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Patient Priorities

patient-priorities.jpgYou’ve probably heard this one: “If you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten.” This little cliché usually shows up when someone is exhorting the value of making some type of change, whether adjusting technique, first visit procedure, report of findings or the way to communicate with your teenage daughter. It’s related to the one about doing the same thing but expecting different results being a sign of insanity.

In light of today’s changing practice environment, a more accurate rephrasing of the statement would be:

“If you keep doing what you’ve always done, you’ll keep getting what you’ve always gotten. Until you don’t.”

In short, the procedures, scripts, new patient acquisition strategies, financial policies and care recommendations that seemed to work only five years ago are growing increasingly ineffective.

We are creatures of… habit. Every day we rely on dozens of habits, whether it’s our morning wake-up ritual, consultation routine or even driving to work. Habits free us from having to be present, permitting us to daydream or turn our attentions elsewhere. If you’ve ever missed your exit because you were on autopilot thinking about something else, you know what I mean.

Many chiropractors are feeling like they missed their exit these days. They notice the statistics are in descent and suddenly find themselves on a new stretch of road; foreign territory, feeling lost and a bit disoriented.

If it were just you feeling disoriented, you’d simply make a U-turn, retrace your steps and return to the security and predictability of more familiar surroundings. But while you’ve had your head down helping people, they’ve changed too. And while getting your headspace turned around has been addressed here and elsewhere, as you go about accommodating the changes produced by patients who have changed, keep one thing in mind: priorities.

Patient behaviors are based on what they believe and the conclusions they’ve reached, consciously or unconsciously, about their body, their health, their diet, their lifespan, delayed gratification, convenience and countless other aspects of their worldview. Last time I checked, God grants each of us the free will to prioritize our health the way we see fit, integrating it with the other demands on our time and money. Besides the fact that few patients seek chiropractic care for better health, and instead merely want to feel better, many have come to be spoiled expecting an insurance company to pick up the tab. Obvious today, but back when you were on the receiving end of generous reimbursement, this distinction was easily overlooked and seemed like it would never end.

Bottom line? You’re probably encountering increasingly larger number of people who prioritize their house or car payment over ponying up their co-pay. Many chiropractors take this choice personally. But don’t fall for it.

“I agree with you Bill. So what do I do to get patients to place a higher priority on their health?”

Somehow, I knew that question was coming. The short answer? You can’t. The long answer? You can’t.

Just asking the question suggests that you may believe there is something you could say or do that would cause someone to value their cat above their spouse, place their weed-free lawn above playing catch with their six-year old or to forsake a Caribbean cruise over saving for retirement. You think mere words are that powerful?

The fact is you can do little about how a patient prioritizes his or her health. But you can do something about your reaction to their priorities. And that’s where the busiest practitioners shine.


  • They recognize we learn best by failing. (Do you create a safe place for patients to fail so when they have their inevitable relapse they’ll feel safe returning?)
  • They make it easy for patients to discontinue care when they’ve had enough. (Do you talk about how to say goodbye? Do you encourage patients to announce their last visit?)
  • They don’t force patients to lie on the admitting paperwork, asking whether they want inferior “patch care” or the more enlightened “fix care.” (Have you removed that question?)
  • They look long term, laying the groundwork the reactivation. (Do you correctly assume that most chiropractic virgins must start and stop care several times or more before “getting” chiropractic? If ever?)


There are plenty of people in your community who sufficiently value their health with whom you could have a thriving practice. People for whom money is no object. People who are ready to try just about anything. But you’re too afraid to get out of your office, share your ideas, plant your flag and claim your territory, thinking that your sign, your reputation or your pure intention should be enough to manifest a fulfilling practice. It’s not. It doesn’t. And it won’t.

Comments (3)

Helen Cox:

Thanks... I needed that today!

Anonymous:

Right on Bill,
The dynamics of a Chiropractic Office are unique and precarious. There is a tone that is set in the ambiance of each particular Office. If it's resentment, you will be granted more to resent. If it's appreciation, you will be granted more to appreciate. If it's deception, man there's an abundance of that to go around. When I meet up with invitations to the lower band of emotion, I choose to appreciate. What I'm finding in my practice is more patients to appreciate. I already tried the resentment, self-pity one in the past and you know what happened there. I have people associated with my practice who fall within all these emotions. I find that when deception is consulted, deception and disappointment is awarded, wholesale. Yet they keep choosing that route. Kind of like that definition of insanity. They are free to do as they please. After 14 years of experience, sincerity and appreciation win out. When will these new graduates and interns learn? When?

I spoke to a neighbor the other day that said the only chiropractor that he ever had a consultation with reccomended a three-year program of care and reqired a $7000 deposet to get started. Needless to say the patient did not start, and said he wouldn't go to a chiropractor again, instead he went to an acupuncturest with symptomatic results in "only 14 visits" another one lost due to an inept communicator.

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From November 2, 2008 12:54 PM

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