Handling Patient Anger, Fees, Setting TX Plans, Boundaries, and Teamwork


So BCA has a patient a few days ago, someone in severe pain. I am shocked, actually, when I see that 'all' he complains of is severe, debilitating back pain. I'll call him Tony. Tony is emaciated, drawn, big black circles under the eyes, very little qi to work with in general. He comes in as a new patient with his wife, also new. 
His wife on that evening is communicative, open, friendly, and excited to try acupuncture. She's a physician, one of my favs as a new patient. 
Getting Tony to talk, however, is like pulling teeth. So I figure, “Great! Let the needles do the talking!”  I needle them both and leave them. When I come back, I ask the woman to come weekly through at least 2-3 menstrual cycles for some chronic GYN complaints. Then I roll on over to Tony and say, “Ideally, I'll see you daily for as many days are needed to get a real shift in  your pain.”
“HOW many days,?!” Tony demands to know. “As many as it takes to feel a significant change in your debilitating pain,” I reply. “It could be 4, 6, 10…” 
“TEN DAYS?!” shoots back Tony. “If this were China, all of that would be paid for, and you want TWO HUNDRED DOLLARS for me to even know if this is working?” To which I say, “Yes, true, if it takes 10 treatments. I would hope for change sooner than that, we'll know pretty quickly how you are responding.” I also say “$200 will buy you 2-3 acupuncture treatments anywhere else in town; we are offering 10 treatments at that price.”
All  the while thinking, wow. If I had a sliding scale starting at $15, it would only cost $150 for that many treatments. I'll post again at some point about our choice to go flat rate. Anyway…
We have some free acupuncture resources in San Diego, so I hand over the resource list. At this point he's repeatedly ranting “TWO HUNDRED DOLLARS!” And lets it slip that he did thrice-weekly chiro treatments for quite a long time with no appreciable results. Ah. A relevant history. Now I know why he's practically yelling at me, in the clinic he voluntarily came into, in front of a room full of people. And even though I tell him again that I am not insisting on 10 treatments (an thinking that I am not holding a gun to his head, that he came to me, not vice-versa), I totally understand where he's coming from. I don't even know Tony yet. I only know his pain. It's impossible to see past that much pain. I'm kind and empathetic, but also stand my ground.
This could be a good discussion, because I know lots of clinics will slide under the scale, as in, “Come every day until you feel better. What is reasonable for you? $10 a treatment? $5? $3? I just want you to get the care you need.” In fact, I was so inspired by hearing Lisa talk in this way 3 years ago. I offered lower rates consistently, when it became clear that finances were the main barrier. OR…when people asked just because sometimes that is what people do. And then sometimes they will skip the treatment plan and hop in every few months with 5 bucks…
So now, I don't do this. Because it started getting all muddy. I ran amock with this on my own shifts, but did not offer other punks the same flexibility, given our slim profit margin and payroll pressures. Also the FD got confused… “X only paid $6, am I supposed to say something?”
I know this post is all over the place, sorry. It feels like a day in the clinic. 
Anyway, I am not at all confident the patient will come back. But I am happy, when his wife asks me, “Will he get better if he comes once a week?,” that I say, “Sure, acupuncture will never be harmful, but given the severity of his pain, more treatments closer together will not only give faster relief, but will require fewer treatments in the end.” Because even if he doesn't come back, I am as honest and helpful as I feel I can be.
Then, he does come back. The next day. And grills the other punk about treatment plan. She advises daily. And he comes the next day. To a third punk. And tells her he is feeling better, and asks for advice on what next. And she says daily, since we are making good progress and want to see it continue.
I hope he comes again tomorrow on my shift. Because I will get to work with him in a different way, with him having moved past some of the worst pain. And I am so grateful to the team we have, all wanting to help, and knowing it's not always going to win the  popularity tiara to tell the truth.
Growing pains are a real clinic phenomenon. We will all mature differently, just like people. It's nice to have more of a sense of identity as a clinic, though, and to have set systems and policies. We could always do better, but our best is working right now.
Author: obnicole

Beach Community Acupuncture (BCA) is located in San Diego's historic Point Loma. We opened in 2009, and provide more than 10,000 affordable treatments a year. Treatments at BCA are $25 for everyone, every day.

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  1. Great blog! Im stealing this: “given the severity of his pain, more treatments closer together will not only give faster relief, but will require fewer treatments in the end.”


  2. Thanks, Nicole, this is a good lesson. We have someone (not as severe, but still…) who had post herpetic neuralgia for 6 years, at the waist. After coming daily, he is now at the point where we find out about more of his health issues. Like you say, some people just can’t think, can’t feel, past that immediate pain.

  3. Update: he came 5 days straight, is feeling WAY better, can start coming less frequently already, starting to thank everyone for the clinic’s services.
    And thanks, MM 🙂
    When life sucks, it’s hard to know who to trust. I’m glad he came back.

  4. thanks OBN, it’s important to find patience and consistency ( as you demonstrate) with patient communication and treatment plans, because there will be other Tonys on down the line over the years.