This original article was featured in the June 2021 issue of The American Chiropractor

Difficult Patients Within Our Practice

Interacting with and caring for our patients is one of the most enjoyable experiences of being a Chiropractic Assistant. Not only do we get to witness the impact chiropractic care has on their lives, but we also get to cheer them along their health journey. 

But occasionally, we have to deal with difficult patients and this part of the job is not so enjoyable. How we respond in handling these difficult patients can make or break the relationship they have with us and with 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, the doctor, and for some patients, it can affect their impression of chiropractic as a whole.

Before I go into handling 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, 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 the first visit 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 come in, 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 care and starting to feel better. 

But then something shifts….the consistent experience they had for the last couple of months now begins to change. Sometimes when they arrive for their appointment they’re not greeted by anyone. The CA comes out of the back office and 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 get.

The doctor runs behind occasionally and the patient has been late to work a few times because they’re used to 20-minute appointments but lately they’ve been in the office for 30-45 minutes. 

Then, the patient gets a phone call from the CA saying their last two monthly care plan payments have declined because their billing expired and they have a balance due. This is the first time the patient is hearing about their declined payments. The patient gets upset on the phone and snaps at the CA because this 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 and they never return. The enjoyable and consistent expectations that were 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 for becoming a loyal patient are much greater. What keeps patients coming back is the certainty of what’s going to happen throughout the course of care. 

In the example above, had the patient’s experience remained consistent and their expectations were met or exceeded, they likely would have stayed the course of care. It’s imperative that each and 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 you resonate with this, I recommend you check out the book, “The E Myth” by Michael E. Gerber. I first read about this concept in his 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. And 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 that we select to communicate all carry some value. However, we must use the proper channels when communicating with patients in order to ensure patient satisfaction and to further build upon 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, when the fact may be that no one clearly communicated the fees and the financial policy to them.

Perhaps the disgruntled patient that shows up late to every appointment then 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 them 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 above 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 as well. 

No matter the method of communication you’re using, be sure to follow the 7 C’s of Communication….even if it’s an email or text message.

Lack of Trust

As humans, we need to be able to feel trust from others. This means we need to be honest, keep our word, and be authentic in the way that we communicate and interact with patients. 

Every time you ask a patient 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 from 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, then 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 the 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 but 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 what caused them to express themselves in a challenging manner is the complete breakdown of trust.

Loyal patients need to feel they can trust in their decision to choose your practice. They need to feel they can trust your business in order for them to stay, pay, and refer.

Handling Difficult Patients

First and foremost 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, 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 have to deal with a lot less drama.

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