Chiropractic Blog

I got a cup of coffee at a Starbucks this morning. From time to time I “go off” coffee, and after a couple of months I often take up the habit again. Now, is one of those times.

It’s expensive to buy professionally brewed coffee. At least I think it is. Many people spend a hundred bucks or more a month on their caffeine fix. These are the same folks who claim they can’t afford chiropractic care!

But it boils down to priorities, doesn’t it? People have a feeling about their coffee (physically or emotionally) that is more compelling than how they feel before, during or after their chiropractic care. Which got me thinking about the 25 years I’ve been receiving my chiropractic care. What do I get out of it? How does it make me feel? Why do I keep doing it?

I got a speeding ticket on my way to the airport today. It’ll be a $120 fine and two points on my record. It’s my third speeding ticket. In 35 years of driving. With over 500,000 miles under my belt (seatbelt). Some would say that I was overdue. No matter. My pulse still quickened and I felt that sinking dread in my gut when I saw the motorcycle policeman in my rear view mirror with his flashing lights.

I think I was more angry at myself than anything. Angry because this speeding ticket occurred under the same circumstances as the other two: I wasn’t driving consciously.

If you’re one of those chiropractors guilty of caring for patients too much, you’re likely to have unhealthy attachments to what patients do. You probably take the occasional lack of perfect compliance and follow through, personally. It’s counter-intuitive, but this is usually a sign that you’ve made practice about you, rather than patients. Fearing patients who override your recommendations won’t get the results they expect and will blame you, is merely a deception. This became even clearer to me after I completed my three-hour “What Patients Do What They Do and What To Do About” presentation for the Blair Society yesterday morning in Charleston, SC.

I attended The Masters Circle Super Conference this past weekend. It is by the far the classiest, most upscale success movement in the profession. At its root is their focus on quality and excellence. For years chiropractors have often seen themselves as second-rate doctors. So when an organization like the Masters Circle shows up with such a high-class, organized event, it sends shock waves of improved self-esteem throughout the profession.

I’ve been spending some time recently thinking about why some patients embrace chiropractic as a way of life, and how others simply see chiropractic as a short-term diet for relief of their current symptoms.

What if this issue was not a reflection of each person’s attitudes about health, but their perception of time?

Consider this. There are three types of time. Past, present and future. Could it be that people who are inclined to live in the present (or past) see little need for preventive measures, and thus less inclined to use chiropractic for nothing more than their present ache or pain? Conversely, could it be that those who are more future-oriented might be more available for nonsymptomatic chiropractic care whose value is measured in one’s future health and potential vitality?

Are your patients proud of you? Do patients see their own reputations enhanced by revealing their relationship with you? What is it about you that would prompt patients to vouch for you or your practice?

If you think patient referrals come solely from the great results that chiropractic is famous for producing, then you’re simply not enjoying the new patient referrals you deserve. That would be like an airline assuming that transporting you safely from Point A to Point B should alone be sufficient to garner your loyalty and gratitude!

No, great results, like safe transportation, is on the “Expected” side of the ledger. In the minds of patients, results, along with all the other technical stuff most chiropractors hold in such high regard, merely gets you to zero. Practices that enjoy a constant flow of new patient referrals know this. They also know what it takes to inspire patients to become persuasive advocates.

I completed my 65th in office consultation and patient focus group yesterday. I’d forgotten how much I enjoy the process of sleuthing for the lynch pin holding up practice growth and providing some objective feedback for the doctor and staff. And while most offices strenuously clean up their office in preparation of my arrival (attempting to hide some of the very issues holding them back), in spite of their efforts, from time to time I get a glimpse as to how things really work. Yesterday was no exception.

Usually it’s a couple of dozen Post it notes cluttering the front desk. Or the chiropractor who has made his desk presentable by scoping his desk piles into boxes, stuffing them into a closet he hopes I won’t peak into. This time, it was the diagnostic area of the practice—the area where they use ionizing radiation and other technology to document the source of the patient’s problem.

Probably one of the greatest sources of suffering comes from resisting what is. You can tell when someone is resisting circumstances when they use the word “should.” As in, “Patients should place a higher priority on their health” or “Patients should follow my recommendations.”

Right. And I should be taller and better looking.

Besides revealing a resistance to what is, using the word 'should' admits a lack of power. Wishing things were different and stating your powerlessness does little but distract you from those areas in which you do have control.

While patients should place a higher priority on their health, many don’t. And while few chiropractors dream of basing their own lifestyle on the whims of irresponsible patients who look to their insurance coverage as a guide for how much care to receive, this is where many chiropractors find themselves.

No, you can’t control patients but you can control your reaction to them. Here are some possibilities:

From time-to-time, I encounter chiropractors who get indignant when merely describing patients who call and just “want to get cracked.” Or get tense simply thinking about patients who reveal that they just wanted a “patch job.”

Why so easily offended? Does a patient’s unenlightened language diminish you? Does a patient’s poor choice reflect on you? Do you believe their shortsighted outlook threatens you? Or that their behavior somehow tarnishes your reputation? Is your self-image that fragile?

Oh, I know that the “my-way-or-the-highway” attitude feels empowering, creating the illusion that you can control patients, but think about it. Imposing your health values onto patients in the hopes it will engender respect or a change of heart flies in the face of how a patient would come to adopt a healthier consciousness. (Clue: it isn’t by threatening them or using your social authority to get them to do something—even if it’s in their best interests.) Pushing potential patients away because they don’t “get” what you’re about may make you feel righteous, but it doesn’t create respectful, appreciative patients. In fact, it’s rather self-indulgent and probably works against your desire for a more influential practice.

There seems to be quite a buzz in chiropractic about confrontation. As in confrontational tolerance; specifically the ability, willingness or emotional fortitude to volitionally elevate the tension in the doctor/patient relationship. When you Google “confront” you get synonyms such as to “oppose,” “accuse” or to “criticize.”

And this is somehow a desirable trait?

While I was on the treadmill this morning, I was listening to an interview with a prominent chiropractic leader. I had heard the lie that he uttered many times in my chiropractic journey. However, this morning it seemed to take on greater significance than at other times. Perhaps because this lie takes such a toll among chiropractors, producing needless pain and frustration. Worse, believe this lie, and you’ll never enjoy the emotional satisfaction of a stable practice and your patient communications are a repetitive, burdensome, ineffective chore.

What did he say? What did he assert that causes so many chiropractors to misdirect their patient education efforts?

“If patients knew what you knew, they would do what you do.”

You’ve probably heard this one before. It’s a lie. It’s simply not true.

You’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.

Increasingly as I speak to chiropractic audiences, I’m noticing an alarming trend. It’s the justification that is used to get patients to do the “right” thing. It’s as if anything is fair game if it will cause patients to get under chiropractic care.

However, the “do-gooder” attitude that prompts these patient management techniques have the effect of producing some unwanted consequences that become more obvious in light of today’s practice environment. The words and actions taught to trusting chiropractors may produce the desired result in the short term, but often end up costing far more in the form of few patient referrals and even fewer reactivations.

You might consider passing every patient procedure and every word you speak through this simple filter:

As the spirit of fear continues to be promoted by the mainstream media, more and more patients are making choices that reveal that attending to their health isn’t among their higher priorities. This is serving to empty some practices who have had the habit of attracting patients who consulted a chiropractor only if the bill was assumed by a third party.

Today, with $1000 deductibles or higher, many patients are deciding that attending to their neuromuscular-skeletal complaint can wait. Or should clear up in considerably fewer visits than when their insurance company picked up the tab.

This puts many veteran chiropractors in a situation they’ve never experienced before. Besides discovering how significant the influence of insurance companies has been in determining a patient’s decision to begin and continue care, they are discovering how powerless they are to enforce their usual treatment plans. The rote, almost mindless “three times a week for the first four weeks, followed by two times a week for the next four weeks, blah, blah, blah" is increasingly ignored by patients.

A solution is contained within an observation that many chiropractors may have overlooked.

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.

Enormous amounts of energy are consumed in an attempt to get patients to do the “right” things to promote healing, advance their health and improve their well-being. Many professional caregivers seem bent on saving patients from themselves. Others seem resigned to the apparent fruitlessness of the effort and apply their ministrations with a detachment almost bordering on indifference.

Can you change the priority that patients place on their health?

Without looking through a spiritual lens, you might see the task before you as merely using the right videos to educate patients or delivering a persuasive rof. Certainly these can be helpful, but there is something else at work here that you might want to consider. And it may dramatically change how you communicate with patients.

With all the different overtures that I’m involved with, especially Patient Media, our Perfect Patients website service and more recently the Choose Natural health directory, non-chiropractic patients will often weigh in with their perspective.

That happened recently in an exchange with my business partner, Steve Anson, which reminded me that chiropractic is still saddled with considerable “negative brand equity.” The email exchange began with a request to have his name removed from the mailing list of one of our Perfect Patients clients:

“I'm getting spammed from XYZChiropracticClinic.com. They've emailed me 4 times in the last week - none has an unsubscribe button. I'm sure he picked up my business card at a networking meeting - but that gives him no right to email me. I'm one of those who consider chiropractic more scam than medical science and never have and never will consult one except on the recommendation of my MD.”

The allure of new patients can be potent. Profitable exams. Frequent visits. Insurance reimbursement. And let’s not forget the emotional payoff of having easy proof that chiropractic is working as patients see their symptoms melt away! In short, new patients are profitable—financially, clinically and psychologically.

This, combined with the fact that few patients seem to want post-symptomatic care, reduces chiropractic to little more than physical medicine and puts many chiropractors on an endless treadmill of chiropractic marketing overtures to get more new patients.

At speaking gigs, I frequently remind audiences that of the nine chiropractors I’ve consulted over the last 30 years, chiropractor number seven and nine have enjoyed far greater financial rewards than the first one back in 1981 who harvested my insurance benefits. So, if the appeal of new patients is financial, many shortsighted chiropractors are missing the practice stability and predictable cash flow afforded a tribe of nonsymptomatic practice members who show up once or twice a month. For life.

Consider these three distinctions shared among practices that enjoy high patient retention:

Virtually every new patient has heard the old saw, “Once you go to a chiropractor, you have to go for the rest of your life.” And because many chiropractors, especially those who see the highest and best use of chiropractic is as a life-long adjunct to optimum health, either overlook or ignore addressing this issue with a new patient.

Big mistake.

“Since the chiropractor hasn’t mentioned it, it must be true,” surmises the patient.

That’s when many unhealthy patient behaviors are actually created as patients go about the business of planning how they are going to “beat the house.” In other words, get the chiropractic that they want, without getting the lifelong care their chiropractor wants for them.

With the chiropractic consulting and coaching that I’ve been doing recently, invariably the subject of getting new patients comes up. It may show up in the context of reduced insurance reimbursement or the revelation that the doctor is tapping his or her savings to keep things going.

Regardless of how it comes up, chiropractors get little comfort from my observation that “…you wanted a practice but you’re actually in a small business, facing the same challenge virtually all small businesses face: getting new customers.”

Only when you completely own this idea, make friends with it and cozy up to it, are you likely to escape the bondage of imagining you somehow deserve a constant stream of new patients simply because you endured four winters in Davenport. It may have worked that way 10-20 years ago, and your professors may have believed that, but those days are long gone.

Jettison the notion that marketing your practice is somehow dirty or beneath you. “But Bill, I didn’t sign up for this to become a salesman.” Really? Everybody is a salesman. Whether it’s the drug companies minimizing the unwanted effects of their concoctions or your seven year-old child who wants a later bedtime. Begin by abandoning the entitlement mentality and acquired helplessness learned from the days of low deductibles and $75 office visits.

While I rarely urge chiropractors to look outside themselves for solutions, part of the solution may reside with the person you’ve chosen to answer your telephone at the front desk. Especially, if that person has been with you five or six years or longer.

I have used this space repeatedly to assert that the consultation is more important than the report of findings. That’s primarily because it’s an opportunity to set boundaries, delineate responsibilities and supply leadership in the relationship. Yet, far too many chiropractors see the consultation as something to be endured or a procedure that merely delays getting their hands on the patient’s spine.

Chiropractors who rush through the consultation or fail to see its opportunities rarely enjoy the intimacy or influence afforded chiropractors who do. In fact, they continue to tinker with their report of findings, incorrectly thinking that the lack of patient follow through is due to some shortcoming in “selling” their recommendations at the report.

Instead, a far more productive pursuit would be to examine whether appropriate “rules of engagement” are being set when first meeting the patient at the initial consultation, pre-care interview or whatever you call it.

When chiropractors reveal to me that their numbers are down, they reluctantly cite the economy as the culprit, almost as if they know it isn’t true.

“People just don’t have the money these days,” they observe.

Really? While it’s true that their $5,000 deductible insurance policy pretty much makes them a cash patient, their financial reserves are exhausted and their unexpected bout of back pain wasn’t exactly a line item in their monthly budget. (Read Financial Fragility which sums this up nicely.)

However, I’ve noticed that they’re still restocking the organic produce department at the grocery store. And I’m still seeing people putting the smaller, less attractive, more expensive produce in their cart—without expecting to be reimbursed by a third party. (The stock for Whole Foods Grocery hovered around USD $10 a share in November of 2008. Today it’s cresting over $80. Hello McFly.)

Apparently there are still plenty of people in your community who value their health enough to pay a premium for organic produce, grass fed beef, cage- and antibiotic-free eggs and rBGH-free milk. All this, while you’re holed up in your office yakking about the biomechanics of back pain and misleading patients into thinking that chiropractic is about bones rather than the nervous system and symptom relief rather than reviving their ability to self heal.

After you’ve been in as many hotel rooms as I have, you pretty much know what to expect. Electronic card opens the door. Closet. Bathroom. Bed. Television. Chest of drawers. Worktable. Sitting chair. Lamp. There seems to be about 4-5 floor plan permutations, but that’s pretty much it. And how much you pay for the room in which you spend most of your time with your eyes closed doesn’t seem to change that.

So I was surprised, even amused, when I checked into my hotel room Friday night in Sioux Falls to conduct a special Debrief for The Conversation and found something that broke the pattern. Next to the telephone (both of them) was an alcohol prep pad. Something one might use to sterilize an area of the body prior to giving an injection.

Since I’m a student of people’s health beliefs and attitudes, I couldn’t help myself when checking out yesterday, asking the twenty-something front desk clerk to explain.