February 3, 2025 • 16 mins
As healthcare providers, we strive to build strong relationships with our patients, but sometimes, ending that relationship is necessary. Whether due to non-compliance, boundary violations, or missed payments, discharging a patient can be uncomfortable—but it’s crucial for maintaining professionalism and protecting your practice.
In this episode, we’ll cover:
✅ The most common reasons for patient discharge
✅ How to maintain professionalism and empathy while setting boundaries
✅ Legal and ethical considerations for patient discharge
✅ Best practices for handling outstanding balances and missed appointments
💡 Whether you’re a solo provider, clinic director, or practice owner, this episode will help you navigate this challenging but necessary part of patient management.
🎧 Listen now on Spotify, Apple Podcasts, or your favorite podcast platform!
💬 Have you ever had to discharge a patient? How did you handle it?
Share your thoughts with us on Instagram @theprovidersreport!
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Scarlett Solo USB (00:00):
Hello.
(00:01):
Have you guys ever had to fire apatient before?
I know that question and thatconcept doesn't really come up
enough.
What are some of the reasons whywe might have to stop seeing or
treating a patient?
The list is kind of endless andI feel like we're not educating
our students and our youngproviders well enough on this
topic.
So in today's episode, we'regoing to talk about the
(00:21):
importance of establishing thatpatient provider relationship.
the goal of achieving positiveoutcomes and what to do when
we're not quite getting there.
We're going to talk about whatpatient discharge even means and
then why it can be such achallenging topic, but a big
time necessity in some cases.
And then the key question ofthis episode is how can
providers discharge a patientwhile maintaining
(00:43):
professionalism and beingfriendly?
So first let's talk about someof the most common reasons why
we might need to discharge apatient.
So number one is pretty obvious.
non adherence or non compliance,a.
k.
a.
a patient's not following yourrecommendations, whether you are
prescribing a certainmedication, they're not taking
it, or maybe you've recommendeda certain number of visits,
they're not following that, andthere's just a clear disconnect.
(01:06):
Number two would be behavioralissues.
You have your classic physicalabuse, sexual abuse, verbal
abuse, even.
these are also very, very commonin healthcare.
Next up is going to be any kindof boundary violation.
So let's say there are veryclear rules in your practice
maybe inappropriate demands havebeen made from that patient onto
(01:26):
the practice, and they arerequesting Some kind of
preferential treatment or maybethere's actually been a
substance misuse if you are aprescribing physician of some
kind.
Boundary violations are a veryreal thing and you have to have
some systems in place that yourteam is aware of too on how to
address these as they occur.
Next up would be providerlimitations.
(01:46):
Let's just say that you'retaking care of a patient and
it's very obvious they just needsomebody else.
Maybe that's somebody with adifferent skillset, or maybe the
connection is just not there.
I know a really common areawhere this occurs would be in
the world of mental health.
Sometimes a therapist can justtell after a few sessions that
it's just not a good fit, andmaybe you can decide that sooner
than the patient can, and out ofthe goodness of your heart.
(02:09):
Out of your expertise as ahealthcare provider, we should
know how to sit down and havethat kind of uncomfortable
conversation, but ultimately forthe betterment of that patient.
And lastly, missed appointmentsor non payments.
What if you have a patient thatjust flat out doesn't pay their
bill, starts racking up abalance, or maybe they don't pay
a bill and don't come back foran appointment.
Kind of the two fer there.
(02:30):
And then just in general, missedappointments.
Missed appointments.
What happens if you have someonethat routinely no shows and
takes advantage of your time,but then still expects to be
placed on your schedule at theirconvenience so those are a lot
of reasons, which is why thisconversation is important.
What I've been seeing,especially when I'm meeting with
offices and chatting withproviders, They tend to let a
lot of things go because intoday's world, we live in suing
(02:52):
culture.
We obviously know that thecustomer is always right if
you've ever worked in retail oranything like that.
But when you own your ownpractice, or you're a manager,
or you're a clinical director,or anyone for that matter, it's
really important to make surewe're setting boundaries.
This is something I have stoodby from day one, but If you
start to allow patients to walkall over you in practice, they
(03:13):
will continue to do that.
And that does impact their care.
I'm not saying that the patientis never right.
That is not true.
when you work in a professionalsetting, there are rules, there
are standards, there areregulations, there deserves to
be a sense of professionalismfrom both parties involved.
So I want to talk about what wewould do in the event of a
(03:33):
discharge.
Let's say somebody has racked upa bill, and this is something
that happens all of the time.
And not all of our smallpractices have a billing
department with specific peoplewhose sole job it is to worry
about collections.
This could just be your numberone front desk person.
Sometimes this could be theprovider themselves if they
don't have a team.
So there's two ways I like to goabout this.
(03:53):
you could also send an email,you can send a text message or
you can have that conversationin person.
I would make that determinationbased on one, if they have an
appointment or not, if they'restill coming for care and two,
what that patient is like.
Maybe their age demographic.
behavior in general, if theytend to be combative, maybe,
maybe don't meet with them inperson to discuss this.
(04:15):
If they're very, very cordial,maybe it's something that can be
discussed in person and comingup with something that everyone
can agree on.
So here's what I recommend ifyou're going to go the email
route.
So when you're sending an email,obviously the subject is going
to be something in the realm ofoutstanding balance and next
steps.
I would just be straight to thepoint and say, Hey Mary, I hope
this email finds you well.
We're just contacting you toreach out regarding your your
(04:37):
current balance in our office.
This has been due sinceFebruary.
We've made a few attempts tocontact you and as of today We
still just don't have a paymentplan or a payment scheduled in
order to continue care at ouroffice We do require outstanding
balances to be paid We offerflexible payment options and we
would be happy to discuss thiswith you if that works for you
If we don't receive a payment bythis specific date we will not
(04:59):
be able to schedule futureappointments for you and we will
attempt to run the card on filefor X dollar amount.
Please reach out to our officeif you have any questions or
reply to this email to discussfurther options.
We value your health and we hopethat we can find a way forward
together.
That's it.
Like very simple.
You've given them multipleoptions, but at the same time
you're letting them know like,Hey, if there's a card on file,
(05:21):
it's going to be run for thisamount.
I'd say we're pretty flexibleand sometimes we'll totally just
break up that payment.
We'll let them know, hey, we'regoing to run 100 this week, 100
the following week.
but honestly, we keep AR so lowthat most of the time when we're
reaching out for an outstandingbalance, it's no more than 50 or
60.
this is what I would recommendvia email.
It allows you to also takecontrol, run that payment.
(05:41):
And this is another reason why Ido recommend that you have cards
on file for everyone.
Sometimes balances get missed orthere are changes to their
insurance and that's how thisconfusion can happen even with
cards on file.
But you can still send thisemail out even if there is no
card on file.
You would just simply let themknow, hey, this is the payment
plan structure that we can dofor you.
(06:02):
If you have any specifics, letus know.
I was actually just talking to aprovider about this, this
morning.
typically what we will do is ifthere's no card on file, we will
literally send an electronicstatement or a way to pay online
once a month for like six to 12months or so.
and I know that sounds like alot, but we typically won't
write it off or do anything withit until that one year mark.
(06:25):
Here's why.
The economy is what it is.
Times have just changed.
And so we understand thatsomebody might have a negative
relationship with money andfinances, and maybe they're
embarrassed to let us know thatthey can't make even a simple 50
payment.
Do they still owe that money?
Absolutely.
Should we be holding themaccountable?
(06:46):
Absolutely.
You provided a service and youdeserve to get paid for that.
However, I think having an ounceof grace really does go a long
way.
There have been countless timeswhere we have sent that out once
a month repeatedly and by theninth month or 10th month, all
of a sudden that balance ispaid.
At that moment, we don't need toknow why.
We don't need to know whatstruggles they're going through.
(07:08):
But we take solace in the factthat we were able to provide
them that cushion.
I don't recommend doing that foreveryone, but it is something to
take into consideration withyour systems.
Again, at the end of the day,it's best to have a card on file
at all times, but things happen.
Let's say the card gets declinedand that's your only option.
That is how I would recommendgoing about that.
So next I want to talk aboutlegal and ethical
(07:28):
considerations.
Let's say you have decided todischarge someone for a variety
of reasons.
We have to remember that in manystates there is this thing
called patient abandonment.
You can't just not see apatient.
You can't not have thatconversation and try to just
stop seeing them or maybe switchpractices and not let them know
where you're going.
And this is mostly state bystate, but even the AMA has some
(07:49):
ruling when it comes to this.
It's really important to makesure we're doing our due
diligence to make sure that weare being as professional as
possible in the moment.
So let's say you are leavingyour practice or something's
happening and you're taking amedical leave.
You are technically required toquote unquote discharge, even if
it's temporary, your patients orjust let them know where they
can go during that time.
(08:09):
So try to give 30 days noticewhen you can, and make sure
there's a reason for it.
Put something in writing thatsays, you know, we were unable
to meet treatment goals, or I'mgoing to be taking a, an
extended medical leave, Offerthat patient a referral list of
alternative care options.
So two or three is the magicalnumber that I typically
recommend.
Make sure you're giving them avariety of providers.
(08:30):
Maybe a few female, a few maleproviders, different parts of
town, that kind of thing.
That way they can choose whothey want to go to based on your
recommendations.
So let's go through a couplescenarios.
So let's talk about the patientthat is just not following your
recommendations.
It could be visit number, itcould be a specific medication,
it could be anything.
I'm going to go ahead and statethe obvious.
(08:50):
In this case, you're not goingto want to say, hey, you're not
following our plan, so I'm notgoing to be able to help you
anymore.
Believe it or not, providers aredoing this.
And I'm hearing about this frommy patients that and some of the
people I'm consulting with.
This is actually a very realproblem.
So what we recommend is havethat conversation at one of the
appointments they do show up toand just say, Hey Mary, it
(09:10):
really just seems like thistreatment plan is not working
for you.
This is what we're recommendingbased on what you've told us
that you're going through.
And we're starting to think thatmaybe switching to a different
provider just may be bettersuitable for your needs.
Something as simple as that cango a long way and then sit back
and let them talk.
Most of the time they may saysomething like, oh, you know
what?
My, Father in law is in thehospital, and this just isn't a
(09:33):
priority for me right now.
It is a great way for you to getthat information and allow them
to feel comfortable and not feellike they're letting you down.
Most of the time, there'sprobably a reason that you're
probably just not even aware of.
So it's really important to havethat conversation.
The next one's a little bittougher.
So you've probably listened to afew of our old episodes about
sexual harassment in theworkplace.
(09:54):
That's fine.
This can happen.
It could be aggression.
It could be harassment.
And we need to talk about how toaddress these patients.
this could be the lead doc thatdoes this, you as the provider
if you're comfortable, amanager, anyone can really take
this role, but it's important toknow in your clinic who should
be doing this.
The obvious of what not to sayis flat out yelling at them
saying, Hey, what you're doingis inappropriate.
(10:16):
I refuse to treat you or, Ugh,that was nasty.
Sorry.
I don't feel comfortable.
there's no need to add fuel tothe fire, right?
So typically what I recommend isyou let them finish, you know,
whatever nonsense that they'respewing at you.
Once you get that awkwardsilence, you say, Hey, Mary,
maintaining a respectful andsafe environment in our practice
is actually really important forus, for everyone.
(10:39):
And because of today'sinteractions, I just think it's
best that you find careelsewhere and I'll help you do
that.
It could be as simple as that.
and even in an aggressive typeof setting.
As long as there's dialogue thatcan happen, that type of
sentence structure actuallyworks well.
It's a form of de escalating thesituation instead of responding
by being just as combative.
(11:01):
Obviously, in the event of anactual, physical, hands on
situation, you wouldn't do thisuntil after the fact.
But nine times out of ten,thankfully, A conversation can
be had here and that is how werecommend going about it.
Next up would be someone whocannot pay their bill.
We talked about how to send theman email or send them a message
outside of the office, but whatif they're in person with you?
(11:24):
So one patient kind of jumps tomind, we don't really have a lot
of patients with balances in ourpractice, thankfully, because we
have a lot of systems in place,but I am seeing patients from
former practices where therewere less.
strict rules, I think, onpayment structures.
So we do have someone that usedto rack up like a bill of 200,
300, 400, and so we did have tohave a sit down.
(11:46):
And with this patient, sincethey were well known, very
cordial, it made sense to dothis in person.
So at the time, my lead adminjust sat them down and instead
of saying something rude like,Hey, if you can't pay your bill,
you can't be seen.
That's too direct.
You have no idea what's going onwith them.
So here's what we did.
And here's what we recommend.
Sit that person down or greetthem when they walk in.
(12:07):
As long as there's no one in thewaiting room, obviously don't
embarrass them, but let's saythere were, you can feel free to
take them into another room.
Flat out say, Hey Mary, we justwanted to remind you that we do
have an outstanding balance andper our office policy, we don't
really like that to get higherthan 200.
Can I help you today set up apayment structure?
Are you able to do 50 today?
Something as simple as that comeup with a solution.
(12:29):
Let them know what that solutionis, but also do so in a friendly
manner.
Most of the time they're goingto be like, oh, I completely
forgot.
Yeah, let's take care of thewhole thing today.
Or they'll say, yes, 50 soundsgreat.
Thank you for understanding.
And then you're not addressingthat in a embarrassing way for
them, but you'll still get yourcollections.
So both parties end upsatisfied.
(12:50):
You can tell we're trying todeescalate.
That is the key word here,deescalation, deescalation.
Try to remember to always usethe word I, I, I here instead of
you, you, you in reference tothe patient.
So making it about you insteadof them or about your practice.
For example, like saying, Hey,this is our office.
policy.
Instead of you personallydemanding something or saying
(13:12):
that, hey, you as the patientare failing to comply with this,
deescalating is really importanthere.
And saying things like, I thinkit's a great idea that maybe we
transfer your care to someoneelse.
I would just like to bring thisup.
And always maintainingcompassion.
passionate and professionalwords when you're having these
conversations.
Staying calm is also reallyimportant as well in making sure
(13:35):
that you've gone through thesescenarios with your team so that
when you're busy treatingpatients, your team is able to
de escalate these situations aswell.
And I want to close with onefinal tip.
So as you can see, these thingshappen, and we've gone over
multiple ways today on how tosquash them and effectively
bounce back from these.
But ultimately, if you don't setup these systems in practice
(13:55):
early and set these boundaries,it's going to keep happening.
So what I recommend isconstantly check in with your
patients every single visit,figure out how they're doing.
Are they better?
Are they worse?
What other things do they need?
Are they being compliant?
Check in with recommendations,remind them, Hey, yeah, I do
need to see you once a week forfour weeks, or, you know, it is
important that you get theseregular CT scans every six
(14:16):
months and reminding them inperson.
Even though they receive thatinformation on the MyChart, it's
going to help them be morecompliant.
It's going to make sure thatthere is no lapse in
communication and that everybodyis on the same page.
Setting up these systems in yourpractice can help prevent
outstanding balances,disgruntled patients.
I speak with a lot of practices,especially those who buy
(14:38):
practices from older providerswho are retired.
MyChart.
A lot of times it was just thewild, wild west in some of these
practices.
So if you were listening to thisand you are a new provider and
you are just constantly goingthrough this battle daily with
patients who don't pay bills,this is your sign to put your
foot down.
There's no need to be rude orangry, but establish some
(14:59):
practice systems.
Put them on your website.
Put them in your consent forms.
Put them on your booking emailconfirmation.
It's 2025.
We can totally do this.
if nail techs and hair salonsand all these other places have
impeccable systems and they getpaid on time, why can't we as
healthcare providers?
So I hope this information washelpful.
(15:20):
I look forward to hearing howthis has made a difference in
your practice.
Thanks for listening.
Hello.
(00:01):
Have you guys ever had to fire apatient before?
I know that question and thatconcept doesn't really come up
enough.
What are some of the reasons whywe might have to stop seeing or
treating a patient?
The list is kind of endless andI feel like we're not educating
our students and our youngproviders well enough on this
topic.
So in today's episode, we'regoing to talk about the
(00:21):
importance of establishing thatpatient provider relationship.
the goal of achieving positiveoutcomes and what to do when
we're not quite getting there.
We're going to talk about whatpatient discharge even means and
then why it can be such achallenging topic, but a big
time necessity in some cases.
And then the key question ofthis episode is how can
providers discharge a patientwhile maintaining
(00:43):
professionalism and beingfriendly?
So first let's talk about someof the most common reasons why
we might need to discharge apatient.
So number one is pretty obvious.
non adherence or non compliance,a.
k.
a.
a patient's not following yourrecommendations, whether you are
prescribing a certainmedication, they're not taking
it, or maybe you've recommendeda certain number of visits,
they're not following that, andthere's just a clear disconnect.
(01:06):
Number two would be behavioralissues.
You have your classic physicalabuse, sexual abuse, verbal
abuse, even.
these are also very, very commonin healthcare.
Next up is going to be any kindof boundary violation.
So let's say there are veryclear rules in your practice
maybe inappropriate demands havebeen made from that patient onto
(01:26):
the practice, and they arerequesting Some kind of
preferential treatment or maybethere's actually been a
substance misuse if you are aprescribing physician of some
kind.
Boundary violations are a veryreal thing and you have to have
some systems in place that yourteam is aware of too on how to
address these as they occur.
Next up would be providerlimitations.
(01:46):
Let's just say that you'retaking care of a patient and
it's very obvious they just needsomebody else.
Maybe that's somebody with adifferent skillset, or maybe the
connection is just not there.
I know a really common areawhere this occurs would be in
the world of mental health.
Sometimes a therapist can justtell after a few sessions that
it's just not a good fit, andmaybe you can decide that sooner
than the patient can, and out ofthe goodness of your heart.
(02:09):
Out of your expertise as ahealthcare provider, we should
know how to sit down and havethat kind of uncomfortable
conversation, but ultimately forthe betterment of that patient.
And lastly, missed appointmentsor non payments.
What if you have a patient thatjust flat out doesn't pay their
bill, starts racking up abalance, or maybe they don't pay
a bill and don't come back foran appointment.
Kind of the two fer there.
(02:30):
And then just in general, missedappointments.
Missed appointments.
What happens if you have someonethat routinely no shows and
takes advantage of your time,but then still expects to be
placed on your schedule at theirconvenience so those are a lot
of reasons, which is why thisconversation is important.
What I've been seeing,especially when I'm meeting with
offices and chatting withproviders, They tend to let a
lot of things go because intoday's world, we live in suing
(02:52):
culture.
We obviously know that thecustomer is always right if
you've ever worked in retail oranything like that.
But when you own your ownpractice, or you're a manager,
or you're a clinical director,or anyone for that matter, it's
really important to make surewe're setting boundaries.
This is something I have stoodby from day one, but If you
start to allow patients to walkall over you in practice, they
(03:13):
will continue to do that.
And that does impact their care.
I'm not saying that the patientis never right.
That is not true.
when you work in a professionalsetting, there are rules, there
are standards, there areregulations, there deserves to
be a sense of professionalismfrom both parties involved.
So I want to talk about what wewould do in the event of a
(03:33):
discharge.
Let's say somebody has racked upa bill, and this is something
that happens all of the time.
And not all of our smallpractices have a billing
department with specific peoplewhose sole job it is to worry
about collections.
This could just be your numberone front desk person.
Sometimes this could be theprovider themselves if they
don't have a team.
So there's two ways I like to goabout this.
(03:53):
you could also send an email,you can send a text message or
you can have that conversationin person.
I would make that determinationbased on one, if they have an
appointment or not, if they'restill coming for care and two,
what that patient is like.
Maybe their age demographic.
behavior in general, if theytend to be combative, maybe,
maybe don't meet with them inperson to discuss this.
(04:15):
If they're very, very cordial,maybe it's something that can be
discussed in person and comingup with something that everyone
can agree on.
So here's what I recommend ifyou're going to go the email
route.
So when you're sending an email,obviously the subject is going
to be something in the realm ofoutstanding balance and next
steps.
I would just be straight to thepoint and say, Hey Mary, I hope
this email finds you well.
We're just contacting you toreach out regarding your your
(04:37):
current balance in our office.
This has been due sinceFebruary.
We've made a few attempts tocontact you and as of today We
still just don't have a paymentplan or a payment scheduled in
order to continue care at ouroffice We do require outstanding
balances to be paid We offerflexible payment options and we
would be happy to discuss thiswith you if that works for you
If we don't receive a payment bythis specific date we will not
(04:59):
be able to schedule futureappointments for you and we will
attempt to run the card on filefor X dollar amount.
Please reach out to our officeif you have any questions or
reply to this email to discussfurther options.
We value your health and we hopethat we can find a way forward
together.
That's it.
Like very simple.
You've given them multipleoptions, but at the same time
you're letting them know like,Hey, if there's a card on file,
(05:21):
it's going to be run for thisamount.
I'd say we're pretty flexibleand sometimes we'll totally just
break up that payment.
We'll let them know, hey, we'regoing to run 100 this week, 100
the following week.
but honestly, we keep AR so lowthat most of the time when we're
reaching out for an outstandingbalance, it's no more than 50 or
60.
this is what I would recommendvia email.
It allows you to also takecontrol, run that payment.
(05:41):
And this is another reason why Ido recommend that you have cards
on file for everyone.
Sometimes balances get missed orthere are changes to their
insurance and that's how thisconfusion can happen even with
cards on file.
But you can still send thisemail out even if there is no
card on file.
You would just simply let themknow, hey, this is the payment
plan structure that we can dofor you.
(06:02):
If you have any specifics, letus know.
I was actually just talking to aprovider about this, this
morning.
typically what we will do is ifthere's no card on file, we will
literally send an electronicstatement or a way to pay online
once a month for like six to 12months or so.
and I know that sounds like alot, but we typically won't
write it off or do anything withit until that one year mark.
(06:25):
Here's why.
The economy is what it is.
Times have just changed.
And so we understand thatsomebody might have a negative
relationship with money andfinances, and maybe they're
embarrassed to let us know thatthey can't make even a simple 50
payment.
Do they still owe that money?
Absolutely.
Should we be holding themaccountable?
(06:46):
Absolutely.
You provided a service and youdeserve to get paid for that.
However, I think having an ounceof grace really does go a long
way.
There have been countless timeswhere we have sent that out once
a month repeatedly and by theninth month or 10th month, all
of a sudden that balance ispaid.
At that moment, we don't need toknow why.
We don't need to know whatstruggles they're going through.
(07:08):
But we take solace in the factthat we were able to provide
them that cushion.
I don't recommend doing that foreveryone, but it is something to
take into consideration withyour systems.
Again, at the end of the day,it's best to have a card on file
at all times, but things happen.
Let's say the card gets declinedand that's your only option.
That is how I would recommendgoing about that.
So next I want to talk aboutlegal and ethical
(07:28):
considerations.
Let's say you have decided todischarge someone for a variety
of reasons.
We have to remember that in manystates there is this thing
called patient abandonment.
You can't just not see apatient.
You can't not have thatconversation and try to just
stop seeing them or maybe switchpractices and not let them know
where you're going.
And this is mostly state bystate, but even the AMA has some
(07:49):
ruling when it comes to this.
It's really important to makesure we're doing our due
diligence to make sure that weare being as professional as
possible in the moment.
So let's say you are leavingyour practice or something's
happening and you're taking amedical leave.
You are technically required toquote unquote discharge, even if
it's temporary, your patients orjust let them know where they
can go during that time.
(08:09):
So try to give 30 days noticewhen you can, and make sure
there's a reason for it.
Put something in writing thatsays, you know, we were unable
to meet treatment goals, or I'mgoing to be taking a, an
extended medical leave, Offerthat patient a referral list of
alternative care options.
So two or three is the magicalnumber that I typically
recommend.
Make sure you're giving them avariety of providers.
(08:30):
Maybe a few female, a few maleproviders, different parts of
town, that kind of thing.
That way they can choose whothey want to go to based on your
recommendations.
So let's go through a couplescenarios.
So let's talk about the patientthat is just not following your
recommendations.
It could be visit number, itcould be a specific medication,
it could be anything.
I'm going to go ahead and statethe obvious.
(08:50):
In this case, you're not goingto want to say, hey, you're not
following our plan, so I'm notgoing to be able to help you
anymore.
Believe it or not, providers aredoing this.
And I'm hearing about this frommy patients that and some of the
people I'm consulting with.
This is actually a very realproblem.
So what we recommend is havethat conversation at one of the
appointments they do show up toand just say, Hey Mary, it
(09:10):
really just seems like thistreatment plan is not working
for you.
This is what we're recommendingbased on what you've told us
that you're going through.
And we're starting to think thatmaybe switching to a different
provider just may be bettersuitable for your needs.
Something as simple as that cango a long way and then sit back
and let them talk.
Most of the time they may saysomething like, oh, you know
what?
My, Father in law is in thehospital, and this just isn't a
(09:33):
priority for me right now.
It is a great way for you to getthat information and allow them
to feel comfortable and not feellike they're letting you down.
Most of the time, there'sprobably a reason that you're
probably just not even aware of.
So it's really important to havethat conversation.
The next one's a little bittougher.
So you've probably listened to afew of our old episodes about
sexual harassment in theworkplace.
(09:54):
That's fine.
This can happen.
It could be aggression.
It could be harassment.
And we need to talk about how toaddress these patients.
this could be the lead doc thatdoes this, you as the provider
if you're comfortable, amanager, anyone can really take
this role, but it's important toknow in your clinic who should
be doing this.
The obvious of what not to sayis flat out yelling at them
saying, Hey, what you're doingis inappropriate.
(10:16):
I refuse to treat you or, Ugh,that was nasty.
Sorry.
I don't feel comfortable.
there's no need to add fuel tothe fire, right?
So typically what I recommend isyou let them finish, you know,
whatever nonsense that they'respewing at you.
Once you get that awkwardsilence, you say, Hey, Mary,
maintaining a respectful andsafe environment in our practice
is actually really important forus, for everyone.
(10:39):
And because of today'sinteractions, I just think it's
best that you find careelsewhere and I'll help you do
that.
It could be as simple as that.
and even in an aggressive typeof setting.
As long as there's dialogue thatcan happen, that type of
sentence structure actuallyworks well.
It's a form of de escalating thesituation instead of responding
by being just as combative.
(11:01):
Obviously, in the event of anactual, physical, hands on
situation, you wouldn't do thisuntil after the fact.
But nine times out of ten,thankfully, A conversation can
be had here and that is how werecommend going about it.
Next up would be someone whocannot pay their bill.
We talked about how to send theman email or send them a message
outside of the office, but whatif they're in person with you?
(11:24):
So one patient kind of jumps tomind, we don't really have a lot
of patients with balances in ourpractice, thankfully, because we
have a lot of systems in place,but I am seeing patients from
former practices where therewere less.
strict rules, I think, onpayment structures.
So we do have someone that usedto rack up like a bill of 200,
300, 400, and so we did have tohave a sit down.
(11:46):
And with this patient, sincethey were well known, very
cordial, it made sense to dothis in person.
So at the time, my lead adminjust sat them down and instead
of saying something rude like,Hey, if you can't pay your bill,
you can't be seen.
That's too direct.
You have no idea what's going onwith them.
So here's what we did.
And here's what we recommend.
Sit that person down or greetthem when they walk in.
(12:07):
As long as there's no one in thewaiting room, obviously don't
embarrass them, but let's saythere were, you can feel free to
take them into another room.
Flat out say, Hey Mary, we justwanted to remind you that we do
have an outstanding balance andper our office policy, we don't
really like that to get higherthan 200.
Can I help you today set up apayment structure?
Are you able to do 50 today?
Something as simple as that comeup with a solution.
(12:29):
Let them know what that solutionis, but also do so in a friendly
manner.
Most of the time they're goingto be like, oh, I completely
forgot.
Yeah, let's take care of thewhole thing today.
Or they'll say, yes, 50 soundsgreat.
Thank you for understanding.
And then you're not addressingthat in a embarrassing way for
them, but you'll still get yourcollections.
So both parties end upsatisfied.
(12:50):
You can tell we're trying todeescalate.
That is the key word here,deescalation, deescalation.
Try to remember to always usethe word I, I, I here instead of
you, you, you in reference tothe patient.
So making it about you insteadof them or about your practice.
For example, like saying, Hey,this is our office.
policy.
Instead of you personallydemanding something or saying
(13:12):
that, hey, you as the patientare failing to comply with this,
deescalating is really importanthere.
And saying things like, I thinkit's a great idea that maybe we
transfer your care to someoneelse.
I would just like to bring thisup.
And always maintainingcompassion.
passionate and professionalwords when you're having these
conversations.
Staying calm is also reallyimportant as well in making sure
(13:35):
that you've gone through thesescenarios with your team so that
when you're busy treatingpatients, your team is able to
de escalate these situations aswell.
And I want to close with onefinal tip.
So as you can see, these thingshappen, and we've gone over
multiple ways today on how tosquash them and effectively
bounce back from these.
But ultimately, if you don't setup these systems in practice
(13:55):
early and set these boundaries,it's going to keep happening.
So what I recommend isconstantly check in with your
patients every single visit,figure out how they're doing.
Are they better?
Are they worse?
What other things do they need?
Are they being compliant?
Check in with recommendations,remind them, Hey, yeah, I do
need to see you once a week forfour weeks, or, you know, it is
important that you get theseregular CT scans every six
(14:16):
months and reminding them inperson.
Even though they receive thatinformation on the MyChart, it's
going to help them be morecompliant.
It's going to make sure thatthere is no lapse in
communication and that everybodyis on the same page.
Setting up these systems in yourpractice can help prevent
outstanding balances,disgruntled patients.
I speak with a lot of practices,especially those who buy
(14:38):
practices from older providerswho are retired.
MyChart.
A lot of times it was just thewild, wild west in some of these
practices.
So if you were listening to thisand you are a new provider and
you are just constantly goingthrough this battle daily with
patients who don't pay bills,this is your sign to put your
foot down.
There's no need to be rude orangry, but establish some
(14:59):
practice systems.
Put them on your website.
Put them in your consent forms.
Put them on your booking emailconfirmation.
It's 2025.
We can totally do this.
if nail techs and hair salonsand all these other places have
impeccable systems and they getpaid on time, why can't we as
healthcare providers?
So I hope this information washelpful.
(15:20):
I look forward to hearing howthis has made a difference in
your practice.
Thanks for listening.
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