Dear Bill | Patients Who Can't Afford Care

Posted by Bill Esteb on May 16th 2020

Dear Bill

What's the best way to respond when a patient says that they can no longer afford care?

How about, "I understand. Just remember that should your problem ever return your records will be here along with our genuine concern for you and your health. If we can ever be of help in the future, just give us a ring."

That's probably not what you were hoping for. More than likely you were hoping for some type of compelling argument or script that would persuade the patient to see the error of their decision and reconsider.

Sorry, such a script doesn't exist. Regardless of anyone who promises otherwise.

There are two opportunities here. The first is to show up in such a way that when they have their inevitable relapse, that they will return to your practice rather than going down the street or giving up on chiropractic altogether.

The other opportunity is confronting the meaning that you may be attaching to patients dropping out of care. Since you can't control what patients do, it might be helpful to know why their behavior provokes your reaction.

Patients use the affordability excuse for several reasons. The first is that it's unassailable. You don't know what their financial situation is, so there likely won't be any arguing.

Another reason why they may play the financial card is that they are giving you the opportunity to lower you fee now that they feel better. In other words, they might still like to come in, but not at the fee they willing to justify when they were in pain.

Which begs the question, what meaning are you assigning to the circumstance called "patients discontinuing care"?

  • The loss of potential income?
  • Being confronted by your lack of control?
  • Thinking you forget to say something?
  • Regret over something you did or didn't do?
  • Sadness over the patient's shortsightedness?
  • The need to replace the patient with another?
  • Doubt about your clinical or reporting abilities?

One or more of these are convenient stories, but most likely it doesn't have anything to do with you, what you did or didn't do or even what you said and or didn't say.

Take yourself out of the picture for a second.

What any of us do, whether it's to avail ourselves of chiropractic care, or read this blog post, is based on the value we obtain from doing so. We each perceive that value differently. Some value feeling good over being truly healthy. And they have the right to make that choice.

There's little we can do to influence or change what someone else values. That probably won't stop you from trying, but it's true nonetheless.

If getting patients to move beyond symptomatic relief to some type of ongoing wellness care is important to you, you'd probably want to retarget your practice marketing efforts to reach those who value their health.

Not actively targeting your practice marketing? Then expect to see those who 1) embrace the cultural notion of why you would see a chiropractor (neck and back pain) and, 2) expect those individuals to discontinue their care once they feel better.

That's probably what you're experiencing.

But even a blind squirrel finds a nut from time to time. So you may discover that 1 in 10 or 1 in 20 new patients seem available for ongoing wellness care. The temptation is to think that it's because of something you said or did with that particular patient.


Instead, they continued to receive some sort of value from your post-symptomatic care. A value based on their reasons, not yours.

So let patients know that some folks stay beyond the relief of their symptoms to maintain their progress and avoid a relapse. Others come in only when they have obvious symptoms. Either way, "We're here to help you get what you want."

The point? This issue is probably more about your practice marketing than clever scripting or even a compelling report of findings.

Thanks for the question!

Email Bill with your question.

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