Getting a new patient can feel exciting. You’re meeting someone new, and you have the opportunity to help them live a healthier life.

The day comes when you meet them for the first time. But soon after you open the door or hop onto that Zoom call – something goes wrong. You aren’t communicating well and the patient is getting on your nerves for no apparent reason. Soon, there’s noticeable friction between you.

This becomes a recurring experience at every appointment. No matter what, it feels like every interaction with this patient goes south. You’re now starting to believe that you and this particular patient may not be the best fit after all.

What do you do?

Terminating a patient relationship is not easy, nor is it uncommon. In fact, nine out of 10 primary-care providers have let at least one patient go in the past two years.^[1] As a healthcare practitioner, it’s never very comfortable to have that conversation – and it’s certainly not pleasant. You may lose sleep, have knots in your stomach, or feel that undeniable sense of dread wash over you.

You care deeply for your patients and their well-being. You want them to get healthier, but you have this nagging feeling that this just isn’t going to work. Part of you caring for them may mean finding them another practitioner who’s better suited to meet their health needs.

To better prepare for a repeat of this scenario, consider the following two questions:

• How will you know if a patient will be a good fit?
• What do you do when you need to let them go?

Let’s explore both of these questions.

How to Know If Your Patient Is a Good Fit

Finding and connecting with the right patients involves some discernment. It takes knowing and looking for those little clues that either provide you with reassurance – or give you an inkling something isn’t clicking.

Finding the right type of patient makes all the difference in the world – and in your practice. It strengthens you as a practitioner. It creates that positive, energizing atmosphere that you and your staff love. Connecting with that right fit can grow referrals and reviews for your practice.

But it takes a bit of a keen eye. Here are 10 mental checkpoints to help you discern if you and your new patient are a good fit.

1. Is there a connection? You want to make sure there’s something there you can work from. This will become the foundation of your relationship, so make sure you feel that kind of jive or energy with them.

2. Does your patient trust you?  If you deliver on what you’ve promised, your patient will believe you’ll come through for them in the future. This will strengthen your relationship and build trust. But if there’s been a failure to follow-through, things might get a little rocky.

3. Does communication between the two of you happen naturally and easily? One example of when this doesn’t work is if your patient constantly interrupts or cuts you off. Communication is based on mutual respect, so keep an eye (and ear) out for how you and your patient interact.

4. Does your patient respect your staff? This one is huge. Your staff is an extension of you, so watch how your patients interact with them. Are they considerate when speaking with your staff? Do they act differently in-person than over the phone?

5. Is your patient demanding special treatment? Examples could include asking you to hand-deliver their supplements, expecting you to only see them certain times on certain days, or demanding your cell phone number so they can call or text you when needed.

6. Are they expecting more than what you said you would deliver? If your patient expects something different than what you’ve committed to, that’s going to create conflict. You’re constantly going to feel like you’re falling short, and they’re going to continue to feel frustrated. This is a guaranteed way to damage the relationship.

7. Do they run to Dr. Google for medical advice? It’s one thing for a patient to ask questions and be actively involved in their healthcare. It’s another for them to constantly search online for additional treatments, therapies, supplements, etc. because they don’t trust you and think they know better. Trust is vital, so look for evidence that they may be looking elsewhere.

8. Does your patient need an excessive amount of proof before they’ll believe you? If a patient needs a fully-detailed, fully-referenced, verified, notarized, double-blind, placebo-controlled study that’s been repeated at least a dozen times, it’s a red flag. Part of being a trained, certified, and experienced healthcare practitioner means you know your stuff. So, keep an eye out for the patient who believes they know more than you.

9.  Are they continuously challenging and/or fighting your suggestions? At the core, patients want to feel heard and valued. By the time they come to your office, they may feel frustrated at past attempts to resolve their health concerns. But if they are generally unwilling to even try, right from the get go, this can cause tension between the two of you and make for a difficult clinician-patient relationship.

10. Do they have a history of being a practitioner hopper? There are a ton of reasons why a patient may change practitioners. But if it seems like they’ve been going from practitioner to practitioner, there may be an underlying belief that no one will ever be able to help them and ultimately, they will never be able to get better. If this is the case, consider encouraging your patient to seek counseling or peer support.

There are a number of factors to look for in determining if you and your patient are an ideal fit. So, what do you do when you have a patient that didn’t work out? If you’ve tried everything, and now you feel stuck on what to do next, here’s what I suggest.

How to Let a Patient Go

No one likes confrontation or hard conversations. They’re uncomfortable. They’re not fun. But they’re important. And they definitely require grace and compassion. You want to make sure to uphold your integrity and that your patient feels fully respected, honored, and valued. How do you go about doing that? Here’s a 5-step strategy to guide you when letting a patient go yet keeping their dignity intact:

1. Before you have that conversation, spend a few moments putting yourself in their shoes. Identify the problematic behavior and look for the intent behind it. Maybe they’ve experienced some hurt or disappointment. Your goal is to try and bridge that gap.

2. Try and meet with them either in-person or over Zoom. Let them see your face so they can best understand your heart and that you want what’s best for them.

3. Let them talk first. Ask them how they’re feeling about how things are going. Then, let them talk. Don’t interrupt and make them wrong. This is their turn to get it all out. Consider asking probing questions to make sure they know you’re genuinely listening and value what they have to say.

4. Empathize with them. Show them that you care about their experience and are sorry that their expectations haven’t been met. Let them know that it wasn’t intentional, and express that you might not be the right person for them.

5. Offer to find someone you believe can help them. Your goal is to make sure they’re taken care of. Reassure them that this is about them and finding someone who can best meet their needs. Follow through with written, certified communication and commit to their continued care during this transition period.

As soon as you realize that you and a patient aren’t the best fit, consider having this conversation. And the sooner, the better. Waiting isn’t good for you, and it certainly isn’t in the best interest of the patient.

Having a Plan Helps

Terminating a patient relationship is tough and certainly not the highpoint of your day. But your ultimate goal is to ensure the patient felt heard, valued, and will have someone to care for them moving forward. And in certain cases, putting your patient first may very well mean letting them go. Hopefully, this won’t happen to you often. But when it does come up, consider having a plan that will ultimately make the process much easier.

If you’d like more information on how to connect with the right patients – or what to do when you need to let one go – check out my recent podcast episode. It’s filled with tips and actionable advice on how to handle this tricky but all-too-common situation.

Sources

1. (2017, June 5). You’re Fired! When Doctors Let Patients Go – WSJ. Retrieved September 16, 2020, from https://www.wsj.com/articles/youre-fired-when-doctors-let-patients-go-1496681903