Reader D. asks:

“What are your most successful tips for closing the appointment on time with verbose patients?”

For those of you with “talk-heavy” consultative practices, a talkative client (or a series of them) can either throw a busy schedule completely off-kilter, or turn a not-so-busy schedule into a day of chatter that you don’t get properly paid for. Here’s our strategy for reigning in the chatty ones without being rude.

1. Use a Clock. You really can’t be on time if you don’t know what time it is. Same goes for your clients.

That may seem obvious, but it’s amazing how many practitioners don’t have a clock in their office. A watch can work, but it can be hard to glance at your watch in some situations—a clock may work better. Better yet, try two—one that you can see, and one that your patients can see, too.

2. Take Responsibility

Practitioners with real chops for managing time will tell you that an appointment isn’t just a meandering conversation. It’s a guided, structured interaction. And the guide is you, not the client.

An appointment that ends right on time isn’t luck. It’s not because of a cooperative client, or the ability to simply shut someone down mid-sentence and say, “Your time is up.” Appointments finish on time because the practitioner controls the appointment, not the client.

If your appointments run consistently late, you need to accept that it’s within your control to change that.

3. Lead The Interaction

It may be your job to guide the appointment to a timely finish, but talkative clients can be very persistent. Here a are a few tips to taking control of the appointment flow:

• Re-state the time frame. Chatty clients tend to forget how much time is available. You can gently remind them up front by saying, “We only have until 2:30, so we should get right to it.”
• Don’t ask “How are you?” with verbose patients. Stick to more closed questions that are specific to your patient’s complaint. Instead of “How are you?” try, “How are your headaches?”
• Don’t ask open-ended questions after the halfway mark. With verbose patients, you’ll need to start closing sooner. Don’t open up a whole new topic, or ask for more information after the midpoint. The first half is for them, the second half is for you – you need time to diagnose, treat, create a plan, explain, etc.

Any suggestions for keeping a runaway appointment on the rails? Let us know in the comments!

Related posts:

1. 5 Random Files: An Easy Way To Reactivate Clients
2. 3 Ways to Let Go in Practice
3. The New Found: Who Gets the Oh-So-Close Clients?

…would you do anything differently?

We tend to tackle “firsts” with a special kind of energy. We give more to them. We immerse, offer up more of ourselves.

And then something happens. First becomes usual, and our energy shifts, ever so slightly. It’s normal – after all, you only get one first. It’s a distinct moment. After that, it’s all variations of something we’ve done before.

That is, until one more unique event arrives: the last time we do something. We tend to treat that moment differently, too.

The trouble with last, though, is that we don’t always get to know in advance when it’s happening. You always know a first, but lasts can be sneaky.

But last does have a special feature: we can imagine it better than we can a first. The challenge is that we don’t do it.

What if your next client were your last? Would that change how you do what you do? Would you give more? Take a risk? Be more forthright, honest, or authentic?

And most important: would it make a difference for that person?

Maybe you can’t treat every patient like your last. But you can try one and see what it feels like. And maybe – just maybe – there’s something in that last that should be an always.

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1. 6 Good Reasons to Offer Shorter Appointment Times

Sometimes, clients just appear on your mental radar. They pop into your mind out of the blue, and you think, “Gee. I wonder what happened to so-and-so?” They might have been in active treatment, but have since dropped off, or recovered from a condition and haven’t been back since.

Whatever the reason, it happens, and we’ve often wondered if we should be doing something at those times. Recently, instead of just continuing to wonder, we decided to try an experiment.

We have a dry erase board in the staff room, and lately we asked the team to simply write down clients when they think of them out of the blue. Pretty simple stuff, really – just write their names on a board.

For a while we wondered about the best way to connect with them, though. Call? Write? Email? We’d been using personal letters to reengage old clients, but the truth was we wanted to connect with those people. After all, we really did want to know what was happening with them.

In the end, we decided to experiment with email. Tara wrote six personal emails to clients who had appeared on our “mental radars” in some way. The result was incredible: people loved it. All six responded quite quickly, and at least two have booked to come back in. Just like that. Minimal time investment, zero cost.

Why did it work so well? I think part of it was the medium – email’s less invasive, and more convenient for starting a dialogue. Letters aren’t great for instant dialogue, and it’s often hard to get people on the phone at a time that’s convenient for everyone. More important, though,  I think it was because these were in no way “salesy” emails. They were genuine inquiries: we were thinking of you and wondering how you were. The decision to reengage with the practice was entirely their idea.

The lesson? If someone’s on your mind, then maybe it’s time to be on theirs, too.

Update 2: The book’s here! You can find The Practitioner’s Journey here, and learn more here. Enjoy!

Update: The Practitioner’s Journey is off to the presses! We’re really excited about this book. It’s the end of a long stretch of writing and rewriting, but best of all, it’s going to change the way that many practitioners think about growing their practices. More details to follow as the book hits the shelves, of course, but in the meantime, we’ll be moving AHP to a new online home. With any luck, that’ll be a seamless process, but if things get dark and strange in here for a while, you’ll know why!

Related posts:

1. 5 Random Files: An Easy Way To Reactivate Clients
2. 3 Ways to Keep Chatty Clients on Time
3. The New Found: Who Gets the Oh-So-Close Clients?

Getting new clients takes time, energy and sometimes money. For all that investment, it’s a shame when they don’t come back. We’ve had a lot of faces through our practice doors over the years, and while we do our best to keep them engaged, we don’t retain everyone. As a result, we’ve got our share of “dead” files in the back room.

This year at our strategic planning day, one of our team members came up a great idea for reactivating some of those old patients. It only takes a few minutes a week, and although we’re just starting out, I think it’s a great plan.

5 Random Files: How it Works

After this idea came up,  Tara reminded me of a chiropractic marketing guru  – I’m pretty sure it was Dr. Demartini -  who talked about how his staff would pull a random client file every week at the office and just…well, just think about the client.

According to the story, more often than not that person would call out of the blue and return to the practice. Kind of a law-of-attraction approach.

Our process is a little different, but geared toward the same result of re-engaging past clients in our current practice. Here’s what we’re doing:

1. Each week we pull five old files at random from the archives. (If you don’t keep files, you could just as easily check old appointment records, invoices or other client notes.)
2. We quickly review the files to see if we have anything new to offer, or some reason that we may be able to help now, when we might not have in the past
3. Where applicable, we write a personal letter to the client, describing when and why we saw them last, and why we think we might be able to better serve them now.

That’s it! Just a few minutes down the memory lane of your practice past to see if there’s anyone you might be able to help.

Why It’ll Work For You

Here’s why this approach is likely to bring back some old faces to your practice:

• You’re better now than you were then. Since you last saw these clients, you’ve probably gotten better at what you do. You’re more experienced, more confident. You may have done some continuing education, or have some new treatment tools at your disposal. Or perhaps your pricing, service, staff, hours or other aspects of your practice are more appealing.
• It’s personal. Each client is getting a letter just about them, talking about why they visited in the past, and how you might be able to help now. It’s far more personal and relevant than a newsletter or bulk mailing, so your clients are more likely to respond.
• It’s cheap & simple. Really. This is a no-brainer. The first few letters take a few minutes to put together, but after that it starts to get faster and faster as you realize part of what you’re saying each time is similar. In total, it only takes about 20 minutes a week of time commitment, and a under $5 in stamps, paper and envelopes.

Why five files? It just seemed like a manageable number. Five was small enough to ensure the job gets done and retains its individual patient focus (of each five we pull, there are only 2-3 that get letters), but big enough to get through quite a few files in a year.  You can do just one, if that’s what works best for you.

I’ve got high hopes for this effort, and I love the personalization of it. It’s also really rewarding to see how much more we offer now than we did a few years ago. It’s easy to forget how much progress you make over time!

Related posts:

1. Top of Everyone's Mind: Reconnecting With Missing Clients
2. The New Found: Who Gets the Oh-So-Close Clients?
3. 3 Ways to Keep Chatty Clients on Time

Most businesses wouldn’t even consider firing a customer. But sometimes it’s the smartest thing you can do.

Unless you’re blessed with Mother Theresa-esque patience, I’ll bet there have been days where you’ve been pushed to the edge of reason by one of your clients. Rude behavior, seemingly un-resolvable or never-ending complaints, unpaid bills and non-compliance – they’re the patients you see in the schedule that make your heart sink.

Most people would never consider actually “firing” a client, but have you stopped to consider the impact that some of your “less than ideal,” patients might be having on your practice? These irritating or otherwise difficult patients create two negative cycles in your practice that in the end cause emotional and financial drain.

The Emotional Drag
Overly difficult patients can create a steady decline in the emotional climate of your office. It starts with them slowly draining the life from you and your staff. We’ve all encountered these people before – they leave you emotionally exhausted.

This in turn messes up your office atmosphere and reduces the energy level in your clinic. The enthusiasm and warmth drops off; the office “vibe” becomes neutral or negative. This in turn starts to affect the patient experience – it’s not the same relaxing, healing experience it used to be. Your ability to engage patients and treat them properly starts to decline. And all of this is reflected in a decrease in referrals, return visits and growth.

The Effectiveness Drag
Difficult patients may not comply with your treatment plans, or if they do, they may continue self-destructive health habits that offset any treatment gains. Naturally, this means they don’t get better. And when they don’t get better, they don’t refer, or worse still, they complain to others about how your modality “doesn’t work”.

Again, this is reflected in decreased referrals, return visits and growth. Not to mention one (or more) unhappy CAM practitioners.

If you’re experiencing these negative cycles with one or more of your patients, here are some ways to deal with them:

Tell Them the Truth and Help Them Change
Start by acknowledging that part of their “bad” patient behavior may be part of your responsibility as a health care provider. Who’s to say it’s not part of their health problem? Instead of thinking of their behavior as a detriment to your day, consider that it could be a detriment to their healing. With time, most patients you approach truthfully on these grounds will either improve themselves, or drift away on their own.

Refer them Elsewhere
This isn’t just about dumping your worst patients on someone else. Your highest mandate, from a medical and business perspective is to increase health. Consider that your worst patient could be someone else’s bread and butter. Think of all the MD’s in family practice who can’t stand people with chronic, lifestyle related issues. For some CAM practitioners, like naturopaths, those patients could be a gift.

If there’s someone out there who can better serve these people, it’s your job to send them there. If you’re worried about competition, don’t. If you focus legitimately on improving patient’s lives, your practice will always benefit.

Send ‘em Packing
In the case of highly abusive, disruptive patients, simply ask them to not come back. Don’t charge them for that visit, but make it their last. Explain that you’re sorry, but you’re not able to help them any further. This is not about making them feel bad, or you feel good, it’s simply ending a client relationship that’s doing no one any good.

Note: If you have patients with anger management or severe emotional issues, don’t do this on your own. Be smart.

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There ain’t room enough in this town for…oh, wait, yes there is.
What Makes a Great CAM Patient?

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When you start your holistic practice, it seems like any patient is a great patient – money’s tight and every face that comes through the door is another chance to pay the rent.

Over time, though, it becomes critical to cherry-pick the best of the best. Here are a few characteristics of great patients for any alternative health practice:

Compliance
A patient that can’t or won’t follow your treatment is not likely to find success with your modality. This leads to the bad patient spiral : no success = no return = no payment = no referral = negative publicity = less growth. It’s hard at first, but you may find your life gets a lot easier, and your practice busier, if you warn patients up front of the time, effort and cost of a particular course of treatment.

Wealth
Obvious? Perhaps, but clients that don’t pay not only leave you cashless, but they tend to get poorer results, leading to the same compliance problems listed above. (See pro-bono work and discounts for more on the relationship between payment and health.)

Referrals
In most practices, the bulk of your new patients over time are going to come from referrals from existing patients. Patients that don’t refer don’t build your practice.

Success/The Right Health Problem
If you’ve been in practice for any length of time, you’ve no doubt realized that there are some conditions you’re more likely to have success with. This success breeds more success in the form of positive word-of-mouth and referrals. Learning when to say, “I don’t think I can help you.” is critical to growing a great patient base.

It may be tempting to grab every patient you can, but remember that your success over time is going to be through finding the best clients for your particular talent.

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1. A Great (and Free!) Practice Growth Book

The allopathic community has a set precedent for reaching a “practice capacity”. Many MD’s will reach a designated number of patient files, and then no longer accept new patients, particularly in regions where health care is publicly funded.

Since most CAM practices run on a private sector business model, my suggestion is that you never stop accepting new patients. Here are a few reasons why.

Practices Shrink Over Time
Over time, your clients will die, move, change practitioners and undergo a limitless list of life changes that result in them no longer coming to see you. If you’ve shut down the new patient engine of your practice, it takes some time and money to start it up again.

Your existing patients and colleagues will have grown accustomed to you not accepting new clients, and will have forged new referral relationships. These are often hard to undo. You may have limited signage, advertising, etc.

You Don’t Have to See Them Yourself
Many practitioners stop accepting patients because they’re just plain busy. That’s fine – all work, no play is a valid argument, particularly if you’re a CAM practitioner promoting life-work balance in your practice.

However, before you turn them away, consider getting an associate. Then each additional patient grows your income, but not your workload.

You Can Increase Your Rates
The principles of supply and demand can work wonders for alternative health practitioners, as they can for any business. When you have more patients than you can handle (high demand), you can raise your prices without fear of losing clients.

And although many practitioners are not interested in associates, I have yet to meet a CAM doc who wouldn’t like to charge more for their services.

If and when your practice is full, consider new patients not as increased workload, but as a way of working your way to the next level in your business, where you don’t have to put in time for every dollar earned.

Related posts:

1. 3 Ways to Let Go in Practice
2. Love in an Elevator

“I have some clients who miss appointments without calling. It’s very frustrating. Should I be charging them a fee?”

This one has no clear answer. Ask around, and you’ll get different opinions. Compared with more mainstream medicine, my guess is CAM professionals are less likely to charge for no shows, simply because lack of insurance coverage and a smaller patient base may have made the industry more service-oriented.

I’m in the camp of “no”. I’d rather focus on reducing the number of missed appointments than on charging for them when they happen. It’s a better place to focus your energy.

However you may need to gently remind chronic no-shows…

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