Common Sense Management

Kiki Herfert brings over 30 years worth of worldwide chiropractic experience to her columns, convention presentations and management work.

Resolving those Touchy Situations

Here's a question I received from a DC:

"Who do you think is the best person for discussing touchy topics (finances, missing appointments, etc.) with patients? These are particularly troublesome areas and my staff, one person in particular, doesn't want to talk to the patient for me. Any suggestions?"

No one likes a possibly negative encounter/confrontation with a patient. That's why you want your staff to do it! The trick is figuring out who in your office, including you, is the most appropriate person for each situation. So, I'll begin by saying that if the situations you mention routinely reach a "crisis point," you need to figure out why.

Dissect a few "worst case scenarios." Look at the chain of events, and actions taken or not taken. Decide how you could have acted more effectively. Was the problem a lack of communication between staff, or between the staff and doctor?

Figure out what went on without accusing anyone. Are you giving clear directives? Are you slowing things down by insisting that everything requires your individual decision? If it does, are you taking too long to decide? Once you decide, are staff acting promptly or avoiding action?

You'll need to do the detective work before you can determine the underlying causes and fix the problems. You will have to actively work with your staff, preferably with "role-playing" until they or you can say the words that are difficult for them or you. Support each other. Everyone benefits. Review each situation that needs to be corrected before and after until you feel you are getting the results you want. If after coaching and practice a staff person doesn't want to be involved, it's up to you to decide how valuable they are to your office. The smaller the office and staff, the more important it is that they are willing and able to talk with patients about difficult subjects.

Who should explain finances and deal with financial issues? Who's best at it? It may be the doctor, a staff person or a combination of both. If the doctor is going to do it, a staff person needs to assemble all the necessary information well before the patient is due in the office. This is true for a new or established patient. The doctor needs time to look things over and maybe think about choices, and may need time to talk with staff or make a phone call. Quick action is called for with a possible problem. Someone on the staff should be able to handle routine questions so that the doctor doesn't sink under details.

If a staff person is going to handle matters, all of the above holds true. The person needs to understand policy completely, check with the doctor if the problem exceeds their authority, and then act promptly with the full confidence that the doctor is 100 percent behind them. Doctors, you do support your staff 100 percent when they have followed all of the above, don't you?

Office policies need to be clearly explained, not in "buzzwords," bookkeeping or practice management terms, but in words like: "Mrs. Smith, your total charges for your routine checkups here will be this amount. We expect you to pay that amount (or whatever you want) on every visit. We accept cash, checks, MasterCard, or Visa, and your insurance company's expected payment. If you choose to write a check, you may write one each time or one in advance for the week, based on the doctor's recommendations. If you choose to use a credit card, we will have you sign an authorization form allowing us to bill them should you forget to sign on a particular visit.

"If for some reason your insurance company does not pay what they have told us by phone, we will notify you immediately and your responsibility will be $XX. Do you have any questions about this? If you should have questions about your insurance company's payments or your balance please talk to Mrs. Knowitall immediately. Are you sure you have no questions? Fine, I'll just initial and date your file showing we had this little talk today. We're pleased you chose us to help you with your health problems."

Follow up at a specific time for about 3-5 visits, asking for questions or feedback specifically on financial issues. Pass along any new insurance information you may have. Be prepared for a certain small percentage of patients who have finally figured out that they "actually have to pay for your services." Why avoid or postpone this conversation? Those who are going to whine and moan about fees are better dealt with in a planned method rather than letting them hit the doctor during their visit or the staff when they're busy at the desk. Think of it as cutting them off at the pass! Review the benefits of care and actually recap the reasons they came in. They may start to feel better and think they are close to being "cured"!

If the problem is something more directly related to actual patient care and recommendations, the doctor should be actively involved. After the first missed appointment, it's not enough to have staff call the patient to reschedule. The doctor needs to take a moment on the next visit to specifically call attention to the missed visit, something like, "George, I missed you here yesterday. I know things happen that we can't predict, but I made my recommendations based on you following them closely." If the response appears that the situation was truly unavoidable, you could end the conversation with, "Well, it looks like there was absolutely nothing short of a helicopter that could have gotten you here! I'll see you tomorrow."

If the reason seems less believable, say something like: "I'm afraid I didn't explain the problem clearly enough during my report of findings. I'm going to ask (Sally) to schedule some time on your next visit so I can recap things for you." On the next visit, take the patient to "another place" besides your adjusting room. Have their full file, x-rays ... everything you need to do a mini-report, hitting the highlights and why following recommendations is important. Ask for questions. Conclude with: "I hope you understand how important it is to get the best possible results that you follow my results closely. I'll see you again on (day)." You could do it the same day, if and only if you can do all of the above.

The idea is to make the first missed visit a big deal. Impress on the patient why they need to be there. Make them want to please you and make them want to avoid another special talk with the doctor. Be sure it's not a scolding. Leave them with the impression that, "We know if we had explained the importance of a missed visit more completely, you never would have considered not being here!" Once the patient has been very gently and tactfully corrected and given the "proper mindset," it should only be necessary to rearrange an occasional appointment time.

With some detective work, some problem solving and a team approach, you can go a long way toward reducing the hassles and increasing the satisfaction in your practice.

Dear Readers:

I am always interested in hearing your thoughts and questions. I want my column to reflect your real life. You can talk to me or write me at the address below.

For those of you who would like to contact me by e-mail, I will need your fill name, city, state, age, time in practice and normal weekly patient load. Also include your hours, number of staff and other pertinent facts that you think I'll need to answer your question. I don't answer nonspecific questions like, "How can I improve my practice?" I may ask you to call me if your question is long or complex.

Kiki Herfert
15852 Jefferson Avenue
Grosse Pointe Park, Michigan 48230-1445
Tel/fax: (313) 822-9199
Kikiherfer@aol.com