When I first graduated from chiropractic college, I thought the DCs who were “making it” were the ones who could sell. High-pressure scripts, big treatment plans and packed schedules seemed to be the standard.
But I had an aversion to all of that. It didn’t feel authentic, and the thought of selling people on care they might not need rubbed me the wrong way.
In my effort to be the opposite of scripted and sales-driven, I leaned too far the other way. I overloaded patients with information, gave them too many self-management strategies and left them thinking they didn’t really need me. Patients who truly did need a treatment plan would often ghost me after two or three visits. It was frustrating. I knew I could help them, I understood their case — but for some reason, I hadn’t earned their trust.
That frustration cut deep. I found myself comparing my numbers to those of high-volume practices and wondering what I was doing wrong. Sometimes I felt misunderstood, and at other times I questioned my confidence. Eventually, I had to accept something important: I was playing a different game. I wasn’t trying to be the busiest DC in town. I was trying to deliver a different level of care.
That realization led me to transition from an insurance-driven, volume-based model to a time-based model, allowing me to be more present with my patients.
What drives you?
Another shift came when I reframed what I was really chasing. Initially, I wanted to be successful—and by “success,” I meant numbers, reputation and income. Over time, I realized what I really wanted was to be significant. Success was about serving myself; significance was about serving others. Ironically, when I started focusing on significance, the “success” followed: patients stuck with care longer, patient compliance was better, referrals increased and people left more reviews.
Communication is key for patient compliance
Through trial and error and extensive reading on motivational interviewing, I learned that effective communication is everything. Patients don’t need a lecture; they need a conversation. They don’t need to be sold to; they need to feel understood. Motivational interviewing taught me to listen with curiosity, acknowledge ambivalence without judgment and invite patients to be active participants in their own recovery.
Take the pressure off
A few strategies in particular changed the way I practice. One is what I call a “trial of care.” Early on, I felt pressure to have every answer on day one. If I couldn’t map out the perfect plan right away, I worried the patient would lose confidence. Now I explain, “Let’s try this approach for a few sessions and see how your body responds. If we’re not making progress, we’ll pivot.” Patients instantly relax. They no longer feel trapped in a rigid plan, and I no longer feel like I have to play fortune-teller.
Be realistic
Another shift came with how I frame chronic conditions. I once had a patient with degenerative disc disease who kept asking, “When will this be fixed?” In the past, I might have offered a vague reassurance. Today I’m more direct: “This isn’t something we can ‘fix,’ but it can be managed. Some patients do best weekly, others space care out every month or so. We’ll figure out what works for you.” Instead of disappointment, I usually get gratitude. Realistic expectations build trust faster than false promises.
Make sure patients understand
I also learned to confirm patient understanding instead of assuming it. In the past, I thought explaining the plan once was enough, but when patients dropped off, I realized my words weren’t sticking. Now I’ll say, “Just so I know we’re on the same page, can you explain back what the plan looks like?” When patients restate the plan in their own words, they’re far more likely to follow through.
Do a video demonstration
Another small but powerful change was in how I teach self-care. Instead of handing out generic exercise sheets, I’ll have patients record me on their own phone while I demonstrate the stretch or movement we practiced together. It only takes a minute, but they re-watch those clips at home, and the follow-through is much higher. More importantly, it builds trust and likability. Patients see me as a partner invested in their progress, not just a provider giving instructions.
Follow up
Finally, I make it a priority to follow up outside the office. A quick text or short video, sometimes about tendon health, sometimes just a reminder of what we practiced, helps patients feel cared for. Increasing patient compliance, more importantly, it keeps the conversation alive even when they’re not on my table.
Final thoughts on patient compliance
I still lose patients from time to time, but I no longer take each one personally. People drop off care for many reasons: lack of money, too little time or simply being in a different stage of readiness to change. My role is to meet them where they are, give them clarity and build trust. When patients feel understood and empowered, their compliance isn’t forced. It flows naturally.
Jeffrey O’Guin, DC, is a practicing doctor of chiropractic and clinic director in Kirkwood, Missouri, where he has provided chiropractic care since 2008. He offers a wide range of services, including spinal manipulation, soft tissue therapy and functional rehabilitation. O’Guin has taught advanced biomechanics, rehabilitation and myofascial techniques at Logan University and regularly lectures through the Missouri Chiropractic Physicians Association. Drawing from experience as a US Marine and his own injury recovery, he integrates strength training, soft tissue therapies and functional movement to help patients live stronger, more resilient lives. Learn more at chiropractorkirkwood.com.
