Why Patients Haggle Over Your Fees,
and Why It Is a Clinic Design Problem.

Key Takeaways

• Patients haggle where haggling works. Nobody bargains at the lab or the pharmacy, because a fixed system taught them the price will not move.
• It is a clinic design problem. Only one segment of patients haggles, and only in some clinics: the way a clinic sets, states and protects its price shapes the behavior.
• Seven conditions decide whether a price gets negotiated, from who sets it and whether exceptions exist to how much of the service you give away free on WhatsApp.
• The loudest critics are not your patients. The price-first segment dominates social media; the patients who value quality already understand that it costs more.
• The fix is a fixed, respectful system: a clear price stated as information, staff trained to protect it, a brand that matches it, and no need to justify it.

Who is Prof. Hatem Eleishi?

Prof. Hatem Eleishi is a Professor of Rheumatology at Cairo University’s Faculty of Medicine and a former Deputy Director of its Medical Education Development Center. He runs a rheumatology clinic at his own medical center in Maadi, Cairo, and coaches doctors on private practice management through DHE Academy, which he founded.

He has taught rheumatology, immunology, and management and leadership for doctors for more than 30 years, and holds diplomas in medical education and in management and leadership. Alongside his practice in Cairo he is a consultant rheumatologist at the Medical Reference Center in Jeddah, Saudi Arabia, and a regular keynote speaker at medical conferences.

Through DHE Academy he teaches the subjects he sees as essential to a doctor’s career yet given too little attention in medical school and postgraduate training: private practice management, pricing, patient segmentation, medical branding and career development. The academy runs online courses, one-to-one virtual coaching and live events. His own clinic runs on the Excellence Clinic model this article describes.

Why do some patients haggle over a doctor’s fee but not over lab tests or medicines?

Because negotiating a doctor’s fee often works, while negotiating a lab, scan or pharmacy price never does. Only one segment of patients haggles, and only in some clinics, so the behavior is shaped by how the clinic sets, states and protects its price. The “medicine is humane” argument is just the most effective thing to say.

Plenty of doctors in Egypt know the scene. A patient walks into the clinic, then pushes back on the consultation fee or on an extra procedure done during the visit. The same patient paid for lab work, a scan and a bag of medicines that week without a word. They probably bought a phone or booked an outing without bargaining either.

Two things are worth saying before anything else. Not every patient does this; it is one segment. And that segment does not do it in every clinic, only in some. That detail is the whole key, because it means the behavior is shaped by the clinic, not only by the patient.

When doctors try to explain it, the reason they reach for most is some version of “patients think medicine is a noble, humane profession, so any doctor who charges more than they expect is greedy.” Prof. Hatem Eleishi argues that this is not the real reason at all. If it were, people would say the same thing to the lab, the radiology center, the ICU billing desk and, above all, the pharmacy selling a life-saving drug. They never do.

The humanity argument is simply the most effective thing to say. Nobody will tell you “lower it because I heard doctors cave if you push.” They use language that sounds respectable and lands hardest on a doctor who is already unsure what his work is worth. So the useful question is not “why don’t people want to pay the doctor?” It is: why do people try to negotiate with the doctor in particular, when it never crosses their mind with every other medical service?

Why do people negotiate some prices and not others?

Because haggling is an investment: people push when they believe pushing can lower the price, and stop the moment they learn it cannot. Nobody enjoys bargaining for its own sake. A price that has never moved for anyone simply gets paid or walked away from, and the motive to negotiate disappears with the result.

Try two thought experiments. You need something priced at 10 pounds, and you learn it can be had for 8, or even 5. Most people, even comfortable ones, will push for the 5. In an economy where people worry about tomorrow, they push harder and longer, because they know others got the discount before them.

Now you need something priced at 200 pounds, and everyone who tried to get it for 199 got nowhere. Would you spend even one minute trying? Almost nobody would. You buy it at 200 or you walk away.

That is the logic behind the whole problem. People negotiate when they see negotiation as an investment that can pay off, and they stop when they learn it cannot. They do not enjoy haggling for its own sake. They enjoy what haggling gets them. Remove the result and the motive disappears with it.

It also explains why the singer at your daughter’s wedding can charge half a million pounds with little pushback, while a doctor charging 100 pounds gets argued with. The difference is not respect for science or sacrifice. It is a set of conditions that either invite negotiation or shut it down.

What makes a price open to negotiation?

Seven conditions decide it: whether an institution or a person set the price, whether exceptions exist, whether the provider believes the fee is earned, whether payment goes through a cashier, whether value is given away for free, how strong the name is, and what the premises signal. Many doctors meet most of the ones that invite haggling.

Compare how the public treats prices across different services and the same conditions keep showing up. Many doctors, it turns out, meet most of the ones that invite haggling.

1. An institution set the price, not a person. A price list reads as a solid wall. A person reads as something soft that might give under pressure. Even the way a price is said matters: “The fee is 600, would you like to book?” closes the matter. “The fee is 600, is that OK?” is an invitation to give an opinion, which is an invitation to lower it. The issue is rarely the number. It is whether the price looks like a final decision or the opening of a negotiation. (watch from 6:38)
2. No exceptions. The wall has to stay a wall. Once people learn the price is really two or three prices depending on who pushed hardest, long rounds of bargaining begin. A clinic that has priced properly should hold the price even if the patient refuses and leaves. (watch from 7:42)
3. Know your worth. The provider has to believe there is a real professional exchange happening and that the fee is earned. The humanity of medicine has never meant a lower price or working for free. It means better care, more attention and higher quality, and those things cost more, not less. Many doctors quietly doubt they are entitled to their fees, and over time that doubt creates an inflated sense of entitlement in some patients. (watch from 8:37)
4. Pay at the cashier. Paying through a collection point, rather than handing money to the doctor, strengthens your position. It is not a requirement, but a doctor who collects directly needs a clear policy that leaves no room for pressure. (watch from 10:05)
5. Protect the perceived value. You cannot give away a large part of the service for free, repeatedly, outside the paid service, and expect the paid part to keep its value. The clearest example is WhatsApp. When a patient gets most of the medical opinion over chat, at any hour, and then is asked to pay 600 pounds at the clinic, objecting feels logical to them. If they believe they already got 70% for free, paying full price for the remaining 30% is hard to accept. The doctor created that perception. (watch from 10:35)
6. Be a strong name. A Rolex can sell at 50,000 pounds with no bargaining while an unknown watch gets haggled at 500. A known doctor’s patients worry about getting an appointment this week instead of in three weeks. A doctor with no clear position gets argued with even when his fee is already provocatively low. (watch from 13:27)
7. The premises send a message. A good address, a decent space and trained, professional staff lower the odds of haggling on their own. Decor does not set the value of care, but the whole environment tells people what kind of place this is and how it expects to be dealt with. (watch from 14:27)

Why is a doctor’s fee so easy to negotiate?

Everyday prices fall into three tiers: fixed by a system (utility bills, fuel, lab tests, scans, medicines), negotiable within limits (most shops and private businesses), and open to negotiation (private professional services). A doctor’s fee usually lands in the third tier, because it fails almost every condition that shuts negotiation down.

Apply those conditions to everyday purchases and three tiers appear. Doctors’ fees land in the one that invites negotiation most.

Nobody stands at the pharmacy counter saying “the drug is 700, make it 550 for my sake, be humane.” That is not because people respect the pharmacist more than the doctor. A clear, fixed system taught them the price is not up for discussion.

Run the doctor’s fee through the same checks and it fails almost every one. To the patient, the fee comes from “Dr. Hany, the nice doctor who examined us,” not from clinic management, so pushing is worth a try. Many patients have learned from other clinics that pressure works: 500 becomes 400, then 300, and a paid visit comes with four free follow-ups plus unlimited WhatsApp. The service is often fragmented, with much of it given away between visits. And many doctors are not convinced they deserve the fee, so they start negotiating against themselves before the patient opens their mouth.

That does not make the patient a bad person. They spotted an opportunity that many doctors leave open, through confusion between professionalism and charity and through weak management of their practice. Prof. Eleishi’s advice: don’t be too upset with the patient; look at yourself first.

Doctors sit along a spectrum. At one end is the doctor with a clear service, a fixed price and no bargaining. If he waives the fee for a genuinely poor patient, that is a line item in his own policy, not a crack in it. Deliberate help for someone who cannot pay is one thing; letting the price depend on how well each person haggles is something else entirely. At the other end is the doctor who wishes the fee were 500 but, under pressure and embarrassment, ends up charging 400, 200, 100, with free follow-ups on top. That clinic usually survives only by pushing patient volume up, and then the problem stops being money. It eats into time, quality of care and the doctor’s own energy.

Which patients push back on a higher consultation fee?

Prof. Eleishi splits patients, hypothetically, into three segments: those who genuinely need help, those who can pay but put price first, and those who can pay and put quality first. Most of the backlash comes from the price-first group, the loudest online, not from patients in real need, who rarely call private clinics to ask the price.

To make sense of the backlash, Prof. Eleishi splits society, hypothetically, into three segments. The numbers are illustrative, not survey data.

If you don’t see these segments, the objections of segment 35 will sound like the verdict of the whole society. That can make you feel guilty enough to give up on an organized model you believe in and build the same chaotic, high-volume, low-fee clinic everyone else runs.

The point is not to win the argument with segment 35. The economy-focused patient belongs in the high-volume commercial clinic built around a lower price. The quality-focused patient belongs in the excellence clinic with a real appointment system and enough time with the doctor. Neither should be trying to convert the other’s doctor.

How do I stop patients negotiating my fee?

Treat the fee as a decision, not an opening offer. Accept that you deserve to be paid, stop defending or justifying the number, focus on the patient segment your model is built for, build a brand, train staff to state the price as information, expect it to take effort, and expect pushback from some colleagues too.

1. Accept that you deserve to be paid. You are a professional delivering a real service, and real humanity in medicine means mastering your work and keeping your training current. If you want to see some patients for free, decide how many, and have a way to make sure they genuinely cannot pay. Help for someone in need should be your decision and your system, not the result of someone succeeding in embarrassing you into it. (watch from 8:53)
2. Don’t defend, don’t justify. Do not start listing your years of study, your exhausting training and your dedication, whether to a patient or in a frustrated Facebook post comparing doctors to singers and actors. It tells people you secretly feel you need to justify your fee. Some patients bargain knowingly; others sincerely believe a humane doctor works for a token fee. It makes no difference. Excuse yourself politely from the discussion and move on. You do not have to convince everyone of your model. It only has to be clear to the people it was built for. (watch from 9:34)
3. Focus on your segment. Not every patient fits every clinic, and not every patient who can afford you is right for your model. Instead of rounds of persuasion with the wrong segment, focus on attracting the patients who value the way you deliver care. (watch from 12:50)
4. Build your brand. The price you set does not live apart from the value patients see in you and your positioning. You need a clear plan for what you want to be known for, how competent, with what service model, and that shapes how you market on social media. Relying only on patients from insurance, hospitals and contracts gives you less control over who walks into your clinic and what they expect. Setting that plan is what our Strategy Consultation and Branding & Foundation services are for. (watch from 13:42)
5. Train your staff to protect the price. The receptionist should never say “the consultation is 800, is that OK?” or “let me see what the doctor can do for you.” The price is information, not a question. For how the front desk should answer “how much does it cost?”, see your ads bring calls but no bookings. (watch from 14:51)
6. Expect it to take more effort, and expect it to work. In a developing economy you are not dealing with one patient trying to lower a price. You are dealing with an environment shaped over years: doctors who believe the “medicine is humane” objection, confusion between professionalism and charity, doubts about entitlement, anxiety about the future and a culture of bargaining wherever loopholes exist. Your policy and fixed price have to stand against that current. With proper planning, they can. (watch from 15:23)
7. Expect pushback from some colleagues, too. Doctors who built their practice on high volume and low fees can turn that business choice into a moral view: a lower price is more humane, a higher one less so. To them, choosing quality over price can look like abandoning humanity. In reality it is a different service model, and possibly the fairer one, if the higher fee really buys better care. (watch from 17:20)

What is an Excellence Clinic, and what stops doctors building one?

An Excellence Clinic is Prof. Eleishi’s name for an organized practice with real appointment times, enough time per patient and a clear system governing patients, clinic and doctor. Doctors who want one usually stall at six obstacles: higher cost, patient backlash, other doctors, being known, income, and, behind all the others, their own mindset.

Stopping fee negotiation is one part of a larger choice about what kind of clinic you run. Many well-known clinics have no real appointments: patients wait for hours, then see a doctor who is rushing to the next case. Some doctors, and some patients, even read that crowding as proof the doctor is good.

Prof. Eleishi calls the alternative the Excellence Clinic model: an organized practice with real appointment times, enough time per patient and a clear system governing the relationship between patients, clinic and doctor. It is less common than the crowded model, but it exists. His own clinic runs on it. Doctors who want to build one usually stall at six obstacles. Some are mistaken beliefs; others are skills to learn.

On that sixth point, Prof. Eleishi contrasts the employee mindset that formal training produces with the founder mindset a clinic needs. It is not genetic; it is a way of thinking that can be learned.

• Moving to action. A founder studies, plans, then executes. The employee-minded doctor keeps studying, asking and waiting, and calls the fear caution.
• Investment versus expense. A founder sees systems, staff, training and marketing as investments. The employee-minded doctor sees money leaving and wants results before spending, which never happens, because results come only after investing in what produces them.
• Going first. A founder who has studied the risk can be among the first to act. The employee-minded doctor waits until twenty others have done it.

He sees the difference in the doctors who ask about his courses. One asks what transformation the course will deliver, weighs value against cost and decides. Another asks about the same course for months, looking for a discount or a free version through the medical syndicate. For the second doctor, even a free course will not fix the problem, because the thinking has to change before the tools can help.

The practical steps follow: understand society’s segments in detail, decide which patient you serve and design the clinic around them, price correctly (cost is only part of pricing), build your brand and positioning, reach the right patient, and build the right team and systems. Most of all, learn to run it as the owner of an institution, not only as the doctor who sees patients in it. We look at the same shift from the marketing side in why some doctors succeed at marketing and others don’t.

What should I ask myself when a patient haggles?

Not why the patient is bargaining, but what in your clinic made some patients believe the price was negotiable. You are not responsible for the economy or the culture that makes people cut costs. You are responsible for whether your clinic teaches, visit after visit, that the posted price is fixed or that pressure works.

It does not matter that the patient carries an iPhone or what they spent on something else yesterday. That is not your business. The question that belongs to you as a clinic owner is: what in my clinic made some patients believe the price is negotiable?

You are not responsible for the economic and cultural conditions that make people try to cut costs. You are responsible for whether your clinic teaches people that the posted price is fixed, or teaches them through experience that pressure can change it. Every time pressure works, you have taught the patient to push harder next time. When the system is fixed, respectful and clear, your patients learn over time that this is simply not up for discussion.

Watch the full videos

• Part 1: Why do some patients negotiate doctors’ fees? (15:43)
• Part 2: How to stop it (20:09)
• How to Build an Excellence Clinic: 6 obstacles doctors must overcome (20:49)

All three are in Egyptian Arabic and long enough to listen to on a drive.

Frequently asked questions