Encouraging patients to take extra treatment

Q. Clients at my chiropractic clinic can get a discount by signing up for a ten-visit course of treatment. I usually refund patients for unused visits, but sometimes I am convinced that a client has a genuine medical need for the full course of treatment. When this happens, can I tell the patient that she can’t get her money back and has to finish her regime? After all, I only want to do this when it is in the patient’s interest from a medical point of view. YF, Jerusalem

A. Even though medical practitioners like to think of themselves as the boss, let us recall that ultimately you are being hired by the patient for the course of treatment she is interested in. When she doesn’t want to finish the treatment, this is another way of saying she wants to fire you.

Jewish law is very protective of the hired worker, and many laws shield him from being exploited by his employer. For example, the fired worker does not get paid “pro rata” according to the amount he worked. If his current employment deprived him of earning opportunities, then his compensation must reflect this. So you may adopt a refund policy which reflects this, like charging for the used visits as if they were single visits and not part of the plan.

But you can’t compel someone to hire you. Even if someone is hired for an agreed-upon period of time, like your ten-treatment plan, if the employer decides she doesn’t need the work or doesn’t like the worker, she isn’t locked into the agreement. Her only obligation is to make sure the worker gets fair compensation. It’s not fair for you to exploit the fact that the money was paid up front to take away the patient’s right to choose or decline a treatment program.

There is another consideration in your case. The relationship between the treatment provider and the patient needs to be based on trust. Using monetary sanctions as a way of enforcing your medical opinions is bound to erode your patients’ confidence in your professional judgment. Even chiropractors should avoid this type of manipulative behavior.

Source: Shulchan Aruch, Choshen Mishpat, 333