My post last week on “caregiver vs. caretaker” philosophies generated a comment from a reader that I think is worth addressing here. Dr. Jeff Kesling wrote to say that this was a problem he had been dealing with for some time, and asks, “What suggestions do you have so these “caretaker” problems don’t occur in the future? Is it a written policy that needs to be gone over with each individual patient? Do you have any advice on how to avoid this scenario?”

That is the big question for every practice, isn’t it?—how to get past the caretaker problems. And without knowing the specifics of the practice it is hard to give specific prescriptive advice. But I can tell you this: What it ultimately comes down to is the patient’s level of engagement and what you are doing to raise that level one-on-one. It’s about examining every aspect of the practice to ensure you’re creating the right value, understanding and accountability so patients can make the right choices.

A written policy, then, is a good example of the clarity we need as a team, but it doesn’t get to the heart of the level of engagement with the patient I’m talking about—which, again, has to be created one-on-one over the course of the relationship, with the policy supporting the understanding that comes from your interactions.

I’ll give you an example: You don’t expect to check into a hotel without providing payment at the time of check-in, and for good reason. If you reserve a room but can’t pay, the hotel loses, so they protect themselves with this policy. The industry has trained us to accept this. But they still make sure we understand everything that’s involved: the nightly rate, the smoking restrictions, the check-out time—so that we have absolute clarity about what we’re signing for. It’s part of the check-in process to confirm these matters, and as a result hotels have very few misunderstandings with their guests about expectations.

By the same token, when you are discussing a treatment plan with a patient, a fundamental part of your responsibility has to be discussing financial and appointment expectations, so they can be clear about their responsibilities in advance of each visit. It has to be done consistently, and with the right language to create the right value.

There are many things you can be saying or doing that are either promoting or undermining patient engagement levels. For instance, take a look at how you appoint. If you are using a system of routine appointing, with follow-up calls to confirm, you’re encouraging some people to take the opportunity to cancel, because just using the word “confirm” suggests that you are giving them an option to either honor their appointed time or decline. It’s language that creates the wrong mindset and establishes the wrong expectations.

The better way is to create value for the appointment and make the patient understand up front that an appointment is a confirmation. Hand them their appointment card and say, “Your appointment is now confirmed. We have reserved an operatory and the doctor’s and assistants’ time especially for you. We’ll give you a courtesy call two days before your confirmed appointment.”  Then use that call to reinforce the language: “This is your courtesy call; we look forward to seeing you at 2:00 p.m. on Thursday for your confirmed appointment.” By establishing this kind of clarity, you are training patients to approach their appointments with the right mindset—one that respects your time and theirs.

Having said all this, the bottom line is that no single policy or strategy is going to work unless the patient buys into the treatment plan you have created on an emotional level and is excited about the clinical vision you have presented. Without that fundamental perception of value, they will always find a justification to evade policies and make you the caretaker. Give them a reason to believe—and to want what you’re presenting—and you’ll be surprised how eagerly they take ownership for participating in the process.