Five Motives For Referring
by William D. Esteb
Ask any licensed professional the preferred way to get new patients, clients, or patrons and they will almost always say that by referral is the best. Less expensive than advertising, patients who are referred to the practice are usually more cooperative and compliant. Someone has vouched for the practitioner and paved the way for a productive relationship. Many doctors brag that they have never advertised and depend totally on referrals from patients and other professionals. Yet, for all the emphasis on referrals, few chiropractors have looked at the referral process from a patient's point of view. Or, if they have, they've misinterpreted the full range of patient motives that may be involved in the process. Doing so would give doctors ways to stimulate or increase referrals from their patients--without asking for them.
The Good Samaritan: This is the model most doctors think motivates patients. It is a model based on the compassion and awareness of each patient to be constantly on guard, looking for people they encounter who could be helped by chiropractic. If that only happened with regularity! Critical ingredients to the functioning of this approach is a patient knowledgeable enough to explain chiropractic and able to effectively defend the issues of safety, doctor education, and other myths that permeate our popular culture. After being laughed at or ambushed by a friend or work associate with questions they can't answer, they often just keep quiet about their chiropractic secret.
Action step: Ask your patients what they think is the greatest myth about chiropractic. Then, ask them how they explain that it isn't true. If they fumble the ball, on a future visit, supply them with the information they may need to be better equipped to handle the objections others outside your office are likely to raise.
Action step: Instead of instructing patients with something vague like, "I hope that if you meet someone you think we could help, that you'll send them our way," be more specific. "This month we're trying to help as many people (children, seniors, etc.) with headaches (low back pain, or some other specific symptom) as we can. I hope if you meet someone at the office (on the tennis court, at the golf course, etc.) who gets headaches you'll send them our way." Being specific helps focus and direct patients, making them more aware.
The Proud Parent: I remember vowing that I would never force baby pictures on anyone. Yet, I distinctly remember racing from the hospital to the one-hour photo store so I could show off pictures of Eric when he was just minutes old. The Proud Parent model is like the reaction parents have when their son or daughter brings home a great report card. They want to tell the world about it. Even total strangers. Due to their positive experience in your office, some patients refer others because they are proud of you.
Pride can be a powerful feeling. This sort of pride comes from having a high level of confidence in you. And that's good, until a friend reports back that they didn't get the results that were promised (probably over-promised). Then the referrals stop.
The other danger of course is the proud patient's condescending attitude. All of us at one time or another have been put upon by our parents or friends to "tell that really funny joke, you know the one," or "do that great impression you do" or "sing that song like you did at the school play" or whatever. Frankly, it can be demeaning and we rarely measure up. The continued pleadings that attempt to counter our better judgment only serve to raise expectations further, almost assuring disappointment.
While as a referral strategy it has its flaws, the Proud Parent model can be an especially effective way to stimulate referrals if you're careful to realistically temper patient expectations. The machismo doctors who boast that with the power of chiropractic they can help anyone, are often the ones who get caught by this trap.
Action step: The time tested adage, "underpromise and overdeliver" comes to mind. There's little risk from downplaying expectations at the beginning of care since many patients try chiropractic only after giving up hope with conventional methods. Set the precedence that while chiropractic is good, it is not a cure-all and results vary due to age, condition, lifestyle, and the length of time the problem has existed before seeking care.
Action step: When patients start gushing how wonderful you are as they report their first full night's sleep (or however they measure their success with chiropractic), be careful. Claiming too much credit now, sets you up for disappointing the patient later, when someone they've referred doesn't respond as quickly or as dramatically.
"Look what I found!" This is my favorite. This model is the same one we use to recommend a new movie, divulge the name of a secret little restaurant, or point out the unseen detail of an antique carving. We become the tour guide to some inside information or perspective. The delight, astonishment, or joy our friend experiences from our revelation, rubs off on us. We bask in the glow and our image and reputation is enhanced by being the one who has pointed the way.
Unlike the Proud Parent, this approach isn't accompanied by overpromises. This is a more sophisticated model that comes from providing extraordinary service. The positive word of mouth advertising from "Look what I found!" is produced not necessarily by what you do, but how you do it. An important distinction. It's the difference between a recording of Barbara Streisand and a live performance. It is in the how, not the what. Same song--different performance.
Doctors who fail to recognize the performance side of chiropractic and still think great results are enough to stimulate referrals, rarely benefit from this patient referral motive.
Action step: Brainstorm areas of your practice that can provide ways to pamper patients and orchestrate a better chiropractic performance. Locate and improve the smallest details of everything a patient encounters in your office; from the parking lot to the admitting paperwork, to the cleanliness of your bathroom and everything in between. Raise your standards. If you want more articulate and appreciative patients, create a higher quality experience in your office.
Action step: Make the invisible visible. There are details about your practice and your career that you take for granted and which go unseen by patients. How many adjustments have you safely delivered? How many hours of continuing education have you received? How many patients with headaches have you successfully helped? Isn't this the type of information you'd rather have circulating about your practice than how much an adjustment costs or how long the wait is?
"I'm right." This rarely used referral motive is based on the notion that with enough patient education, patients will look for ways to express the chiropractic point of view when confronting friends about everything from drinking milk to avoiding vaccinations. While I'm sure this happens occasionally, it takes more than patient education alone to equip patients to tell others. It may be more important to focus on context, rather than merely content.
All too many doctors are overly concerned about the content of their patient education. Some believe that every patient should have a firm grasp of spinal function and nervous system physiology. Others are convinced that every patient should be able to recite the Harvey Lilliard story. Still others think nutrition and proper exercises should be the major part of a patient's chiropractic curriculum. Remember, the issue here is how to equip and empower your patients to tell others. What type of information do they need?
Sadly, in our "sound bite" world, your major patient education themes need to be reduced to bumper sticker brevity. So whether your chiropractic model is based on pain relief, function, structure, or subluxation, enhance your patient's ability to tell others by reducing it down to its barest essentials. Think how focused you'd need to be if you had to feed Bob Hope or Jay Leno with pithy one-liners about chiropractic. Make your information relevant and to the point.
Action step: Design a postcard campaign that reduces your particular approach to chiropractic into 12 different paragraphs of 50 words or less. Print each paragraph on a postcard and send a different one to your active and inactive patients at the beginning of each month. It's an inexpensive way to keep your name in front of your patients and might even produce some reactivations. Perhaps more valuable is the clarification you'll receive by identifying the 10 or 12 essential points you want your patients to know.
Change the world: This is when patients get the big idea and see the applicability of chiropractic philosophy in every aspect of their lives. Here, the motive for referring others is most similar to the evangelist. They appoint themselves the Johnny Appleseed of chiropractic and enjoy the psychic rewards of doing the right thing.
Certainly it is the rare lay individual who embraces this referral model. Partly because so few doctors see their role in chiropractic as life changing, and secondly, so few people see themselves as change agents. Too often we are guilty of a "nose to the grindstone" focus on what we do, that we overlook or discount the possible far-reaching significance of our actions. These are the patients whose car bumper sticker reads, "Think Globally, Act Locally."
Action step: Identify and clarify your own purpose so you can articulate it to patients during regular office visits, print it on your office brochure, and include it on your admitting paperwork policy documents. Make sure your patients know where you stand in the "big picture" of things. You may discover like so many, that your vision can have a profound influence in the lives of your patients, attracting others. Most people like being part of something bigger than themselves and are silently begging to be led. Lead on.
There's more to the referral process than meets the eye. Uncovering the selfish motives patients have for telling others about your office is crucial if you want even more referrals. If you're not getting the number of referrals you think you deserve, reviewing these five patient motives may be instructional. Remember, a referral is a symptom; a result. And so is a lack of referrals. Without sufficient numbers of patients willing to vouch for you, you have a one-shot promotion, not a practice.
Originally published in 1995
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