By John Hinwood, DC

In business, the Pareto Principle rules: 20 percent of customers account for 80 percent of complaints. In chiropractic, the rule is somewhat modified: 5 percent of patients seem to produce 95 percent of a practice’s problems.

The patients in this 5 percent are known as “Drain People.” When they enter your office, they drain the energy, time and emotions from everyone around them, especially empathetic CAs. Drain People are drawn to chiropractic clinics where they can suck the life out of staff who are trained to provide a caring environment in an attempt to soothe deep emotional wounds.

Your team members most likely recognize your practice’s Drain People. And they do everything they can to avoid being on duty when these patients come for care. The energy that these patients absorb from the environment means that the other 95 percent of patients who come to the clinic that day are robbed of the healing energy you and the CAs have to give.

What are you to do?
How do you deal with these patients?
An adage says, “The best offensive is a good defensive.” In other words, be proactive. Author Paul Hawken wrote in his classic management book, Growing a Business:

“The best way to avoid firing people is to hire well in the first place. Hiring is one of the most critical activities of any business, and you should learn to do it well. It can make an enormous difference in your success. I estimate that one-half of all business problems originate with the perceptions, attitudes and practices of the owner. The other half of the problems are caused by faulty hiring.”

The lesson in hiring applies to patient management: Don’t “hire” problem patients. And if you do? Fire them — just as you have to sometimes fire employees in business.

Here are some tips on dealing with the Drain People:

1. Just say no. More than 20 years ago I sold my rural practice to move to the city. The doctor who bought the practice worked with me for a week in a changeover. He took all new patients that week.

The first new patient to enter the practice on Monday morning was a newcomer to the town. He had just moved to the country from a large metropolitan area. The “new” doctor (actually an experienced chiropractor with 14 years of practice under his belt) asked the patient why he had moved to our town.

The patient proceeded to tell us that he had moved here because he wanted to get away from the city where people were blah, blah, blah. He complained about the human foibles of the people he had known in his previous environment for what seemed like an hour.

Much to my surprise, my experienced colleague said to the new patient: “Since you are only renting an apartment week by week until you find a house to buy, I suggest you pack up your belongings and find another town.”

The patient looked at him astonished and asked why.
My colleague replied, “People in this town are just like the ones you left in the city. I wouldn’t like to see you waste your time or money by starting care with me, since you’ll be moving to a far better community soon.”

We wished the patient well and that 5 percenter was on his way without causing a major drain on the practice energy.
The moral: Do a thorough pre-consultation screening. When you identify someone who fits into the category of a Drain Person, turn him or her away. Keeping that person as a patient would be a bad “hire.”

2. Set boundaries. Although you don’t want to hire a bad patient, don’t be too hasty in labeling a new patient a Drain Person. Dr. James W. Parker once said, “Sick bodies have sick minds.” It’s sometimes hard to tell if a person is a Drain Person or is just somebody who is in a great deal of pain and is consequently quite reactionary.

What to do: If you suspect the person might fall into the 5 percent category, set attitude and behavior boundaries for them. Patients among the 95 percent will make a major attitude shift when the pain decreases. Keep those patients. Dump the others.

3. Hold them accountable. Drain People notoriously miss appointments, run late and otherwise cause disturbances in your practice. These problem patients invariably complain that they are not getting the results that they expected.
Years ago, I developed a system of marking missed appointments, rescheduled appointments and no-show visits in green in the case notes. When problem patients complain, I show them their file and explain that the green entries mean that they are delinquent, a label many people do not want to have.

The result: The problem patients either leave the 5 percent group and join the 95 percent model patients — or you fire them for not playing their part in the healing journey.

4. Say good-bye. The question still remains: How do you move a patient who does not participate in the ethos of your practice off your patient roles?

The best way to fire these patients is to do it the same way you would terminate an employee: Be short, specific and direct: Tell them that you need to refer them to another practitioner since your care is not meeting their needs.
It’s hard. Just like firing a problem employee is hard. But once it’s done, you and your staff will feel revived and the practice will thrive.

Dr. John Hinwood is an international speaker and life coach who inspires his audience into taking practical action steps to move their lives to new levels. He is the CEO of Powerful-Practices.com. You can reach him at johnh@powerful-practices.com.