Once your patient has made it through the first two or three visits and has committed to a care program, the next several visits are critical. Generally, the risk of patient drop-out is greatest during the next five to six visits. A team with a solid plan will be able to help the patient through the next level of care.
Of course, if your patient has committed to a care plan, made multiple appointments, and possibly even paid a certain amount in advance, you will have a more committed patient. There are still two situations you and your team must be on the lookout for. The first is when the patient begins feeling better, and the second is if the patient begins feeling worse. In either of these two scenarios, the risk of patient drop-out can be quite high, and only the most perceptive team will be able to see it coming.
Your team must be able to recognize the clues. If a patient begins feeling better, he may be wondering why he has to continue with the program. Even if you have done a thorough report of findings (ROF) and you adequately educated the patient on alleviating symptoms vs. correction, when the patient begins feeling better, his commitment may weaken.
Your team will usually be the first to know, since the patient may make telltale comments such as, “I’m feeling so much better, I’m not sure why I’m coming in so often,” or, “I won’t be in for my appointment today, I’m feeling much better. My next appointment is Friday, I’ll see you then.”
Your team must be equipped with the communication tools to handle this situation. A script for this scenario should be agreed upon and practiced so your chiropractic assistants are comfortable. The script should go something like this: “Mr. Miller, Dr. Johnson will be delighted that you’re feeling better; it sounds like your adjustments are beginning to work. Your care has just begun, however, and I do not have the authority to change your care plan. Symptoms are usually the last to come and the first to go, and you certainly won’t want to lose your forward progress. If you can’t come in today, we do ask that you make up the visit before the end of the week. Can you come in the same time tomorrow?”
If the patient is not agreeable, your staff needs to communicate that to you. It is very important to take the patient’s care plan seriously. If the staff bends too easily and cancels appointments at will, it sends a negative message to the patient about the importance of following your care plan.
The second big reason for patient drop-out is when patients aren’t getting better or when they feel they’re getting worse. Patients often will direct their frustration and disillusionment to the staff instead of the doctor. They feel more comfortable addressing the staff, and they don’t want the doctor to know they are getting discouraged.
Your staff must be comfortable in answering the following questions and statements from patients:
- “How long does it take to begin feeling better?”
- “I was feeling fine yesterday, but today I am much worse.”
- “I am actually worse now then when I first came in.”
- “I came in for low back pain and now I am having pain in my upper back.”
- “Why do I have to come back so often? Can’t I just come once a week?”
When a staff member gets the feeling a patient is becoming discouraged, there must be communication with the doctor, and the information should be noted in the patient’s file. A good system of communication between the staff and the doctor is crucial in bringing the patient through the phases of chiropractic care, along the path to wellness.
The important thing to remember is that not all patients will show immediate improvement, and that expectation should not be passed along to the patient. Too often, unrealistic expectations are passed on to patients. Questions like, “Are you feeling better?” or “How are you feeling today?” give the patient the idea that you or your staff are expecting immediate improvement.
More realistically, patients should be expected to progress gradually, especially the patients who have had a chronic condition over a longer period of time. Body language, facial expressions, and specific scripts to encourage patients along the road to recovery will help the patient understand that chiropractic care is a process of slow improvement with applied patient involvement.
If a patient does get immediate results, your reaction should be one of cautious optimism, letting the patient know there may be setbacks along the way.
Pre-framing the patient about what to expect along the road to recovery will help her deal with the possibility of a more difficult recovery. When you are able to give your patients a more realistic approach to their care, they will be more apt to follow through with care and not get discouraged.
Cautious optimism is a far better approach to bringing patients through all stages of chiropractic care and ultimately making them wellness patients.