A disturbing enigma that has been a part of chiropractic practice since D.D. Palmer adjusted Harvey Lillard is how to get patients to return for maintenance care. Why should they? Because you said so… ha! Simply telling patients to return for maintenance care has never worked – and never will.
Though most people support the concept of prevention, wellness care, etc., few seek it out and even fewer are willing to pay for it. As doctors, it’s our responsibility to provide our patients with the healthcare they need, and this can only be accomplished if our patients understand and accept the importance of following recommended care, including maintenance visits.
Let’s consider a typical rationale as to why patients should return for care, recognizing that there are two different schools of thought in our profession:
1) the subluxation-based chiropractor; and 2) the neuromusculoskeletal-based chiropractor. The subluxation-based chiropractor usually attempts to convince patients they should return to “keep their subluxations reduced,” “maintain better health,” or “prevent future health problems from arising.” The neuromusculoskeletal-based chiropractor recommends maintenance care so patients can stay out of pain. Both these lines of reasoning make sense – but for the most part, they simply don’t work.
When patients feel better and are relieved of pain, they usually discontinue care and don’t return until the aspirin, ibuprofen, etc., stop working. In other words, patients typically don’t return for care until they are in substantial pain. No matter how often a doctor tells patients they should come in for maintenance care, very few patients will. On average, fewer than 10% of a chiropractor’s patients accept maintenance care. Unbelievable? Compare the number of active maintenance patients you are presently treating with the total number of patients you’ve seen since you started practice. Many of you will not even come close to the 10% average.
In order to increase your maintenance care numbers, consider the following:
- Practice a chiropractic technique that has corrections that can be measured and observed by patients, such as biophysics, Pettibon, Logan, scoliosis care, kinesiology, etc. Seeing is believing. Your maintenance-care recommendations will be most convincing when your patients can actually see what you’re talking about. If your patients can see their corrections, they will also be able to recognize a loss in correction, all of which supports and substantiates your explanation as to why they need to return for maintenance check-ups (e.g., “Come back in three months to make sure you have maintained the corrected curve in your neck.”)
By using the these, or similar chiropractic techniques and prescribing maintenance check-up visits in this manner, your patients will want to come back so they can see their correction has not slipped back, their scoliosis correction is still where you placed it, their muscles have kept their strength, their body balance has been maintained (by using bilateral weight scales), etc.
- Conduct weekly health-care classes. Present hands-on classes to teach your patients how chiropractic care works, i.e., “to decrease, eliminate and keep pain away,” or “to decrease, and prevent future subluxations,” etc. The more patients understand chiropractic’s “big picture,” the more they will come back for check-up visits.
- Send birthday cards to your patients with a coupon for a free maintenance check-up visit. This will encourage them to come in to make sure their chiropractic correction, subluxation correction, etc., has been maintained.
- Recall your former patients. Once a year, you or your staff should place a friendly, non-pressure telephone call to patients you have not seen for the past 12 months. You are calling to see how they are doing and to make sure their old symptoms have not returned, or that any new ones have developed. Obviously, if they are experiencing symptoms, it’s time to schedule them for a check-up or return visit.
- Present a series of educational classes that your patients would like to attend, even though they are not presently under active care. Popular topics include: self-care for neck problems, self-care for back problems, activities of daily living, osteoporosis, anti-aging, proper nutrition, weight loss, etc. Invite your present and former patients, and teach one of these classes every few months. Your former patients will attend these classes, and while they are there, many of them will decide to make an appointment.
Give your patients specific reasons to come back. Advise them to schedule maintenance check-up visits to:
- Determine if their intervertebral discs have deteriorated further. This requires a check-up every 12 months.
- Determine if their osteoporosis has worsened. Check for osteoporosis every 12 months.
- Determine if their urine and blood chemistries are still normal. Blood and urine chemistries should be checked every six to 12 months.
- Determine if a previously corrected health problem has re-occurred. A check-up every 12 months is usually sufficient for this purpose.
- Perform a nutrition evaluation to determine if their nutritional regimen needs to be altered. Nutritional evaluations are usually performed every four to six months.
- Determine if their calcium balance remains healthy. This analysis is appropriately done every six to 12 months.
- Determine if their permanent impairment has worsened, thus creating a need for additional care. Impairments should be evaluated every six months for the first 18 months, and once every 12 months thereafter.
- Determine whether their orthotics need replacing. Replacement is usually needed every six months, so this type of check-up should be scheduled at six-month intervals.
- Determine if the foam rubber in their cervical pillow is still adequate. With usage, the foam rubber in a cervical pillow compresses until the pillow is no longer beneficial. Replacement is usually needed every six months, so this type of check-up should be scheduled at that frequency.
- Determine if their foot orthotics need to be updated. Updating foot orthotics necessitates a once-a-year check-up or appointment.
- Determine if the corrective exercise program you placed them on is still working to strengthen those specific muscles you have targeted. Check on your patients’ exercise technique every two months for the first year, and every six months thereafter.
- Determine if their maximum range-of-motion has been maintained. You should check a patient’s range-of-motion every two months for the first year, and every six months thereafter.
By giving your patients these logical and specific reasons to return for maintenance check-ups, you are eliminating the “why” that keeps most from following recommended maintenance care. Instead of asking themselves, “Why should I go to my chiropractor when I’m no longer in pain, or when I feel okay?”, your patients will want to come in for check-ups to find out how well they are maintaining your corrections, and to detect any digression before it’s allowed to become a more serious health problem.
However, in order to reach the highest level of patient understanding and acceptance, you must give your patients repeated reminders of the reason for their check-up visits.
If you would like to further increase your number of kept maintenance visits, the following procedures are recommended:
- In your report-of-findings, describe the maintenance check-up visits the patient will need to make. For example, tell the patient: “I’ll need to check your blood chemistry (scoliosis correction, etc.) six months after you are dismissed from care to make sure your blood factors remain normal (your scoliosis remains straightened). Your blood problem (scoliosis correction) will have a tendency to return with time, and we don’t want that to happen. I don’t want you to go through this health problem again (have this scoliosis return to where it was) if we can prevent it.”
- At the same time, give the patient a written explanation of why it is necessary and wise to check that particular function/product.
- At the end of your patients’ active care, have them place their home address and the date of their first scheduled maintenance visit on a specially printed “reminder postcard” that pertains specifically to each patient’s health problem/product, etc. On the reverse side of this postcard, there should be a written explanation as to why the check-up visit is necessary and important to the patient’s specific health problem. Have your staff place the reminder postcard in a “tickler file” to be mailed to the patients five days before the scheduled maintenance appointment. Then, one day before the patient’s scheduled maintenance appointment, a CA should call to remind the patient of the maintenance appointment and why it’s necessary. It is very important for the CA to once again explain why the check-up is needed, and not just remind the patient of the date and time of the appointment.
When patients come in for their maintenance check-up visits, 70% will reactivate themselves: to make sure their subluxations stay reduced; to receive tune-up care for a painful condition; to return their spine to its pre-dismissal condition; to fix blood and urine problems, etc.
Once your former patients are back in your office, it should be simple to convert them to maintenance visits. “Hype,” “insistence,” “sale jobs,” etc., may work in the retail market, but they don’t work in healthcare – never have, never will. However, if you give your patients sound, logical reasons to come back, they will.