Issue 3 - March 2005

Keep your patients’ passion alive
by William D. Esteb

Having a cash-based wellness center offers low stress and stability. But it comes with an obstacle: This type of practice rarely offers the gratification of dramatic symptomatic improvement.

The results that patients experience at the beginning of their care are replaced with progress so incremental as to be often imperceptible.

Lacking these affirming changes, both the chiropractor and the patient can easily lose interest as progress becomes more subtle. Visits run on autopilot:

“On your back.

“Now, face down.

“Turn your head to the right.

“Deep breath in.

“And exhale…

“Okay, and this side up.”

Patients can practically predict each request.

If your practice degenerates to taking patients for granted, drop out is around the corner. If you want to keep things fresh on the 25th or 250th visit you’ll require creativity and resourcefulness that are unnecessary when patients (and chiropractors!) are seeing obvious progress.

Most practitioners think they have a new “patient-getting” problem, but it’s usually a “patient-keeping” problem. Here are some suggestions to help you get off the new-patient treadmill and inspire longer relationships:

1. Stop, look and listen. Before doing anything new, discontinue policies and procedures that may actually serve to prevent patient relationships from blossoming long-term, such as accepting insurance assignments, adjusting on the first visit and focusing on the skeleton instead of the nervous system.

Insurance assignments. The notion that you can successfully convert a patient to paying cash when they exhaust the benefits of their policy and are feeling better is delusional.

Not prepared to go that far? No problem. At least now you know why patient visit averages in the high double digits seem out of reach.

Second visit adjusting. To make sure patients attach the proper meaning and majesty to the chiropractic adjustment, practices with lasting patient relationships don’t adjust on the first visit.

Sure, they lose a few patients who demand an immediate chiropractic aspirin. However, this creates openings for patients more likely to see chiropractic care as a way of life, rather than a short-term intervention for episodes of back and neck pain.

Nerves rather than bones. These practices make sure patients understand chiropractic is about the integrity of the nervous system, not the skeletal system. They frame all explanations in terms of nerves, function, performance and vitality.

2. Explain third-party motives. Countless patients come into a chiropractic office waving the identification card issued by their carrier, figuring it will cover all the care they’ll need. This places you, or a staff member, in the unenviable position of breaking the bad news that insurance doesn’t cover everything.

If you thought patient education was challenging, you may find the new realm of financial patient education even more wearisome. It’s essential that patients understand that insurance carriers are motivated by stockholder profits, not the health of their policyholders!

This reality runs counter to the soft-focus television commercials and the enrollment brochures extolling prevention and wellness. Be sure to warn such patients the danger of using their limited coverage as a guide for how much care they’ll need.

3. Ask better questions. Initially, patients are motivated by how they feel. As they improve, engage their intellect to keep them motivated. Otherwise, post-symptomatic care is unlikely.

Don’t squander a single visit yakking about the weather or sports scores. Instead, ask questions that could serve to enlarge their understanding.

In a light, airy, “I’m-just-taking-an-informal-poll-today” tone of voice,” ask questions that assess their ability to understand the implications of chiropractic care, such as:

• “Why would the vaccinated be afraid of the unvaccinated?”

• “What’s the difference between a good drug and a bad drug?”

• “How do you explain that some people are allergic to pollen and others aren’t?”

• “Why do certain foods cause heartburn for some people, but not others?”

• “Why do some drugs require a prescription, but others do not?”

Sure, some patients won’t want to participate in your Socratic exchange, but by asking questions you make visits more interesting and intellectually stimulating.

4. Create pattern interruptions. One way to make routine office visits more interesting is to change your office environment regularly. (Even you no longer see that wall chart you’ve painted around twice!) Some suggestions:

• Insert appointment book reminders to rotate your posters and make changes to your bulletin board.

• Bring in a worn tire with exposed cord and lean it up against a wall to stimulate questions (the effects of poor alignment).

• Similarly, put an old 10-12 pound bowling ball in a corner of your office. Ask patients to pick it up. Use the occasion to make sure they know how to lift properly. Then, have them hold the bowling ball out at arms length to demonstrate the muscle fatigue of a forward-leaning head.

Involve patients! Make sure you always have something new or different going on in your office.

5. Stimulate more conversations. Write ambiguous statements on a dry erasable white board to coax patients to ask for clarification. Use their request as an opportunity to offer a brief explor-ation of a chiropractic principle.

6. Use more accurate language. If you want more people staying for prevention and wellness after their symptoms resolve, what are you going to call them? After all, the word “patient” comes from the Latin word meaning “to suffer.” Those who continue beyond relief care are rarely suffering like a new patient.

Since language creates our reality, use a term that implies something beyond mere symptom relief in your office. Some offices use the term “practice member” or “client” to describe these non-suffering individuals.

Then, have a graduation ceremony marking the transition from being a patient to becoming this new identifier. Create a ceremony — a rite of passage — that marks the conclusion of their relief care, transitioning them into the post-symptomatic aspects of their care.

The ceremony? For starters, consider taking a photograph of you shaking their hand at the front desk that you can post on your “Wall of Fame” bulletin board of similar graduates.

7. Conduct regular progress exams. Use 12-visit intervals to remind every person what they originally presented with, what’s better, what remains to be done and to give them a plan to advance in the journey to optimum health.

If patients have plateaued, suggest ways they can complement their chiropractic care to create new, higher levels of health and wellness.

Offices with high patient visit averages not only keep patients longer, they avoid the uncertainty that comes from depending on the largess of third parties. They enjoy the affirming, soul-satisfying result of long-term patient relationships. They’re keenly aware that patient relationships can go stale, resulting in patient “divorce,” just as a marriage can when one partner grows apart or takes the other for granted.

William Esteb is the creative director of Patient Media, a patient communication resource for the chiropractic professional. Review his tools (including “talking points”) and subscribe to Monday Morning Motivation, his free weekly e-mailed patient communication tip at www.patientmedia.com.