For DCs: Bullets to dodge


Last summer, we had a small rash of defiant, feisty, borderline crazy elderly people grace our presence.  We all know that not all elderly people behave this way, but a surprising number of them do.  They successfully thinned themselves out of the practice, and we all breathed easier afterward.  I figured that was pretty much past us…

…Until tonight.  Our after-hours cleaning lady brought an elderly lady to our side door.  This lady seemed nice and normal.  Within a few minutes, though, I watched her transform into a fairly difficult ticking time-bomb that spelled nothing but disaster for whomever agreed to take her on as a patient.  In the hour we spent with her (mainly for goodwill, because there’s no way either of us would take her on as a patient), she exhibited so many red flags she probably could’ve gone swimming in them.

Beware the Bullets…

Bullet To Dodge #1: Those who don’t respect you as a Doctor
Sometimes, people will call our office, and when I answer, they recognize me and say, “[first name]”.  No “Doctor”, no nothing.  These people fall into 2 categories:

  1. Some of these are nice enough people whom we know, but since our familiarity doesn’t extend beyond a professional setting, it’s inappropriate for them to call me by my first name without preceding it with Doctor.
  2. The other group consists of prospective new patients with whom I had no relationship at all yet, and thus it is entirely inappropriate for them not to address me as Doctor.  Especially when said people are keeping me on the phone for upwards of an hour, at no charge.

For the record, I have never introduced myself as simply [First name]; since there are two of us who share the same last name, I have introduced us as “Dr [First name #1]” and “Dr [First name #2]” simply to avoid mix-ups.

Why this is a big deal:
People who forget or neglect to address you by your title are basically disrespecting your education, your license, your profession, your services, and your value.  It’s not like they don’t know better.  They know to address doctors as “Doctor”.  They’d never do this to their MD (we don’t think), so why do they do it to DCs?  If they can’t accept and recognize that we’re doctors too (I correct people on this all the time), then how are they going to accept, respect, and value what you have to say as a healthcare authority?  Are you going to spend your life playing second fiddle to their “regular doctor”?

Bullet To Dodge #2: Those who want to run your practice
It’s fine for people to state that they prefer certain appointment days or times.  However, it’s not fine when, after you’ve given them a couple of remaining time slots to pick from (“I have an 11 o’clock or a twelve-thirty”) they insist on, “well, I have a [such-and-such] appointment at 4, so I’d rather come in at 1” when you break for lunch at 1pm.

It’s also OK for them to ask if you take their insurance or Medicare.  It’s not OK for them to badger you about it after you’ve explained the perfectly understandable reasons that you don’t.

It’s fine for them to ask what’s involved in a Physical Evaluation and whether or not it’s necessary.  It’s not fine for them to argue about it after I’ve told them it is.  I find it perfectly cool for people to call me with a quick question on a Sunday (I do nutrition stuff, so no real emergencies here).  When that conversation lasts more than 15-20 minutes, that’s crossing the line.

Why this is a big deal:
People who want to just come when they want and act as they please or expect you to bend the rules because they don’t think those rules apply to them are dangerous.  They have no respect for you, your staff, your practice, your skills, or anything else but themselves.  They tend to have a me-first attitude with no regard for anyone but them.  The world revolves around them and if it inconveniences you or poses a detriment to you in any way, well, tough.  At best, these people will destroy your morale.  At worst, they’ll suck your energy, cause a scene, or otherwise drive away other patients.  Accommodating them is a slippery slope; if you’re going to give in at all, decide ahead of time how far you’re willing to go.  If you have trouble saying no and you think you might not be able to stop once you start down that path, role play with someone else.

Bullet To Dodge #3: The Litigator
If you’re lucky, they’ll start ranting right away about how this doctor wronged them or that one screwed up.  Everyone’s entitled to be vocal about a bad experience with a healthcare provider, but watch the context.  Is the person also having trouble containing their emotions?  Is their story vague or full of mistakes (honest or not)?  Do they have their facts messed up?  If you’re really lucky, they’ll mention that lawyers won’t talk to them.  This tells you 2 things: 1) they actually went through with an attempt to sue and if they did it to another doc, chances are they’d think nothing of doing it to you, too, and 2) they’re full of BS because even the snaky-shark lawyers wouldn’t even touch them, which means they don’t have a case.

Do yourself a favor and let them rant, smiling and nodding all the way, until they tire themselves out and then pray they don’t come back.  Or, if you start to tire faster than they do (some can go on and on), mention you have to get back to some work or close up shop, and kick them out.  You’ve got to be proactive with these people and remain in control – they’re proud of the fact that they speak their minds and they’ll run you right over.

The good news is, they do speak their minds, which means they spill their guts and basically throw red flags at you.  These are gifts; use them wisely.

Why this is a big deal:
Do I really have to explain why letting people who would sue doctors into your practice is a bad idea?

Bullet To Dodge #4: Those who won’t answer questions (i.e. when things don’t add up)
This summer, we had a patient who was involved in a serious wreck.  I didn’t treat said patient, so I don’t know 100% of the details, but I do know that this person was referred out for an MRI and when the imaging center had a few additional questions, my partner gave the patient a brief additional questionnaire, which the patient refused to fill out.  They didn’t want to answer any of those questions.  And then, they promptly disappeared off the face of the earth.

Why this is a big deal:
People who won’t answer questions, especially regarding serious injuries (and possible financial compensation as a result) are almost always hiding something.  Either they were at fault, they lied to the police, they’re trying to scam money, or they’re trying to avoid punishment of some kind.  These people acted less than honest on at least one (probably several) occasions, and are now telling additional lies to cover their tracks or to pull a scam.

Having these people as patients puts you at risk for getting dragged into the mess.  After all, once you take on a case, you’re responsible for accurate questioning, physical examination, imaging, follow-up investigation, diagnosis, treatment, documentation, and re-evaluation.  Your records become legal documents, and your neck is on the line.  Don’t stick it out.  No patient is ever worth that, no matter how cool they appear to be.

Bullet To Dodge #5: Those who are pissed off at doctors
These people also usually fall into the second (running your practice) or third (likely to sue you) categories, although not always.  They’re also likely to rant for a while about how this place messed up or that other doctor screwed them, or that hospital scammed them.  It’s all the same; multiple other providers screwed up, and of course none of it could possibly be a misunderstanding on the ranting person’s part (end sarcasm).  As I mentioned before, everyone’s got a right to be PO’d at a healthcare provider who did something wrong.

When one doctor becomes multiple, though, or the person comes off as a little irrational or excessively animated, it’s time to break out the salt shaker…and find a subtle way to show them the door.

Why this is a big deal:
These people are pissed off at previous doctors.  This often means that their expectations may be unrealistic; at the very least, they’re tough to please.  You’ll work hard to keep them happy, if it’s even possible to do so.  Their treatment mileage is often limited by their mental/emotional state, and some people aren’t willing to let go of their negativity; it has become a part of who they are.

Bullet To Dodge #6: Eyeore
This is sort of a continuation of #5 (regarding the part about negativity becoming part of who some people are) but I gave it its own Bullet because sometimes negativity can exist without hostility (especially not toward healthcare practitioners).  These people are fixated on the fact that their life sucks and while that can be a very understandable and well-deserved mindset, it’s not a healthy one, especially over the long term.

There are, without question, more constructive ways to handle negative emotions; in fact, they can be turned into even greater positives, as avenues for personal evolution and growth.  But some people are so stuck in their rut that it interferes with their entire quality of life, including their physical state.  These people may improve, but they’ll almost assuredly plateau (the more negative their are, the sooner this will happen) and wonder why.

Why this is a big deal:
Unless you have a spunky cheer that won’t quit or you’ve learned to protect yourself against bad vibes, their melancholic condition may likely rub off on you or worse, other patients.  Also, your reputation is at stake when their treatment benefit levels off before their problems are corrected.  It’s tough to bring up the possibility that their mental/emotional state may be interfering with their physical improvement and healing, but it’s true.  Do your best, and don’t be afraid to refer to psychologists and whatnot.

Bullet To Dodge #7: Those who keep pushing insurance/Medicare issues when you don’t accept them
This often goes hand-in-hand with #1 (those who fail to respect your credentials) and #2 (those who seek to run your practice), and we’ve seen this time and again.  We explain we don’t take Medicare or certain insurance (usually those with the crappiest insurance are the most insistent and persistent when it comes to asking about insurance coverage – never quite figured this out); most people accept it and pay out of pocket with no questions asked.

Others, however, cannot accept reality.  They don’t seem to care.  This is especially true of the Medicare set.  We’ve had to practically order people not to submit their visits to Medicare because where there’s a will, there’s a way, and if they see a way, they’ll try.  I actually know of one person who, after my partner explained to him that Medicare reimbursement doesn’t even cover our basic bills/overhead, had the balls to say something along the lines of, “well, something is better than nothing, isn’t it?”

Looky here, mister: sometimes, nothing is better than something, if that something doesn’t pay your bills and that “nothing” could be time spent acquiring a patient base who DOES pay your bills.  After all, we didn’t go to school and put in the blood, tears, and sweat equity (and the 6-figure student debt to match) just to pay to take care of your well-off lazy butt.  So there….

Why this is a big deal:
I probably don’t have to explain why you don’t want a practice full of people who don’t think you’re worth your already-reasonable rates, do I?  I (really) didn’t think so.


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