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Busted! Now What?

busted.jpgI have a presentation coming up next week for the CORE Colorado group. I was discussing this speaking opportunity with a local chiropractor friend and asked if he had any ideas about what I should talk about in the hour or two that I’m going to have in front of a handful of Denver-area chiropractors.

“I don’t know if it’s just me or Bonnie at the front desk or what, but recently it seems that our patients are valuing their health less and less,” he confessed. “I don’t know if it’s the economy, gas prices or what, but what you might want to talk about is how we can help patients see how important their health really is. In fact, I bumped into my dentist friend in the grocery store last night and he said his numbers were down too.”

This, from a chiropractor who has been out in the trenches for more than 20 years and who is sitting on thousands (yes, thousands!) of inactive patient files.

His suggestion is based on the idea that there is something a chiropractor could say or do that would somehow compel a patient to dramatically shift their priorities. Imagining there’s a communication approach that would prompt a patient to forsake other demands on their time and money in favor of receiving chiropractic care is a pipedream.

Is this a widely held belief? That there’s something you can say or do to sway a patient away from their live-for-today-instant-gratification-if-it-isn’t-broken-don’t-fix-it mindset?

Heaven help us! Just how powerful and influential do you think you are?

Imagine what it would take to get you to change your political affiliation, sexual orientation, hand dominance or to give up speaking for the rest of your life. When it comes to health care behaviors, you’re working at this same primal level. My experience has been that significant, lasting change happens under duress or significant hard-to-plan circumstances. (“I’m never going to do that again!”) Even those suffering heart attacks or by-pass operations rarely change their habits for long. Thinking a more elegant phone answering script, a more direct report of findings or some other office procedure could produce a fundamental shift in a patient’s worldview (and behavior) would imbue you with way too much power (and responsibility).

Thank goodness that’s not possible.

If you’re fresh out of school and frustrated by a lack of patient follow through, I totally understand. But why would a practitioner with years of experience and thousands of potential reactivations be suffering?

I’ve asked hundreds of seminar audience attendees the likelihood of a patient suffering a relapse if the patient has discontinued care as soon as they felt better. Unanimously I hear figures in upper 90% range. In other words, it’s almost certain that patients who drop out prematurely are likely to see their symptom return. It could be two months or two years or longer. But their problem is almost certain to return.

So why aren’t they returning for care?

Instead, they’re going down the street. Or giving up on chiropractic in favor of decompression or acupuncture or some other treatment. What if it’s not the economy and instead it’s an unwillingness to face you again? To admit you were right? What if they’re avoiding you so as not to be scolded or be the recepient of your sanctimonious gloating?

While that might not be your style, it’s what many patients imagine will happen. Their real or imagined fears must be significant since most patients would prefer to return to a familiar office rather than take a chance with someone new.

“Great Bill. Busted. So I screwed up. Maybe I was a little too clingy. Perhaps I cared about their health more than they did. I probably tried too hard to prevent them from discontinuing care. Now what? What do I do to get my numbers back up?”

There’s an old saying that if you find yourself in a hole, stop digging. Start there. Because chances are if you were to receive a sudden influx of new patients, you’d probably show up the same way you’ve shown up in the past, prolonging the moment when you implement a much needed change. The change? Make it incredibly easy for patients to disengage from your practice.

I know. It’s so counter intuitive. Especially at a time when you need to extract every possible visit out of anyone warmer than room temperature. In fact, it goes against everything you’ve paid thousands of dollars in consulting fees to learn.

Sorry about that. But if you have a better explanation of why you don’t enjoy more reactivations, let me hear it. Because if you’ve been in practice for 7-8 years or longer, you should have enough reactivations and referrals to significantly reduce your dependency on new patients or weather an erosion in your patient visit average.

Second? Apologize.

I’m not suggesting that you call or even write patients that you saw 10 years ago and confess your guilt-producing behavior, judgmental attitude or covert attempts at micromanaging them. But you’ll want to confess your transgression and ask for their forgiveness. A surrogate will do. Such as their case file. Retrieve a few. Close your office door. Review their records. Visualize the patient.

“Hi Dorothy. Dr. Bob here. I’ve been thinking about the time you spent in our office back in early 2002. I’ve become present to the fact that I may have abused my authority. I may have made you feel guilty for discontinuing your care. Or made you feel like you were letting me down by not valuing your health as much as I value mine. In short, I probably made some mistakes in the way I handled the interpersonal aspects of our relationship. Today, I’m apologizing for my behavior and asking you to forgive me for how I acted. I’m deeply sorry that I may have prevented our relationship from deepening. Please accept my profound regret and my promise from now on to respect and honor the individual health goals of everyone who enters our practice. If you can forgive my old way of being, and if you or someone you love could benefit from the care we offer, please give me another opportunity to prove myself as your chiropractor.”

And mean it.

Sure, this will likely produce a few reactivations. But that’s not its purpose. Instead, it’s about humbling yourself, assuming a clean heart, purer motives and a servant attitude. This is about dying to your old way of being and showing up healthy enough to no longer see patients as inferior or thinking that their free-will choices are a poor reflection on you.

Comments (1)

Rob Savage:


This is an interesting comment. I too agree that many of us need to humble ourselves and remember that we are here to serve our communities and not ourselves. Our patients have choices to make and I do believe that finances alomost never dictate care it always goes back to education. If we spent more time educating our patients about chiropractic and not our own personal interest then our practices and chiropractic itself would certainly grow.

Thanks for all your team does for chiropractic.
Dr. Rob

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From June 4, 2008 10:37 AM

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