Neighbor keeps referring hard-luck cases! Grr.

[sunnylv702]

Heh, not sure what to do about this situation.

We're not LMTs anymore (well, we keep up the license but we don't do massage therapy), but I think that y'all might could relate and hopefully help me see our way out of this.

Some background: we're both fairly new DCs who have started up a family practice. Our office is in a professional building, just down the hall from some other healthcare practitioners (there's someone who does colon hydrotherapy, and another who does thermal imaging as an excellent--and safe--alternative to a mammogram, etc). We like everyone, and everyone seems to like us. So far, so good.

My husband used to offer his first adjustment on the house. He wanted people to experience his technique, because it is SO DIFFERENT from any other DC. (Our mentor offers his first visit on the house, too, so we sorta took after him.) Everyone we talked with (we talked with a LOT of people in our first few months) LOVED that idea. So did we. So far, so good.

Now, my husband's technique combines not just the adjustment but also a neuromuscular therapy-style soft tissue work that is incredibly taxing. I mean, this guy is releasing the psoas muscle and then adjusting the sacrum anterior-to-posterior instead of the other way around. We're talking layers and layers of chronically tight tissue. It's a workout for him.

The first-visit-free didn't generate the result for us that we had seen with our mentor. It seemed to work for him, but our results were different. So after about 4 months in practice, we grew concerned that we were being considered a "free clinic" and so we started charging regular price. That actually generated a MUCH better quality patient (which did NOT surprise us). We explained to everyone we had previously talked with (including our building neighbors) that we no longer offer the first visit free. This way, as they were in a position to send in a referral, there would be no unpleasant surprises. So far, so good. What DID surprise us, though, was that those colleagues we had talked with all expressed a sort of disappointment that we were unable to continue the first-visit-free concept, but that's neither here nor there.

What irked me was, one night last week, when my husband was occupied with a new patient, our neighbor came over and said she had a lady in her office right now who was down on her luck and was wondering if my husband would give her an adjustment. I.e., she was wondering if we'd give free work. She explained the situation - the lady had been abused in a previous marriage and is now a single mom, the whole shebang. Now she's having trouble breathing, etc. My response was that I never speak for my husband (I never volunteer his services, especially without compensation), but that I'd ask him when he was finished with the new patient. The neighbor, a nice lady, kind of pushed on, saying she'd cover the cost if we needed to charge. Kinda manipulative, because we'd look like arses if we charged, but what the hey. I talk to my husband, he says send her in. I understand that I had kinda put him on the spot, asking him to make a split second decision.

So the lady comes in, is made up, hair done, well-dressed, and has a cellphone. OK, I know that sometimes people receive things as gifts and who am I to judge, but this lady does NOT look like someone who is down on her luck. And it's not like she just came from work either, because she remarked that she's out of a job. The first thing she starts talking about is the abuse. I know that can be therapeutic, but I've known LOTS of abuse survivors and they do NOT just start talking about their abuse to strangers. She pours out with a story that kind of reeks as a sob-story - always the one to give the benefit of the doubt, things are starting to kinda not add up. Let's just say that I had clues that we weren't being given the whole story. Nothing super definitive, but definitely suspect.

In a way, this experience did us a favor because my husband, after the fact, felt somewhat taken advaneforum.xxxe of. He is frustrated that the only referrals he receives are for people who claim they can't (won't?) pay for our work.

This kicked us in the pants to come up with options for those with sob stories, either genuine or otherwise. We came up with a barter list and a referral program. Provide one of 5 things on this list, or refer x number of people and receive y benefit, etc.

We're just irked that
1) even though our neighbor knew we didn't do pro bono work, she (nicely, but still) pressured us into doing free work
2) this neighbor hasn't referred us anyone who can keep their appointments and pay for our work (and we've been open since April and she is a busy lady, with plenty of clients who could definitely use my husband's type of work)
3) on top of this, I've received ZERO referrals for Nutrition/Functional Medicine (and she is quite familiar with Func Med and who can benefit)

What do y'all think? Care to rant with me? Do you like the barter list idea? Do you have other ideas? Alternate perspectives? Please feel free to share Thanks in advance!!

 

[Pompal 09.]

Neighbor keeps referring hard-luck cases! Grr.

I understand how hard it is to make decisions based on peoples' reported hardships, but unfortunately it really does open the door to be taken advaneforum.xxxe of. If this was the case of this particular patient, what might happen if she wants to come back? She's likely to try to pressure you into doing free work again, or she might start soliciting the kind of word-of-mouth advertising you DON'T want- that you give out freebies for anyone with a tear in their eye, crocodilian or not.

It sounds like you've done a good thing setting up some boundaries on referrals and barters. I would encourage you to speak to your neighbor about it and explain that she put you and your husband on the spot with her previous referral, but aren't in a position to constantly be giving free adjustments that aren't exactly just a push here and a pull there. You were very kind enough to not send her a bill for this patient, but tell her you might have to start doing that if you keep getting referrals who just can't seem to pay. It's probably better to have no referrals at all than manipulative ones that cost you time and money.

 

[prettyBoy]

Neighbor keeps referring hard-luck cases! Grr.

The neighbor, a nice lady, kind of pushed on, saying she'd cover the cost if we needed to charge.

Charge this neighbor for the services rendered to her referral(s). Her referral behaviors will change.

 

[[email protected]]

Neighbor keeps referring hard-luck cases! Grr.

Actually - in this case, it is your husbands call.
What was his plan when he agreed to treat this person?
Did he make the decision to do the work pro-bono - or did he plan on billing the patient or the referrer?

It is my belief that the universe sends us experiences so that we can learn and grow.
Obviously you need to make a decision on how you will handle this in the future and plan in advance on how to communicate this.
It's funny - but once you make the decision you have learned the lesson and the "thing" often never happens again.

fwiw - I also believe that it serves no purpose to judge the patient )the bringer of your lesson). Many people can be poor and still be clean and well-groomed. And when you are a parent you HAVE to have a cell-phone. If she is talking about abuse then that is her "stuff" to process and hopefully she will move beyond it and not have to identify with it so much in the future. It has nothing at all to do with your business and how you choose to run it.

 

[jaymax173]

Neighbor keeps referring hard-luck cases! Grr.

Your neighbor offered to cover the charge..... why didn't you take her up on it?

 

[The INFORMER]

Neighbor keeps referring hard-luck cases! Grr.

I have to agree that being well groomed or dressed nicely doesn't always mean someone has money - for years I dressed almost completely for work (in an office setting) from Goodwill (designer names, even). I was always clean and neat, wore makeup etc. The cell phone, ehhh, iffy, we have them but we don't have a house phone anymore either and there are a lot of pay-as-you-go plans and inexpensive phones at places like Walmart.

HowEVER...I think it is wrong of your neighbor to put in this position. I understand where you're coming from with the barter system but that might end up being more trouble than it's worth if this happens often. I'm inclined to agree with Jason, bill the neighbor and this will stop. Talk to her politely and tell you she really put you on the spot and not to do it again, if you want to let it go this one time, but let her know that she will be footing the bill the next time.

 

[Bob S]

Neighbor keeps referring hard-luck cases! Grr.

I'm inclined to agree with Jason, bill the neighbor and this will stop. Talk to her politely and tell you she really put you on the spot and not to do it again, if you want to let it go this one time, but let her know that she will be footing the bill the next time.

I agree with sending the bill to your neighbor, with a note stating your fee structure and that you are no taking pro-bono work.

Plus if anyone called into my office saying they had someone there who was having trouble breathing - I'd have said it's time to call them an ambulance! :grin:

Of course Chiropractic work & Massage can certainly help with freeing the ribcage & whatnot, to aid breathing problems, that goes without saying - but I just had to make the above statement!

 

[Kathy C]

Neighbor keeps referring hard-luck cases! Grr.

I agree - send a bill to the neighbor and while you're at it, feel free to send her a few hard-luck/can't pay cases for her to do pro-bono.

 

[Juanito Ice]

Neighbor keeps referring hard-luck cases! Grr.

I think a referral program for people who say they can't afford it is a good idea.

 

[Bob White]

Neighbor keeps referring hard-luck cases! Grr.

There is also nothing that says you have to go deeper or longer or whatever for a 'free' client even though she is down on her luck and poor. Maybe she has issues, maybe she is just manipulative. She came for a reason - you will probably never know but you might have made a huge difference in her life.

I am assuming that if your hubby does psoas release it is not done in 5 minutes. A freebie is a taste or an appetizer, not the whole meal! If her ribcage was tight, loosen it up. Don't look to fix everything.

I like the idea of charging the neighbour although I think it would be hard to do after the fact. Perhaps you could explain to the neighbour that if they are willing to pay you would be happy to see their poor clients. Just as a side thought - if she is so broke, how was she paying for the other practitioner?

If someone wants to come and I know they can't afford it, I now suggest they pay for half an hour (or pick an amount) and I will go longer if I can.

 

[Iceman]

Neighbor keeps referring hard-luck cases! Grr.

He is frustrated that the only referrals he receives are for people who claim they can't (won't?) pay for our work.



This kicked us in the pants to come up with options for those with sob stories, either genuine or otherwise. We came up with a barter list and a referral program. Provide one of 5 things on this list, or refer x number of people and receive y benefit, etc.

We're just irked that
1) even though our neighbor knew we didn't do pro bono work, she (nicely, but still) pressured us into doing free work
2) this neighbor hasn't referred us anyone who can keep their appointments and pay for our work (and we've been open since April and she is a busy lady, with plenty of clients who could definitely use my husband's type of work)
3) on top of this, I've received ZERO referrals for Nutrition/Functional Medicine (and she is quite familiar with Func Med and who can benefit)

What do y'all think? Care to rant with me? Do you like the barter list idea? Do you have other ideas? Alternate perspectives? Please feel free to share Thanks in advance!!

Building a chiropractic practice can be much harder than building a massage practice, depending on where you are located and if you are accepting insurance.

With the neighbor only referring people who can't pay for the work, and your business continuing to allow this, my opinion is that you are setting yoruself up for disaster.

Colleagues are upset about you no longer doing free work? What kind of jobs did they have in the past? Maybe their parents are supporting them now, or maybe they are just living off of their loans and don't get the whole concept of needing to pay the rent. Most likely they don't plan on paying back their student loans, like so many others in our profession. t013 Who knows? And, better yet, who really cares? At some point those colleagues become less friends and more as aquaintances anyway. 80% of our chiropractic colleagues become real snots toward their "friends" from school. And, they become worse if you are doing what you want, and not stepping to their beat. Been there, done that... don't let them drag you down.

I wouldn't give the neighboor a barter list. It is obvious that she doesn't care enough about your practice to send you paying customers. She knows you are new in business. She has a business. Surely she knows how hard it is to get a struggling business off the ground. One would think she would want to help you pay the bills, not make your life more difficult. She doesn't seem to be thinking that way. If you want FM patients and aren't getting them, what makes you think a barter list is going to change her? Possibly you just have to have this convesation with her; telling her you want to pay the bills, not become a free clinic.

She offered to pay, send her a bill. You have to make the rent. Your sincere hope is to find patients that are hurting, and value your help, just like when you were a therapeutic massage therapist. You never did fluff work, so you are still in the same game, just doing it in a different way. Nothing has changed, except the letters behind your name.

I'd find someone else to consider bartering with, if that is even the way you want to go.


/rant over

*hugs*

 

[casinobar]

Neighbor keeps referring hard-luck cases! Grr.

Thank you all for your feedback! I gained some very valuable information from y'all, not to mention support - all for which I'm very grateful!

I apologize it's been a while and that I never posted an update, so here it is

She was in our office a short time after the incident (within a couple days) and my husband explained to her in his office that we simply don't do that anymore. We explained that with him becoming an in-network provider for a few insurance companies very soon, we have to treat all patients the same - insurance patients must be treated the same (and pay the same) as a patient with insurance. (The only difference being, of course, an allowance for the Time Of Service discount.) In other words, we can't charge different patients different rates. Charging a patient less because they happen to be hard-luck is like charging the other patients more because they're not hard-luck. (Now, the law DOES allow an exception for "financial hardship" but that's up to the practitioner to utilize, and with our fees being so reasonable already, we're choosing not to utilize it.)

We did make up a Trade/Barter list for those who ask, but I like what you had to say about that, Pueppi - the neighbor, as cool a lady is she is, doesn't care enough about our practice to refer us normal, paying patients, so I'm not even going to go down that avenue with her, at least not at this time. It still kinda irks me that we're right next door, she's busy and established, and I know she's vocal about referring practitioners because she gave me the name and a detailed review about the nurse practitioner she uses, and yet we get....nothing...except those looking for a handout. (Please believe me when I say that there were waaay more nonverbal red flags than the clean well-kept appearance that made me question the patient's genuineness - decades of instantly sizing up strangers while working with the general public made me reasonably good at spotting those who aren't the real deal. And there was more to this patient's story than she wanted us to know about.)

Our neighbor is otherwise a great lady, and we trade some services out - it's not a real strict arrangement, it's more of a "we'll take care of you as needed, you take care of us as needed, nobody abuse the privilege" kind of deal.

Yeah, as much experience as I have with boundaries, boundary pushers, and restablishing boundaries when they've been breached, I still have a long way to go. Several other patients (the needier ones) are starting to kind of "stalk" our office (during our lunch break if we happen to work over, even with the door locked and our lights off!) or on Saturdays (!! Eek! We're NEVER open Saturdays), always have "a few questions" (which I enjoy and welcome from patients...during a scheduled appointment or our free Tues-night health class, though, not during the day when I'm trying to get stuff done), so it's time to reign them in LOL

*Sigh* I totally agree with what was said about "once you nip this in the bud, the Universe quits handing it to you" (paraphrasing LOL), and I've had that happen before! For some reason, I haven't yet figured it out, I keep stumbling with this. I'm going to keep plugging away at it, though!

 

[England Sadness]

Neighbor keeps referring hard-luck cases! Grr.

Yeah, as much experience as I have with boundaries, boundary pushers, and restablishing boundaries when they've been breached, I still have a long way to go........
*Sigh* I totally agree with what was said about "once you nip this in the bud, the Universe quits handing it to you" (paraphrasing LOL), and I've had that happen before! For some reason, I haven't yet figured it out, I keep stumbling with this. I'm going to keep plugging away at it, though!

We all do, I think. Once we believe we've seen and dealt with it all, something new pops up. That's why I love having this site at my fingertips to get so many different points of view to mull over and help out with any situation .

 

[misha]

Neighbor keeps referring hard-luck cases! Grr.

*Sigh* I totally agree with what was said about "once you nip this in the bud, the Universe quits handing it to you" (paraphrasing LOL), and I've had that happen before! For some reason, I haven't yet figured it out, I keep stumbling with this. I'm going to keep plugging away at it, though!

Sounds like you are on your way to having this taken care of. What was the other practitioner's response to what you said to her? Did she seem to understand or care?

I'm having some boundary issues myself - feeling a little squeezed I guess. I think that maintaining good boundaries is a constant process. I'm not sure that we ever 'arrive' per se, but hopefully we get more efficient and better at nipping it in the bud so that we can move on and not have it bother us for longer than it needs to.

Thanks for the update! I love updates :grin:

 

[jessika721]

Neighbor keeps referring hard-luck cases! Grr.

Was this patient a patient of your neighbor?? If so, did she provide a free service to this patient?? Is she the colon hydrotherapist?? I wonder if she provides free services so you can refer to her?? Pardon the pun, but this lady sounds like a pain in the butt.

 

[Diddy]

Neighbor keeps referring hard-luck cases! Grr.

Was this patient a patient of your neighbor?? If so, did she provide a free service to this patient?? Is she the colon hydrotherapist?? I wonder if she provides free services so you can refer to her?? Pardon the pun, but this lady sounds like a pain in the butt.

Hehe THIS is a good question This patient was indeed also a patient of our neighbor's! She's not the colon hydrotherapist, but she does something else in the colonic office (I don't wanna give TOO much away - small town feel, easily-Googlable, etc ) She does run her own separate service/practice out of the same office.

She didn't charge that lady for her particular service, so that lady didn't pay anything directly. However, this practitioner has a little fund to which people can make donations that go to pay for services for a few needy people. I'm not sure if the practitioner does it for a discount or not (i.e. pays herself full price for the service from the donation fund or not), but I do know that she does pay herself something, and does not do it for free like she was asking us to do. t017

LOL So this is what we brain-farted about doing (you'll love this ) We thought it might be cool to do something similar to our practitioner neighbor - start up a small fund in which people could donate for services for those hard-luck cases. And we could make up a flyer about it and drop it off at their office and ask if they'd like to make a donation. LOL Just being a smart-butt, but I reckon it wouldn't be a half-cracked idea :

 

[Jabroni]

Neighbor keeps referring hard-luck cases! Grr.

Actually, Jyoti, I kinda like the idea of a "hard-luck fund". The power companies who service our area do this, as does the IRS (? - on the tax return forms, it asks if you want to donate $3 to the Presidential Election Fund, whatever that is?) I wonder just how "apropos" that sort of thing would really be. I'm not insinuating that your neighbor is doing anything unethical or illegal, jut sayin'... we've learned to make for darn sure we're above-board on *everything* we do (and get it in writing, to boot!). Not that I'd encourage you to use such a fund to torment your neighbor, but it could indeed be something worth considering, if it could be planned properly and kept on a *strict* account.

 

[^_^]

Neighbor keeps referring hard-luck cases! Grr.

However, this practitioner has a little fund to which people can make donations that go to pay for services for a few needy people. I'm not sure if the practitioner does it for a discount or not (i.e. pays herself full price for the service from the donation fund or not), but I do know that she does pay herself something, and does not do it for free like she was asking us to do. t017

That's just an interesting concept. Maybe you should start a new thread on that. The ER Vet Clinic I am close to does this. They call it their "Hope Fund".