July 2002

Timing Is Everything
A Patient-Centered Approach to Helping Your Patients
By William D. Esteb

Ever encounter an overly aggressive, converted religious zealot? Or a rabid multi-level marketing disciple? Blinded by their enthusiasm, they often push others away with their fanatical rantings and rabid style. Using language meaningful only to them - consecration, redemption, downline, going direct, leverage, etc. - they can’t see how off-putting their approach is.

Not unlike some chiropractors on a new patient’s first visit. An unfair comparison? Consider the countless chiropractors who do most of the talking at the so-called “consultation,” immediately using language like nerve interference, subluxation, homeostasis, and urge a year’s worth of care on the first visit! Like the religious fanatic or MLM cultist, what these chiropractors are really revealing is that chiropractic is about them, not the patient.

Here’s a more patient-centered approach, based on the idea that the intent of practice is to help patients with their presenting complaint(s), using the opportunity to change their beliefs and inspire healthier patient behaviors.

The Purpose of the First Visit
Anxious to “prove” chiropractic or to validate their subsequent recommendations, some chiropractors rush in too quickly with the patient education process. They may sabotage the opportunity for a long-term relationship by adjusting patients on the first visit. The downside of this symptom- treating approach overshadows any upside that might be rationalized by a chiropractor anxious to be liked or accepted.

Offering treatment on the first visit is often justified by the weak argument that patients expect some form of therapeutics on their first visit. Combine this medically trained expectation with the neurological implications and cellular compromise of uncorrected subluxation, with a misplaced dose of so-called compassion, and you have a formula for the pain-relief-only relationships many chiropractors experience these days. (Never mind most patients wait weeks before making their first appointment!)

With the intent of creating lasting, long-term relationships there are four major objectives of the first visit:
1. Begin a relationship. This means anticipating patient fears and apprehensions. Volunteer information about yourself. Conduct an office tour. Outline the boundaries of the relationship. Explain the financial ramifications of beginning care. Review the first visit procedures, their purpose, and how long they will take. In short, attend to the patient’s emotional and academic needs.

2. Listen to the patient’s story. This means asking questions, and more importantly, listening. “So tell me, what do you think your problem is?” “What other methods have you tried in an attempt to solve this problem?” “What have you heard about chiropractic?” “Why do you think chiropractic can help you?” “How long do you think you’ve had this problem?” “How long do you think it will take to correct it?”

Asking these and similar questions creates an opportunity for your patients to reveal their understanding, their likes and dislikes, and what they’re looking for in a doctor/patient relationship.

3. Gather information. Not only does this mean obtaining a case history and conducting your usual examination procedures to determine if a patient is a chiropractic case, it means uncovering the “softer side” as well. Find out what motivates your new patients. Why do they want their health back? How has their lack of health interfered with their life? What would it take for them to feel comfortable telling others about your practice?

4. Offer hope. Reassure patients they are in the right place. Let them know you have helped others with similar health problems (if you have). Offer encouragement, support, and collaboration. Observe that they have every reason to remain optimistic and hopeful.

Even more important than what’s included above is what has been left out! Notice “patient education” isn't listed, and neither are nerve interference, innate intelligence, the superiority of your adjusting technique, your educational achievements, or the phases of subluxation degeneration. The first visit is about the patient!

Notice that the first visit is as much emotional as it is clinical. Yes, there is a history to obtain and an examination to conduct, but not at the expense of the patient’s feelings and perceptions. Attend to the patient’s emotional needs and you’re automatically credible, competent, and to be trusted.

Create an information-rich environment so patients can help themselves to brochures and hand-outs. Send each new patient home with a “care package” that explains chiropractic and answers questions that they or their friends/family may have about chiropractic.

The Purpose of the Second Visit
Most patients with whom you’ve demonstrated your sincere interest and compassion will return. Now it’s your turn. Having honored your patients by listening to their stories, you have earned the right to tell your (chiropractic) story.

I’m a big proponent of using video to quickly and consistently communicate key chiropractic concepts. This helps avoid some of the repetitive nature of patient explanations while freeing the doctor and staff to attend to other matters.

Here are the four major purposes of the second visit:
1. Tell your story. What business are you in? What is your intent when you accept a new patient? How will you measure progress? At your report of findings (ROF), outline a model of health and healing congruent with your beliefs, experience and intentions. Help each patient see the distinction between the medical model they are probably familiar with, and the chiropractic approach you offer. No need to slam medicine, though. Simply explain the chiropractic premise.

2. Make exam findings meaningful. The fact is, you can report your findings in about 30 seconds or less. The more difficult and valuable objective at your ROF is to make your findings meaningful to each patient.

You need to pose questions/statements such as: “When I see a lack of cervical curve, what do you think that means?” “When I see the beginnings of a bone spur, what do you suppose that means?” “When we observed that you couldn’t turn your head to the right as far as you should, what does that tell us?” Rather than lecture, ask questions. Send each patient home with the documentation to recreate your explanation to others.

3. Offer choices. Presented with the fact that you believe a patient is a good candidate for chiropractic care and you’re willing to accept him or her in your office, there are several choices for the patient. Demonstrate your confidence and objectivity by reminding patients they need to make some decisions: They can begin care in your office, they can seek a second or third opinion, or they can choose drugs or surgery, and if they do, you’ll need to refer them to a different practitioner.

4. Deliver the first adjustment. Use the first adjustment to explain the workings of your table. If you have drop pieces, allow the patient to test them. If you use an instrument, demonstrate it on your own finger and then theirs. Take it slow and easy, especially if this is the patient’s first exposure to chiropractic. Make sure patients understand the importance of repetitive visits and afterwards, what they can expect to feel after their first adjustment. Finally, be sure to explain that future visits will go more quickly because the patient is buying your talent, not your time.

The report portion of the second visit should take only 10-12 minutes or so. Longer, and you’re probably doing too much talking (unless the patient is asking lots of questions). Shorter, and you risk minimizing chiropractic or beginning a relationship in which the patient isn’t fully invested.

Regular Visit Opportunities
After the first visit or two, some offices run the risk of turning regular patient visits into a hum-drum routine, for themselves and their patients. Yes, there are adjustments to deliver and documentation to perform, but what can you do to enlarge each patient’s understanding and make each visit enjoyable?

Here are a couple of ideas. (Remember, some patients will remain lukewarm regardless of what you do. So have fun, anyway!):
• Ambiguous statements. Install a dry erasable white board and write ambiguous statements on it - statements that will pique patients’ interest and prompt them ask you for clarification (see related sidebar article, page 32).

• Ask questions. Discover how your patients think about health matters by “taking a poll” or asking them their “theory” about everything from what they think causes cancer to what they think of the “germ theory.”

• Compliment patients. Pick a day each month to find something to raise the esteem of every patient you see: “You look so good in blue.” “I love what you’ve done with your hair.” “We appreciate you always being on time.” Make it genuine!

• Thought for the day. Ask your patients: “Did you read our thought for the day at the front desk?” Train patients to read your health tip, wellness suggestion, or “factoid.” It’s not a test! Plant ideas that give you something else to talk about instead of the weather and sports scores.

• Bulletin board. Your bulletin board can be your “office refrigerator.” Just as your magnet-covered refrigerator at home serves as a communication center for your family, update your office bulletin board frequently with photos, short articles, cartoons, and research updates. Twice a year isn’t often enough!

• Rotate posters. Move your posters and wall charts to new walls each month to help patients notice them. Retire a few. Add some new ones. Framed behind glass, use a dry erase marker to annotate them with comments or questions.

The fact is, you’re in the relationship-building business first, and the chiropractic business second. Practices that enjoy the emotional satisfaction and financial rewards of stable, long-term patient relationships recognize this.

Their strategy is to release, not control. Educate, not merely teach. Honor, rather than just serve. The happy result is a practice that is fun and fulfilling for patients, doctor, and staff.

Mr. Esteb has been a chiropractic advocate and patient for more than 20 years and provides patient-centered communication tools for the chiropractic profession through Patient Media, Inc. He can be contacted at bill@patientmedia.com; by calling 800-486-2337; or sign on to www.patientmedia.com