How to stop feeling guilty about charging your patients

How to stop feeling guilty about charging your patients

Do you ever feel guilty about charging your patients?

Even just a little bit?

Perhaps you’re a clinic owner, and you’re frustrated that your physios or osteos aren’t bringing patients back to clinic, and you suspect it’s because the patients are self-funding.

Maybe you’ve been holding back from raising your prices, because you’re afraid how patients might react?

Don’t worry. This is normal. The good news is, it makes you human.
The bad news is, it’s bad for business – and here’s the key thing – it’s also bad for the patient.


Here’s why:

Even if you’re the most awesome clinician in the land, it’s not often that you can cure the patient in a single session.

The majority of medical conditions, especially musculoskeletal ones, are going to require the patient going through a series of treatment steps. It’s a journey of recovery, not a moment in time.

Even if you were capable of giving that patient everything they needed to manage their condition in one-sitting, chances are, you’d completely swamp them.

And this doesn’t just apply to physios and osteos. Doctors can be just as bad. This week, I was speaking about marketing at a Primary Care Conference at the NEC. During a break, I was having a cup of tea in the speakers’ lounge and had a natter with a Consultant Paediatrician, and we got around to talking about her own Private Practice.

I asked her if she was enjoying Private Practice, and she replied that she didn’t like it as much as the NHS. She confessed that after each consultation, she’d spend ages and ages preparing a really lengthy follow up report, with loads of imported files about guides for this and guides for that. She was going ridiculously above and beyond for her patients, and the result was, the parents of the patient felt buried under a ton of information. The result was a stream of emails with more and more questions, as they tried to digest what she had given them.

What would have been better? Following up with a ‘follow up’ appointment!

I enquired as to why our lovely paediatrician didn’t offer a follow up, and the answer came as ‘I felt guilty that they’d already spent money on seeing me and paying for the echo’.

In trying to help the family (and I’m sure she did an excellent clinical job), but not giving them the further opportunity to invest in a follow up, it probably let everyone feeling a little dissatisfied. Too many of these situations was also making our paediatrician resentful of the amount of her own personal time she additionally spent, preparing guides and information that would perhaps been better imparted as face to face information giving.

Why you must review your patients.

I remember when I used to get stuck with this mindset around asking patients to return.
There was a time when I used to say to a self-funding patient ‘see how you get on now you’ve had injection and you’re doing your physio exercises and come back and see me if you’re not getting better’.

The problem with this is, it puts the onus on the patient to decide their treatment is going to plan. Whilst patients can of course know if they are comfortable or walking without pain, are they really the best equipped to determine if they are conditioned enough to return to footy?

Have you ever experienced the feeling of frustration when a patient had undergone a treatment or a procedure, and they’d returned many weeks later, indignantly declaring that they weren’t any better?

Did you feel annoyed that they didn’t come back sooner, so that you could have adapted or changed their treatment? Of course you did! The irony is, in trying to save a patient from parting with money, you’ve actually done them a clinical disservice.

If you’re not sure whether this is going on in your own clinical practice, ask yourself how you feel about bringing patients back from follow ups if they are self-funders, versus, bringing them back if they have insurance cover.

Would you give the same standard of clinical care to both patients? Yep. I’m sure you would do.

Strange, isn’t it, how asking patients for their own money, not the insurer’s money leaves us feeling like the bad guy?


Here’s how to get over yourself, and stop feeling guilty about charging your patients:

1) Recognise that you have a mindset around money that will have been honed through years of conditioning

Did you grow up in a home where it was impolite to talk about money, and were you taught that that acquiring money made you a greedy (and thus, bad) person?

Do you see yourself as the clinician who cares deeply about the welfare of their patients, and asking people for something you feel you should give them for free (because you’re a decent human who can help them), feels ‘wrong’?

Do you feel bad that you’re charging patients for a treatment that they could (eventually) get for free with the NHS?

Did you ever have an experience with a patient who balked at the idea of paying for your treatment, which left you feeling a little wounded?

2) Remember that just because it comes easily to you, doesn’t mean the patient doesn’t appreciate it.

This is one of the dilemmas about being good at what we do. I’ve worked in the world of hip and groin pain for years in my own clinical practice. I’m pretty darn good (if I say so myself) at solving groin pain problems for patients who’ve sometimes been struggling for years. When these skills come ‘naturally’ to us- and because it feels ‘easy’, there’s a danger that we can undervalue the value that bring to our patients.

3) It’s OK to be paid for providing convenience, in nice surroundings.

Only recently I was overjoyed to come home to a newly decorated flat, which had been finished to perfection, including gloss work to die-for.

Could I have done the same without shelling out several hundred quid? Well, maybe I would done an adequate job, but it would have meant time out of my schedule, lost earnings or holiday time (and my hourly rate is a lot more than my decorators), and paint in my hair.

Instead, I invested in paying skilled decorators, and three nights in an apartment stay in town. My hubby and I could continue working (sans paint stink), go out for a nice supper or two, and then come home to a shiny new home, marriage intact.

Why not let patients invest in what makes their lives easier? It’s why I love my dentist – he’s open on Sundays. It’s freakin’ awesome.


4) Make sure you’re providing excellent care.

This is the part where I ask you to check in on the quality of the care you’re delivering – and I don’t just mean clinical care.

What is your patient’s ‘journey’ like? Are you delivering a five-star concierged service, or do you need to shrug off the morning’s NHS fracture clinic funk?

If you don’t believe in the quality of what you’re offering, why should you patients? Make sure you show them the value.

I don’t need to give you permission to go above and beyond for your patients – you’re going to do that anyway. But for heaven’s sake – remember to charge what you’re worth.

5) Let patients choose to invest in getting better.

Talking about money makes many of us feel uncomfortable, so rather than putting yourself through the agony each and every time you see the patient, get ‘buy-in’ from them at the beginning of their treatment course.

Giving excellent clinical care means taking patients on an entire treatment journey. If you’re not doing this to completion, you’re not helping the patient to GET BETTER.

Patients want to know that you are the right person to take care of them, and you can demonstrate that by explaining your process.

For instance, you’ll be ‘seeing them on six to eight occasions – we’ll be covering this, this and this in the first two sessions, and by the third session I’d expect you to be able to do ‘x’. By the six session, most patients would typically be able to start these kinds of activities, and we’ll be aiming to have you back to playing footy by the eight session’.

Patients who can understand the transformation they can expect to see by working with you, will understand the value of what you are offering them, and will be happy to invest in that process.

Try it. It really helps you to feel great about delivering the help you know you can deliver, in return for being properly paid for it. Win-win.


6) Accept that you can’t help everybody.

As a recovering people-pleaser, I have come to believe this to be true.

Brooke Castillo (podcaster and life coach tutor) describes people pleasers as ‘liars’. She’s got a point.

We can’t help everybody, and there will always be the occasional someone who will try to barter with us or give us hard time about our prices.

They do this because it’s typically their default behaviour, and not a reflection on you and your self-worth.
Even if you did elect to treat them, chances are, they’d become a complete pain in the bum, because they don’t value what you do.

I ‘indulge’ my inner giver by giving pro-bono treatment (typically to injured, overworked contemporary dancers), but it’s on my terms, and interestingly, it’s never directly asked for by the patient. The ‘ask’ will come from their therapist, and I’m happy more than happy to help.

If we rush to be ‘nice’ and find ourselves giving it all away, it can actually put the patient in an uncomfortable position, because it leaves them feeling like they ‘owe’ us something. That doesn’t make for a healthy working relationship.

7) Remember that when we pay for something, we’re more committed.

Ever booked to attend a free evening event, and the got distracted by the offer of an afterwork beer in the sun?

Me too.

But you can bet that I got out of bed to catch a 6am flight to a one-day conference in Edinburgh, even though it was January, raining, and I left behind a smug husband in a warm bed. And a puppy.


Because I’d paid for it, and I wanted to get value for my investment.

Don’t deny your patients the chance to invest in their health.

Do you or your team need help with charging what you’re worth and demonstrating the value of what you do?

Get in touch. I can help with one-to-one coaching, and in-house workshops for clinical teams. Ping me an email at and let’s have a natter.

Now it’s time for you to grow your Private Practice.