What is Transaction Avoidance Syndrome? Part 2 of 3

Part 1 | Part 2 | Part 3

A transaction is what happens at the end of a business exchange. The word comes from the Latin: trans- (“through”) and -agere (“to drive”).

As discussed in Part 1, many things can go wrong when we exchange payment for a service or product. A lot of us feel an underlying discomfort when we receive money.

This discomfort can look harmless at first. As a practitioner, you might spend “a few extra minutes” with each patient, or put off discussing payment options until the end of the visit. But the subconscious avoidance can have a very damaging effect on our business profitability.

Let’s take a look at why this happens.

When Transactions Go Wrong

Natural health practitioners enter the medical field due to a deep desire to eliminate pain and suffering. They want to give patients options to balance the body, mind, and spirit. Most healers also feel a deep connection with their patients. In some cases, they even “go the extra mile,” much further than a typical conventional medical provider would go.

Yin Imbalance and Fear Response

This extreme self-sacrifice can go too far, resulting in what I call a “Yin Imbalance.” When practitioners focus on nurturing, supporting, and serving others to the exclusion of running a profitable business, they will eventually run into negative cashflow. A business cannot remain sustainable when money is going out but not enough is coming in.

You might find it easy to collect payments in exchange for your services or products. “Sales isn’t that hard,” you may be thinking. “What’s the problem?”

But for many of us, the idea of taking someone else’s money—even if it’s justified and consistent with standard rates—feels very uncomfortable. It can even result in a flight-or-flight response. Whether due to past negative experiences or a feeling of inadequacy, we instinctively react in one of 3 ways:

  • Repel and engage the threat: Fight 
  • Repel and disengage the threat: Flight 
  • Attract and disengage the threat: Freeze 
fear, fear response, fight, flight, freeze, face, fight or flight
The 4 Responses to Fear

Overcoming the discomfort allows us to use a much more effective approach, which is:

  • Attract and engage the threat: Face 

The tendency to avoid transactions stems from a variety of root causes. We might feel:

  • fear of rejection
  • self-doubt
  • misplaced guilt
  • sense of inadequacy
  • over-generosity

Whether we prevent a business deal from taking place consciously or unconsciously, the result causes damage… financial, professional, social, and even to personal and family relationships.

How Imbalance Can Destroy a Practice

The natural health community tends to provide outstanding patient care, excellent knowledge and expertise, and an amazing level of compassion. The one huge problem, in my opinion, is a huge “transaction blind spot.”

As a practice owner, you may subconsciously believe that your services don’t have much value. Or that you aren’t as qualified as other practitioners. Or that if your services are too expensive, patients won’t want them anymore.

Things quickly spiral out of control when a practice owner

  • deliberately stops collecting payment,
  • offers discounts or free services to every patient (believe it or not, this happens a lot),
  • “forgets” to mention payment,
  • delays sending the invoice,
  • doesn’t follow up with an e-mail, letters, or phone calls, or
  • is overly apologetic about the cost of services

Avoiding the topic of money won’t magically make these problems disappear. They’ll just keep simmering on the back burner of your practice, eventually boiling over in a catastrophic financial nightmare.

Transaction Avoidance doesn’t discriminate; it’s present in solo medical offices and group practices; it affects newly graduated doctors and those who’ve been in business for 25 years.

I have seen Transaction Avoidance Syndrome happen in well-established practices, where the doctor allows patients to come in for several appointments without sending a single bill.

It also happens when a practice expands quickly. They may add extra staff and new locations, but internal processes are still inefficient. As a result, documentation gets delayed, paperwork goes missing, and dozens of claims aren’t sent out.

Finding a Balance

Re-balancing an excess of Yin involves swinging the pendulum back to the Yang side. This involves:

Yin and Yang, extreme, balance, strategic balance
Grace LaConte’s description of Yin and Yang balance in strategic decision-making

Running a successful practice depends on your ability to

  • charge what you’re worth (not less),
  • when services are scheduled or completed (not weeks later),
  • for clients who value your time (not those who expect things for free).

This type of mental re-framing doesn’t happen overnight. It involves a sometimes painful process of recognizing your own value, how patients truly benefit (it’s often much more than you think), and standing strong when you’re asked to offer more discounts.

In Part 3, I’ll share some practical solutions to get more control of your healthcare practice.


Interested in hearing how you can reverse a toxic workplace? Find out more here.


Grace LaConte is a business consultant, writer, workplace equity strategist, and the founder of LaConte Consulting. Her risk management tools are used around the globe, and she has successfully reversed toxic work environments for clients in the healthcare and non-profit fields. Grace specializes in lactation law compliance & policy development, reducing staff turnover after maternity leave, and creating a participatory work culture.

Find more at laconteconsulting.com, or connect with her on Instagram and Twitter @lacontestrategy.

Grace LaConte is a profitability expert, writer, and speaker. She is the founder of LaConte Consulting, which provides business owners with practical ways to improve their company's profit, growth, and value. Grace also shares her thoughts about marketing strategies and the dangers of predatory tactics used by MLM (multi-level marketing), which you can find at https://laconteconsulting.com/blog. She is based near Houston, Texas.

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