Ten Excuses

by William D. Esteb

When the stats are down or things aren't going right, the temptation is to look for someone or something to blame. Because few doctors look at their practices as a living organism, they often overlook the many organic causes of a drop off in new patients or other statistical areas of concerns. Instead, they make a trip out to the front desk.

True, the front desk staff member is the gatekeeper to the practice. Yet, that's not the first place to check. Look in the mirror. No one likes to accept the blame or the responsibility, but with all the finger pointing it's hard to know for sure. Until you know, you're likely to keep repeating the errors responsible for the new patient shortage.

If one's intelligence is measured by the ability to adapt to changes in the environment, today's doctor of chiropractic must be more intelligent than the one's twenty or thirty years ago. It is tempting to jump at the first right answer, embrace the opinions of seminar leaders, or to start doing what the doctor down the street is doing. These shortcuts for thinking for oneself overlook the fact that no one knows what the future will bring. Those that think they know, are simply good at extrapolating from current trends or just lying. Because no one knows that the future holds, we all have an equal chance to make accurate assumptions about it. The real issue is how much you trust your own instincts and how much confidence to have in yourself. Those with little of either are the most vulnerable.

Those quickest for blaming issues outside their control as the reason for their problems, regularly refer to certain factors. In no particular order, here's their Top 10 excuses:

1. Economy. This is a favorite among those who have difficulty communicating the value of chiropractic to their patients. Some doctors complain that the "recession" dropped their income as much as 20% last year. Others brag that it was their best year ever. It's not that the financial health of the country isn't a factor, it's how one deals with it. And simply claiming that you're "not going to participate in the recession" isn't the issue. You automatically participate if your patients or potential patients participate. What are you doing to adapt to the changing environment?

2. Weather. Snowstorms, hurricanes, tornadoes, flooding, a severe cold spell; like chiropractic and the Duracell bunny, the weather just keeps going. Few weather-related slowdowns last forever. But beating oneself up after a temporary downward blip in office statistics is crazy. If your office is healthy, like shedding wet clothes after a rainstorm, you should warm back up and be ready to pick up where you left off. If below the surface there is a fundamental lack of practice health with a reduced immune system response, weather could knock you out. But it's not the fault of the weather report!

3. Technique. Seems the grass is always greener on the other side of the fence. We learn about some doctor getting phenomenal results and the first question asked is what technique are they using. As doctors rush from one technique seminar to another, they become a "jack of all trades and a master of none." Besides the fact that most patients could care less what approach you use, clinical results would suggest that all the major techniques work. The key is mastering whatever technique that fits your individual physical and intellectual criteria. The goal is to achieve mastery without dogma. Make art.

4. Procedures. Finding the right office procedures by going from one management seminar to the next, successfully distracts some doctors for years. Thinking that finding and instituting a certain procedure will solve every problem, or worse, that once something works they won't have to ever change it again, plagues doctors who are destination or bottom line driven. Practice is a process. And the procedures that seem to work for thirty patients a day are rarely effective for sixty patients a day. The most adaptable doctors admit change is part of the agenda. Forever.

5. Competition. "Things would just be fine if the board wouldn't let all those new practitioners into the state," bemoans a doctor. "I remember when there were just the three of us in the whole town. Now there are over twenty chiropractors within five miles of my office," sniffs a 12-year veteran of practice. When the community sees a chiropractic office on every corner it can't help but raise the consciousness of the community and lead people to believe chiropractic is growing and becoming more successful. Hoarding a geographical area or adopting a scarcity outlook is counterproductive. Assure your right to survive by providing outstanding service, differentiation, clinical excellence, and exceeding patient expectations. It's called the free enterprise system. It's a wonderful example of homeostasis, benefiting patients and the doctors who serve the needs of their communities. If you've lost your unique factor or become irrelevant to the needs of your prospective patients, maybe the marketplace is trying to tell you something.

6. Insurance companies. The way some doctors talk you'd think the insurance industry was some type of private manna from heaven! What doctors weaned on $100 deductibles sometimes forget is that an insurance policy governs the relationship between the company and the patient. The health care service provider is just an unwelcomed fly in the ointment. The way some doctors are howling would lead you to believe that they feel they have some automatic claim, or that their patients deserve some type of special low deductible or carte blanche visit schedule when it comes to chiropractic. Dream on. If the changing insurance climate has changed your patient's ability to start, afford, or follow through with appropriate chiropractic care, what's your plan? It's likely to get worse. You'd have to think Medicare was pure genus to hold out hope that the bureaucrats in Washington are going to save your practice.

7. HMOs and PPOs. Remember the cigarette advertising that featured smokers with fake black eyes stating they'd "rather fight than switch"? Many doctors are torn between the acceptance ("all my patients belong"), and the yoke of being told how long, how many, and how much. And for patients that look to a list for guidance in picking a doctor, it's a troublesome dilemma. More and more doctors are "getting on the list" and concentrating on the education of the patient so as to encourage a greater commitment to forms of continued wellness care not usually covered by managed care plans.

8. City. While the chamber of commerce of the town you're in would beg to differ, there really isn't a lot of difference between one town or another. Sure, the weather and geography may be different, but the patient attitudes, medical biases, and public perceptions about chiropractic are just about the same wherever you go. Thanks to the homogenizing affect of television, millions can see the CBS news story about chiropractic or read the Wall Street Journal article about chiropractic on the same day. The media makes a considerable impact on what people think and how they act. Whether they're told to "Nupe" their muscular aches and pains or that chiropractors are money hungry and are trying to seduce children into starting care, the media has a bias. But it's the same bias across the nation. It's not your city's fault that people don't seem to be available for chiropractic care.

9. Location. And within reason, it's not the fault of your office location that you're not getting enough new patients. Of course, if patients simply can't find a parking place or have to dodge crack cocaine dealers to get into your reception room, your location probably is a factor! Just remember, there was a time when people would fly from around the world to descend upon a little town in Wisconsin to get adjusted. If you have something people want and value, they will go to great lengths to get it. But if you've taken the path of least resistance and have been just peddling relief of neck and back pain, that may not be compelling enough to prompt patients to go to any extraordinary lengths to make appointments, keep appointments, or refer their friends and family. It's not your location.

10. I don't know. When a specific excuse isn't readily available, simply shielding oneself with a vague, "I-haven't-the-foggiest-notion" works perfectly. This one works the best because without being specific, there is little compulsion to investigate or take action steps to try to overcome the problem. It's a lot like when medical doctors can't seem to find the cause of the patient's problem they tell them "It's all in your head" or "You're just going to have to learn to live with it." Absolving any responsibility to try further, the M.D. simply throws up his hands, blames the patient, and gives up.

I've been in offices that by conventional wisdom shouldn't be seeing as many patients as they are. I've talked to doctors with poor grooming habits, lack detectable personalities, or muddle through with inadequate clinical skills, who enjoy enviable patient volumes. I've met staff members with attitudes that chase away patients, yet the practice continues to grow. I've had lunch with patients who know exactly what they'd do differently if it was their practice. The point is, there is a reason for everything. And anything can cause just about anything else. However, when looking for cause, focusing your examination on inside-out causes will almost always be more productive than looking for outside-in causes. It has a familiar ring to it and works great whether you're diagnosing a patient or a practice.

Excerpted from
Beyond Results
Originally published in 1995
240 Pages
US $24.95

Not a reader? Bill reads his favorite chapters from all nine books on Bill's Best.