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No is a scary word. It’s definite. It’s final. It
shuts down communication and closes the door to further
conversation.
It’s ok to say no if saying yes would be illegal or
unethical and it’s ok to say no if saying yes would fail
to meet your practice goals.
Is it ever OK to say NO to a patient?
Well, yes it is. When you reach the point in a
conversation where you realize that what the patient needs
will never intersect with what the patient wants or what you
can provide, it’s ok to say NO.
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I learned that very important lesson early in my career.
A young lady was in my office to purchase a pair of
sunglasses. These were the days of glass lenses, by the way.
Her brother, who was “in the optical business”, had
advised her that the very best sunglasses were grey 3 glass
with a full mirror coating. She was a hyperope. I explained
several times that grey 3 glass lenses were not a good base
color for a mirror coating. It would be too dark to wear
safely. She insisted and, not wanting to lose the sale, I
gave in. Perhaps her brother knew more than I did. When the
sunglasses arrived from the lab, she was horrified. She
couldn’t see anything through them. Well, if she looked at
the ceiling, she could see the lines of the fluorescent
lights, but absolutely nothing else. Perhaps her brother
swept the floors in the optical business.
Yes, I remade the lenses for her (at half price). Yes,
she learned her lesson, but more importantly I learned a
valuable lesson. It’s OK to say NO to a patient.
How and when to say NO
Learning how and when to say No is an important skill.
You need to fine tune that skill so it won’t cost you a
patient, or a friend. You need to be able to say no and
satisfy your patient at the same time.
Know what you’re saying “no” to. If your patient is
asking for a product or combination of products that you’re
only vaguely familiar with or you’ve never heard of, or
might be discontinued or you know has been discontinued,
stop and look it up. Call the lab, call the manufacturer,
phone a friend, but never just say NO unless you KNOW you’re
right. If your patient is asking for something you can’t
do or something you can’t do well, then saying NO is the
correct business decision. If you say no to a patient, and
the patient discovers that the answer should and could have
been yes, you lose your credibility and the patient.
How you drop the NO-bomb is critical.
Saying NO like a two-year-old will not work. It doesn’t
even work for two-year-olds. Two-year-olds get put in “time-out”
for saying NO. If you say NO to a patient like a
two-year-old, they won’t put you in “time-out”; they
will forget you were ever alive.
Victoria Koval, writing for The Sales Challenger™,
describes four ways to say no to a customer (patient). But
first, she advises, know what type of (patient) you’re
talking to.
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The Controller—practical, concise and direct, this
patient needs to know why your answer is no. She needs a
clear and rational explanation for your response and will
appreciate a specific and logical explanation of an
alternative. She needs the rational NO.
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The Thinker—process- and detail-oriented, looks for
root causes and likes to hypothesize, this patient needs to
consider all the alternatives before choosing the best
solution. He needs several options to choose from, with all
the pros and cons associated with each one, but be clear
about what you can and cannot negotiate. He needs the
alternative NO.
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The Entertainer—enjoys personal interaction,
initiates small talk and openly shares personal facts. She
enjoys the challenge of creating innovative solutions. She
understands that her best solution is going to be a
collaborative effort and should be encouraged to think
outside the box. She responds to the innovative NO.
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The Feeler—diplomatic, patient and driven by
emotions. He’ll let you finish your thoughts and will
appreciate real life examples of how various solutions will
or will not work for him. Soothe him with the considerate
NO.
Additionally, Ms. Koval advises that “unless you’re
running a charitable foundation, saying no is a critical
skill, especially now. In the current economy, (patients)
feel entitled to more discounts, more customization and less
risk, and they don’t hesitate to ask for more.”
Trying to do everything a patient wants you to do can and
will cause problems. The secret is to give them what they
want in a way that makes good business sense, reduces the
number of “no’s” and still satisfies the patients’
needs. If your patient wants or needs a product you can’t
supply, then know your market well enough to direct him or
her to someone who can. It’s ok, your patient will
appreciate your honesty.
The ultimate NO—firing a patient
As frightening as this may sound in the current economy,
sometimes it’s the only logical and profitable solution to
the situation. If a patient consistently pays late, demands
more of your time and your staff time than is
cost-effective, requires too much hand-holding or becomes
verbally abusive, it’s time to take action.
I’ve only had to fire a patient one time in my nearly
40 years in this business and it was a painful decision. Not
difficult, but definitely painful. The patient and her
husband were verbally abusive to a staff member, not once
but twice in the same week. I decided that their behavior
was intolerable and wrote what I considered a polite letter
explaining the practice position and enclosing a copy of her
current spectacle prescription and referrals to other ECP’s
who carried the frame and lens selections she preferred. The
patients’ husband returned, letter in hand and berated us
once again. I stand by my decision to this day.
Now, had I been paying closer attention to our initial
encounter, I would have keyed in on her statement that she
had multiple bad experiences with eyecare in the past. Do
not accept that challenge, no matter how confident you are
in your skills as an eyecare professional. Her multiple bad
experiences just means that your practice is the next stop
on her path of unfulfilled demands.
If you reach the decision that firing a patient is the
only option, do it as amicably as possible. Explain calmly,
rationally and respectfully why your practice is not able to
meet that patient’s needs and wants and offer to refer him
or her to another practice.
It’s ok to say no if:
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The patient is costing you your sanity, your
profitability and your staff.
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You can offer appropriate alternatives, even if that
means a referral to another practice.
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You know that it is the right answer.
