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Welcome to Red Dirt, Montana

red-dirt.jpgI’ve been thinking about why certain procedures and policies that are recommended by practice consultants seem to work well for some chiropractors, but fail miserably for others.

Naturally, it’s not just the “do” but even more important is the “who.”

And while that explains the apparent disconnect between what may be recommended during the weekly coaching or quarterly seminars, and what actually manifests in the real world, I’ve become present to one other dynamic that I’ve heard few acknowledge.

What is this overlooked aspect of practice growth recommendations?

The size of the community in which you practice.

I’m guessing that you can get away with a host of heavy-handed patient management techniques if you live in a large city. After all, if you annoy patients with an all-or-nothing annual care plan or insist on enforcing some other policy (justified as being in the patient’s best interest), there are thousands of other prospects within a 3-5 mile radius of your practice waiting in the wings.


However, if you practice in Red Dirt, Montana (a made up name representing any one of tens of thousands of small towns), alienating patients, because of a recommendation from a well-intentioned consultant thousands of miles away, can be considerably more costly. These are patients you’re sure to run into at the Busy Bee Diner, PTO meeting or grocery store.

“He’s a nice guy, but…”
“I think she helped me, but…”
“I saw him once or twice, but…”

Reputation management is a much more serious issue in a smaller town. After all, not only are you likely to encounter these put-off patients elsewhere and the number of prospects are limited, but in an everybody-knows-everybody’s-business small community, bad news travels quickly. And is long lasting.

What are the procedures that are so counterproductive to advancing chiropractic in a small community? Probably those that attempt to overpower or are disrespectful of a patient’s free will. If the underlying philosophy behind the recommendation is based on the belief that if given the chance, patients will make the wrong decision, expect trouble ahead. If it’s believed that left to their own devices, patients will make poor choices, sabotaging their health and longevity, expect some fallout. Worse, if by not following his or her recommendations, the chiropractor imagines that what patients do (or don’t do) may tarnish the chiropractor’s reputation, you can almost be certain reputations will be lost.

A surefire recipe for being misunderstood and even resented is to assume a parental role in the lives of patients. Not only is this emotionally draining and unsustainable, it makes the relationship about you, rather than them. It makes your agenda paramount to theirs. It makes you big and patients small. It’s practically guaranteed to keep your practice small.

At the helm of the largest practices, especially in smaller communities, are humble servants who respect the sovereignty of every patient. And while this may produce occasional disappointment as they see patients making poor choices or embracing unhealthy habits, such chiropractors are rewarded by those who, at least episodically, are engaged in the practice over the course of decades and speak highly of their chiropractor.

Those hell-bent on advancing their agenda may deride this folksy, small town mentality and long-term vision. However, in “flyover country,” clear boundaries, good fences and a respect for your neighbor, are enduring values that create order, tolerance and community.

Comments (2)

John Jarolimek:

Hi Bill,

Brilliant! And as the world seems to get smaller, word gets around more quickly. Having lived and practiced on an island for many years, it was interesting to see some of the newcomer-"mainlanders"-who came there with heavy-handed approaches, in various areas of business. It was a small island, word got around fast! Most of these people were gone about as quickly as they appeared.

So, I guess it gets down to one's intentions as well as sensitivity to others. Even a nice bull is going to reap havoc in a china shop!

Tony Russo:

Hi Bill,
Beautiful. This passage depicts what a chiropractic office "IS". And one thing that is not stated is that this type of office grows s-l-o-w-l-y. That's the kind of practice that would be the envy and the gold standard for every office to follow.
But sadly Bill, and this is with firsthand knowledge, I'm not sure new graduates freshly coming out of all chiropractic schools, have the patience to wait. They just don't get it.

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From September 24, 2009 6:29 PM

This page contains a single entry from the blog posted on September 24, 2009 6:29 PM.

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