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Lately, many physicians are asking, “How do I handle a high maintenance client (HMC)?” When I ask for a definition of “high maintenance,” I receive some passionate responses. In summary, most state that these clients are “difficult to deal with” and “take up an overwhelming amount of physician and staff time.”

The unfortunate fact is that HMCs often impact operational efficiency and prevent doctors from providing optimal care to other loyal clients. HMCs are notorious for overstaying their allotted appointment time, and they often demand to be seen without an appointment. They subject other patients to longer wait times and cause practice team members to scramble to stay on schedule. Their relentless calls, complaints, and even challenges to policies and pricing tire the staff and physicians. Simply put, the typical HMC monopolizes the practice's time and resources, leaving the staff weary and other patients wondering if they are getting their fair share.


When HMCs repeatedly drain your resources and test the patience of your practice and staff, you may need a better way to manage these clients. It is possible to learn to maximize these clients' value to the practice by having strategies in place to manage their unique—and sometimes unrealistic— demands. The following strategic tips provide direction in managing difficult clients and describe what to do if, despite your best efforts, the relationship fails to benefit both parties.

Understand the characteristics of an HMC. Having an awareness of the typical characteristics of an HMC will help you identify exactly who these clients are. HMCs that tend to wear the practice and its staff out generally exhibit one or more of the following warning signs. They may:

  • rarely be satisfied with results.
  • challenge you continuously on getting a lower price.
  • bring competitors' coupons in to see if you would match.
  • ask you to cut corners (i.e., provide less than an optimal outcome).
  • come in with photos of celebrities and say “make me look like her/him.”
  • call the office on a regular basis and want to talk to the physician.
  • have an inordinate amount of complaints and issues.
  • suffer from body dysmorphic disorder and need psychiatric help, not another procedure.

Identify your HMCs early on. Now that you understand the characteristics of the typical HMC, you and your staff need to watch for red-flag behavior and identify these clients early on in the practice-client relationship. This will help in heading off any potential issues as the relationship develops over time.

Have a strategy. Once your HMCs are identified, you can implement a set strategy to manage them. Your strategy should involve all team members and include these tactics:

Schedule early. It's best if you can get to this type of client first thing in the morning when your mind is fresh. Make sure you have ample time with the client, but not too much. Plan for a staff member to come knocking on the door when the client's allotted appointment time has expired.

Schedule often. HMCs like to feel as though they have a lot of contact with you. So, as hard as this may be, scheduling several shorter appointments (versus one long appointment) will go a long way. You will potentially reduce the opportunity for HMCs to present with a laundry list of issues they would like you to resolve.

Be prepared to probe with purpose and listen. Unrealistic expectations often can be uncovered by asking the right questions and listening carefully to the answers. Find out if the client has been to several other practices for the same procedure. Ask why he/she was not satisfied. Get to the crux as to why this particular procedure is important to the client and what he/she expects to change as a result of it. A response like “I've had three eyelid surgeries because I want my eyes to look like Kim Kardashian,” may be a red flag.

Be firm with what you are able/unable to do. This is critical. For example, it is perfectly acceptable to tell a patient with a certain eye shape and features that you will never be able to give him/her Kim K's almond-shaped eyes. There is no shame in admitting that you are not capable of providing this outcome.

Set clear expectations. Always discuss expectations with the client before commencing with any treatment or procedure. Repeat them, and then repeat them again. Make certain the client understands what to expect. Use before and after photos of real patients, patient/staff testimonials, e-books, brochures, websites, etc.

Keep staff in the loop. All recommendations, expectations, and steps moving forward must be made crystal clear to each team member having contact with the client, from exam room to checkout and any follow-up. To do this effectively, you may need to develop a process for this information to travel quickly up and down the patient-care continuum.

Respond versus react. Often times exchanges with HMCs can be emotional, and the client may say something hurtful. Remember to remain cool and confident. Take the high road and allow the client to be heard. Restate their feelings, check for understanding, and offer a solution. Avoid saying anything you may regret. Remember, in today's technology-based world, the client has the opportunity to vent further online.

Know when it is best to break up. It may be time for the client to move on when it becomes apparent that neither you nor the client are benefitting from the relationship. You will know this when: a) the drain of the practice's resources far outweighs what the client brings to the practice, and b) the client is continuously unsatisfied despite your best efforts. If you decide to “break up,” don't blame yourself. This is often hard to come to grips with as many physicians believe, “I can make that client happy.”

Know how to break up. Leave the relationship on good terms. If you struggle with this, think about employees that you may have let go, but with whom you are still are on good terms. Most likely you took the time to do this in person. Let the client know that you feel it is time you part ways. Express to the client how much you appreciated his/her business but that you think it is best, based on his/her needs and your resources, that you part ways. Do not leave the door open. Make every effort to ensure that clients do not feel it is their fault; however, do not blame yourself. You don't want to represent yourself as incapable. If you refer them to someone else, tread lightly as you want to ensure good relations with your colleagues moving forward.


The truth likely is that there are many delightful clients you currently have in your practice and many more that you will attract given your reputation and results. Having a strategy to manage HMCs in your practice will allow you to minimize their negative impact and maximize the time you can spend nurturing those positive client relationships. As Dr. Phil says, “You teach people how to treat you.” Teach them well.

Kim Blackwell is a management consultant with the Allergan Practice Consulting Group, of Allergan, Inc., a specialty pharmaceutical company based in Irvine, CA.

Ms. Blackwell consults with dermatology and plastic surgery practices in areas of financial analysis, practice valuations, human resource issues, internal and external marketing, leadership training and team building, sales training, compensation, and aesthetic practice development. She has more than 11 years of successful field-based sales and management experience in the Southeast, Middle Atlantic, and Pacific Northwest. Prior to joining the Allergan Practice Consulting Group, she served in a number of sales and management positions in the pharmaceutical industry, including senior sales representative, sales manager, and national field sales trainer. She has participated in corporate marketing initiatives that included planning and strategizing the launch of several new products and indications into the field of aesthetic medicine.

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