What to do when clinical relationships turn sour, and how to turn it around.


Every now and then in our private practice lives, we may hit a bump in the road when we find ourselves out of sync with a colleague we thought we knew well.

Here’s the thing …To be a success in Private Practice we have to rely on good working relationships.

Whilst you might have despised some of those you worked with in the NHS, chances are, your pay packet wasn’t too dented if you weren’t soul mates. Not so, in the private sector, when you are out to gain referrals from others.

So what do you do when a practice ‘bro-mance or wo-mance’ turns sour?

I wonder if you have experienced one of these three ugly situations…

  Situation 1. The unfaithful.

You have had a nice little to-and-fro referral relationship with a surgical colleague -let’s imagine you are a Physio and normally the Ortho-bod and you are ‘tight’. One day, however, you learn from a therapist’s friend that your patient has been referred on to see an osteopath without your knowledge. Your instant reaction may be to fire off a vitriol-fuelled e-mail tirade, asking said Ortho-bod,Oi, Mate, why did you send my patient elsewhere?’

Try to pause and try to put your twisted knickers on back the right way around.

It pays to try and expand your thinking around what may have gone on in the consultation between the patient and the surgeon. Is it possible, for example, that the patient personally asked to see an Osteo ‘wot his mum recommended’? He didn’t want to cause offence to you, so he absent mindedly failed to tell you this. Or maybe the Bupa allowance had run out for physio but the patient found a way to finangle the system, so that he could get further therapy with an Osteo allowance.
Perhaps the patient was simply bone idle and didn’t fancy doing the excellent rehab that you suggested.

This could be wishful thinking, but it’s surprising the number of times this actually happens. I have even experienced it from both sides. Whilst it’s good manners for a Clinician to discuss the onward referral of a patient, sometimes patients even request that this conversation doesn’t happen (‘he seemed like such a nice physio, I would really hate to come across as being disloyal if he were to find out’).

Why not pick up the phone or ping a politely worded email to enquire with the Consultant, as to what exactly has gone on. If at all possible, steal yourself to give a face saving ‘out’ for that clinician.

You can maybe write something like …

‘Hi, I’m getting in touch with you because I understand that Mr Kanny-B-Bothered is now going to see an Osteo colleague. I know that it would be out of character for you to not to return the patient to me, and we all know how some patients can be ‘funny’, but I was just wondering if there was a particular reason for your decision?’

It’s even better if you get to speak to the Clinician, in person. Chances are you will hear an apology and a palpable sigh of relief when they confess to you that they felt really bad about this. You will probably end up agreeing that Mr Kanny-B-Bothered is a general pain in the backside because he doesn’t do his rehab. Take home message is…

There is usually always another explanation.

  Situation 2. The disappearing act.

You may have a good working relationship with a referrer and then suddenly all you hear is crickets…It’s like they have literally blown away. You are left baffled about whether or not you have done something scandalous to offend them that you didn’t know about. Rather than tie yourself in knots, take a step back and ponder the following:

Clinical cases are sometimes a bit like buses; there are none for ages and then they come along in threes.

In my own practice this strange phenomenon frequently occurs. I might have ten patients with groin pain that I refer to my fab therapy buddy, and then suddenly there is an outbreak of tennis elbow, and the hip patients dry up for a while. This may give the external impression that I no longer want to refer my hip patients to that therapist, when actually current times mean that elbow problems are more in fashion.



Sometimes clinicians take time out to do stuff.

This might be research, looking after an elderly relative or even after a bereavement. I had a colleague who once took a sabbatical after a divorce. (Why not?) In other words it may all be in your mind as to why there has been a hiatus in referrals to you.
If you can’t think of a mega clanger you may have dropped inadvertently, it’s definitely worth getting in touch and asking to meet for a quick beer after clinic, or hang out in clinic or theatre with them.

Maybe you have been taking the relationship for granted?

Perhaps because you haven’t been so good at keeping in touch, a younger, flashier therapist has now become the apple of your referrer’s eye. Sometimes as clinicians we are keen to try and spread our net a little further, so we try and seek out new relationships but neglect looking after our past ones.

Keeping in touch with your tribe via blogs and email list broadcasts, is a good way of reminding people that we are still there.

  Situation 3. The Fall Out.

Finally, because we are human, we sometimes do things that offend others. You know when you’ve done this because it makes you feel bad. Being human means we often get hung up on the idea that ‘I’m right and you’re wrong’ and we use this to justify our bad behaviour. Maybe you have even been mentally logging ‘he said this’ or ‘she said that’ scores.

This is not super helpful nor productive, especially when you have been building a gloriously elaborate construct around what you imagine that person is thinking about you.

Don’t assume you can suss out how a person feels- you have to ask them. They may be completely in the dark that they have put your nose out of joint.
Try to make room for a little compassion. Where they having a really crap day, that time they said something curt to you in the corridor?

Carve out time to chat on mutual ground. Rather than pick through the debris of what you felt did or didn’t happen, see if you can focus on the bigger picture of actually getting back to a harmonious relationship where you both work together to look after your patients.

Be proactive, extend an olive branch and try not to burn bridges. The world of private practice is small so as my mum used to say… ‘If you haven’t got something nice to say about someone don’t say anything at all.’

Relationships of all kinds need nurturing. Schedule a little time to reconnect with your favourite clinical chums, new and old, and if they have done something fab for one of our patients lately, let them know about it! Nothing feels nicer than to receive a rave review from a patient. It’s a lovely way to strengthen bonds and remind them that you value their care.

Everyone likes to receive a pat on the back, plus giving praise makes us feel good too. It’s a win win situation.

Sometimes, we all need a little extra help in building our practices – from a business perspective, as well as a clinical one.

Are looking for guidance and advice ?

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