Listen to the podcast here: Dealing with Entitled Patients
Episode Summary: In this episode, Phil and Marina discuss the challenge of dealing with entitled or difficult patients in a Direct Primary Care pediatric practice. Using recent real-world examples, they explore how unrealistic expectations, manipulative behavior, and misunderstandings can create emotional and operational strain for physicians. The conversation emphasizes the importance of maintaining clear communication, setting firm boundaries, trusting your instincts when interactions feel problematic, and recognizing that not every patient is the right fit for your practice. They also highlight the value of using difficult encounters as opportunities to refine processes and messaging while protecting both physician well-being and the culture of the practice.
Welcome to DPC pediatrician we’re Dr Phil Boucher and Dr Marina Capella two DPC pediatricians who are on a mission to share our love of direct primary care with you.
Welcome everyone to another episode of the DPC pediatricians podcast today Phil and I are going to be talking about dealing with entitled patients now there are lots of different words for it I just felt like entitled felt like the right word this week because I’ve had two particularly difficult interactions with patients and I know Phil had one as well this week and it happens I won’t say that it happens frequently I would say that the vast majority of my patients have been lovely to work with.
But every once in a while it happens that I have a family a parent who just really rubs me the wrong way and really shows their entitlement in one way or another. So what happened to me this last week was I had a patient reach out. Actually, it was one of the rare times when I answer the phone and I happened to talk to this mother directly.
She expressed interest in the practice. I gave her my little spiel that I give everyone that I no longer do one-time visits, but you can choose between an integrative consult or the membership with the minimum contract of six months. And I, she seems to understand she didn’t have any weird questions at the time.
I did mention, and this was probably my fault. I said, you don’t have to commit to one or the other. We can see you for that first visit. And then by the end of the visit, you have to choose one track or the other.
And so I went ahead and I scheduled her and I sent her the intake paperwork, et cetera. She comes with her daughter. I spend 70 minutes with her. I’ll try and understand plus the time that i had reviewed the intake form and
70-minute visit which we went over time and at the end of the visit she goes down to the front desk my front desk manager my office assistant had given her the paperwork for the contract and you can either just initial next to the integrative
consult package which is three months of care or next to the membership minimum six month requirement and she was really confused. And she went to the front desk saying, wait, you didn’t tell me that I had to commit to one of them from the beginning and I wasn’t prepared. So my office manager did the best she could.
And she said, look, okay, I understand you’re confused. I don’t know exactly what happened, but we will honor our historic rate of a one-time visit for $300. And you can just pay the 300 for today and we’ll communicate Dr. Capella and find out what happened.
So I happened to leave to go visit my dad in California like the next morning and i keep seeing phone calls like this same number calling on my phone like eight times the next morning as I’m trying to enjoy time with my family and eventually she
leaves a message and she says i’m like upset about the communication i would like a call back and so I did exert a boundary there. And I said, I’m on vacation. I’ll go back to you on Monday. So on Monday, she sends me this angry email, which was actually not… Some people don’t hide their anger well.
Hers was angry, but it was as if she had written it in ChatGPT and made it sound not angry. Very professionally worded, but also the undertone and the very clear sentiment coming through was this entitlement and anger. that she said that she thought on my website that the enrollment fee of $100 meant
that she got a first visit for $100 and we ended up having a conversation which was a waste of time she ended up demanding her money back and I said no I can’t do that I already spent 70 plus minutes with you it’s not fair for you to ask me for that money back
and she continued to insist and I said like in five years of owning this practice nobody has ever been confused by the use of the word enrollment fee we have enrollment fees at gyms we have enrollment fees at lots of places right so I don’t
understand how you were confused I tried to be as professional as I could I think I kept it pretty calm but inside I was kind of boiling because her whole interaction just reeked of manipulation and it reached of entitlement. And I did end up conceding because I just wanted to end the conversation.
I said, I’ll give you 50% back. Is that okay? We just end it. No further follow-ups. I ended up sending her her daughter’s lab results, which had some abnormalities. And I said, good luck. Go deal with it with another pediatrician. So that’s just that whole interaction left me such a bad taste in my mouth.
I blacklisted her chart. I told my whole staff, never again is this dpcpediatricianadmin DPC Pediatricians
issue. It was clearly somebody that had the wrong expectations or didn’t get what they were wanting out of it rather than like it was our fault. We didn’t make it clear enough because you have a track record of this being fine and people understand.
Yeah, exactly. And we did just to never have this happen again. We went and clarified some wording on our website, but it just, it just, it was an ache, a definite, I got to shake off the ache of this interaction. and i think that sometimes in dpc we are going to encounter those people who have
really unreasonable expectations or are trying to manipulate us even if they deny that that’s what they’re trying to do if you read the energy of manipulation it’s there like trust yourself trust your spidey sense about those things because people can put on a certain face and they can talk and talk you sense under the surface
that there’s something going on i would say that dpcpediatricianadmin DPC Pediatrician admin dpcpediatricianadmin there. They’re going to come along. I think a lot of us do meet and greets in order to try to kind of filter out these sorts of families. Sometimes we’re going to be able to detect it early and sometimes not really. So I’m curious,
Phil, what’s an experience that you’ve had with the family that led to that feeling of
I think the times when we feel it, I think we’ve gotten so used to gratitude from our patients because we do a good job. We take care of them, we ask the questions that we need to, we squeeze them into the schedule. And so it’s hard not to know dpcpediatricians.com
then it’s not going to rise to the level because everybody’s kind of grumpy but we have such grateful patience that when we don’t sense the gratitude or we sense the you need to do this because I’m paying you or something along those lines That really stands out. Now for me, it’s very few and far between.
And I know that’s part of the privilege of being a male is that people don’t complain in the same way or have the same expectations as our female pediatrician colleagues face. But I think it’s one of the worries when people are talking about direct primary
care is that patients will just be walking all over you and demanding this, that, or the other thing. and what I have found is the opposite is the case when I say hey you know we could do an antibiotic today but I’d really rather wait and I’ll just text you tomorrow
and see how we’re doing with this ear infection that’s going on yeah patients are so grateful and excited for that rather than I just came here because I wanted the antibiotic. And I think that’s one of the things where we often feel like if we’re starting a
DPC practice or we’re thinking about DPC practice that people are just going to demand antibiotics or ADHD medications or all the different things that they’re perceiving that I’m the gatekeeper of the eye drops or I’m the gatekeeper of the good night’s sleep. Yeah.
But when you’re when you’re able to have those relationships that it’s few and far between. So one recent example with us was just a family had wanted us to refill an antibiotic because it had been forgotten. And it came to light that like we had
sent it to this pharmacy in a nearby state where they were at but they thought it was the wrong one so they kind of sent us unfriendly message and i just shared with them like here’s exactly where i sent it the nice thing is we get this little
digital receipt of exactly where it went and here it is down the road from where you’re at but it just didn’t feel good because there wasn’t the like gratitude that we’re used to i think we get so accustomed to grateful patients that it really stands out
when we have these patients that are not expressing gratitude or maybe just making us feel more like a service that they’re entitled to around the clock access or those sorts of things.
Yeah. I think that’s, it’s the demanding energy of a parent texting you and saying, you did this wrong, make it right, right away. That can be really off-putting. And again, the undertone of that is that entitlement and not appreciate. I think that part of what i’m talking about is also just not appreciating not reciprocating what
the wonderful thing that we offer right and the time and the value and the the the presence and the just the fairly unique approach that we have to care and how much we truly do care about our our patients in our practice which tends to be smaller
therefore we have the bandwidth to care right more um so yeah it seems like in that in that scenario you just shared there was a really a lack of appreciation for you and just
a more demanding attitude yeah and it’s usually not a one it’s usually a pattern right with with a family it’s not one time where they’re a little bit grumbly or they didn’t have enough exclamation points on their thank you or something like that but you start to sense the pattern and then you have to decide like
okay am I going to tolerate this am I going to say something am I going to say we’re not a good fit for each other and I think that varies based on oftentimes how frequent it is and how severe the episodes are yeah but it made me grateful that we
have all these other patients that are just so thankful for the way that we practice and the things we do despite putting up the i think rather stringent boundaries that we put a place in what we’ll what we’ll do and how far we’ll go outside of the normal traditional practice bounds yeah exactly
i had another interesting experience too last week it was a family who has lovely parents single child who’s just the apple of their eye and i’ve had really pleasant interactions with them they’ve been patients now for about three years and they have asked they travel to go see family internationally every once in a
while and even though it’s not in my contract to allow this I have allowed them to pause their membership when they’re out of the country twice now and they kind of demanded it a third time and this time it was under a little bit more of expectation because I had completed before
And they were asking me because I raised my rates just a couple of months ago. So when they came back and they reactivated their membership, it was at the slightly higher, only $25 a month more rate, right? It was $125 instead of $100.
And so the dad emails me saying, Hey, can we be grandfathered in to your old rate? And can you pause our membership again? Because we have to go back one more time. and it was because there was a parent that was suffering from an ailment and so tugs at my heartstrings, right?
I want to be the nice person. But first of all, my membership doesn’t work like that, right? The understanding is that the visits when you do use them are paid for by the months when you don’t use it, right? It all kind of is out. Then second of all, I don’t pause other people’s memberships.
I have many families that travel internationally or away from Utah for long periods of time sometimes, and they don’t ask for me to pause their membership. They’re not pinching pennies like that. and I know this family is well off. If they’re well off enough to be traveling internationally and to do the things
that I know that they do, they’re not hurting for money. So I just felt like they were kind of stepping all over me in a sense that they weren’t really appreciating the expertise that I offer, the level that I offer. And so there was just that energy.
I had to write an email response to kind of stand my ground and say, look, these are the economics of the practice this is why the membership is structured the contract doesn’t allow pauses I’ve allowed it twice before because I really
like you guys and I want to keep it but I can’t keep doing that and of course I express sympathy for the situation that their family was going through in terms of their sick mother. But also I said, ultimately at the end, I said, if this just doesn’t work for you, you’re welcome to leave the practice.
I would be sad to lose you, but it has to work mutually. And it was hard for me to write that email because it’s hard for me to insist on getting what I need from people. I’m really good at giving and I’m not great on insisting on getting what I deserve in return.
and it just was a great example of recognizing that dynamic for myself and how that’s a challenge for me but also saying you know what i’m feeling this anger because the boundary has been violated and i’m not going to express that anger in
my email but i am going to insist on respecting that boundary for my sake and for theirs so that was another bit of entitlement i think this is a family that is lovely in many ways but they tend to not be shy about bargaining or about asking for I don’t know
unequal unequal bargains I guess in their life yeah but I was proud of myself a little bit for being able to at least write that email and send it and say hey this has to work for me too I mean we’re all dying to know this was just like a few days
ago and they have not responded we’ll find out stay tuned
we’ll have to do an updates episode and find out but I think that’s I think it takes a lot of courage to do that because otherwise it’s easier to just say yeah or to continue to do this and to feel that sense of my boundaries have been violated and yes it’s DPC Pediatrician admin dpcpediatricians.com
It’s not the police officer that pulls you over and is like, hey, I think you were going too fast. You were going faster than I wanted you to. It’s nuts, you guys. The speed limit was 40 and you were going 47.
So of course I’m going to pull you over.
And in the same way, it’s nuts. I really like that too. Our new office policy is this period and then that’s that’s the end of the the it um and that’s been really helpful for us to just kind of be able to enforce those boundaries especially when
people are pushing up against them rather than like hey i don’t like it that you guys are doing this to me which might be how we’re feeling i just say this is our new policy or this is the policy um and yeah i let you go in the past or i i made
this exception but our office policy is that period yeah
And with them, I think I gave a little more detail because I know they’re business owners also. They own a software company. And so I said, I know that you understand as a business owner, you have to make the numbers work. I’m like, this is how I need to make my numbers work.
I tried to ask for a little reciprocal understanding in that regard but ultimately I also when I said that I had to be okay that whatever happens whether they choose to stay or choose to go that I said what I needed to stay to kind of be in a good
place but respectfully obviously and compassionately and whatever the outcome is I feel like I did what I needed to do to be okay
Well thanks for sharing that because I think that’s really helpful for other people to hear that probably have those little things like as I’m listening to this I’m thinking of my own similar stories or the own versions of that and I’m sure that other people that are listening to this are having that same like this has never
felt right but I haven’t felt comfortable or I really need them to stay members because I need the money or those sorts of things that it’s bringing those to light and hopefully giving them a little bit of a script of how to come to a good place
where you’re practicing in a way that you want and you’re putting those boundaries and expectations in place for both yourself and for your patients.
Yeah, definitely. And I guess one parting piece of advice I would give to others that maybe have these sorts of experiences every once in a while is One of the questions that I actually talked about with my mentor this morning was like, how do I respond to these sorts of things without getting really angry? And she said,
the anger is just your brain and body’s recognition that something has been violated or that something is not okay, right?
Right.
and she said you don’t have to respond with anger but recognize it because when you if you don’t recognize it you deny it you suppress it over time it’s going to explode one way or another right and then you’re going to maybe react or be more reactive than was warranted towards another situation that’s completely unrelated because you
didn’t respect yourself in that situation and recognize what the anger was trying to communicate to you. Right. And so that helped me reframe it a little bit of like, okay, when I feel that anger, it’s like, what is it that’s being violated or what is being overstepped or what, like what’s going on here?
How can I respond in a non-angry way, but how can I honor that anger that I’m experiencing and use it to guide me in a wise step forward,
right?
So hopefully that’s some others. I know that especially us women physicians, we get a little more stepped on and a little more, we get some more frequent interactions related to entitlement in patients. So we hope you found this episode helpful. Thanks, Phil, for sharing your experience as well. And until next time.
