August 2018

August 2018

The Office: Management Series – How To Handle Difficult Patients

  • Generally what I do is to quickly figure out whether we did something wrong or if the patient is just being outrageous. In other words, are we wrong or is the patient wrong? Which side did the mistake?
  • You need to always let patient voice out their complaint and you need to sit down and listen to it.
  • Then, if the mistake was on our side, I will then 100% admit that we did a mistake, that we screwed up and that we are sorry. I completely take the blame. That will solve 90% of all bad scenarios and completely calms down the patient.
  • I will then name the measurements that will be undertaken to not do this mistake again in the future (e.g. better scheduling or not having that patient be treated by a certain practitioner).
  • I will then leave the decision to them if they want to continue treatment or not, so it’s 100% their decision.
  • If they are still angry after you fully apologized, you need to get this patient out of your clinic by suggesting an alternative place to them and refund the money they have not spent yet.
  • Usually the difficult patients are the ones that are not getting better, which is what is fueling their unhappiness with the clinic.
  • I tell them: “Usually this medicine works extremely well and when it works it’s obvious, it’s not a guessing game. And when it does not work, it looks like your chart – The person is 10-20% better and then they are chopping sideways for a while. It’s possible that if we continue your care we cannot achieve the goals that we set out. So I think it’s best to stop your plan and refund what you have not spent. And then I will try to find a practitioner that will do better than us in trying to fix your particular situation.”
  • Now, 90% of the time these kind of difficult patients want to stay and take the opposite position to yours (which was to let them go and refund).
  • The more people you help, the more you grow in stature as a human being, which is essentially the reason for us being here.

The Office: How to successfully present a treatment plan

  • We have a 81% close-rate (for a lack of a better word) this year.
  • How do you open up a patient? It’s about friendliness and simply indulging them into talking about themselves.
  • Once I start to see that they relax and like me, then and only then I start taking their pulse.
  • I don’t look at their charts but simply at their pulse and most of time will figure out what they came for without looking at their charts.
  • I usually will have already told them what I can and cannot fix and how long it will take by the time I opened their chart.
  • I will tell them that they need acupuncture and herbs for their problem and that they need to take herbs for 5 months, that it will get better after a few months, but that you need to keep taking the herbs for at least 5 months, otherwise the problem comes back.
  • Then I print out their plan, which is pre-set and looks official.
  • Then I show them the cost of care and how much it costs if they pay as they go (nobody does that) and if they choose a pre-payment plan.
  • I show them clearly that paying in advance is the better choice even if they would put it on a credit card with bad interest.
  • Then the patient pays upfront and we start their care immediately.
  • If the patient says that $2700 is a lot of money I compare our care (which is 5 months of care) to one night in the local hospital, which costs $6000.
  • Don’t sell plans to people who continue to show resistance to the pre-payment plan, especially young (millennials) people don’t like to be sold.
  • If the patient is very skeptical and you did not build rapport with them in the initial talk, do three acupuncture visits (at a discount) instead presenting a treatment plan on the first visit.
  • We “close” 80% of patient who walk in this clinic and they have never gotten treatment from us!
  • We don’t talk about Chinese medicine at all!
  • In summary: I just make friends with patient. Then I read his/her pulse (which demonstrates credibility and expertise) and I tell the patient what is wrong with them. Then I tell them how much it would it cost to fix their problems; How much the discount is and then I ask them what they want to do.
  • Make sure you are friendly, enthusiastic & show that you are an expert in the field.


The Office: MPD Treatment Principles For Respiratory Conditions

  • Case-study: Wegener’s granulomatosis could be healed with Chinese herbs alone
  • 2(-3) general categories:
  • Inflammatory
      • Right Yang Wei will be pounding and big
      • Rx
      • Ding Chuan Tang 40
      • Zhen Ren Huo Ming Yin 40
      • Di Long 10
      • Herbal ABX 20-30
      • Chen Xiang or Xiang Fu Hua, if there is phlegm 10
      • Huang Qin, if you need to strongly clear the heat (inflammation)

    Bad blood circulation through the lung

      • Right Yang Wei will be scattered
      • Rx
      • Xue Fu Zhu Yu Tang 90
      • Di Long 10
      • Cold breakers (San Leng, E Zhu, Wang Bu Liu Xing), if there are cysts in the lungs

    Weakness (COPD)

    • Right Yang Wei will be thin and weak
    • Rx
    • Dun Sou San 40 (stop coughing and warm the lungs)
    • Huang Qi 20 (Or Yu Ping Feng San)
    • Dang Shen 20
    • Xiao Qing Long Tang 20, if there is white, runny phlegm


The Office: How to change a formula during a course of treatment?

  • The average patient has let’s say fatigue, anxiety, insomnia combined with pains and/or depression and irritability.
  • The key is to ask each week “How much better is XYZ from the original condition?”
  • The patient then says “Sleep etc. is better 20%, but anxiety is still 0% better.”
  • So then I would tweak the formula to address the symptom that is “lacking behind”.
    • Xue Fu Zhu Yu Tang 20 (vasodialates coronary vessels)
    • Yan Hu Suo 15 (sleep, anxiety)
    • He Huan Pi 15 (Anxiety)
    • Dan Shen 10 (vasodialates coronary vessels)
    • Dang Gui 10 (vasodialates coronary vessels)
    • Sheng Ma 10 (vasodialates coronary vessels)
    • Chuan Xiong 10 (vasodialates coronary vessels)
    • Si Ni Tang 20 (chest pain)
  • Since the anxiety is 0% better, I would now add more “anxiety herbs”:
    • New Rx:
    • Add in:
    • + Ji Xue Teng 10
    • + Yuan Zhi 10
    • + Hu Po 10
    • + Long Dan Xie Gan Tang 20 (bc their irritability also has not improved yet; or Chai Hu Jia Long Gu Mu Li Tang)
  • Next week the patient says:
    • Fatigue 40%
    • Anxiety 30%
    • Irritability 15%
    • Rx
    • now I would add more liver herbs; e.g. + Hu Zhang 15 (or Huang Shui Qie or Cha Chi Huang or Zhi Zi or Yin Chen Hao Tang or Xia Ku Cao)
  • The following week the same procedure repeats…
  • Simply check which symptom is lagging and then enrich that part of the formula.
    • If they are still not better simply add more herbs that address the “lagging” symptom or increase the dosage of the herbs already in the formula that address this symptom and/or pulse
  • If they are doing better all across the board, don’t change anything, simply refill!
  • Every time you see the patient you need to ask every symptom!
    • If you don’t do that:
    • You loose loose control of the case
    • You rob the patient from the joy of reporting how they are doing across the board
    • You will not have brought them to become more aware of their body, so they become more in-tune with how they feel
  • Tell them: “You don’t have to tell me story. Just give me a percentage.”
  • Ask every single time – that way you completely control the case and the patient (in combination with his/her pulse) tells you how to tweak the formula!


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