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Is This Payback Time?

wrong_way.jpgAfter a flurry of speaking gigs for several state associations it appears that many chiropractors are paying the price for years of patient coercion, manipulation and exploitation learned during the practice management era. At a time when insurance money was generous, at least compared with today, many chiropractors were urged to employ management tactics that were so abusive as to constrain the natural flow of referrals and reactivations; the foundation of a healthy practice.

And why not, there were more $100 deductibles waiting in the wing!

Referrals and reactivations are under the volitional control of patients. Which is to say, if you mistreat patients for short-term gain, even if justified as being in the patient’s “best interest,” you cut yourself off from the fuel of delighted patients telling others and those who return when they suffer the inevitable relapse from having discontinued care once they felt better. Pinch off these two sources of patients and you sentence yourself to the increasingly burdensome task of new patient procurement. You have to become the marketer, promoter and advertiser because you have obstructed the only process by which all profitable, self-sustaining small businesses prosper: repeat business.

Instead, many practitioners created a series of “one-night stands.” True, these encounters may have lasted several weeks or months, with many patients emerging impressed by chiropractic, but appalled by the way their chiropractor treated them. So they don’t recommend you to their friends. And they certainly wouldn’t return for another round when their problem comes back.

Just what are the tactics that leave such a bitter taste? Here are some of the most onerous:

Annual care plans. Sure, when chiropractic is used as a healthy habit, annual care plans make sense. But that’s not how it’s implemented. Instead, it’s used to seduce patients at what seems to be a discounted price. Imagine their anger when they want to opt out and are confronted by the fine print! Offer annual care plans, but not until after their first progress examination.

Asking for referrals. Promoted in front of the adoring crowds in hotel ballrooms, the “he-who-asks-gets” tactic falls flat in actual practice. Not only is putting patients on the spot largely self-serving, it corrupts the meaning of the word referral. A referral is a gift, given without being prompted for and is only awarded if you can be trusted. Which is why asking doesn’t produce referrals. It may produce people who can benefit from chiropractic care, but they’re not referrals. Further, why would I send my friend to you if I suspect that they’ll be similarly hounded?

Scare tactics. Subluxation kills. Early death. Needless suffering. Leaving your children home to develop what you have. You’ve undoubtedly heard these and other catch phrases and special scripting to manipulate patients. In some circles, getting the patient to break down in tears is the sign of an effective report! Ultimately, having to pander at this level acknowledges the real powerlessness chiropractors have.

Letting you down. The “I’d-rather-not-accept-you-as-a-patient-if-you’re-not-going-to-take-your-health-as-seriously-as-I-do” crowd attempts to shame patients into prioritizing their health. Not only is this approach ineffective and rarely long lasting, it uses up the modest amounts of social authority currency you have in an attempt to extort patient compliance. Humiliating patients into care is paternal and eventually makes you feel dark inside.

Never discussing the end of care. Virtually everyone has heard that once you go to a chiropractor you have to go for the rest of your life. Most chiropractors have been counseled to ignore this 800 lb. gorilla, yet doing so has not stemmed the tide of patients leaving. Claiming that discussing it would become a self-fulfilling prophecy is a flimsy excuse when you look at the trophy case of inactive patient folders in offices who shun this important topic.

Neglecting inactives. Most practitioners, if they didn’t abuse patients too badly, are sitting on a goldmine. Yet, there seems little interest in trying to resurrect dormant patient relationships other than unexpected, heavy-handed phone calls, as in, “Uh, yes, the doctor has found something on your X-rays and would like to set an appointment to discuss it with you…” Yuck!

Quantity over quality. The fascination with numbers in this profession is breathtaking. From management groups that exaggerate their membership and seminar attendance figures to individual chiropractors who pad their practice statistics, more is always better. Apparently, bigger is better. The “mine’s-bigger-than-yours” focus is the mantra of the low self-esteem crowd and must be abandoned for the profession to emerge from its adolescent stage and enter adulthood.

Tragically, many of these tactics are still being taught today.

The common denominator is a profound mistrust of patients. At their root, they advance the belief that patients are stupid, will do the wrong thing and have to be “managed” for their own good. This “do-gooder” mentality, saving patients from themselves, is fueled by the financial gain the practitioner is supposed to expect by implementing these manipulative techniques. This apparent win-win philosophy makes these procedures sufficiently palatable.

Today, after sowing the seeds of disdain and lack of patient respect for all those years, many chiropractors are reaping reduced patient volume. Turns out it’s not the economy, or the reduced reimbursement, the subprime meltdown or the higher prices for gasoline. While these provide a convenient excuse, perhaps it’s merely payback time. Unfortunate, after a career of producing spectacular results, but bludgeoning patients with high-pressure sales tactics that reflect a latent hostility and resentment for the free-will choices that patients make about their health.

But here’s the rub. Resolve to embrace a more patient-centered approach to practice, honoring their free will and avoiding the use of your limited social authority to induce patients to do the “right” thing, and your numbers drop.


And while the drop is merely a short-term adjustment, with the practice rebounding even stronger than ever afterwards, it is often enough to cause many chiropractors to abandon their desire to show up as humble servants. Instead, they put their head down and push even more forcefully to get patients to do the “right” thing to get the numbers up.

This prompts me to wonder whether these chiropractors are more even worse victims than the patients they’ve been taught to victimize!

If you recognize this pattern in your own patient interactions, here are some action steps to consider:

Lighten up. There’s more to life than one’s health. Make sure you don’t turn health into an idol. For all you know, the money they “should” be spending on their health is being used to care for an aging parent, supporting an overseas missionary or some other worthy cause.

Think reactivation. Consider each patient relationship as eternal, punctuated by periods of dormancy when they aren’t under active care. Make sure you don’t do or say anything that would prevent their return or would preclude a heartfelt referral of a valued friend.

Show up as you. Instead of showing up as the “parent,” an “enforcer” or a nagging “coach,” how about showing up as you? Concerned. Interested. And willing to serve. You’re the servant. They’re the master. Keep that in mind the next time you’re feeling Indignant or resentful.

Honor their choices. Their choices aren’t your choices. What they choose to do is not a reflection of you, your talent or your reputation. Just remember their Maker loves them enough to give each one free will. Even the free will to reject that there is a Maker. (Hint: It makes the choice of reconciliation (reactivation) all the more sweet!)

Apologize to inactives. If you screwed up in the past, don’t blame, apologize. Gather up their inactive file folders and apologize to their records. Apologize for acting like a jerk, making them feel small or hounding them into compliance. Promise to start anew if given the opportunity.

It’s not too late to turn things around. But you’ll unlikely experience the instant gratification you’d like. Patients are understandably cautious and want proof that this is the real you and not simply another “technique” you’ve learned. The test will come during that temporary dip in your numbers. Did I mention it’s just temporary? The dip is temporary but the results on the other side can last forever.

Comments (5)

Tony Russo:

Just another rave review Bill. "Here's how to run a practice" and it's all for free. How Bill, how do you do it? I did practice that way almost all my career. While watching my friends using the tactics you mentioned. To see them now flounder around with their 20-30 patients/day as opposed to 120-130 of the good old days. Now they're questioning their decision. They should have questioned their decision to fall for the marketing ploys they subscribed to. Where my office is finding a slow, but steady increase in number of patients. And especially reactivations of up to 10 years ago! And these guys have been to the other chiropractors. I kept the door open for them to come back. They tested the sizzle. They found it was just that, sizzle. And they came back. I wonder what my collegues who adopted those aggressive marketing techniques, are doing now. Thank you for your compassion, thank you for your passion, thank you.

Julie Seymour:

I attended my annual technique seminar this past weekend. The technique's co-founder was there this year ~ he makes an appearance about every 3rd or 4th year to give us all a pep talk and try to make us feel better about how much the weekend is going to cost. He's charming and enthusiastic and, apparently quite successful. He has a list of publications and accomplishments as long as his arm, and he's happy to talk about all of them.

Anyway, during his portion of the program on Saturday he actually said that he expects his reputation, his "cultural authority" to carry a lot of weight with his patients, and that if they don't do as he says.......if they don't follow every treatment recommendation and every home care suggestion, he KICKS THEM OUT!

I couldn't believe what I was hearing. He says he's "in practice," but I think he must actually be making a fine enough living with his speaking engagements and his technique retail sales that he doesn't have a very realistic grip on what it is to show up for a practice everyday. Or maybe he says things when he's in front of a crowd that don't really have much root in reality... The problem is that many of the doctors in attendance this weekend agreed and applauded him for this attitude.

It's easier than actually showing up and listening to, and coaching, and educating patients, I guess.

Dr. Dan Hestera:

I appreciate your boldness and objectivity in your statements. Not very popular words for chiropractic circles, but since when has saying the right thing ever been popular?? The chiropractic landscape is changing and it's not just about third party reimbursement. It has much more to do with finding chiropractors who will respect and honor the patient's choices. The majority of the population is much wiser than we give credit. Intent and integrity will always shine through even if it takes a bit of time to be revealed.

Bob Wagner:


I believe the true moral to the story lies in being a good steward. A good steward of your time, money, referrals, gift of time, and people. Learn to live within your means and wait and see what God really has for you today. The new trick in practice management is selling you God! Yes, if you come to my seminar God will also show up and give you a reason to sell care plans to people. After all, God won't mislead you, right? No, but the people collecting the huge fees will! Proverbs 3:5-6 is a good starting point for all of us. Sit and wait for people to come and they will! Also get a Perfect Patients website and watch it happen on auto pilot! Thanks!

Dr. Bob

Bryan Siegel, DC:

Thank you for this entry; it pretty much sums it all up! Trust and faith in patients, people and the process is what so many in the profession have lacked; when times get tough, it's been easy to fall back into old patterns of "scare tactics" and "heavy handedness". I believe those controlling and subjugating attitudes and approaches are the result of professional inbreeding. After 14 years in practice, I've been on both sides of the line and I can tell you I like showing up as a humble servant a million times more. Trusting and honoring people's decisions produces miracles. Thank you for being one of the most significant contributors to the healing of the chiropractic profession.

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From April 27, 2008 2:43 PM

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