Some Weeks There Are No Bookings

Private practice runs hot and cold, and the temperature changes faster than I expected.

Some weeks the calendar fills up. Referrals come in from providers who see the value in what I offer, someone shares a post, and Swan Health Genetics starts to feel like a practice instead of a plan. I catch myself thinking the hard part is behind me. Then a few weeks later, crickets. Nobody books. The emails I send to potential referral sources go nowhere, and calls don't get returned. Patients no-show without ever saying why.

I send a survey after every appointment and almost nobody fills it out. So I'm left wondering: did they get what they came for? What could have gone better? What was actually useful?

Then there's the noise. Everyone is certain AI is about to replace us, which makes a slow week feel like evidence. And there's a recurring claim that private providers in the hEDS space are taking advantage of patients who have run out of options, that genetics has nothing to offer hypermobile patients, and that ordering testing for these patients makes a provider part of the problem. (I've already written about why hEDS and HSD patients belong in genetics in a separate post.)

A few quiet weeks alongside that kind of criticism will make anyone question their motives. Why did I start Swan Health Genetics? Does the reason still hold?

And then there are the other weeks. A patient and her mother thank me for my time, because nobody had ever given her ninety uninterrupted minutes to walk through her full medical history. A provider tells me she's been looking for somewhere to send her patients and had no idea where. A mother books an intro call about her teenage son. I tell her I don't see pediatric patients, but we talk for a few minutes anyway, and she hangs up appreciative and with a clearer sense of what to do next.

Both sides tend to show up in the same week, sometimes in the same afternoon.

What I try to remember in those moments is why Swan Health Genetics exists in the first place. hEDS and HSD patients rarely get in front of a genetics provider. Their doctors refer them. Genetics clinics, buried in referrals and with no test to offer for hEDS, turn them away. I wanted to see whether a practice built around these patients could work, and I still don't have the answer.

I also remind myself that nobody assigned me this practice. If the work stops being interesting or worthwhile, I can stop, or step back, or build something different.

So I go day by day, frustration and all. Next week I'm heading to Sea Ranch, my favorite place in the world to decompress. An empty calendar makes getting away easy.