Seven Reasons Patients Don't Refer
by William D. Esteb
When you got involved in chiropractic you implicitly or explicitly accepted the notion of looking for cause rather than treating symptoms. Regardless of which chiropractic college you attended, you were introduced to a perspective so radical, yet so simple that you probably take it for granted now. The role of the nervous system in controlling health (function) is a new idea for most patients.
Getting to cause instead of treating symptoms is a perspective helpful in virtually any endeavor. Yet, we are a culture of symptom treaters. All too many parents treat the symptoms of their children's poor behavior instead of the cause. Instead of ferreting out the cause of frequent speeding tickets we treat the symptom with a radar detector. Rather than confront the cause of being overweight we buy something, join an organization, or distract ourselves in some other way. Denial becomes so ingrained in our behavior that real solutions to our problems are obscured. Our behavior becomes a series of rationalizations that make us feel trapped and alone.
It's interesting that a profession that ascribes to finding the cause of a patient's health care problem and avoids treating the symptom, is rift with doctors treating the symptoms of a less than optimum practice! Poor compliance is a symptom. High staff turnover is a symptom. Low patient volume is a symptom. However, the solutions prescribed by management specialists or the "I-had-a-great-practice-once" seminar lecturers rarely offer approaches that attack the true cause of these common frustrations.
We pay dearly when we are lied to. First we pay to attend seminars so someone can whisper sweet nothings into our ears. Then we pay again when their advice backfires or is so personality dependent as to be non-information.
We are constantly on the lookout so we can blame causes outside our own responsibility. The snowstorm. The economy. The small rural community. The A.M.A. The insurance companies. The paperwork. The HMOs and PPOs. The chiropractor down the street. Yellow page ad placement. Being the youngest child. Being the oldest child. Being too short. Not having enough time.
Have I missed any?
When patients look outside for solutions (drugs and surgery) and when doctors look outside (excuses and rationalizations) they rarely get lasting results.
If growing a practice, like healing, is an inside job, it's necessary to look inside the practice for the cause(s) thwarting the natural referral process. That means looking at the doctor, the patients, the staff, and the physical surroundings of the office itself. Here are some common, yet often overlooked causes for a lack of referrals:
1. Poor doctor/patient rapport. Improving a patient's spinal biomechanics is more than just a clinical procedure. The doctor's personality and communication skills play a larger role than most doctors think. Doctors must walk the fine line between being a "friend" and being a clinician. This balance is difficult for the analytical and the technique guru who measure success with a protractor. Don't expect a lot of referrals if patients perceive you as distant, preoccupied, or unenthusiastic. Make sure your passion about chiropractic and your hope for the patient is continually obvious.
2. Patients lack the words to refer. Can you describe chiropractic without using the words "subluxation," "adjustment," "fixation," and other language that most prospective chiropractic patients have never heard before? One of the easiest detectable reasons why patients don't refer is because they don't have a way to describe what goes on in your office to others. That's why some form of systematic, relentless patient education is so critical. If patients can only describe their chiropractic experience by how they "feel," they will be severely limited in their ability to tell others what chiropractic is and feel confident fielding the inevitable questions.
3. Can't defend their decision. More subtle is the peer pressure that prevents many chiropractic patients from telling others. The alternative-not-approved-last-resort-cultist-charismatic image that chiropractic suffers from stops many image-conscious chiropractic patients from revealing their chiropractic identity to others. Even patients who get phenomenal results are often closed-mouthed about chiropractic. It's not cool enough. It suggests poor judgment if one has been swayed by some non-mainstream practitioner who offers free exams and uses coupons to solicit new patients. Because few patients are equipped to explain why chiropractors are seemingly not allowed to prescribe drugs, or detail a chiropractor's educational achievements, or counter the dozen other myths and misconceptions about the profession, they don't say a word. It's easier that way.
4. Nothing worth talking about. When you do something (or don't do something) that doesn't meet a patient's expectations it causes negative word of mouth about your practice. "He/She's a great doctor but..." When you exceed a patient's expectations it causes positive word of mouth. "You gotta come meet my chiropractor because..." When you simply meet a patient's expectations there is no word of mouth. In all too many offices this is a major obstacle to more referrals. There's nothing extraordinary to talk about. If you want your patients to be compelled to tell others you must romance your office, your procedures, and every aspect of a patient's encounter with chiropractic so it exceeds a patient's expectations. Start by holding a staff meeting devoted to making a list of the expectations of today's quality- and time-conscious new patient. Then brainstorm ways of exceeding those expectations in a consistent and systematic way.
5. Lack of patient education. Many chiropractic patients think chiropractic is appropriate only for the complaint they consulted your office for. No wonder low back patients refer other low back cases and headache patients only refer headache patients. And why so few children receive care in chiropractic offices. Besides the short-term goal of improving compliance and speeding the healing process, patient education should broaden a patient's understanding of chiropractic so they see its almost universal appropriateness. Without patient education, conventional wisdom would suggest most children don't need chiropractic care. Without patient education your patients can't explain chiropractic or answer a friend's well-intentioned questions.
6. Referral efforts aren't rewarded. Human Nature 101 suggests that what gets done is what gets rewarded. Want more referrals? Reward this positive behavior in a way that gets a patient's attention! The Thank-You Gram, name on the referral board, and free adjustment aren't as dramatic and as appreciated today as they once were. Funny how many offices that still use these uncreative techniques are the same ones squandering thousands of dollars on advertising! If you've ever watched a patient count the number of names on your sign in sheet and multiply it by the cost of care, you know that they know what a new patient is worth. Up the ante and say thank you in a more memorable way. Consider a tickets to movies, sporting events, concerts and other cultural activities. Perhaps certificates for car washes, a massage, having one's "colors done," or some other indulgence. Other patients might enjoy an evening in a limousine, a harbor cruise, singing telegram, or a champagne breakfast hot air balloon ride. Use your creativity to say "thank you" creatively and memorably.
7. Office capacity already reached. Most of us are quite selfish. Why introduce others to chiropractic so we have to wait even longer for our care? Every factory, business, or service provider has some type of capacity limitations. It may be legal, physical, psychological, procedural, or some other restriction. Patients are more sensitive to the capacity of your office than you think. Ask patients "how full" they perceive your office to be at the time they receive their care. The higher the percentage, the more unlikely patients will refer others. If the limitations you've assumed or imposed on your practice cannot be changed, start working on strategies to increase your off-peak practice hours.
There are some in chiropractic who make the point that if you want more referrals, you need to ask patients for them. That's treating a potential symptom. Consultants who recommend heavy-handed approaches and super-duper-this-will-get-patients-to-refer scripts often accuse reluctant doctors of an "unwillingness to confront" if they don't panhandle their current patients for referrals. There is a reason why patients don't refer. Simply asking them doesn't get to the cause. In fact, it puts patients in an uncomfortable position. They resent divulging the name of a close friend or business associate, not only because of one or more of the reasons mentioned earlier, but because they can reasonably expect you'll treat their friend in the same heavy-handed way you're treating them!
Reminding patients of their responsibility to tell others about chiropractic needn't be uncomfortable or manipulative. "I'm so glad you're doing better Mrs. Jones, now because you know more about chiropractic than probably any of your friends, be sure to let them know how we can help." Most patients would find a low key approach such as this to be perfectly professional and warranted.
Want more love? Don't whine to others that no one loves you. Become a better lover yourself. Want more new patients? You don't ask. Become worthy of the risk patients take when they vouch for you by telling their friends. Until you see your practice through the eyes of your patients, the lack of referrals will remain a better kept secret than chiropractic itself!
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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