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Undoing 20 Years of Bad Advice

bad_advice.jpgHave you mistreated patients for the last couple of decades, using manipulative techniques that were justified as “being for the patient’s own good.”

Relying on fear tactics, using your limited social authority or imposing financial policies in an attempt to get patients to do the “right” thing (according to you) has prompted hundreds of inactive patients to avoid your office. They shun your practice when they experience their inevitable relapse. They fail to recommend you to their friends at work, saving them from your heavy-handed interpersonal skills.

What’s worse, you don’t see how parental and manipulative your tactics actually are!

Due to the inbreeding within chiropractic (chiropractors teaching chiropractors about what patients should do), many chiropractors are oblivious to the damage they’re doing in their efforts to save patients from themselves. Acting on the advice of highly-paid practice consultants, many chiropractors rely on artful bluffing, trickery and deliberate scare tactics.

Here are some of the most revealing, self-sabotaging examples that dry up reactivations and suppress referrals from what otherwise would have been delighted patients:

Three times a week. “…so we’ll be seeing you three times a week for the first four weeks, then twice a week for the following four weeks, yada, yada, yada.” It rolls off your tongue with practiced precision as if you had a crystal ball that can accurately predict the future! The intent is to impose a care plan that will prolong their care for as long as possible. Why three times a week? Why not three times a day? Why not once a day? To offer what is apparently a canned, one-size-fits-all set of recommendations is mindless, robotic and ignores the individuality of each patient and how much (or little) the patient will do to support their adjustments.

Instead, how about something like this? “…so in the beginning, to create enough momentum to overcome the established pattern in your spine, I recommend three visits a week for the first four weeks. And since you and I have no idea how your body will respond to chiropractic care, on the 12th visit you and I will get together and conduct some of the same tests we did yesterday. By then, we can objectively compare where you are, with where you were, and together chart a course for the future that makes sense for you and your health goals. Do you see anything standing in the way of making that commitment?”

Fix care or patch care. For some reason, many chiropractors need to know whether the patient is going to opt for “fix” care that intelligent, enlightened, attractive patients choose, or “patch” care that stupid, ugly patients choose. “Don’t tell me! I know the right answer to this question,” patients think to themselves. “Fix care please.” Asking this question at the beginning of the relationship before you’ve proven yourself for the problem that prompted them to consult your office in the first place is the height of hubris. Regardless of their choice, it won’t change your recommendations for the first month’s of care anyway! Asking this question on the first visit or two practically forces patients to lie—not exactly the best way to begin a new relationship. (Just so you know, when the symptoms subside they believe they’re fixed!)

Instead, how about something like this? At the consultation explain “…there are five ways patients use chiropractic care in our practice. Most start with the desire for Relief of their presenting ache or pain. Chiropractic can be quite effective for this. However, discontinuing care once the symptoms subside will often produce a relapse because underlying muscles and soft tissues haven’t been retrained to healthier patterns. That’s the purpose of Corrective Care. The third way to use chiropractic care is what we call Maintenance Care. Here the intention is to maintain the progress that’s already been made. Then, there’s Preventive Care, with the purpose detecting little problems early before they become serious. And finally there’s Wellness Care with the goal of optimizing your total health and well-being. You don’t have to tell me now, but be thinking about how far you want to take your care and we’ll discuss it on a future visit.” (Many chiropractors rely on the graphics of our How Far chart to make this explanation more powerful.)

Annual care plans. Annual care plans are great for patients who “get” the idea that chiropractic is a lifestyle decision, not merely a short-term diet for pain relief. That’s a distinction lost on patients who are having their first chiropractic encounter after a lifetime of symptom treating. Chiropractors who overlook this little detail go to extraordinary lengths to “sell” chiropractic as a long-term investment. Using your financial policy to seduce patients into making the “right” decisions about their health is manipulative and demonstrates a profound mistrust of a patient’s judgment. Most patients will need to start care and stop care several times before they see chiropractic as a lifestyle decision. And perhaps not even then. Luring patients with a lower-per-visit-fee is right out of “the-ends-justify-the-means” playbook.

Instead, how about something like this? Sure, have an annual care plan. Announce it on that first or second visit when you discuss the financial implications of your care recommendations. But let patients know that they aren’t eligible for it until after their first progress examination. If that sounds unattractive or you fear few patients would choose it after obtaining relief, it’s proof you’re offering an annual care plan for the wrong reason.

How to say goodbye. Virtually every patient who enters your practice has heard the old adage that “once you go to a chiropractor you have to go for the rest of your life.” Most chiropractors do little if anything to convince the patient otherwise. Rather than an error of commission, this is an error of omission. This oversight leaves a wake of guilt and shame when the patients try to extricate themselves when they’re feeling better. The fear of letting you down and having to explain their decision, pales in comparison with how they imagine you’ll react to sell them on care they don’t want. Instead, they force your staff to break the news by making appointments and then repeatedly canceling them. Ending in this way, what would have otherwise been a wonderful relationship, costs many chiropractors the steady stream of reactivations and referrals they deserve.

Instead, how about something like this? Acknowledge the myth! Recognize that failing to mention this unmentionable prompts the patient to keep their eye on the door. The fact that you intend to use chiropractic for the rest of your life, and that you recommend everyone do so, isn’t the point. By failing to explain how to leave; how to say goodbye, you force the patient to be evasive and distant at the very moment when they should be most delighted with their decision to consult your office! “…and when you've had enough chiropractic care, be sure to let me know so we can celebrate your success.” By avoiding this simple conversation you needlessly doom the relationship and cause patients to select a different practitioner when they have their inevitable relapse months or years later. Making it difficult for patients to leave probably extracts an additional visit or two, but significantly reduces the chance of a long-term relationship.

I know. Many of these recommendations fly in the face of what you’ve paid good money to receive from practice consultants. Your instinct at the time was to reject this poor advice, but the desire to be “successful” blinded your better judgment. Turns out, they used the same techniques on you. Two-year contracts. Accusations of a “poverty consciousness.” And don’t forget the sure-fire observation that “…even Tiger Woods has a coach.”

How many of your peers have you referred to your most recent practice management consultant? Which consultants would you sign up with again? Unlikely, right? How come? Why is it so surprising that when a so-called practice coach is manipulative, seductive and over-bearing with you, that they would offer anything else but the same for use with your patients?

Comments (7)

Patrick Perschke:

Hi Bill: we have been looking for a consultant, but it is always the same type of thing - long care plans coupled with low quality work designed to jusify the care plans. I have seen manipulation tactics to the point of strong arming and coercion. Successful doctors of this ilk use beautiful forceful talk about the ideals of chiropractic and ignore any improvements in technique that might hurt their wallets. This smacks of witchcraft in my book. Surely there is a better way! We present the care plan as an option in the bests interests of the patient and make it clear that it is their choice to continue.


You have nailed it with this post! Done all of the above in the past except for the annual care plan scenario. Even the last chiro consultant I had left a sour taste in my mouth, and was stuck with the contract for two years! Applying your ideas has lessened the stress by giving patients the options you recommend. Thanks again for all your insight!


Dear Bill,

I had found myself, for many years, unable to implement so many of the recommendations made by the typical practice consultant - to the point that I had questioned whether I should continue as a chiropractor - after all, if I'm unable to practice as I've been taught, why bother.

In reading you, I am truly inspired to continue to serve others through chiropractic. In reading you, I realize that relating to patients as I would want to be related to, the "Golden Rule," is the key to success. Success, measured not just by statistics, but also by the peace of mind that comes from being congruent with ones self. Thank you so much for your unique "patient perspective."

"WOW" When you said you where going to be bold this year and send out the truth, you weren't kidding! I am proud to be a client of your products. You are not going to be popular in most management circles. I admire you for your courage and wisdom. This information could not have been released to the profession at a better time.

Our patients are smarter and have more choices than ever before. The common sense approach you offer is the answer to build a steady, stable long term practice that will allow the doctor "to be" him or herself and not get caught in the trap of "getting" new ones and "closing" them. There is a difference between having the information on practice management income producing techniques and passing them off as ethical decisions for the good of the patient versus the short term immediate income of the doctor.

I look forward to what the next ten years has to offer. My hope is more of the chiropractic leaders begin to approach the future practice model based on these basic principles.


I wholeheartedly agree. I have come to conclude that the healthiest approach for me to take in my practise is to behave toward my guests the way I would most want to be treated. That is, to be genuinely compassionate; honest about what I recommend, and; when there is a conflict, put their best interests above mine. If I trust their body to do the healing, I can certainly trust their educated mind to make the best decision for them. All of that allows me to live and practise from the powerful position of freedom. And it is so much more fulfilling than the trickery I was previously engaged in.

Tony Russo:

Holy "Sh---piled hi---T"! You hit a grand slam...again. Wow! And you must have pissed off a lot of people when you discussed yearly plans, but you're right. They (yearly plans) are manipulative, deceiving and distasteful. I personally have never tried them, but don't you think I wasn't maybe a little jealous, hearing of the 125 patients/day while I was doing a mere 35? And some of these advisors I consider close friends and colleagues. And well intentioned without a doubt, don't get me wrong, though short lived when it comes to results of a full practice. I believe every single Chiropractic Graduate should have Esteb down cold. And they can't graduate if they haven’t achieved a 90% on his course. Why? Because all the anatomy, all the biochemistry, all the problem based learning, all the what have you's, though important in its own right, will do nothing to "cure" an empty office. Bless you Bill, bless you.

Kimberly Higney, D.C.:

Bill...we talk so much about congruency in this profession...these are some of the most congruent ideas(with respect to treating those who seek our assistance) I've heard in a long time.
Thank you for your great suggestions for "instead's."

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From May 10, 2008 9:25 AM

This page contains a single entry from the blog posted on May 10, 2008 9:25 AM.

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