Chiropractic Wellness Center in San Diego, California. For more than a decade, she has continued to serve the chiropractic community as a professional speaker and the chief operations officer for Cash Practice Systems, the software and training company founded by Dr. Bodzin. To date, she has trained thousands of DCs and CAs on how to successfully attract, enroll, and retain more patients while skyrocketing cash collections. For more information, visit www.CashPractice.com. Holly may be contacted at 877-343-8950 or [email protected].
