Q: Dr. M I have one patient who is on disability, has agoraphobia and anxiety and needs but can't afford care, so she comes to help with paper work at lunch time or at closing. I know I'm still training her and even tho she's pretty good with the computer she's too dependent, like a child. She's not dependable because she requires the family to ride with her to prevent a panic attack. While I appreciate her help, I can't get anything else done while listening to her complain about her aches and pains (including her husband and 22 year old live in son) and all her drugs. And she reeks of smoke, tho she smokes out back. I'm considering letting her go but I know she won't continue care if she can't return the favor somehow. Any advice on how to take control of the situation without offending her? A: Chapter Four in my Smart Start Book concerns hiring a CA .. I'm not sure of the exact words I used .. but the message is clear .. don't make a CA out of a patient who needs your emotional assistance besides the adjsutments .. just have them be a patient and never be too chummy. Trust me .. you will and possibly are falling into a few bad traps .. bartering has to be kept at a limit .. especially in a small town. Word gets around that you are an easy target with a big heart .. but this doesn't pay the rent .. student loans .. grocery bills nor taxes. Everything in moderation. Another point .. a person such as you describe .. also talks to others .. these folks are grateful today but screw you later .. I am not being cynical just sharing my thoughts. Be delicate with this woman .. she already has emotional problems but as you are finding already .. her burdens should be set aside for special private times not during office hours. Just tell her that you want to create another project and therefore she is no longer needed. Her care is important and if she wishes to continue she can at a fee she can afford. Believe me .. she has gross subluxations .. many from the neck up .. and will be dependent on you for your kindness as well as your adjustments. You'll learn soon that decisions are made early to determine if you wish to be a minister or a chiropractor .. at this stage of your office life being a minister just adds to the burdens and stress. Have a Great Day Dr. M