Making Chiropractic Valuable

by William D. Esteb

You're doing your shopping at the supermarket after forgetting your shopping list. You do the best you can, pausing here and there, attempting to remember what you need and don't need. Between the paper towels and napkins you pause in front of the bathroom tissue. Was bathroom tissue on the list? Four rolls of two ply is priced at $1.09. After a slight hesitation you decide bathroom tissue wasn't on the list and you finish filling up your shopping cart.

Upon reaching home you're dismayed to learn that bathroom tissue was on your list. In moments you're back in your car. However, this time you're not going to the mega-mart with built-in bakery, fish market, and video rentals. This time you're headed to the open-24-hours-a-day convenience mart.

Pulling into the lot, you grab a parking spot just 20 feet from the door. Thankfully, you take the few steps to the rear of the store and reach for the same four roll, 2-ply package of your favorite national brand bathroom tissue that you saw at the supermarket. The price? Fifty cents more at $1.59. Without hesitation, you take the object of your desire to the checkout counter and give the cashier $2.00, get your change, and seconds later you're back in the car heading home. The extra 50 cents was paid for the added value of the convenience that was bundled with the bathroom tissue. It was paid after making the decision that avoiding the two-mile parking lot hike, and the mother standing in line having a power struggle with her four-year old, was worth the extra half buck. It was the same bathroom tissue, yet its access and convenience made it "worth" more. In other words, the convenience was a "value" or quality that was added to the price.

In a chiropractic setting it's tempting to lower fees and disregard the option of adding more value instead. In fact, the whole issue of compliance and the dismay many doctors felt in the 1980's, when they encountered a cash patient, is directly related to being able to create or add value to a patient's chiropractic experience. Just about everyone can afford chiropractic care, it's just that they value their annual ski weekends to Colorado or driving a late model car even more.

The path of least resistance is to lower the fees, or make special "deals" that clutter the books and make it difficult for staff members to collect fees and administer the financial policy. Worse, when patients talk, as they often do, and find out Mrs. Smith is only paying $XX per adjustment, tempers can flare and doubts about the doctor's integrity arise.

Lowering fees is almost always just an expedient way to treat a symptom. The cause is a lack of value communicated by the doctor, or not adding enough value to the patient's experience of receiving care. This seems especially difficult for doctors to do when patients are relieved of their pain, or their most obvious symptoms have cleared up.

Perhaps it is because of this, that there is still a sizable contingent of chiropractic doctors who don't "believe" in non-symptomatic care. They observe that without obvious symptoms, there is no need for chiropractic adjustments. Plus, insurance companies don't pay for that sort of care anyway. Why bother?

First, these are the same doctors who for the last ten years, have gotten adjusted at least once a month themselves, sometimes more often. Second, only treating patients with obvious symptoms (and insurance policies) is a stressful and limited way to serve the community, ignoring children and preventive care. Third, avoiding the self-esteem-wrenching confrontation required of a doctor to place a value on what his or her (nonsymptomatic) care is worth, in favor of personal injury, workers compensation, and major medical patients, transfers an inordinate and inappropriate amount of practice control to third parties.

The issue here is value. When patients, even cash paying patients, are receiving the symptomatic relief they desire during the earliest stages of their care, there are usually few problems with patient compliance. Patients get value for their financial exchange. It usually isn't until later, when they're feeling better, that the lack of perceived value starts to emerge. The seeds for this patient rebellion are often sown on the first visit and reinforced throughout their experience in the office.

It often starts by the doctor or office staff communicating in many subtle ways, how delighted they are to have the patient. With new patient volume down in so many offices these days, this is more of a problem than it used to be. When you forget that patients need you a whole lot more than you need them, you fall into a leadership trap that comes back to bite you later. Feeling the need to "prove" that chiropractic is appropriate, or trying to "sell" chiropractic, digs the hole deeper. Allowing patients to dictate what you will and won't do (take X-rays, adjust on the first visit, don't touch my neck, etc.) further erodes their confidence and endangers the leadership role you'll need even more, later.

Another subtle way some doctors sabotage their ability to effectively communicate value to their patients when they're feeling better, is to focus their chiropractic explanations around the concept of misalignments instead of spinal malfunction. (Ironically, these are the same doctors unwilling to document the effectiveness of their regimen with post-X-rays!) That's a dangerous double standard. Worse, doctors can get into trouble when symptomatic patients present themselves with proper spinal curves and apparent subluxation-free static views. It is easier to explain the necessity of continued non-symptomatic visits, if a dynamic model of spinal function is used instead. Here, functional X-rays, and the related non-symptomatic muscle and soft tissue involvement, make a stronger case to patients.

Yet, the most overlooked issue that sabotages the value patients will place on their chiropractic care, is the health of their chiropractor. If you're overweight, still smoking, or sanction these and other poor health habits in your staff, you have a serious credibility problem. The "do-as-I-say, not-as-I-do" school of patient management isn't as effective as it once was. Setting a good example is important. "If the doctor doesn't value his health, why should I?" reasons a patient. "If she isn't going to follow her own advice, why should I?" justifies another patient. "Obviously chiropractic doesn't work," surmises another.

Adding value to the patient's chiropractic experience takes more than simply avoiding certain mistakes. It takes a conscious effort and a willingness to persevere, even in light of outright patient rejection or the lack of instant gratification. All of the following suggestions require extra time, energy, or worse yet, change. They are often common denominators of those doctors able to "collect the extra 50 cents" during a recession, or see a full patient load during a winter snowstorm. Do you have the discipline and courage that's needed?

Relentless patient education: These doctors never stop! Videos and brochures? Of course. Lectures, orientations, and chiropractic topic-of-the-day, further round out their efforts. Without being a bore, they're always talking chiropractic with their patients. These doctors recognize that most patients will not go to chiropractic college nor will they trust the media to expand their patient's understanding of chiropractic principles. They take their responsibility seriously.

Interesting environment: The doctor must show respect for chiropractic and themselves before patients will. Adding value to the patients perceptions starts with their first impressions upon entering the office, and continues through a series of many visits. Unlike a sterile, unchanging medical doctor-type office, creating an interesting environment is crucial in demonstrating value for patients. If the doctor doesn't think chiropractic is important, exhibited in tangible terms by the office they practice in, patients won't think chiropractic is valuable either. That doesn't mean you create a showplace and leave it alone! It means constantly romancing the bulletin boards, updating the magazine rack with new and interesting titles, introducing new toys, and giving the entire office a continual facelift. If you want patients to return again and again, it must be interesting, stimulating, and have a "up" tone.

A passionate doctor: Patient education, office environment, and other aspects described here, share this one element in common: the doctor is excited and committed to chiropractic. It's hard to add value to a patient's experience, if the doctor projects a black cloud from burnout or financial problems. Patients can tell when the doctor isn't having fun. They can "smell" the doctor's stress and the constant fixation of getting more new patients. Patients (or staff members) are rarely more excited about chiropractic than the doctor.

Attach to patient's key value: One important and frequently overlooked way to increase a patient's value of chiropractic is to help them more directly associate their care with something they do value. Are you finding out "...what they hope to do better or enjoy more upon regaining their health through chiropractic?" It shouldn't take too much creativity to associate the need for continued adjustments (even non-symptomatic adjustments) with being able to sleep through the night, improve their golf game, or enjoy quality time with their grandchildren. Refresh the patient's memory that this is why they're continuing to show up in your office throughout their subsequent visits. Before you begin their care, ask your patients why they want improved health.

Crediting the patient: While your ego craves the affirmation that producing chiropractic results so frequently offers, turn it around instead. Help patients realize you are merely a facilitator for their body's own inborn healing potential. Adding value this way is not only more honest, it shows that you're in partnership with their bodies. This anchors their chiropractic experience at a deeper, more fundamental level than an self-indulgent luxury or a "can-I-afford-it?" extravagance.

Short waiting time: It's not just the financial cost of care that can discourage continued care, it is also the cost in terms of time. Time is the new luxury commodity. If your office hours are inconvenient for the plant workers down the highway, it can interfere with their visit schedule. If parking is a problem, your lack of parking may be affecting patient compliance. Like the convenience store around the corner, removing barriers to the access of your office is essential in the drive-up-window-microwave-world we live in today.

Let's face it. There are some patients, like horses led to water who won't drink, that have little inclination to continue the care into a preventive or wellness mode. So while you aren't likely to connect with everyone, you owe patients at least some explanation of the value of continued care.
Add value to a patient's chiropractic experience before taking the easy route of lowering your fees. Ironically, the most common result reported by those who lower their fees, is a drop in their income. Lowering your fees will not automatically increase your patient volume. Without adding some form of value, you could give your care away and still have an empty appointment book.

The problem in most offices isn't the fee structure. It's an issue of value. After all, how many of those convenience stores with the expensive bathroom tissue have you seen go out of business?

Excerpted from
Making Change
Originally published in 1995
240 Pages
US $24.95

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