The New Patient Menu

by William D. Esteb

How accessible is your office? I don't mean its location or easy-to- remember phone number; how accessible is the doctor? In the Bloomington, Illinois Survey of McLean County Residents' Perceptions of McLean County Professionals, Doctors of Chiropractic were rated along with 18 other professionals in over a dozen categories, including trustworthiness, honesty, helpfulness, accountability, professionalism, fees, and accessibility. How accessible were chiropractic doctors? Not even in the top 10.

The Bloomington survey was conducted in October 1990 by college marketing students on behalf of the Bloomington area Chamber of Commerce. At several area shopping malls, students asked over 200 people their perceptions of professionals, from realtors and stockbrokers to chiropractors and medical doctors. Sadly, chiropractic placed 19th out of 19 in a majority of the categories. The only bright spot was accessibility, with chiropractic scoring its highest ranking (at 13th). Apparently, the public sees Doctors of Chiropractic as being more accessible than engineers, pediatricians, and attorneys, but less accessible than hospitals (rated 1st in accessibility), physicians (5th), dentists (6th), and even surgeons (11th).

Call screening

While better than being at the bottom (shared by stockbrokers and architects), accessibility for chiropractic doctors is still woefully poor.

C.A.: "Good morning, Dr. SoAndSo's office, may I help you?"
CALLER: "Yes, this is Mary Smith, I'd like to speak with Dr. SoAndSo"
C.A.: "I'm sorry, Dr. SoAndSo is with patients right now; can I take a message?"

Terrified that a salesman might slip through, the staff is well trained to limit access to the doctor, even if the doctor is free to come to the phone. The door slams shut on a potential new patient.
Many new patient phone calls are the culmination of many courageous decisions, usually caused by painful symptoms. This fragile decision can take months, even years, to make, slowly moving the patient towards your front door. It is during this process that the effect of all the stories and negative baggage associated with chiropractic is most readily seen.

In the beginning

Every new patient starts out life oblivious to chiropractic. This isolation and ignorance may exist only in childhood. Yet, at some time, prospective new patients learn of chiropractic, although in North America it often has negative connotations. While the public has a growing dissatisfaction with the addictive drugs and irreversible surgery of the medical approach to health care, the observations of the Bloomington study are sobering if you mistakenly think the utilization of chiropractic is suddenly going to explode with the right Reader's Digest insert, celebrity endorsement, super bowl testimonial, or the perfect mall show booth design.

After hearing about chiropractic and dismissing it, time passes. If a perceived need (back pain or some clearly spinal-related condition) appears, there may be a perfunctory exploration of chiropractic. "What is chiropractic?" Asking around, your potential new patient asks others about chiropractic. (If he or she locates one of your patients and asks what chiropractic is, how well can your patients describe what goes on in your office?)

"I wonder if chiropractic could help," they ask themselves. Yet their painful symptoms have not yet eclipsed their fear. Their decision to consult your office is delayed further. "Anyway, I remember someone saying that chiropractic can make back problems worse."

Remember, this process is going on right now in the minds of the prospective new patients you'll be seeing next month or in the years to come. They drive by your office, know your current patients, and could easily be helped now, but they must make several more decisions first.

Not desperate enough yet

The internal dialogue continues as their condition slowly deteriorates. Since they've heard chiropractic is expensive and painful, there still isn't any compelling reason for them to consult your office. In fact, their symptoms must worsen just to prompt an exploration of conventional medical solutions first. This decision may or may not reduce their pain. At some point, the aspirin, muscle relaxers, and pain pills no longer help, or the patient becomes reluctant to continue using them. Or surgery is suggested, shocking the patient into seeking alternatives. Desperation forces the procrastinator's hand. "Maybe I should try chiropractic," they decide one day. Do they immediately schedule an appointment? No. There are still more "mini-decisions" to be made.

A moment of truth

"Gee, there are so many chiropractors; which one should I go to?" For the first time they are seriously trying the idea on for size. Yet, the internal dialogue continues. "I wonder if it could help." "What would happen if I came in?" "What would my medical doctor, attorney, boss, friend, or spouse say or think?" Peer pressure rears its ugly head, further delaying the decision, lengthening the recovery period, and making care more expensive. And now, desperate, alone, and hurting, they decide to take a big step and call your office. This phone call has taken years to make, yet the staff screens it with suspicion.

"Dr. SoAndSo is with patients right now..."

Even if the patient hasn't lost interest by the time the doctor or new patient coordinator returns and sets up the new patient appointment, the fear lingers. If the staff isn't aware of the low self-esteem caused by finally embracing a "last-resort-not-approved-what-would-my-friends-say-alternative-health-care provider," they may be inclined to treat this potential new patient in an inappropriate, matter-of-fact way. After all, they know that no one has gotten a stroke in your office. Perhaps this insensitivity contributes to some patients' decision to miss their first appointment.

Point of no return

Most doctors and staff don't realize that crossing the threshold into your office is a huge commitment. Few new patients come in the front door, take one look, and leave, although you might reasonably expect them to after hearing the frightening sounds of your adjusting table drop pieces, children crying as they get adjusted, seeing your 1952 X-ray equipment, or walking past the gyrating torsos of those on your intersegmental traction tables. No, if patients actually make it into your office, it's a significant accomplishment; take their exploratory phone calls more seriously.
Increase your accessibility and help prospective patients move through this multi-step decision-making process more quickly. Consider creating a menu of no-obligation entry points into your office. Here are some ideas you might want to publicize to your community or let current patients know are available:

Telephone access. Doctors available for radio and TV call-in talk shows help callers in the process of making a decision about beginning chiropractic care. If you're not currently available for the media, you could make yourself available to answer questions by phone, perhaps on Mondays during the lunch hour. No elaborate call-screening, just call up and "Ask Dr. SoAndSo your chiropractic health-related question between 12 and 1 p.m. every Monday." Plan to eat in and attack some paperwork when you're not fielding calls. This no-commitment source of information can help move someone along the path towards making a chiropractic decision.

Mail information. How often are you mailing brochures and articles about particular health complaints to members of your community? Have a staff member collect and organize symptomatic brochures, clippings, articles, and other informative materials. If you haven't created an office brochure, do so! At least create a one-page sheet with pictures (and captions) that describes what happens on a new patient's first visit to your office. Let all your current patients know that you have these information packets available; this way they will have access to the resources they need to help those they wish to refer.

Patient referrals. Patients who are referred to your office are almost always less apprehensive and more compliant. Someone they trust has "vouched" for you. You can facilitate confidence among potential new patients who weren't referred by collecting the names of patients who would be willing to take a few short phone calls from prospective patients to answer their questions. Many of your patients would be honored to help you in this way.

The previous suggestions can be effective in moving patients along in their decision-making process while allowing them to remain anonymous. Providing this unconventional level of access can be extremely attractive to a prospective new patient because it acknowledges their reluctance to make the enormous commitment to enter your office. If prospective new patients are ready, there are additional menu choices that can be offered to move them even closer to a chiropractic commitment:

Office tours. You can invite them to tour your office. Use this opportunity to put patients at ease by selecting a relatively busy time of the day. Let them see that the office is successful and attracts other patients like themselves. An experienced staff member can lead the tour and finish it by showing the prospective new patient an educational videotape and introducing the doctor. Staff members can rave about how wonderful their boss is and more easily empathize with a prospective new patient's concerns.

Complementary consultation. This requires even more of a commitment from the prospective new patient. Complementary consultations are widely practiced and well understood. What hasn't been explored are the doctor's expectations and attitude surrounding the outcome of the consultation. Just as animals can sense fear in an opponent, prospective new patients can sense a doctor's desperation to turn someone into a new patient. Automatically expecting them to "sign up" for care is presumptuous and often counterproductive. Respect them enough to let them reach a decision without pressuring them or using scare tactics.

Accessibility is attractive to patients. It removes the unapproachability that creates distance and mystique. Accessibility improves patient rapport, enhancing the healing process and improving the number and quality of the referrals your office receives. How accessible are you?

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A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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