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October, 2010

Don't Take That Patient! Top 10 Reasons to Say No

By Shawn Steel, JD

Doctors work harder than ever. Marketing and recruiting are mainstays for a successful practice. We all know when you seek new patients, anyone can come through your doors. Chiropractors are today's primary health care doctor. The lesson that you don't have to treat everyone who enters your realm will save you precious time, emotional strain and financial hardship. Keep in mind that it's the 5 percent of patients who can disrupt a good practice.

A good formula to follow is the list of top 10 patients to whom you should just say no, particularly for any personal injury cases. Remember, you are an independent professional. You can pick your location, your fees, your treatment methods, your hours and ultimately, your patients. Happy patients will make for a happy practice. Consider the following list of trouble-makers and see which ones apply among your current or potential patients.

1. I don't like them: Trust your instinct. You don't need a reason. If there seems to be something inherently negative between you and your prospective patient, it is time to move on. More important, listen to your front office staff. They are often more sensitive than you to these matters. Although it may not be quite rational, just trust the force.

2. Multiple doctors: Anyone can have one bad marriage, but three or four? "Doctor hoping" is a clear behavioral sign of an unstable patient. Some doctors like to think that the patient finally came to them for the ultimate relief, only to be disappointed when the patient moves on and trashes them to the new doctor. Be acutely aware if the patient always has negative things to say about all their prior doctors. Don't worry; you will be next on the list.

3. Won't pay co-pay: They forgot their checkbook, wallet or credit card. That doesn't work in a restaurant. It should not work in your office either. When the money is missing, it's the first sign the patient is taking advantage of you. That is particularly true with personal injury cases. Too often, personal injury reimbursements are slashed by unscrupulous attorneys. We strongly recommend that all personal injury patients need to pay decent co-pay for every visit. This is to protect the clinic. If an injured patient will not pay you a modest $20 for their personal injury care at each visit, they certainly won't be fighting to pay your whole bill when the personal injury case is finally settled.

4. The "slam dunk" patient: When your patient tells you their personal injury case is perfect, they will either ask you to reduce your fees at settlement or blame you if they didn't get enough money. Some delusional patients expect you to be so "grateful" for their "easy" case that you should give them major consideration. That's baloney. You are not treating a legal case. You are treating a complicated human with all sorts of variations.

5. The quarrelsome patient: It's obvious they are unhappy with life. That includes you and your staff and anything and everything from parking reimbursement, a small delay in seeing them, or unfounded complaints. Don't worry about being subtle. The quarrelsome patient is immediately obvious right at the first meeting. Avoid them at all costs.

6. The Know-It-All: The "Wise Guy" patient is a nuisance. You might be able to tolerate them, if you lay down the law immediately. If they are incorrigible, they will constantly interrupt you while you are taking their history. They will not listen to you. They will not show up on time for their appointments, do their home exercises, or be compliant. This patient is unsympathetic and jurors won't like them. They end up sabotaging their own case.

7. The unfamiliar injury syndrome: Avoid areas and patients where the learning curve is too steep. This may not necessarily be the patient's fault. There was one patient who very carefully explained to the chiropractor and the staff that he suffered from Gaucher's disease, a rare genetic disease found among people of Eastern European descent. The symptoms of Gaucher's disease can include bone pain, degeneration and fractures. Bone disease may lead to neurologic problems such as compression of the spinal cord. Of course, the doctor was sued after only three visits. The consequences of a mistake are too high. Refer to an expert.

8. The gypsy: The gypsy patient is lethal. They know how the personal injury system works. The gypsy patient has probably visited every single doctor of chiropractic in America. There must be a school out there to teach them how it all works. They explain they have been through personal injury cases before and suggest cutting out the "middle man" attorney. They will happily sign for you a promissory note. Of course, the next thing the gypsy does is takes your bill and chart, and settle. However, they conveniently forget to pay you. You go looking for them, but of course, the gypsy patient has vanished into thin air.

9. The hand-off patient: The patient got your name from some big shot doctor, but that doctor was too busy to treat him. You are their second choice. Look hard at this case. Certainly, talk to the prior doctor and see what you can learn. Examine this patient carefully. There may be a strong reason why the other doctor would not take this patient.

10. A relative or friend: The chiropractor insists, "I would not let anyone touch my wife!" So the good doctor treats his wife for an accident she was in and bills more than $5,000. At trial, when the doctor is asked if he always charges for adjusting his wife and children, and replies he does not do so, the case rapidly vaporizes. Too many times, when you treat your in-laws, especially for money, and the case doesn't turn out well, you are one to the blame. Think of it this way; you've got to deal with that resentment at every Thanksgiving dinner for the rest of your life. No good deed goes unpunished. You are forewarned.

These 10 rules apply to lawyers, dentists and even candlestick makers. You will make your life a lot happier and your practice more profitable by exercising your "patient delete" button more often.


Shawn Steel is a chiropractic personal-injury attorney and a lecturer at Southern California University of Health Sciences. He can be contacted with questions and comments regarding this article at .

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