I ate the burger. Now, a week later, I don't like it.
August 15, 2016 9:05 PM   Subscribe

Are medical practitioners expected to re-do sessions free of charge if a patient is unsatisfied? What, if any, are the limits of this expectation?

I am a medical practitioner, and several weeks ago, a patient came in for her 19th session in 2 years. After the 19th session, she emailed me to say that her previous session (#18) was unsatisfactory and she wants me to "re-do" that session because it "didn't have much of an effect" on her. She did not contact me immediately after the session in question. She has insurance which covers 10 sessions per year, and she had used 9 of the 10 for this year. She wants me to provide her with another session and not bill it to her insurance, thus basically giving her an extra session for this year. Obviously, I would not be paid for this extra session.

I feel that this request is like ordering and eating a meal in a restaurant, going back to the restaurant a week later for another meal, and then, the next day, saying, "I didn't like what I got last week. Yesterday was great, but last week was unsatisfactory. Can I get a free meal?" My gut tells me that this request is inappropriate. Data point - I have been in my profession for 10+ years, and I have never had anyone make any such request. And yes, I feel like I did my best work at that session. I have no reason to think that the work I did was subpar or poor quality.

(If it matters, the treatments in question fall into the category of complementary medicine. Results are not not really objectively measurable.)
posted by JubileeRubaloo to Human Relations (19 answers total)
 
I dunno, did you offer the patient any kind of guarantee? Are there any regulations in your field that cover this sort of situation? Might your insurance have anything to say about this? If so, refer to that. If not, then I feel like she's welcome to take her custom elsewhere if you don't feel like giving her a free session, but that's about it.

I would look at it as a matter of business: do you think the free session would make this person feel genuinely happy again, such that it might be worth keeping her around for the sake of the future business and the positive recommendations that she might give to friends and family, or do you think that this would just be ceding power in a relationship with a client who is probably going to continue to be an unhappy pain in the ass, always wanting free stuff, stressing you out, wasting your time, and badmouthing you in public and online?

That's your call to make, as a businessperson. If you decide the former, you should gladly and wholeheartedly offer her the free session, possibly even waiving the co-pay, which may be negligible anyway and hence worth sacrificing as a gesture of goodwill. If the latter, politely but firmly refuse, telling her that what she is experiencing sometimes happens and that it's normal and there's never any guarantee in these matters—she may go away, or you may have to continue working with an unhappy client, but at least you won't be giving away the shop.
posted by Anticipation Of A New Lover's Arrival, The at 9:23 PM on August 15, 2016 [2 favorites]


Oh, and on non-preview, stoneweaver has a point: in no case do you admit fault. Whichever way you go, you say explicitly that these things happen sometimes in the course of whatever it is that you do. You are either giving her a free session because you are so nice, or refusing a free session because she is not entitled to one. Make it clear that you are explicitly not giving her a free session because you did anything substandard or incorrect.
posted by Anticipation Of A New Lover's Arrival, The at 9:26 PM on August 15, 2016 [1 favorite]


Response by poster: Sorry, I should have added - when she asked for the re-do, I responded (by email) that I cannot make any guarantees about results and that it is not my policy to give free treatments. I stated that I was confident in my work. She responded (by text) that she wants me to call her, and that she feels an extra session is "warranted" because the one before last had "zero effect". I feel that I have already explained my policy (no free treatments) and my position (my work was of good quality as it had been for sessions #1-17, and #19). Do I need to continue this discussion with her? What would you expect as a patient?
posted by JubileeRubaloo at 9:35 PM on August 15, 2016


I would not respond to her any further. I feel like this is pretty bizarre behavior on her part and I think you'd be better off without her as a patient.
posted by blackzinfandel at 9:42 PM on August 15, 2016 [32 favorites]


I'm about to make a lot of assumptions, but feel free to course correct me:

I'm going to assume that you did the same kind of treatment (same behaviors and actions) that you've used on previous sessions with her as well as on other patients in the same similar situation. If it's acupuncture: same number of needles in a variety of spots. Chiropractic: same type of manipulation, etc.

If that's the case, I'd state something like, "Treatments often have a cumulative effect and no one session should be evaluated in isolation. The amount of pressure/needles/listening/reiki/etc. used and the way it was used is consistent with my experience with patients in a similar situation and is in line with current recommendations from (whatever training/accreditation/etc. body). In line with the policies of most medical/treatment/etc. providers, our office does not offer guarantees that any single session will have a dramatic effect in the course of treatment nor do we offer free sessions. We will be happy to see you should you want to continue treatment at the regular cost. If you're looking for a more aggressive/dramatic/adjective treatment options, I'd be happy to refer you to another practitioner that, while not covered by your insurance, may be more the style of treatment you're looking for. Our reception desk can assist you in either case." And then don't respond any further if she doesn't want one of those two options.
posted by Gucky at 9:45 PM on August 15, 2016 [25 favorites]


Your first question is, "Are medical practitioners expected to re-do sessions free of charge if a patient is unsatisfied?" This patient obviously expects it. But is it generally expected? I don't know. What do others in your specific profession say?

I wouldn't expect it personally. I'm guessing you provide something on par with a therapeutic massage. I've gotten massages I didn't like, and I didn't ask for another one.

But the more apt question is "Are medical practitioners obligated to re-do sessions free of charge if a patient is unsatisfied?" Here the answer is clearly 'no' in your profession, or you wouldn't be asking the question.

So ultimately, this is a business decision, and my vote is to not do it. If you give in to this client's presumptuous request, she will likely make more demands on you in the future and bug you for more freebies. And if you end up losing this client, you can spend that empty time in your schedule marketing for better clients.

It's also a personal decision. Clearly, you are annoyed by this client, which is another reason not to do it. Just text her back and say "My policy is no free treatments." Copy and paste as necessary. There's no reason to point to the quality of your work or add anything else. There's no reason to talk on the phone. There's nothing to discuss. "My policy is no free treatments."
posted by Leontine at 9:46 PM on August 15, 2016


No. Absolutely not. You're not giving her a manicure where the results can be more objectively observed as good and consistent, or messy, or uneven. You're giving her a medical treatment which works at various levels, not all of which can be consciously evaluated. She's had 19 treatments and clearly sees an overall improvement in her health, or finds that your treatments mitigate some of her symptoms. Whether she notices a major change after every treatment isn't really relevant. It's the general trend that should be evaluated. If you indicate that she should have X observable effects after Y number of treatments, that should be the standard and she won't necessarily be able to observe a stepwise X/Y effect after each treatment. It's telling that she suddenly wants a freebie when she's so close to her insurance's limit.

This is an excellent opportunity to do some patient education about how your modality works and how to evaluate overall trend rather than a discrete and consciously observable effect from each treatment. For all you know, she was extra stressed that week, had poor sleep, bad diet, or engaged in counterproductive behavior, or was getting sick and those factors could have effected her feelings about how your treatment worked.
posted by quince at 9:48 PM on August 15, 2016 [4 favorites]


You told her your policy and unless you're genuinely willing to reconsider, and it sounds like that might possibly be construed as an admission that your services were in someway subpar and you at fault so a bad idea, you don't need to have a debate with her.

What paperwork did she sign before treatment #1? What kind of intake interview did you do? What statements about what she can reasonably expect from treatment are/were included? You should reference those in your next email and then stop engaging.
posted by brookeb at 9:49 PM on August 15, 2016 [1 favorite]


What would you expect as a patient?

As a patient, I expect clear and ongoing communication from anyone I see for a rehab sort of therapy. Clarity around
- what the diagnosis is. Or if it's unclear, direction on how to remedy that with further investigation, either with them or by referral to someone else
- what I can expect in terms of timeframes with a) the injury and b) the treatment - because there is published data that my therapist is using as a base to make that prediction, and data she has from me about my body, that is being considered in her clinical judgement. (e.g.: "with this injury, with this technique, most people see improvements in 6 or so weeks. Because you've got this other thing, it is probably going to take a little longer for you. But we are looking at a couple of months before you want to think about swimming. Until then, you can do ____ ".)
- why the particular approach is being selected over others
- a step by step explanation of anything done to my body, especially involving touch ("you're going to feel something cold now, that's just the gel")

So - with this therapist - I'm never confused by anything that's going on. My expectations are set. If things are not progressing as expected, we communicate more about that.

I would not ask for a "redo" from a rehab-type of therapist who I thought sucked, I would just move on.
posted by cotton dress sock at 9:52 PM on August 15, 2016 [2 favorites]


You've already stated your policy? Stick to it. Don't undermine yourself with the client! You've already made your decision, don't start waffling now. Firm denial. No freebies.

The client is pressing you for free stuff even though you've already refused? Don't give in! You'll never hear the end of it from her if you back down now.

You don't actually want this client anymore. You have to keep working with her (I'm not seeing grounds for refusal in your story) but your best case at this point is that she goes away and finds another practitioner.

She's going to be a miserable time-suck, but especially if you start giving in to her demands. You want to do the polite, medically-ethical minimum from here on out, and focus on cultivating clients who are better to work with.
posted by Anticipation Of A New Lover's Arrival, The at 10:08 PM on August 15, 2016 [10 favorites]


Either she's a scammer (probably a little - I've also never heard of anyone asking for a redo, and the timing is a little coincidental), and/or she is experiencing a recurrence of pain that she had the idea would not occur after the treatment (probably also true). And/or, either her notion of what could be achieved, with this treatment, for her specific issue, was misguided (she had unusual and unreasonable expectations, eg, she thought it would be a one-and-done thing), or the potential efficacy of the treatment wasn't made clear enough, to this patient.

Even if you don't have the kinds of metrics that might be available to practitioners of other kinds of therapies, you are promising to provide something - some relief of pain over time, temporary relaxation and stress relief - there is some idea of a) what is wrong and b) what you can do for that. If you have not clearly met in the middle about what those are, there is room for confusion.

And/or, it may be there's something new going on - some new pain that's close to her old issue and maybe being mistaken for it (by her), but is actually unrelated, has a different cause - and that what used to work fine for the other thing isn't working for this thing, for real reasons.

Whatever the case, the "redo" request is very unusual. At the same time, there is probably room for more communication.
posted by cotton dress sock at 10:33 PM on August 15, 2016 [3 favorites]


i do something similar to you (in the general sense of "complementary medicine.")

At least in my line of work, i would say that 7/10 of people have excellent, really obvious positive effects. 2/10 people have mixed results. 1/10 people have no results. i have no idea why this is. i work very diligently for 10/10 people but every person responds differently.

for that 1/10 person, i tell them "let's try this for 3 sessions (total) and if you aren't feeling very strong positive results, i don't think i'm the therapist for you, you should see someone else." This is great for everyone because the people who come to see me love the work i do, and the people who don't love it, LEAVE. I feel like i'm helping people and not wasting their time OR MINE and there's enough room in my schedule to see more people who like what i do. it's a dream scenario.

people are paying you for your time and effort. if they don't think it is worth it in the general sense, they should go somewhere else, not berate you. i would encourage your patient to see if generally they are feeling positive changes, but if the response isn't very enthusiastic, you would both be better off if they saw someone new.
posted by andreapandrea at 10:37 PM on August 15, 2016 [7 favorites]


It sounds like you could get in trouble with insurance or regulatory people over this. There is your out. You simply say 'I'm sorry, but my licensing body requires me to report and file for every session. This simply isn't possible.' If she pushes, you say again 'it isn't possible.' If she was so dissatisfied, she wouldn't be coming back, would she? It sounds like she is trying to scam an extra session.
posted by ficbot at 4:30 AM on August 16, 2016 [9 favorites]


What ficbot said. Under no circumstances could you possibly treat her without reporting it.
posted by the webmistress at 6:10 AM on August 16, 2016


I don't think you should give this person an extra sessions. This isn't a pair of jeans that fell apart on washing two. There are a lot of returns in our society, but I've never been under the imression medical care is one of them. If they hurt you, you can sue but otherwise, you just pay.

I think people are being harsh but your response was appropriate. I think you're right, but I can see client's confusion. Just stick to your original response. I'd save the email chain.
posted by Kalmya at 6:35 AM on August 16, 2016


I think that this would only be warranted if you did something stupid. Example, I've been to physio with two different physio therapists. And both at one point or another started to do something with the opposite leg. I asked if this was something that they were doing to both legs, or if they got switched around. In both cases, they had accidentally started treating my wrong side and were glad that I spoke up.

During the most recent example, she said that she was once reviewing notes, and realized in retrospect that she'd done about 2/3 of the time on the wrong leg. When she checked her memory with the guy the next time, he said that he thought she was going to do what she was doing with both legs, and when he realized she wasn't it was the end of the appointment, so he didn't speak up. Obviously he should have spoken up, but if I were doing the physio and I treated the wrong body part for a majority of the time, I'd feel that it's warranted to comp an appointment.

If it's just that the client subjectively measured that it wasn't "as good" I wouldn't think comping is reasonable. Moreover, if I wasn't badly in need of this client, I'd take the request as a queue to say, "Perhaps we've progressed beyond where we might be able to get good results and you should consider seeing someone else / stop receiving treatments." I'll note that I've never run a business / had to personally deal with keeping clients, so that might be a bit of bravado.
posted by nobeagle at 7:46 AM on August 16, 2016


. She responded (by text) that she wants me to call her, and that she feels an extra session is "warranted" because the one before last had "zero effect".

I back up what you have said. You explained the policy. The policy is sound (absent any sort of agreement you might have that promises results which it sounds like you don't have) and the client sounds like a pain and the timing is dodgy.

You don't know what else is going on in the client's life that may or may not have impacted the results they did or did not get. And that's their homework to do (with you in a paid session) if they feel like but no I think your instincts are correct, no do-overs. Sometimes treatments just don't take for whatever reason. You can work with them to make it right over time but that doesn't mean free service.
posted by jessamyn at 8:23 AM on August 16, 2016


"Client, if I were ill, or had been unable to give my full work and attention to your session, I would make it up to you. However, I gave you my best work on [date]. I hear that you didn't get the effect you wanted from that session, but the human body responds variably to this work, and thus regretfully results cannot be guaranteed.

OPTIONAL: I have been happy to be your acupuncturist for the last two years and hope that the memory of the 18 sessions you did find useful outweighs the unhappiness of the session you didn't. Yours, JubileeRubaloo"
posted by hungrytiger at 9:06 AM on August 16, 2016 [1 favorite]


What would you expect as a patient?

I would never put a medical practitioner in this position. If there were ever any issues with a session, I would raise it during or after the session or just let it go. Not every session is going to be perfect.

I just think she's trying to get an extra session out of you.

She responded (by text) that she wants me to call her

I don't think you're under any obligation to continue this discussion, though it might be worthwhile to have a brief conversation with her. Is it bothering you wondering why she wasn't satisfied with the session?

If you do call her, I think you'd be well within your rights to put a time limit on the conversation and to make it clear from the outset that you only have x number of minutes to discuss this with her.

She sounds unreasonable and I could imagine this discussion going around in circles and taking so much time that you'll almost feel like you should just give in and give her a free session.

Be prepared that you might lose her as a patient. Is that okay? Maybe it would be for the best, anyway.
posted by kinddieserzeit at 3:20 AM on August 17, 2016


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