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04/15/14

Dear Bill | Unhealthy Patient Attachment

Do you create sticky patients?Dear Bill,

Q: “I believe that a trait that many successful chiropractors have, is not being attached to patient's decisions about care. I struggle with this. How do I let go of this attachment?”

A: My guess is, if you had more than enough patients, you wouldn’t have time to worry about what patients do. That said, here are some areas to consider:

1. Set clear boundaries—know what’s yours and what’s theirs. Create greater clarity around what your obligations and responsibilities are. (Responsible = able to respond) Care, but avoid caring too much.

2. Know that what patients do is not a reflection on you. Each patient has been granted free will to value their health as they please.

3. Avoid depending upon your patients to your social needs met. This is a common cause of attachment that is often the basis for many patient leadership issues.

Hope that helps.

02/26/14

Dear Bill | CA Want Ad

Q: Unfortunately, I find myself needing to hire a new CA. Although typically I look within the practice first, but that doesn't seem to be too fruitful this time. What you you think about the following ad:

Front Desk Receptionist for busy Chiropractic Office (PM hours): We need an organized, friendly, people person to help us help others—will train. Phone number etc.
After having the same women working with me in the AM and PM for 7 and 11 years respectively, one retired three years ago and I've been on a bit of a merry go round hiring four different women in three years! One was an alcoholic, another in the middle of a divorce, one whose husband was diagnosed with a chronic illness and retired, and the last one is leaving for a full time job elsewhere. I'm reluctant to place an ad, since the best fit is not always someone who is looking for work, but someone who instead wouldn't mind working, if you know what I mean.

A: I'm reminded of the Shackleton want ad used to attract an exploration team for his second Antarctica expedition a hundred years ago:

Continue reading "Dear Bill | CA Want Ad" »

12/04/13

Dear Bill | I'm Stuck

Got this email yesterday.

Q: “I’m stuck. Practice has been struggling for years, and what I’m doing to rebuild it isn’t working.

“I used to do very well with public speaking. But it seems that most companies, churches, and organizations are not interested in having me speak to them. And, when I get my foot in the door, there is little to no interest.

“91% of my new patients come from referral. Although that speaks volumes for my table talk, it also speaks volumes about my dismal outside marketing results. I feel I need to get in front of more people to tell the chiropractic story but that’s getting more and more difficult to do. In truth, I feel like I’m doing the same thing with more gusto with fewer results.

“Do you have any suggestions as to how I can change my direction? With business being down for a while, I’ve gotten behind the eight ball financially, so there are heavy financial obstacles right now.”

A: Are you looking for a magic pill that treats the symptoms or are you more interested in addressing the underlying cause? (Sound familiar?)

Continue reading "Dear Bill | I'm Stuck" »

10/25/13

Dear Bill | The Worst Patients

Q: "Why is it that family and friends usually do not take my advice? It's easier to persuade strangers to follow my recommendations than convince family members or friends to follow through with their health issues. Any insight?"

A: This is a common refrain. I have several theories.

The first explanation is that when someone, regardless of their relationship with you, becomes a patient, they believe they need someone who is stronger, smarter and superior in some way. This can be untenable for many. Separating your social role from your professional role may be difficult for them.

Continue reading "Dear Bill | The Worst Patients" »

06/17/13

Dear Bill | A Cash Practice

Q: I love the idea of a cash practice but to be honest I am scared to death of attempting this, especially in this economy and after just being slammed by Hurricane Sandy.

Do you have any other docs on Long Island that have successfully implemented your program that I can talk to?

Thanks for understanding my concerns and I hope I can go through with this. I'm mostly bald and pulling out the rest of my hair trying to get paid from insurance!

A: Unfortunately, I don't get notified when customers implement the principles of Converting to Cash. (Since we extend a money back guarantee and have gotten few such requests, I assume there is a high level of satisfaction with the material.)

However, far more significant is your observation that you're "scared to death" by the prospect of making the move.

Continue reading "Dear Bill | A Cash Practice" »

06/06/13

Dear Bill | Treating Their Symptoms

Q: Having come from a straight chiropractic background when I graduated and having had my head twisted in about 20 different directions, I have a question about the consultation and symptoms.

I know, most if not all, patients come in with symptoms. My experience has shown me that a high percentage get better in the first 4 to 6 weeks, give or take, as far as symptoms go. However, this is occurring not because I am focused on their symptoms, but because I am restoring their function.

Is it really important for me to make the distinction to them? If yes, how, without running them off? Thanks Bill.

Sincerely
Scott

A: If I were in practice I would lay out my "chiropractic covenant" at the consultation and make the necessary distinctions then, which I think would produce the exact opposite effect.

Continue reading "Dear Bill | Treating Their Symptoms" »

12/29/12

Dear Bill

Q: I give lectures in my office and when I can, to community groups and other organizations. However, I struggle with some type of call to action at the end of my talks. Do you have any suggestions for making a compelling one?

A: Whether a call to action is compelling to anyone is up to them, not you. But providing some direction at the end of a lecture, a consultation or report of findings is an essential part of showing up as a leader. As long as there are choices and you honor the free will choice of each individual, you're golden.

Seems to me you'd want to offer a range of choices with varying levels of commitment. Here are some ideas to get you going.

Continue reading "Dear Bill" »

11/26/12

Dear Bill

Q: "I love your MMM every week. This is the first time I've ever responded regarding a MMM. I've been in practice for 30 years and I still love what I do. But this MMM intrigues me. I always treat a patient like I want to be treated. And I wouldn't want to be scolded or belittled. However, even with very good communication, I still experience patients returning after a hiatus with their tail between their legs or expecting to be scolded. What is the best way to defuse this? I just love them up. I guess what I'm trying to say is that I do the best I can and still some patients react with fear. Is that my responsibility? I'm always willing to look in the mirror, but isn't that some of their stuff?"

A: There's a simple action step you can implement to defuse this all too common patient reaction.

Continue reading "Dear Bill" »

10/29/12

Dear Bill

Dear Bill

Q: I've been reading your book Connecting The Dots and have been really enjoying it. One of the practice challenges that I am quite interested in are pre-paid plans. It appears from your writings that there are some aspects of pre-paid plans that you support and others that you are against. I began a coaching relationship recently and the coach does encourage pre-paid plans of varying degrees of commitment. My question is: How does a chiropractor offer pre-paid packages to patients/practice members to commit to care while continuing to honor the patient?

Signed,
Confused in Minnesota

Continue reading "Dear Bill" »

08/19/12

Dear Bill

Q: I got this feedback from one of my first patients five years ago. She’s a very successful real-estate agent who's been in the area for decades and knows a lot of people. You stress the importance of continual patient education. There's no disagreement from me. However, this lady told me recently that the only negative thing she's ever heard about me is that I educate too much. "I don't want to be educated, I just want to be cracked!" is what people are telling her. What’s going on?

A: I suppose there are worse reputations you could have, but nevertheless, this one isn’t especially helpful if you want to enhance the referral process.

Seems to me there might be a couple of things worth exploring. The most significant is that you probably haven’t been educating them!

Continue reading "Dear Bill" »

03/13/12

Dear Bill

You stated in a recent email describing your We Speak Chiropractic poster that “…one of the things that makes chiropractic attractive is that it isn't medicine.” I understand what you mean but the fact is, chiropractic is "medicine." Here is the definition of medicine: The science or practice of the diagnosis, treatment, and prevention of disease (in technical use often taken to exclude surgery).

Chiropractors do diagnosis, treat and prevent disease (or at least they should). Hence, we practice medicine.

I only bring this up because I believe that your use of the term in your article reflects and reinforces one of our problems in chiropractic. That problem is we feel so insecure in our position that we have this tendency to criticize and castigate what the medical doctors do and try so hard to distinguish ourselves from them in any and all aspects, which has never served us well but only succeeded to further isolate us from medical science and the public.

Continue reading "Dear Bill" »

11/30/11

Dear Bill

Q: Do you have any archived articles or a Monday Morning Motivation about the importance of a chiropractor arriving on time for the first scheduled appointments of the day? I work for a DC who consistently strolls in 10-15 minutes late. His self-sabotage not only affects my income but I resent having to entertain patients who have shown up for a specific appointment time. What can I do?

A: I don’t recall a specific Monday Morning Motivation on this topic, however I’ve certainly addressed this subject many times at speaking gigs and Connecting the Dots. (Spin down to the heading ‘Working for Efficient Managers’ in the chapter “Inspired Teams.”)

Continue reading "Dear Bill" »

09/26/11

Dear Bill

Dear Bill

I have followed and read most of your books but your newest, "Adjusting," has been my saving grace in my chiropractic professional life.

I graduated Palmer Davenport and practiced with my father-in-law who had been in practice for 30+ years. After three years of incredible debt, passing of my infant daughter and poor economy, we moved to Joplin, MO. I joined an associate practice of high volume and incredible fraudulent practices thanks to a well-known management company. Then the tornado destroyed the city.

I moved to New Mexico unable to secure financing to purchase a practice in the small town of Deming. I have always had the necessary skill to adjust people. That came naturally. The business aspect has been grudgingly difficult. When I came to New Mexico, I decided to put people first for the first time in five years. Not that I did not before but I really believed that if I did, my worst the patients would just do what I thought they needed. I have really changed my focus and am really trying to become a coach/educator.

I can't believe the difference. We are still struggling but we have been in practice almost 3 months and we are seeing about 70 a week. I just wanted to say, your last book really is part of the reason that I forged ahead in chiropractic. I have wanted to quit so many times and go back to being a chemist but for some reason things keep being put in my path to drive me back into the profession.

I just wanted to say thank you. WE have never met but I feel you have been there supporting me more than most in my inner circle. Really pushing me to be a better chiropractor.

Thank you.

09/12/11

Dear Bill

Q: I have read your MMM for years, most of your books, use some of your materials daily in my practice and I have enjoyed and benefited from your take on chiropractic care from the patient's perspective.

I am now, by necessity, at the end of my practicing career, and not really by choice. Essentially, I have physically worn out after 21 years in daily practice. Well not just from being in practice, but an accumulation of life's events.

I can’t recall any of your writings on "saying good bye and leaving the practice."

For me two things come to mind as I reflect over the years in practice.

1. I was privileged and able to help a lot of different people of the years. I always enjoyed looking after the ones who stuck around for years, watching as they got married, had kids and watching the kids grow up. Or being around as people approached retirement and began to travel and enjoy their lives after the career was over.

2. I always was honest with people seeking care with me and did the best I could to treat them fairly.

So as I leave practice, it's a strange time, emotionally. I didn't make enough money to retire from a really busy chiropractic practice. (But the real estate side helped a lot.)

So where is true success and self-satisfaction derived? Knowing you did a good job for years, or having a big bankroll of money from a busy impersonal practice? I know my answer, but would like to know your thoughts, as I am not the first person to feel this way I am sure.

And thanks for all you have done for the profession over the years!

Continue reading "Dear Bill" »

07/18/11

Dear Bill

Q: I’m wanting to take patient conversations away from their symptoms, but I find myself asking each patient “how are they” when they come into my room. Do you have any suggestions for alternative approaches to greeting the patient in a way that doesn’t open up discussions about their symptoms?

A: You make it sound as if knowing about a patient’s subjective evaluation of their health is a bad thing or something that should be avoided. Or, something to be discussed only after some other “higher purpose” topic.

I’ve heard this before. Usually from chiropractic consultants (or their clients) who have the mistaken notion that by not discussing a patient’s symptoms, it will somehow compel patients to not judge their health by how they feel or the necessity of chiropractic care based on them.

If this were only so.

Creating a taboo topic is NOT the way to accomplish this. Because a symptom is not intrinsically good or bad. Instead, it’s the meaning we attach to the symptom that has significance. Naturally, helping patients embrace a new meaning to their headache or back pain is a more formidable task!

However, if you don’t want to go down that road, why not greet patients with something like, “So, what’s great today?” Or, “What’s worth celebrating?"

06/20/11

Dear Bill

(This one comes from a new patient who happens to be a subscriber to Monday Morning Motivation.)

Q: “After going for a complimentary exam/consultation at a chiropractic office, when I returned the next day the doctor tells me I have to come back to his clinic for three times a week for six weeks, then two times a week for four weeks, and then once a week until a review is made. Is this a legit chiropractor or is he just wanting my money?”

A: Tragically, this is an all-too common treatment plan among chiropractors who are lazy, lack critical thinking skills or think they can use their limited social authority to get patients to do their bidding. (This is addressed in more detail in a March 2010 blog post entitled “Take Two and Call Me in the Morning.”)

While the three times a week sounds legitimate, I’d be suspicious of a chiropractor who claims crystal ball skills sufficient to predict the number of weekly visits required a month or more into the future. Seems reasonable to expect a progress evaluation to be performed 10-12 visits into your care. You might want to get a second opinion.

01/26/11

Dear Bill

Q: What is the best way to address a patient who says they have found other San Diego chiropractors who charge $25 per visit while our office charges $50 per visit? She's acting like we’re over charging her.

A: “They must know what their adjustments are worth,” is probably what you want to say, but that would just give you some temporary emotional satisfaction and avoid the real issue.

Continue reading "Dear Bill" »

09/22/10

Dear Bill

Q: I have been a chiropractor for 19 years and have awakened to the obvious. After going to business networking meetings, I realize that I cannot explain what I do in a simple way that people “get.” Of course, I should have figured this out much sooner after looking at my practice stats! There is so much to say that it clouds my explanation. Is there a way that you could help narrow my focus? If you were a chiropractor and had 60-seconds to explain what you do, what would you say?

A: The first distinction you’d probably want to make is between describing what you do and describing what chiropractic is. What you do as a chiropractor is interesting to only two relatively small groups: other chiropractors and prospective new patients contemplating beginning care. So the question is, how do you make chiropractic fascinating, intriguing and attractive to a larger, more general audience?

Continue reading "Dear Bill" »

09/10/10

Dear Bill

Q: I had a question about the paternalization of patients. There has to be a point where the doctor has to guide the patient to make their own decisions, but where is the line in the sand where you have to push the envelope a little? For example, you offer your 3X/week recommendations to the patient and they say, “I cannot do 3X/week, but I can do 2X/week.”

Where do you draw the line to accepting what they feel to be true (beliefs) or tell them, “Do you think you will get the optimal benefit if you come in 2X/week? Where is the difference between the bending point vs. the breaking point and the DC down the street “…who will see you 2X/week but I am not going to sacrifice your health or my reputation, especially if you do not get your desired result?”

Continue reading "Dear Bill" »

07/27/10

Dear Bill

Q: I'm in the middle of establishing my Perfect Patients website and preparing to submit my picture. I’m a client of a consulting group that requires, as a result of their "research," that all DC's wear a white coat at the office. Their stance is that it demands respect and says "authority.” I was wondering what your thoughts were... from a patient’s point of view. Do you want your chiropractor in a tie and white coat? Should I take my website picture with my coat?

A: Permission to speak freely? Thank you. You can hijack the social authority given medical doctors by dressing like one, but you’re participating in a deception; a manipulation; a lie. Remember that by the time a patient consults a chiropractor, most have tried the medical model and want something different. My suggestion? Be different! Read the long answer in a chapter entitled Lab Coats and Latex, in my ninth book, Connecting the Dots.

05/19/10

Dear Bill Posture Screening Followup

Q: “Our new associate doctor and massage therapist have been conducting posture screenings at health fairs. He has them fill out a stress questionaire and asks for their name and email address. The practice management firm that he has recently joined suggests that he call the prospects after the screening to try to schedule them for an appointment. Is that a good approach?”

A: One school of thought is that if prospective patients are willing to divulge their contact details, go for it!

However, a phone call, depending upon how it is made, can come off being somewhat confrontational. If it were me, I’d send a “report” or information about their condition via email or send an Answers brochure with a cover letter via snail mail.

I can imagine how tempting it would be to call a prospective patient and “ask for the order.” But be careful. Depending upon how it is done it can be seen as “undoctorly,” or worse demonstrates a profound mistrust of the prospective patient. I know. Trying to get these sorts of commitments is justified as “being in the patient’s best interest,” but it’s parental, manipulative and often self-serving.

03/24/10

Dear Bill

Q: During our Conversation last November, you mentioned something about "sacred time.” I made a notation in my journal to ask you about it but forgot to. Could you give me the jest of how you see 'sacred time'?

Continue reading "Dear Bill" »

12/09/09

Talking About Symptoms

symptoms-warning-pixQ: "I am a chiropractor who is stuck on removing a patient's pain. I am moving toward a wellness model, however I fall short at each patient encounter. I ask, "How do you feel today?" or "How are you doing today?" which starts the encounter about their pain, keeping me and the patient stuck there. Is there a per-visit dialog or a few words that you can share to help move the patient away from their pain?"

A: This is a common refrain among chiropractors who would like to morph their practice into something with a greater emphasis on chiropractic wellness care. Yet, how you greet a patient is rarely the problem and merely symptomatic of a deeper, more significant issue.

Continue reading "Talking About Symptoms" »

10/05/09

Dear Bill

volume.jpgQ: What is the difference between us mortal chiropractors and the few who see between 2,500 to 3,000 a WEEK in a single doctor office? While I have NO desire to try to duplicate that, I’m nonetheless fascinated by it. What makes them able to create this kind of demand for chiropractic?

A: Granted, I’ve never actually met these chiropractic superstars who are able to help large numbers of people, but I’m guessing that there are a couple of profound differences between them and the typical chiropractor.

While it’s tempting to look at a single dimension of these individuals (patient volume) and overlook the impact it may have on their marriages, relationships with their children, the overall sense of peace and other emotional and spiritual issues, I would assume such chiropractors would have at least made the following distinctions:

Continue reading "Dear Bill" »

07/15/09

Dear Bill

choices.jpgI find it hard to present choices in an objective way when I obviously want them to choose the healthiest path.

I sometimes feel my ROF comes across as, "Here's a choice, or if you’re a total idiot you can choose this.”

So I get a lot of acceptance at the ROF, but then I have a dropout rate the same as others. How would you suggest making patients feel comfortable choosing short-term relief or corrective care. Or lifetime care for that matter?

Signed,

Dr. Dropout

Continue reading "Dear Bill" »

07/06/09

Dear Bill

Dear Bill,

I see that one extreme end of the spectrum of your Law of Fair Exchange below is the annual care plans. My fiancé and I are newer chiropractors, and we were suggested the annual care plan by our mentor. We do not force it on every new practice member, but do offer it.

I've had some reservation about it, but we've found that a few members wait to choose it until after they start to see result (clearly, our ROF is not where it needs to be yet).

Could you elaborate on why the annual plans are not a fair exchange? Maybe this is at the root of my hesitation.

Signed,

Hesitating in Calgary,

Dear Hesitating in Calgary,

There is nothing intrinsically wrong with annual care plans. Patients who “get” that chiropractic care can be an adjunct to a healthy life, rather than only a short-term “diet” for pain relief will usually appreciate the savings and convenience of an annual care plan. As such, if I were in practice, I would offer an annual care plan, but patients wouldn’t be eligible for it until 60-90 days out, or if they understood the lifestyle implications because they had been under chiropractic care previously, and they were nonsymptomatic, they could start immediately.

My angst about annual care plans is the heavy-handed “selling” of them in an attempt to get the patient to do the “right” thing—at least in the eyes of an enlightened chiropractor who plans to get adjusted for the rest of his or her life. Since most patients enter a chiropractic practice after a lifetime of symptom treating at the hands of medical doctors, the sales overtures amount to talking about kids and marriage on the first date. Or, patients are seduced by what they see as a lower-cost-per-visit, ignore the fine print and begin care with little or no interest in embracing a chiropractic lifestyle.

And not sure what you mean by “our ROF is not where it needs to be yet.” When you report your findings to the patient and offer them choices for acting on what you’ve found, where does your report need to get? You probably want to be careful about turning your report into a sales session. In fact, mixing your clinical findings with overt or covert attempts at getting the patient to do one thing or another, starts to take on the odor of manipulation.

06/05/09

What Would You Charge?

no-sale.jpgDear Bill,

I value your insight as a patient’s point of view, and wanted to get your opinion on fees. As I move to more of a cash based practice, and cannot rely on riding the tail of the insurance industry anymore, I am having a difficult time re-setting my fees.

My difficulty consists of my new patient fees. I perform a "hands on" exam as well as a sEMG/Thermal scan as well as a digital posture analysis on most patients. I also usually perform a front and side view full spine X-ray (two films 18-36 inch), on most adults and occasionally on a child, depending on the situation. I currently charge $180 for the X-rays and $45 for the exam for a total of $225. I was previously with a management group who thought this was too high and recommended keeping it under $100. They thought it might be a barrier to new patients. Their logic was to remove the money barrier so that they can have more money to give chiropractic a chance.

It's no wonder that my Chiropractic Opportunity weeks (where new patients are free) are so successful, but make me feel cheesy. Bill, what would you charge? And would you do any "free" promotions? I have also done the bring-in-something or charge-a-nominal-fee-and-donate-it-to-a-local-charity thing, but that also made me feel creepy. I would rather just donate on my own. Please offer your opinion!

Signed,
Cheesy and Creepy

Dear Cheesy and Creepy,

Setting fees is suddenly a new experience for chiropractors as they disengage from the “price fixing” influence of insurance companies. Many find themselves in the same place as plumbers, hair stylists, lawyers, consultants and others who deliver services rather than products: “How much should I charge?”

Regardless of what you decide, here are some things to consider.

Continue reading "What Would You Charge?" »

11/06/08

Dear Bill

Q: I have tried all different variations on the theme of new patient orientation classes. The running problem I can’t seem to get a handle on is compliance. Currently we have been doing lunches at my office. We had even thought about doing a room at a restaurant on a weekend. We are just not sure if there is a better night, day, venue, etc.

Do you know what has been working well for others?

Continue reading "Dear Bill" »

06/19/08

Dear Bill

He's giving you the sign!I just read your response to “4 months” about how to get new patients. Your suggestions are excellent and I’ll be using many of them. How do you talk to people about chiropractic in line at the bank, in a restaurant, in a store, etc.? I have talked with many of my friends and mentors about this, and most of them say that you just need to do it. Realize that it’s not about you or getting new patients, but it’s about changing and helping these strangers’ lives. Any thoughts?

Signed,
The Timid Doctor

Dear Dr. Timid,

Initiating a conversation may seem difficult if you unconsciously feel like you’re stalking some helpless prey or going in for a self-serving “kill.” Obviously, with an intention like that, any encounter is likely to have an unsatisfactory outcome.

So first, give up the notion that there’s some sure-fire “pickup line” that can turn a casual encounter in the Nine-Items-or-Less line into a committed new patient. It’s unlikely that there’s anything you can say or do that will prompt a total stranger to abandon their hand basket and beg you to show them the way to your office. Instead, set your crosshairs on a less ambitious target—such as having a conversation with a stranger who doesn’t walk away thinking chiropractors are jerks or weirdos.

Continue reading "Dear Bill" »

06/14/08

Dear Bill

fourmonths.jpgDear Bill

I’ve been in practice for about four months and having a really hard time getting patients. I don’t have enough patients to rely on referrals. Please help.

Signed,
Four Months

Dear Four Months,

Naturally, the first thing you’ll want to do is consult the notes from the class you took in chiropractic college entitled “Your First Year in Practice” to revisit the essential action steps that new practitioners must take in order to generate their first year’s worth of new patients.

Don’t have those notes? Don’t remember taking that class? Right. Because it wasn’t offered. And while this would be the perfect opportunity to launch into a riff about the shortsightedness of chiropractic colleges, who, fearful of being perceived as a lowly trade school, often offer little more than a perfunctory class or two about the dynamics of actual practice, here are some suggestions. My guess is that these ideas could help experienced field doctors who aren't getting referrals just as much as a newbie, thrust into the real world.

Continue reading "Dear Bill" »

04/03/08

Dear Bill

titanic.jpgPlease stop sending me E-mails. I do not need any motivation. After 20 years in the chiropractic profession it is quite evident to me that it is dying. The people in my state organization are likened to the band on the TITANIC; they go to parties and meetings, drinking their fine brandy, wearing their best attire while the chiropractic ship slips slowly into the ocean of obscurity. The only way to squeak by a living in my state is to be a personal injury or workers compensation attorney’s bag man.

I would appreciate you stop e-mailing Monday Morning Motivation to me. Nothing you can tell me will change the fact that the insurance companies are paying less than the price of a cup of Starbucks coffee and pastry, not to mention not letting me do my job. Thank you,

Dr. Had Enough

Dear Dr. Had Enough

I have unsubscribed you from Monday Morning Motivation.

There’s no question the chiropractic practice environment has significantly changed in the last decade or so. More telling is your response to these changes! Apparently, you have chosen to become a victim rather than a victor. It sounds like you’re preparing to withdraw your valuable skills from the marketplace. Too bad you seem so resigned at a time when we’re so close to the revolution that will make chiropractors indispensable.

Continue reading "Dear Bill" »

11/26/07

Dear Bill Patients Running the Practice

Patients have free will.Q: “I work primarily with Amish people. Since they have to hitch up their horse and come in to town (which may take awhile, since they travel 10 mph) they use excuses like: I'm busy, if I'm still hurting, I might come in, can I wait till next week or next two weeks?, etc. How can I be more confrontational? I do not want the patients to run the practice, but at the same time, I do not want them upset with me, because in the Amish community, word travels like fire.”

Continue reading "Dear Bill Patients Running the Practice" »

09/20/07

Dear Bill Take It Or Leave It Annual Plans

Q: After years of take-it-or-leave-it-yearly-pre-paid plans I'm starting to let go. I realized that the patients I look forward to seeing the most are the ones that decided on their own to adopt a chiropractic lifestyle despite my best efforts to "keep them on the bus.” Like you predicted in "The Seminar" I have been rewarded with diminished statistical results. I know in my heart that this is the best long-term sustainable route, but I was wondering if you had any knowledge on how long it has taken other offices to rebound to their former (and hopefully greater) glory?

Continue reading "Dear Bill Take It Or Leave It Annual Plans" »

07/13/07

The Key or the Car?

A common chiropractic problemDear Bill,

I've been to a couple of your seminars in the past few years and have always come away from them inspired. Recently I've hit upon a couple of problems. Firstly, I don't seem to be able to get patients to realize how important "their job" is and consequently they don't change their behavior or improve as fast as I and they would like. Secondly, I can't get the right approach when it becomes apparent that the patient wants to discontinue care - they want to run away before I can say anything!

I would be delighted to hear your opinion on these two issues.

Signed,

Frustrated in Dorchester

Dear Frustrated in Dorchester,

Probably one of the reasons these two issues seem like problems is that you may be under the impression that you actually have some type of control over chiropractic patients! Once you accept that you are powerless over what patients do, these sorts of everyday patient behaviors will no longer cause anything more than a passing sadness or a bit of short-lived disappointment.

Continue reading "The Key or the Car?" »

06/21/07

Dear Bill Patient Questionnaire

Do patient questionaires work?Dear Bill

I've been listening to your new CD set, "The Seminar.” I look forward to getting in my car now because that is where I listen to it. So far, I've been glued to the seminar.

I have a question. I'm very much the type of person who is attached to what people think of me. I get a ton of new patients but hardly any of them stay. My average is about 8 - 10 new patients a week. My average patient visits each week are about 80. I take that a little personally and I want to know why they haven't come back, or they quit their care early. Anyhow, my question is, is there anything wrong with sending out a patient questionnaire, to all the patients to get some feedback? If so, do you have any samples, or ideas of what to ask?

Signed,
Dr. Attached to What People Think

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06/05/07

Dear Bill Open Office

emotional.jpgQ: "You’ve suggested it’s important for a doctor to be there emotionally for patients and that this can be done in an open adjusting setting. How can I keep a schedule and still be charitable? Can you reveal how you'd appreciate your chiropractor handling your emotional need/vent in this situation? What beliefs would you need to hold to keep your office patient-oriented and still be aware of business issues (time per patient, money per hour, etc.) if you were a chiropractor?"

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03/30/07

Dear Bill Am I Ripping Them Off?

Q: Late last year I bought your “Converting to Cash” program. I was a bit surprised as it was not exactly what I expected (it was what I needed). I have listened to the “Headspace” CD several times and started regularly reading the articles and other material on your website. I’m embarrassed to say that many of the topics that you have written about hit home.

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02/20/07

The One Visit Fix

Q: I’m stuck in an area where many patients have been trained that one or two adjustments are all they need. I’m trying to change that but it is a huge daily struggle. Any ideas?

A: This is a common complaint among chiropractors who see chiropractic as something more than a short-term treatment (diet) for a particular ache or pain. It’s a situation often created by chiropractors anxious to please the patient, bill the patient’s insurance company, prove chiropractic works, validate themselves or prove how much they “care” by jumping in quickly and obscuring the larger lesson. In the process, they inadvertently minimize chiropractic, reduce it to a therapy and create a communication problem that the chiropractor down the street (you) has to overcome. “Well, my last chiropractor only needed one visit to fix this!”

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01/24/07

Dear Bill Office Attire

Q: We are having a major to do in our office about attire for the staff. What are your thoughts?

A: For some reason, the hoopla surrounding clothing (for doctor or staff) is a common trigger point. You may be asking this question of the wrong person, since I will usually choose comfort over style and I’m inclined to wear blue jeans and tee shirt just about anywhere and everywhere! But here are some things to consider as you resolve this little detail with your team:

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01/07/07

Dear Bill Missed Appointments

Q: If someone misses their appointment, how should we communicate with that patient? Any specific questions to ask this person upon contacting them, either by CA or DC?

A: The short answer? Use the telephone. Ask if they’re okay since you were expecting them at such in such a time.

The long answer is considerably longer. But here goes.

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12/29/06

What Happens Here, Stays Here

las_vegas.jpgI received this email from a chiropractor this morning:

“I plan to open an office in a town of 18,000 people January 8, 2007. I would like to advertise in the local paper and was wondering if you have any example formats or suggestions as to what should be included or avoided. I put together a little description of the spine relating to the nervous system and its effects on our health, without mentioning back pain or neck pain. Do you think that is wise? I didn’t want to be labeled a “pain” doctor, yet I don’t want people to think that I can’t treat those symptoms. I just want to communicate that the underlying problem is more than pain; it’s the nervous system. Thanks for any suggestions you may have.”

The fact is, whether you want to be labeled a “pain doctor” or not is largely outside your control. Because you already have that label. It was assigned about the time chiropractic care became a reimbursable expense under indemnity insurance policies. Decades later, the damage is done.

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12/09/06

Going Spineless

Q: I just received your latest catalogue and read the article about "Going Spineless.” I find that very interesting because my office went spineless years ago. I take no X-rays, have no spinal models, and I only discuss wellness and the nerve system with people. Your article is nice, yet so much of the products you sell are spine related. If one truly understands Innate Intelligence, the major thought of chiropractic, then these pamphlets and charts become meaningless. We are Nerve system doctors! The spine is merely our mode of approach to addressing the nerve system.


A: You and I are in total agreement. But here's my challenge. There are not (yet) enough chiropractors who know what you know who can support a chiropractic patient education supply company that would be totally spineless. Most of the profession is still in the bone-out-of-place-putting-pressure-on-a-nerve model of chiropractic. No problem. Even with what I think could be a shortsighted view of chiropractic, they are still adding value to patients by helping them avoid drugs and surgery.

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11/24/06

Wellness Wheel

Q: On the Wellness Wheel there are categories referring to mental health and spiritual health. If a patient has problems in one or both of these areas, what should a chiropractor do about it? What are you proposing?

A: Naturally, the same could be asked of the financial, family, social and career aspects of wellness. This is because wellness is much more than physical health or regular chiropractic care. Sure, having an interference-free nervous system is the foundation for virtually any notion of true health. But there’s much more to wellness than the integrity of the nervous system!

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11/16/06

Premature Dismissal

goodbye.jpgQ: "I have more patients self-dismiss prematurely than I should. Do you know of some scripting for the ROF that would help to minimize this or at least change how they go about it?"

A: Depends why they self-dismiss. Here are a couple of possible reasons:

1. You're a rough adjuster, have an obnoxious personality or both
2. They're delighted with the care and don't see a need to continue
3. They're busy and visiting your office is an imposition
4. They don't see the need to continue their care

Need I go on? The list is endless.

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About Dear Bill

This page contains an archive of all entries posted to Chiropractic Practice Blog in the Dear Bill category. They are listed from oldest to newest.

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