Saying no to a new client is not always easy.
It is even harder when the client has come through a recommendation, when money has already changed hands, or when the collaboration has actually started well.
Over the years, however, I have learned something that matters much more than closing every deal: not every client is the right client.
In medical marketing in particular, trust is not an optional extra. You are handling a doctor’s professional reputation, their website, their social media presence and, very often, the first impression a prospective patient will have of them.
That requires a shared understanding of how the work should be done.
Here are three occasions when I decided that continuing a collaboration with a doctor would have been the wrong choice.
1. When a ten-day website suddenly became a six-month project
The first doctor came to me through another doctor I had worked with for many years.
That naturally created an initial level of trust.
We discussed a very straightforward project: a small website consisting of four short pages. Nothing technically complicated, nothing unusually demanding. It was the kind of website I could realistically have completed within around ten days.
The proposal itself had been shared with me through a ChatGPT link, so I could review the project we had discussed and agreed upon.
The doctor paid the deposit.
Shortly afterwards, I went back to the link and discovered that I no longer had access to it.
Instead, I was sent a new link.
I opened it expecting to find the project we had agreed on.
I didn’t.
What I found was an entirely different project.
The simple four-page website had been replaced, without any prior discussion with me, by a proposal for a far more complex digital platform. It involved functionality, workflows and technical requirements that would realistically have required months of development and a very substantial budget.
This was not scope creep in the usual sense of a client asking for an extra page or an additional feature.
It was not even a revised version of the same project.
It was a different project altogether — and the change had been made after we had reached an agreement and the deposit had been paid.
That distinction mattered to me.
There had been warning signs before that. Calls outside normal working hours. Repeated phone calls over a very short period. Conversations that regularly began with a joking acknowledgement that he was being persistent, as though recognising the behaviour somehow cancelled it out.
I had noticed those things, but I was willing to give the collaboration a chance.
Changing the project immediately after paying the deposit was different.
A professional agreement only works if both sides are discussing the same job.
I returned the deposit and ended the collaboration.
There was another uncomfortable element: because the introduction had come from a long-standing client of mine, the situation also placed that person in an awkward position.
It reminded me of something else I now consider important.
A referral is an introduction. It is not a guarantee of compatibility.
Someone can be an excellent colleague, friend or doctor and still be the wrong person for you to work with.
2. The doctor with 16,000 followers and almost no engagement
The second doctor also came through a personal recommendation.
I was told he was a very nice person and that I should speak to him about his online presence.
During our first phone call, he mentioned that he already had an Instagram account.
“And I have 16,000 followers,” he told me.
My first thought was fairly obvious: if you already have a genuine audience of 16,000 people, what exactly do you need me for?
I searched for the account but could not find it easily, so I asked him for the exact username.
I opened the profile.
Sixteen thousand followers.
Two likes on one post.
Three on another.
Almost immediately, I asked whether followers had been purchased.
“Yes,” he said, “we bought a few.”
They were not a few.
The numbers and the engagement told a very different story.
The Instagram account was only the beginning.
He also told me about his website.
According to him, it contained around 1,600 articles because every now and then he would become inspired and write extensively.
There was one problem: the website barely appeared in Google.
I asked whether I could access the backend to investigate what was happening.
He did not want to provide access.
I asked whether he would provide it if we eventually worked together.
Again, the answer was no.
That made me curious.
After the call, I started looking more carefully at the public-facing website.
The apparent 1,600 articles were not 1,600 original articles.
What I found was a relatively small collection of repeated texts combined systematically with a relatively small collection of unrelated images, creating hundreds upon hundreds of near-duplicate pages.
The images were sometimes completely disconnected from the medical subject matter: flowers, landscapes, hearts and other generic imagery.
Then I checked the backlink profile.
Thousands of links were pointing to the site from low-quality, spam-like websites.
At that point, the picture was fairly clear.
The problem was not that the doctor had made bad marketing decisions.
Bad marketing decisions can be fixed.
People buy followers because someone gives them bad advice. People hire the wrong SEO provider. Websites get damaged. Domains accumulate toxic links. Companies make mistakes.
If someone came to me and said, “I made a mess of this. I need help rebuilding it properly,” I would have no problem working with them.
The difficulty here was different.
He appeared to know far more about the situation than he had initially acknowledged, while at the same time refusing access to the very systems I would need in order to assess or repair it.
You cannot build a successful professional relationship without transparency.
A bad digital history can be repaired.
A lack of trust is much harder to fix.
I declined the collaboration.
3. When hundreds of likes suddenly appeared overnight
The third story began very differently.
There were no obvious warning signs.
I had initially contacted the doctor about a website because I had found his professional details in a medical directory and assumed he did not have one.
He replied immediately and told me that he already had a website.
So we discussed social media instead.
We started working together.
The first month went extremely well.
Then, one day, while I was out walking, notifications started appearing on my phone.
A post had received another hundred likes.
Then another hundred.
Then two hundred more.
The number was climbing incredibly quickly.
My first reaction was not to suspect the doctor.
I thought I had made a mistake.
Had I entered the wrong advertising budget?
Had I accidentally changed something in the campaign?
I checked.
The advertising settings were fine.
Then I looked more closely at the likes.
They were clearly not the result of the campaign I was running.
So I called him.
I explained what I was seeing and asked what had happened.
He laughed.
“We have a lot of friends who love us,” he said.
At that point, I understood.
The likes had been purchased.
And not just on one post.
The goal seemed to be to inflate the visible engagement across his content so that his profile appeared far more popular than it actually was.
I told him very clearly that this should not happen again.
Buying engagement undermines the work of someone who is trying to build an audience properly. It distorts the data. It makes campaign performance harder to evaluate. It damages credibility and can create problems for the account itself.
More importantly, I believed it was ethically wrong.
He laughed it off.
A few hours later, I sent an email ending our collaboration.
That decision was probably the easiest of the three.
Because we were not simply using different marketing tactics.
We had fundamentally different ideas about what marketing was for.
I was trying to build genuine reach, genuine engagement and a professional presence over time.
He wanted the appearance of popularity immediately.
There is an important difference between the two.
Five hundred likes do not mean five hundred patients.
Sixteen thousand followers do not make someone influential.
A website with 1,600 URLs does not automatically have authority.
Thousands of backlinks do not automatically produce good SEO.
Numbers are useful only when they represent something real.
Choosing your clients is part of the job
In all three cases, I could have chosen differently.
I could have accepted the larger website project and tried to negotiate my way through it.
I could have taken on the second doctor’s accounts and attempted to repair years of questionable digital practices without full transparency.
I could have ignored the purchased likes and continued sending an invoice every month.
Financially, those choices might have made sense in the short term.
Professionally, they did not.
I do not expect clients to understand every aspect of digital marketing. That is why they hire someone.
I do not expect them never to have made mistakes.
And I certainly do not expect every collaboration to be effortless.
What I do need is honesty, respect for the agreed scope of work and a basic alignment on how we want to achieve the result.
The longer I work in this field, the less interested I am in taking on every possible client.
The right collaboration is not simply one in which someone is willing to pay you.
It is one in which both sides trust each other enough to do good work.
And sometimes, one of the most professional things you can say is simply:
No.