An Argument Against First-Visit Adjusting
by William D. Esteb
There’s a popular story that often is told on the seminar circuit about a famous ham recipe. Passed down as a family secret from generation to generation, this recipe was disclosed to the newest family member, a recently wedded woman known for her curiosity.
“The first instruction says to cut 2” off the end of the ham. How come?” she wondered.
The mother-in-law was consulted. She didn’t know. The grandmother was asked. She couldn’t remember. It had always been the first instruction on this revered recipe and was religiously followed. No one had ever questioned it.
Finally, the great grandmother was tracked down. Her eyes lit up when the famous ham recipe was mentioned. When asked why the first instruction in the recipe was to cut 2” off the end, her eyes grew distant for a moment.
“Is that why you came all this way to see me?” her disappointment showing slightly. She thought for a moment and then smiled. “I had to cut 2” off the end so it would fit the pan I had!”
Many chiropractors adopt office procedures prior to thinking through their implications. One such procedure is adjusting on the first visit. If this is your policy, and you choose to continue it, after reading through the following brief exploration of the potential patient mis-perceptions it can produce, great. At least you’ll be practicing consciously and you’ll be aware of the possible advantages and disadvantages by doing so.
If It’s Not Broken, Don’t Fix It
If you’ve always adjusted on the first visit and it’s working for you, since patients remain under care for as long as you hope they will, don’t change. If you have a profound sense of satisfaction and fulfillment because most patients “get it” and bring their families in for care, no need to question the status quo. If you never have a patient return and ask to have their “...neck ‘cracked’ like you did last time,” then first visit adjusting isn’t an issue. And, if you never have a spouse accompany a patient to observe what you do so they can replicate it at home, don’t change.
Yet, on the other hand, if you feel that your chiropractic explanations fall on deaf ears and patients routinely discontinue care as soon as they feel better, consider some of the following points:
The One-Visit Miracle Cure
While patients expect, or at least hope for, some type of therapeutic intervention on the first visit, is that a reason to do so? Is the fact that many patients have had their problem for years, and obvious symptoms for weeks, before coming to your office, a reason to rush in?
Many offices, easily swayed by patients who are suffering (due to no fault of the practitioner), administer adjustments as if they were some type of life-saving procedure like those dramatized in emergency room television dramas. “Clear!”
Of course, this makes the chiropractor feel important and the patient is appreciative of the “compassion” the chiropractor has shown. Only problem is, after the consultation, examination and X-rays, there’s no time to give a proper report of findings, so the majesty and meaning of the adjustment is glossed over in favor of keeping on schedule. The battle for the patient’s body may be advancing, but the battle for his or her mind has been lost, especially when patients don’t return to see their X-rays and to hear a super-duper report of findings. In the patient’s mind, the chiropractic intervention is merely a drug-free “aspirin” and apparently, the purpose of the report is merely a sales session to encourage more visits.
Many chiropractors observe that five minutes or less into the examination, they know exactly what they’re going to do to help the patient. In fact, this is a common refrain. It’s as if quickly knowing what to do is, in itself, sufficient justification to march in and try to “fix” the patient. In so doing, these chiropractors have reduced chiropractic to a mindless mechanical intervention, virtually ignoring the cerebral, perceptual, emotional and psychological importance of ceremony, performance and ritual.
The Lure of Instant Gratification
Because most adjustment routines take relatively little time, and to the patient, seem virtually the same on every visit, patients make assumptions. They presume that adjusting the spine is easy to learn, easy to do and is done in the same manner for every patient. Naturally, these unspoken conclusions do little to enhance their opinion of you or the respect they have for the chiropractic profession.
Intoxication, from the gratitude patients demonstrate when the intervention is performed on the first visit, causes many chiropractors to black out. Basking in the appreciation, they fall victim to the same relief derived from instant gratification as six year-olds in a now famous experiment. When asked to choose between a piece of candy now, or two pieces of candy later, most chose the single piece of candy.
Are you willing to delay receiving your reward? Those who can are the ones who act with the end in mind. They question virtually every procedure, every policy, every shred of paper and every possible patient perception. They manage every aspect of the patient’s experience with the sole purpose of increasing the likelihood of producing the intended outcome.
Those who see the contradiction between wanting a family wellness practice and succumbing to how the patient feels on the first visit, often feel trapped, until they consider the distinction between the first visit and the first day. In other words, you could have a new patient’s first visit in the morning, and, later that day, schedule their second visit. This way, you get the best of both worlds. You don’t have to send patients home with an ice pack and witness their disappointment when you tell them, “We’ll see you tomorrow.” Instead, they can have lunch (or rest in an unused adjusting room) and, later the same day, you can deliver their report, explain the chiropractic story, give your adjustment(s) context, meaning and majesty, and appropriately set the stage for a long-term relationship. If that’s your desire.
What is your desire? What kind of relationships do you want with the people who show up in your office? From what sorts of patients do you derive the greatest delight in serving? What are you doing (or not doing) to attract the types of new patients (and their expectations) that you have in your practice now?
The answers to these questions are vitally important because of something I’ve noticed during the last two decades I’ve spent visiting chiropractic practices. Those who seem to enjoy the highest levels of patient retention, those who attract patients who are willing to pay cash, and those who are still having fun while third-party reimbursement implodes, are offices that rarely adjust on the first visit. Is there a cause and effect link? Maybe. Maybe not. This is a conclusion you’ll have to reach on your own. To know for sure, you may want to test the idea of no longer cutting 2” off the end. Which, isn’t about chiropractic, but courage.
Buy the book
Connecting the Dots
Published in 2005
240 Pages
US $24.95
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