Wothy of Care

by William D. Esteb

Cliches are dangerous because they over-simplify or generalize the truth in such sweeping ways we forget to question their implications. However, "Birds of a feather flock together" is not one of these deceptive cliches. It rings true. Especially when it comes to referrals.

When I work with doctors to help them create the practice they want, we inevitably talk about the kinds of patients they particularly like serving. I imagine every doctor's dream practice is to have it full of Ideal Patients. For the new practitioner, an Ideal Patient is anyone with a spine who can get it to the office. For others, it's anyone who has a spine and pays their bill. And for others, it's merely a willingness to comply. It often varies depending upon how far the doctor has progressed in his or her own economic survival.

The nightmare patient

Many offices are plagued with what some might call "Nightmare Patients." These are patients who don't respect your time or your talent. These are the patients that we let ruin an otherwise wonderful day. With enough of them in your practice, you can start believing that chiropractic would be a great profession--if it weren't for patients.

Because birds of a feather flock together, when the Nightmare Patient feels compelled to refer friends or family to your office, you discover that the meaning of the word "clone" pre-dates genetic engineering! The corollary to this phenomenon is the headache patient referring the headache patient and the lower back patient referring the lower back patient. If 5% of your current patient base is Nightmare Patients, you're stuck with this patient mix--unless you intervene and take active measures to change it.

Do Nightmare Patients receive the same level of time and attention from you and your staff as your Ideal Patients do? Probably not.

There is a finite number of patients who can be seen in any given day, week, month, year, or career. Why not increase the number of Ideal Patients in your patient mix so you'll have more fun, do a better job, and make more of an impact in your community? But how?

List your ideal patients

First, define your Ideal Patient. Probably the biggest reason most of us are unhappy is because we haven't stopped to determine what we want. At your next staff meeting have everyone write down their own list of Ideal Patients. They don't even necessarily have to be active patients. What you're looking for are real people who personify attributes that make them Ideal. Four or five names will do. Then have everyone share their lists, explaining why they've included each patient. This is a valuable exercise that facilitates communication between the staff and doctor. Discover the qualities each staff member considers important in the profile of an Ideal Patient. It's interesting how it often varies depending on job responsibility. Even more interesting, these patients probably receive an extraordinarily high level of service.

Doing this exercise can help you avoid what happened in an office in which the doctor especially enjoyed working with children. During a staff meeting I facilitated, we brainstormed everyone's ideas of their Ideal Patients. After listing six or seven patient names, they compared notes. During this exercise we discovered the front desk assistant didn't like children! She didn't like the mess they made of the reception room and didn't like being a babysitter. Ultimately she had to move on in her career as the doctor expanded the pediatric side of his practice.

Having brainstormed the attributes of the typical Ideal Patient with doctors and staff at seminars, I've discovered that Ideal Patients range in age from newborns to grandpas. Male, female, white collar, blue collar, rich, poor; there isn't a clear cut demographic describing the Ideal Patient. But there do seem to be attitudinal characteristics. They are often described as open-minded, aware, health-conscious, coachable, enthusiastic, educated, willing to take responsibility, conscientious, self-confident, and what the Santa Monica, California think tank Rand Corporation describes as being "inner-directed." These are values that transcend community size, geographic location, and nationality.

I believe all these qualities are simply ways of saying Ideal Patients have a high level of self-esteem.

Based on this observation, you have two choices if you're interested in building a practice full of Ideal Patients. The first is to attract patients who already have a high level of self-esteem by using a variety of marketing approaches within and outside the practice.

The other is to "grow" Ideal Patients from among your current patient base by enhancing patients' self-esteem each time they have an office encounter. Just as patients' acute symptoms can disguise their true personalities during the early part of care, the fact that patients are in a doctor's office may distort their self-image. Happily, this is something you can change--a change that may have profound long-term effects beyond an improvement in their physical health.

Self-esteem can be defined as thinking of oneself with respect. Without discipline and compassion, it becomes destructive pride. Our self-esteem is the image we hold of ourselves, affecting our ability to enjoy life and contribute to others. Low self-esteem, often the result of programming by our parents as a child, holds us back for the rest of our lives. "Be careful." "Take it easy." "You can't do that!" "No!" And a million other subtle forms of programming shaped our self-image "tape loops." How we think of ourselves shapes every aspect of our lives, including our lifestyle, personal hygiene, and our worthiness in spending money (on ourselves) with a health care provider.

That's a major point. What's chiropractic worth? And am I worth it? Am I worth it beyond what my insurance policy seems to think is necessary? A high level of self-esteem (and money) is necessary to persevere beyond relief care only.

One way to increase someone's self-esteem is to consult child development books that explain how to develop this valuable trait in children. Then adapt the techniques into practical things you and your staff can do with patients. Here are some practical examples you can start implementing today:

Run on time. A frequent patient complaint is waiting to see the doctor. An office that runs on time, respecting the value of the patients' time, is an absolute must. Your time is valuable--so is a patient's.

Office environment. Investing in contemporary, comfortable office furniture and accessories tells patients you value them. Don't buy into the "they-don't-want-me-to-look-too-successful" myth! Of course, avoid the marble entry way and the chandeliers, but invest in your patients and their office experience. Show them they're worthy of chiropractic care.

Reward referrals. If you've ever seen patients count the names on your sign in sheet and mentally multiply the cost of care, you already know why you need to say thank you with something more than a pre-printed "Thank-You Gram" created in 1967. "Thank you" and "please" are two words you can't say loud enough or often enough.

Praise patients. Anyone entering your office has recognized the value of the care you provide. Avoid scolding anyone for anything. Didn't do your exercises? No problem. Didn't come in last week like you were scheduled? No problem. Praise patients for recognizing the need to see you at all. Identify ways the patient would benefit by complying with your recommendations. "It'll help you regain your health faster," or "It'll help prevent your problem from returning," etc.

If every patient continued to feel better, and feel better about themselves simply by being in your office, your retention statistics would soar. There's plenty of evidence showing the relationship between psychological health and physical health. Ignoring either thwarts complete recovery. Touching a patient's self esteem is a good way to ensure that you'll have the chance to touch his or her spine for rest of their life.

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

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