What to do when a patient says, “I can’t afford your care.”

By Dr. Russ Rosen | Patient Care

If you’ve been discovering how to run a profitable chiropractic business for more than 5 minutes, then a patient has told you that they need to stop or reduce care because they could no longer afford it!

This exact situation tends to impact us as chiropractors on so many levels. For many of us, it’s like an arrow to the heart and brings up all sorts of issues around value and self worth.

I want to share with you the two big mistakes chiropractors make when confronting this situation and share my top strategies for getting to the real reason your patient wants to stop care.

How You Respond Initially is Important

In my experience working with thousands of doctors around the globe, I have realized that most chiropractors respond to this statement in one of two (equally bad) ways.

Bad Response #1: The Confrontation

Classically “High Ds” or “Drivers” or “Assertives” respond by getting snippy or angry with their patients – trying to scare or manipulate them into care. By letting these troubled patients know about all of the terrible things that are going to happen to them without their care, “Assertives” tie up their frustration and anger in a beautiful pink ribbon labelled “in their patient’s best interests”.

At chiropractic seminars, they get to tell their friends about the time they really laid into their patients. They get to feel good knowing that they said what they wanted to say.

Bad Response #2: Rolling Over

Classically “Non-assertives” join what we call the “O.K corral” and just say, “okay”, letting the patient simply leave without a discussion. They feel very frustrated because they didn’t say what they really wanted to say and the relationship is essentially over.

Regardless of where you land on the assertiveness scale, the end result is almost surely the same: you are frustrated and the patient fails to get the results they came in for. It’s an absolute lose-lose scenario.

Responding with the Patient’s Perspective in Mind

I want you to imagine your patient has mustered up enough courage to finally say to you that they feel that they need to stop care because they don’t have enough money. I want you to recognize the stress that they are most likely under by the time they finally say this to you.

This is a big deal.

Now I want you to imagine you say to them:

“Mary, if you stop care now you will never get the results that you’re looking for and you will have serious problems in the future.”

Although you may manipulate her into continuing care in the moment, the odds are she will very soon quit care for good and never return.

What we find rarely ever works is TELLING people what they “HAVE TO” do. Regardless if they are patients, spouses, children or bank tellers, telling people what they have to do rarely works!

Instead, we need to ask Socratic questions to help us clarify what the problem truly is so we can come up with a reasonable and logical solution.

LAASR Focused

In our L.A.A.S.R process (Listen, Acknowledge, Ask, Solution, Resolution) we always make sure that we actively listen to our patients. Then we must acknowledge them. In this case I might say,

“Mary I am so sorry you’re going to have to stop care. I absolutely love working with you and you’ve been gaining such ground and doing so great.”

Do you see how this de-escalates the situation? Remember: she is stressed about having to quit -or even disappoint you – and has possibly come in ready for a fight! By Acknowledging their concerns and the situation this way we can take the wind out of the sail and de-escalate the situation. Now we can begin to have a conversation. But I am NOT going to TELL her what she HAS TO DO!

Instead we want to ask appropriate questions. I.e. “Mary let me ask you a question, if finances were not an issue – and I know that they are – but if they really were not an issue would you want to continue care? Or are you just (feeling good/unhappy with care/feeling stuck in care etc.) And would rather not continue at this time?”

If Mary says that she would do anything to continue care but she simply cannot afford it. She just lost her job, her mother got sick, her dog got hit by a car and she was living out a country song then I personally would buy it. And I would try to figure a way for her to be able to get some of the care that she needs. The odds are some care will be better than no care. (Of course you have to do what you feel is clinically best for your patients.)

But it if she were to say, “Yes the truth of the matter is I am really feeling pretty good and I think I will just stop at this time” then you have clarified the real problem that you can now address.

My experience is, if you will really focus and clarify the problem the solution will become self-evident. Then if you will use the L.A.A.S.R. process you can help people find solutions and resolution versus pissing them off or joining the okay corral.

I’d love to know your thoughts and hear what’s worked for you.

Much love and aloha,

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