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Unenforceable Contracts

What type of patient contract do you imagine?Part of true health (optimum mental, physical and social well-being and not mere the absence of disease or infirmities) is our ability to interact with others. Even chiropractors who purport to have, or want, a wellness practice often overlook social health. However, the social health to be explored here isn’t that of patients, but the social health of chiropractors.

Many chiropractors are not healthy. Socially.

This manifests itself in many ways. One of the most glaring is a lack of referrals and reactivations, which is often due to the way their patient relationships end as patients attempt to extricate themselves from the practice.

These aren’t the “find-it-fix-it-and-leave-it-alone” chiropractors whose vision is often linear and mechanistic. Ironically, these chiropractors often enjoy high levels of referrals because they are often seen by patients as spine mechanics or natural relief specialists and there is little pressure (salesmanship) exerted on patients to continue care beyond the relief of their most obvious symptoms.

No, it is often the more vitalistic chiropractors who are more likely to imagine (and try to enforce) a social contract with patients that frankly doesn’t exist.

I’m not talking about legal agreement on paper. Or even the patient verbally agreeing to fix care rather than patch care. I’m talking about the social contract governing your patient relationships.

Long before a patient shows up in your practice, most have experienced a lifetime of what they consider successful symptom treating at the hands of various medical practitioners. Yet, deep within your vitalistic worldview, it’s easy to forget that these unenlightened souls rarely want true health. Instead, they are merely hoping to get back to the zero—no symptoms. Few are interested in expressing their fullest potential. Even fewer understand or believe that there would be value in showing up in a chiropractor’s office when they’re feeling great.

Wanting something for the patient that they don’t want; projecting your health values onto them, is what later manifests in broken contracts, misunderstanding and ultimately the price of few referrals or reactivations.

Since chiropractors rarely use the patient consultation to explain why chiropractic is different from the allopathic mindset most patients have, patients assume you’re merely a spinal specialist who uses a low-tech method rather than state-of-the-art drugs or surgery used by the other doctors they’ve consulted over the years.

Virtually every patient has heard that once they see you, they’ll have to go for the rest of their lives. Many show up with the attitude that they’re going to “beat the house,” getting what they want (drug-free pain relief) without succumbing to your “once-you-go” overtures.

Since few chiropractors ever discuss this widely-held belief (often because they agree that patients should continue for the rest of their lives), patients assume that what they’ve heard is true! They begin plotting their escape, even before their first life-affirming adjustment.

It seems so counterintuitive to discuss how the relationship is going to end, while you’re still getting acquainted on the first or second visits, however that’s a critical ingredient of successful social contracts between chiropractors and patients.

“Have you heard the one about, once-you-go-you-have-to-go-for-the-rest-of-your-life Mrs. Jones? Sure. Well, I want you to know that it’s not true. You don’t have to do anything. We see ourselves as servants. You’re the boss. We’ll make our optimum recommendations, the same as we would for a loved one. But it’ll be up to you to decide how far you want to take your care. It’s true that we have some patients who, after starting care, stopping care, starting care and stopping care, have decided to come in once or twice a month to avoid their ‘roller-coaster’ relapses, but that’s a decision you’ll get to make later on.”

You’ve told the truth. You’ve addressed the myth. You’ve explained why some people embrace supportive chiropractic care. And you’ve revealed that you don’t have an emotional charge attached to what they do or how far they take the process. Just try it once and really mean it (that’s the hard part). Notice the change in the patient’s more relaxed breathing, reduced muscle tension and a more collaborative attitude and demeanor.

Turns out there’s little you can say or do, other than warn of the subsequent relapse if they discontinue care prematurely, that will prompt a patient to embrace chiropractic as a lifestyle choice. You may want to continue searching for the magic words or super-secret procedure that “seals them in” and fulfills your highest goals for them, however in my 28 years of searching, I haven’t found it.

Whether you like it not, the mass hypnotic trance produced by big pharma, big medicine and big media has created a powerful cultural force that should be acknowledged and accommodated. It perverts the results that are possible and creates considerable suffering among chiropractors who have big dreams for their patients. Don’t abandon those dreams! Just accept that your patient contracts are likely to take longer to fulfill than what you’d like; that the term of your agreements can last years, even decades, with periods of dormancy when they aren’t under active care but still think of you as their chiropractor. But only if you show up with optimum social health and recognize your limitations to get anyone to do anything. Certainly, patients recognize this. And when you do, you’ll be laying the groundwork for the referrals and reactivations you deserve.

Comments (3)


This was great. I came to this website on purpose tonight. Searching for something on this topic, I literally just graduated. 9th and 10th patients are coming in tomorrow. I have been mentally struggling with this concept a bit. I'm not forcing care or a long contract on anyone. I’m hearing them out, telling the story, advising follow-up care and leaving it at that. It’s a bit defeating when all the "coaches" are getting my buddies to sign patients up for big payments and long plans....
I just can’t do it. I get the BIG idea...and forcing it just seems so dirty to me.
Trust me I’m not looking for a corvette. I only want to be congruent with my beliefs and myself. It’s just hard when staying true to the "intangibles" has a tangible consequence. I just fired a coach who wasn’t leading and he decided to keep half my money when we had only been in the contract 6wks.
It’s tough to stay true when everyone else is after the money. Thanks for the article Bill. I love "hearing" your advice. Thanks to those of you in the trenches!

Tony Russo:

Right on Steve. And right on Bill. All new graduates are awaiting the instant reward. They come out of the gate like the proverbial hare...and with disappointment watch the tortoise pass the finish line in first place.
First order of business after graduating is asking where the nearest Corvette store is so they can put in their order. Patient retention is wrought out of a humble caring attitude of a servant, not a "Doctor.” Gosh, I shake my head...thinking they have the "Chiro-medical" answer to all that ails mankind and their panache miracle technique will have them beating down the doors to have the privilege of being seen. After a couple of months of this honeymoon of staring at an empty office and Corvette (I love a Volvo) payments in default, they're on the phone to the nearest practice manager.

Unfortunately, many graduating DC's want instantaneous financial success in practice. As a recent grad 6 years ago, I have learned that lasting success and respect from the community isn't an overnight sensation. It takes years of building relationships, planting seeds and patience. Patients are allowed to say no to chiropracTIC initially. Leave them with a favorable opinion of the chiropracTOR and they will eventually return to learn more about chiropracTIC when they are ready.

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From November 23, 2009 11:38 AM

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