You’ve probably heard the saying, “The customer is always right.” The question of whether this enduring axiom of customer service—which, according to this article, dates all the way back to 1909—applies to business in the modern world certainly is debatable. And that’s especially true when it comes to the business of health care. Today’s patients are more educated than ever before—hello, Internet!—which means they’re more eager to sit in the driver’s seat with respect to their health care. And with the growing emphasis on patient-centered care, you might be tempted to hand over control. But, letting your patients take the wheel—that is, bending to their every whim or request—isn’t just bad practice from a clinical standpoint; it’s bad for business, too.

Of course, telling a patient “no” is easier said than done. With that in mind, here are five tips for standing your ground while maintaining your patients’ trust, respect, and overall satisfaction with their care.

1. Justify your stance.

Recently, I was chatting with a friend who owns a PT clinic located inside of a gym. She often transitions patients to supervised exercise programs once they’ve reached—or are near reaching—their therapy goals. And while you’d assume that having easy access to a state-of-the-art strength and cardio facility would be a super-convenient perk for a therapy practice owner, it also presents a unique challenge. Why? Because many patients want their specific therapist—not an assistant or other staff member—to be present during those exercise sessions. Sure, that’s a huge testament to the quality of care the therapist has provided, but as my friend explained, it’s not usually the best use of the therapist’s time—especially if there are other patients to treat.

Of course, she doesn’t share that reasoning with her patients when it comes time to release them from the nest—er, clinic—to fly on their own. After all, you never want to leave a patient feeling like he or she doesn’t matter—because that couldn’t be further from the truth.

So, what would you do in her position? One option: explain that because the patient no longer requires clinical instruction and treatment during exercise, there’s no reason for you to supervise him or her in the gym. And don’t forget to assure the patient that if he or she experiences any pain or movement-related issues outside of the clinic, you’ll get him or her back into your office ASAP to address them.

2. Find another way to address the “why.”

Continuing with the example above, let’s say that even after you, as the therapist, have explained the clinical reasoning behind your decision to decline the patient’s request for continued one-on-one treatment, he or she still isn’t on board with the plan. Now it’s time to dig deeper—to find out what’s really at the root of the patient’s reluctance. Is the patient afraid of hurting himself or herself? Is he or she worried about regressing in the absence of your guidance and support? Or, perhaps the patient simply is nervous about working with someone else—someone with whom he or she hasn’t built any rapport or trust. Whatever the case, once you know the “why” behind your patient’s wishes, you can offer up alternative solutions (i.e., ones that don’t require you to give in—at least not completely). Remember, this patient probably wants to feel involved in his or her care, so the more ownership you can give him or her over the decision, the better. That way, it feels more like a compromise that both parties have agreed to—not a directive that one side is forcing on the other. As this Medscape article notes, “your willingness to engage with the patient makes ultimately going against the patient’s wishes much more palatable than a flat-out no because the patient feels that he or she has been heard by you, which is often what patients want.”

In this instance, perhaps you could suggest that your colleague—the person who will be supervising the patient outside of the clinic—attend some of the patient’s final therapy sessions before he or she transitions to the gym environment. That way, the patient has a chance to get comfortable with that staff member ahead of time. Additionally, the patient will have an opportunity to observe you educating the assistant about the patient’s specific situation and history—which could help ease the patient’s worries about losing continuity.

3. Build ’em up.

When a patient is comfortable enough to voice his or her opinions and concerns to you, it means you’ve definitely done something right. After all, if the patient wasn’t satisfied with the care you provided up to that point, he or she probably would have walked away without saying anything at all. It might sound counterintuitive, but if a patient is piping up, you’ve likely already earned his or her trust and respect—which is a good thing. The problem in this particular example is that the patient has come to rely on you to such a degree that he or she doesn’t want anyone else involved in his or her care. But, you can make that trust work in your favor by using it to get the patient on board with your plan.

First, make it a point to highlight the incredible gains the patient has made since he or she first set foot in your clinic. Because while you may be confident the patient is ready to exercise on his or her own—to take the skills he or she learned in the clinic and apply them “in the real world,” so to speak—that confidence may be one-sided. So, show the patient how excited you are to see him or her graduate to the next level—that is, to start putting his or her strength and skills into practice outside of your office. When the patient knows how much you believe in him or her, it’ll only be a matter of time before he or she embraces that sentiment as well.

4. Show empathy.

When a patient speaks up, he or she wants to be heard. And sometimes, showing the patient that you’re hearing what he or she is saying is more important than the actual content of that patient’s dialogue. “If I give a patient my undivided attention, and I sit down in the chair and meet them eye to eye and face to face and I listen, and then I give them my best advice, I think that counts as something,” John Mandrola, MD, a cardiac electrophysiologist at Baptist Medical Associates in Louisville, Kentucky, said in the Medscape article. “It may sound Pollyanna-ish, but I believe it. I believe that if we meet our patients and we listen and have empathy, it works.”

So, when a patient asks for something, take the time to listen—to genuinely understand where the patient is coming from. This American Academy of Family Physicians (AAFP) article suggests taking that interaction a step further: “Once you believe you really understand the patient’s story and concern, summarize these points aloud for the patient. This allows the patient to correct or amplify. It also allows the patient the experience of being heard and understood.” And when a patient knows you’re factoring his or her feelings into any decisions you make about his or her care plan, it’s much easier for the patient to accept those decisions as the right ones.

5. Put your foot down—carefully.

If you’ve exhausted all of your options—including all of the strategies I’ve already covered—and the patient still won’t take no for an answer, then it’s time to exercise a firmer approach. Now, “firm” doesn’t necessarily equal “mean”; in some cases, patients simply need to be reminded that you’re the expert—and the one in charge. “You have to really be firm with certain people,” William Sonneberg, MD, a family physician in Titusville, Pennsylvania, told Medscape. “You have to take the professorial view. With some patients, you have to act like you’re delivering the Sermon on the Mount and do it with authority and conviction.” With these patients, it’s especially crucial that you do not waffle or waver in your intention. As the AAFP article explains, “Firm boundaries are the rule here. Make explicit ground rules and be absolutely clear to the patient what can be expected, then follow your own rules to the letter.”

In the business of health care, your patients are your customers. And while providing great customer service is important, letting your patients hijack the care process isn’t good for their progress—or your practice’s bottom line. 

Have you ever found yourself in a situation where you had to stand up to a patient’s demands? How did you handle it? Share your thoughts in the comment section below.