Lack of Patient Compliance Can Poison Your Practice

In this episode of the DreamPractice Podcast, we dive into the insidious poison that is patient non-compliance…

Big Take Aways

  1. Lack of compliance contributes to poisoning of your word of mouth referral base.
  2. Confronting non compliant patients is a necessity to protect your practice’s reputation.
  3. Trying to convince non compliant patients to make FM based changes diminishes your authority.
  4. At 8:00 you can listen to a script for how to deal with non compliance.
  5. Check out the transcript below.

What do you do when patients fail to comply?  Leave your comments below.

Read The transcript

Hey, it’s Dr. Osborne. Welcome to the Dream Practice Podcast. Super excited today, our topic is one that I think that a lot of doctors and practitioners struggle with. It has to do with patient compliance. What do you do when you have a patient, or a client that has come and paid you money to receive your help and advice and their failing to comply. I think it’s a very, very important topic because a lot of practitioners kind of dismiss this. If somebody doesn’t comply they don’t really say anything they just kind of push it along and move on with life, move on with practice.

And that’s actually one of the worst things you can do. Let’s talk about why. One of the things about compliance is that you know that if your patients comply with your advice that the likelihood that they’re going to improve their health and get better is extremely high. That’s what functional medicine’s all about. We find the root reasons. We offer up education and advice on how our patient’s can change. And if they apply that advice, generally what happens is their health improves.

Now, that being said if we take somebody whose noncompliant, what happens, their healthy doesn’t improve. Now if we take that one step forward, and we say, well, what’s the interaction that that person, that patient has with the rest of the world in terms of your office. Right, they’re going out into the world and now they’re saying, “Yeah, I’m seeing doctor so and so. And I’m not really getting better. I don’t advise going to see that doctor because you probably won’t get better either.” That could be a potential conversation that noncompliant person has.

Another conversation might be somebody asks that patient. “Hey, aren’t you seeing that doctor?” And the patient says, “Yeah, but I’m not really feeling any better.” So there are number of different potential negative conversations that could be had that can tarnish your reputation as a practitioner and that’s not good. None of us want that. None of us want people out there saying either negative or bad things about our advice especially if they’re not following it because that in and of itself is misleading, and it creates a bad reputation for you.

Remember the saying, years to build a solid reputation, moments to destroy it. So if you’ve got problems or if you’ve got certain people coming to see you and they’re not compliant, and you know that because maybe they’re honest with you. And say, “Look, I just don’t want to change my diet, or I just can’t change my diet.” You should not continue seeing them, and it’s very, very important that you understand that. It doesn’t mean that you have to neglect them. It doesn’t mean that you simply dismiss them with hate or with malice. You don’t want to do that, but you certainly don’t want to continue to try to convince them that they need to make changes when they’re not willing to do that.

Several reasons why but one of the biggest ones is it’s not your job to convince people that they’re in the right place. Once they’ve already opted to receive your services, the convincing or the selling part of the appointments and of the practice, that part should be over. If you spend everyday dealing with people who are relatively noncompliant, what you’re in essence doing is you’re building an arsenal of existing patients who are out there potentially saying negative things about your practice.

It’s the opposite of good advertising. We don’t want that message. So you have to make it a point to confront, in a loving way. In our office we have a language for this it’s, we spank people’s heart. Because if they’re not being compliant we have the conversation first about what noncompliance actually will mean for their negative outcomes or for their positive outcomes. And so, if they’re nonresponsive to a conversation about their lack of compliance then you really want to implement phase two in this process.

And implementing phase two means you really want to look at trying to refer that patient to a different practitioner. A practitioner who can work with them on their level because if they’re not ready for functional medicine the reality is they’re not going to comply, they’re not going to follow through, they’re not going to get better. They’re going to become bad advertising and when all of that cascade happens repetitively, nobody wins. You don’t win because you have lack of success and that can lead to a lack of confidence. It can really lead to a reduced confidence in your as the practitioner.

And it’s very, very important as functional medicine docs and practitioners that you have really good confidence in what you do. And the reason why is because it works. And so you don’t want to judge your skill set based on an army of noncompliant people. You want to judge your skill set based on compliant people. So if you’ve got people in the practice who are really, really just not following through. Not sticking to what you’re telling them to do and you’ve had a conversation or two about what that means and why it’s important that they actually comply and how it’s important for their outcomes for them to comply and they’re still not responding and in fact they’re telling you they’re probably going to comply.

It’s at that point it’s really a good idea to find them a referral and just refer them out of the practice and no longer continue to serve them because they’re not serving themselves. Remember our job as practitioners is we don’t do any healing, all the healing comes from within. The body has the power to heal itself if we remove the interferences. If we remove the toxins, the poisons and support nutrition and good lifestyle habits. But if the person is not willing to make those changes then there’s not a whole lot that you can do and again, going back to what I said earlier, it’s not really your job to convince patients once they’ve signed up for your services.

The convincing should happen before they ever even make it into your office. In essence if you’re really doing a great job of kind of pre filtering people who are qualified to see you versus people who maybe are looking for dabbling into the realm of functional medicine or nutrition. We don’t want dabblers in our office because dabblers are generally the ones that give us the most trouble, give your staff the most trouble, don’t comply, create negative advertising and really have the potential to ruin your hard fought, hard earned reputation. So you really don’t want to sit on noncompliance lightly, you really want to take it seriously and have that meaning conversation if it’s not effective then the next step is going to be you really want to look to refer that person out.

Now, here’s a caveat to that. I’ve actually had that conversation with a number of people before we talk about filters, I’ll share this story with you. So the last time this happened in my office I had a woman who had come in originally, she thought she was ready to commit. She’d moved forward with some things but after moving forward we started to discuss nutritional protocol and lifestyle change and she just wasn’t doing it. She just wasn’t following through. So we had a follow up conversation on the phone and she was honest with me and that’s important that you always ask your patients to be honest with you.

Don’t yell at them for being honest with you. Like don’t treat them badly for being honest with you. Always treat them with respect that goes without saying obviously. Because you don’t want to deter people from feeling like they can be honest with you. It’s kind of one of those notorious problems in traditional medicine practices where patients are often times really dishonest with their docs because if they tell their docs they’re doing supplements or nutrition their docs will tell them how stupid they are. So they just lie.

So you always want to keep that open channel of or that open line of communication and that honesty in all of your relationships. I would say it’s better to err on the side of brutal honesty than to beat around the bush with somebody because at least then you know where you stand and you can take effective action in those salutations. But anyway, I had a patient who was coming to see me. She wasn’t compliant. So the conversation I had on the follow up was she was complaining because wasn’t feeling better. She was still lethargic and fatigued and anemic and so one of the first follow up questions I always ask even before I get on the phone or see somebody in person is I make them fill out a questionnaire and I make them grade their compliance for me.

Like I give them the opportunity to tell me on a scale of 0% compliance to 100% compliance where they would grade themselves and that kind of gives a good idea of how you can start a conversation. So this woman said that she had been about 30%-40% compliant and so that was where the conversation started and so I just simply said look, and this is an example of if you handle it with honesty but integrity, you protect your reputation and you potentially get that person to take a corrective action. You also give them an opportunity to take corrective action without just firing them blatantly.

So again, what happened is she said she was 30%-40% compliant. Our conversation went like this, “Mrs. Jones, my time is very valuable just like your time is very valuable. And you’ve come to me to see out my professional opinion and services and you’ve paid me for that, yet, you’ve failed take any action or you’ve taken very, very little action on the advice that I’ve rendered and now you’re somewhat upset because you’re not feeling better. So we really have a conundrum here in a sense. Either you can get on board and you can start following through or you can quit wasting my time and quite wasting your time on things that you’re not willing to do.

No I really want to help you and I really think I can help you and help guide you in the right direction. But I can’t follow you around. I can’t hold your hand through the grocery store. I can’t tell you, no, when you’re sitting at a table and there’s a temptation for food that you know is going to put you in bed for the next day. So you’ve got to really mature and make a decisions as to whether or not you want to continue going through care with me because at this point there’s not a whole lot I can say. There’s not a whole lot I can do for you. There’s not a whole lot of advice I can give you because I’ve already given what I think you should be doing and because you’re not doing it. We’re at a stalemate. So we’re going to get off this phone call. But I want you to go home. I want you to think about what it actually is you want, what it is that your health goals are, what it is that you want to achieve.

And if you feel like I’m not the right doctor, we need to really end this relationship and I can give you a referral to a doctor who might better suit your needs. And if you feel like you really are ready to commit, you can let me know that and we can move forward with a clean slate and applying the techniques and applying the advice that I’ve already given you.”

So that’s the way that conversation went. And what ended up happening, long story short, this woman actually calls the office back, she’s ready to move forward, she’s ready to comply. So she sets up an appointment for several weeks out. The next time I get on the phone with her. She’s feeling about 80% better and she’s really ecstatic because she just needed to be hit over the head with the truth stick. Like in a loving way. She didn’t need to be run off or yelled at but she needed to be hit with the truth. And sometimes that’s what you have to do with your patients or clients if you’ve got to confront them and that can be a very, very uncomfortable conversation to have.

But if you’re not willing to do it, who is going to do it for them. Who is going to do that with them. If you can’t be honest with them and really face those noncompliant people with a dose of truth then nobody’s going to do it. And again, what’s the negative consequence of that? They don’t get better. They become negative advertising. And more importantly that negative advertising leads to a tarnishing of your reputation out in your community or on the internet. If you’re practicing not in a brick and mortar but you’re in an online-based practice. It still leads to a tarnishing of your reputation.

And it can also lead to bad reviews. People can go and leave you bad reviews. Whether it’s on your Google review page or whatever other page that you have set up across the internet. There’s Rate MDs and there’s Health Grades and a number of other rating services for doctors. So you don’t want to accumulate bad reviews because you didn’t have … you didn’t take the time really to have an honest, open conversation about why they weren’t being complaint. So sometimes what you’ll find as you have these types of conversations is you’ll find that the reason they’re not compliant is X, Y and Z. And again, that gives you the opportunity to give them corrective behavioral actions over X, Y and Z. Whatever those excuses might have been.

But also to give them a stern warning that, look, your time is valuable. Part of my mission, you guys know this. We’re out to save 100 million people. We’re out to save 100 million lives and if three out of every seven consultations I do in a day were for noncompliance then that’s close to 50%. Not quite 50 but close to 50% of my day that’s being spent and my energy and my resources that are being utilized on somebody who’s not willing to follow through. That’s no way to get to 100 million.

So whatever your goals are in your practice. If you’re trying to reach out to thousands of people in your community, if you’re trying to really build your reputation, you don’t ever let anyone want to tarnish that reputation and having noncompliant patients is one of the biggest ways to farm out a slow insidious poison of tarnishing your reputation. So, don’t let it go on in your practice. Make sure that you have systems in place, software in place that has the capacity to help your track compliance.

If you don’t, you can talk to us over at Dream Practice about implementing some software strategies. We have a couple different softwares that we use that work really, really well for this and we can help guide you down that path if you don’t already have something that is helping you do that. So it’s very, very important from a systematized perspective to have some type of follow up or follow through-based system, preferably a digital one that can keep track and that can assign duties and details to different staff members so that you can track compliance whether it’s compliance through the supplemental regiment, whether it’s compliance through the labs that your ordering and the follow up test that you need to see in order to kind of objectively evaluate your patients and clients.

So again, tracking is very, very important for compliance because it also helps you identify those who are not compliant. So if we really kind of summarizing how to track compliance, have software that helps basically send out reminders to your team to your staff when it’s time for patients to re-up supplement orders, when it’s time for patients to redo labs. But also have the right paperwork, preferably again digital paperwork that before you ever even have those follow-up visits with those patients and clients that they’re filling that out to inform you about their level of compliance. All important strategies to implement so that you can monitor it effectively and take appropriate action when it is necessary.

So, that’s the tip of the week. Make sure you’re monitoring that patient compliance because again, that means everything. Your reputation is everything and if you spend years to develop it and you allow a few people to slowly tarnish it that’s going to lead down a road that you don’t really want to travel. So again, this is Dr. Osborne with the Dream Practice Podcast. We’ll be back next week with more tips and advice on how you can grow and build the practice of your dreams. Have a great week.

 


    5 replies to "The Importance Of Monitoring and Addressing Compliance"

    • Michael Pratt

      This is far too dogmatic. No Doctor can be right about everything. It may look certain now but time and new evidence will lead to new insights. The patient should not have to accept 100% of your ideas.

      • Dr. Peter Osborne Dr. Peter Osborne

        Michael,
        That’s not the point I am trying to make. You are right. No doc is right about everything. I am talking about the patient who disagrees with fundamental and necessary changes they need to make to improve their health. You can help someone who is not willing to help themselves.

    • Lillingston Fizzy

      Wow – that was powerful. I’ve struggled with these types of patients for ever and I get so frustrated that they just don’t see it!
      Your compliance assessment is such a good idea! I shall look into implementing that tool.
      It’s those patients that come back again and again but don’t get better as they keep thinking they don’t have to do anything and I’m going to give them a magic pill or treatment and they can carry on with their unhealthy lifestyles! Allopathic medicine is to blame here with it’s quick fixes. People don’t want to have to do anything themselves. Thank you for this – a great help!!! IMD

    • Vita

      I would like to ask you if you give the money you got from the patient back or at least partially back or not. Let’s say, that the non-complaying patient payed few 1000$ already in advance. Thank you for your reply.

      • Dr. Peter Osborne Dr. Peter Osborne

        Vita,
        If you are running programs where patients pre-pay for services, yes. Refund the money for the services that have not yet been rendered. If you are having patients pay as they go, no refund is necessary.
        All the best,
        Dr. O

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