The Problem With Mall Shows

by William D. Esteb

Many who profess to have the skills to help unlock the potential of private chiropractic practice seem to overlook a critical ingredient; the patient. For a profession that professes to look to the cause rather than to the treat symptoms, all too many of those rendering advice are overlooking the cause of many types of practice growth barriers. Putting an overemphasis on procedures, scripts, forms and even the doctor's "headspace" ignores half of the success equation: the patient.

All too many management specialists either enjoyed their practice success at a different time in chiropractic (and with a different type of patient than today's image-conscious baby boom generation), or have such potent personalities that many of their suggested procedures are incongruent with those of their typical client's. Focusing on the more visible and easily implemented internal tasks and paperwork is like medical researchers who study some narrow aspect of disease or physiology and ignore its interaction with the rest of the body. One day we hear coffee is bad, the next that it seems okay. Then it's bad. Then it's actually beneficial! Then it starts all over with decaffeinated coffee.

Any speaker, actor or artist will tell you the audience is an important part of the performance. Ignoring the audience (patients) is a recipe for failure or risking the perception of indifference by the very people who write the doctor's paycheck. Relevance and sensitivity to the audience is critical.

That's why most chiropractic advertising is a waste of money.

What do you think of lawyers who advertise? Do they seem like ambulance chasers? Does it lower your respect for them? Does it make you wonder why they have to advertise? Same with chiropractic.

Using advertising and other outside-in artificial stimulants to attract warm bodies with spines is treating a symptom. Why don't current patients refer others? Why don't current patients continue with the same form of maintenance care that you enjoy, decreasing your need for more new patients? These questions get to the fundamental cause of a voracious appetite for new patients. The answers may not be pretty, but the truth should offer a practical game plan for the future.

"I'm either going to become a mall-show-new-patient whore or get an AK-47 and go berserk," said a doctor with quiet resolve on the phone the other day. Apparently he had just finished up with a consultant who had recommended an aggressive advertising program. In desperation he called to pick my brain.

"I'm just too good," he observed, revealing as much pride as frustration. "Patients come in here and they're feeling better in a couple of visits. It seems I get 'em well too fast and I have to keep looking for more new patients. So, what's the best type of handout for a mall show?" he asked, apparently not realizing he had abruptly changed the subject.

"Slow down," I interrupted. "One thing at a time. How often do you get adjusted," I asked

"About once or twice a month," he answered cautiously.

"How come?"

"Just a habit I guess. To keep tuned up," he volunteered.

"Okay then, about how many adjustments does it take before your patient's start feeling better?" I asked.

"Usually about five or six," he said with his voice brightening.

"Why does it take more than one? The point is doctor, by the time most adult patients show up in your office there's been so much muscle and soft tissue damage that many will never really hold their adjustments and will need some type of on-going care for the rest of their lives."

"Yeah, that's probably true," he said.

"And when patients show up in your office, feel better, and immediately discontinue care, how many are likely to have a relapse of their problem sometime in the future?" I asked.

"I don't know," he mumbled.

"Well, do you think 10% of your patients have their problem return?" I volunteered.

"Heck no, it's probably upwards of 80% to 90% I suppose."

"So what you're saying is that you've chosen to offer the easiest, most profitable and least fulfilling type of chiropractic care?" I asked.

"I have patients who stay for thirty or forty visits or more!" his voice becoming indignant.

"How do they pay for their care?" I asked.

"They're primarily work-related or personal injury cases," he admitted.

"So patients stay beyond five or six visits if they don't have to pay anything?"

The pause at the end of the phone made me wonder if he had hung up on me. Suspecting that the doctor was either having an "Ah-ha" experience or consulting the yellow pages for a gun shop, I waited.

"So what does that have to do with mall shows?" he said breaking the silence.

"Lots!" I said. "If you would educate your patients enough so that they would want at least the most minimal type of maintenance care you enjoy, you wouldn't need a constant stream of new patients. Plus, if you educated your patients better, they'd be better equipped to tell others about chiropractic, improving the referral process. Those are two immediate benefits of investing in better patient education."

I was on a roll now.

"Furthermore," I said, "patient education better assures that you'll be doing what a doctor should be doing: adjusting patients, not chasing patients down the mall with a plastic spine. It's not dignified, professional and rarely attracts the types of patients you really enjoy serving!"

"But it's a good outreach for chiropractic," he countered.

"Different motive," I said. "If you can truly divorce yourself from the payoff of getting new patients, knock yourself out. Because if your motive is pure; because the "little people" of the world need to know about chiropractic, that's different. But would you be willing to share the chiropractic gospel at a booth between Pet City and Music Land at the mall without the slightest chance of getting new patients?" I asked.

"Probably not."

Again I was greeted by a long silence. "When you depend on artifical means to attract patients to your practice, you're treating a symptom. Instead, uncover the cause of what's interfering with the natural referral process. What are your active and inactive patients telling others about your office? Until you know why..."

"I already know why," he said hastily, interrupting me.

"And what's that?"

"I'm not educating my patients," he said.

"So what are you going to do about that?" I asked.

"I'm going to do a mall show," he said.

Was this the same frustration chiropractors experience with patients who don't get it? I wondered what it really takes to change people. Does all learning require the School of Hard Knocks?

Like many doctors hooked on new patients with a pain-relief-only practice, stopping cold turkey is difficult. The temptation to do one more mailing, run one more ad or try one more promotion is enticing. Secretly what these doctors know is that they've taken the path of least resistance, deferring to insurance companies and living beyond their means as a compensation for low self-esteem. The only thing they have to show for years of practice are countless X-ray files and artifacts of hundreds of brief patient encounters for headaches and low back pain. And an unquenchable appetite for more new patients.

I'm not sure who was shortchanged more, the doctor or his patients.

Excerpted from
Beyond Results
Originally published in 1995
240 Pages
US $24.95

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