A New Patient's Greatest Concerns

by William D. Esteb

While there is a fixation on new patients in this profession, it's easy for the doctor and staff to forget what a new patient is going through. Remember that their symptoms distort their personalities. Their fears of the unknown impede cooperation in subtle ways. Their misconceptions about chiropractic interfere with rapport. Their expectations are based on a lifetime of indoctrination by visits to medical providers. Ignoring these issues, because patients aren't bold or assertive enough to remind you, invites misunderstandings and poor compliance.

Except in the most disorganized offices, new patient procedures are routine. The doctor and staff are well acquainted with the new patient admitting form that is presented, yet this is the first time the patient has ever seen it. The first visit protocol is well practiced and automatic for the staff and doctor, yet everything is new to the patient. In short, the office and procedures are familiar and second nature to those who work in it every day. But to the patient they are intimidating and even anxiety producing. Fooled by the lack of questions from the patient, it is easy to breeze through those initial visits without bringing the patient into the inner circle and getting them fully involved in their care.

Today's patients bring with them, a set of unspoken concerns about what they are going to encounter in your office. Recognizing and acknowledging these concerns, while creating communication strategies to put patients at ease, promotes respect and raises the patients' self esteem. Patients work hard to cover up their feelings of being alone and frightened.

Here are some common concerns patients bring with them on their first visit or two, plus some approaches you might want to consider to reduce their defensive postures and enhance the healing process:

"Is it going to hurt?" Conventional wisdom tells patients that if a particular spinal joint hurts when they enter your office, working with the joint is going to hurt even more. In fact, it is often this misguided notion that chiropractic care is painful, that delays many patients from seeking care. Yet, the painful symptoms often result in total compliance with every doctor request. Others, who grasp at anything to maintain their dignity and remain in control may make light of the adjustment or "crack" jokes about the procedure. Still others are praying so loudly you might actually hear them while giving them their first adjustment!

Action step: Some doctors take a few moments before rendering the first adjustment to discuss their adjusting approach, "Think of an adjustment as lifting a heavy weight off your toe." Considering mentioning that, as of the last count, this new patient is about to receive somewhere in the vicinity of your 250,000th adjustment, or whatever the number might be. Let your new patient know that your adjustments are precise and you are well experienced in giving them. This is one area in which older, more experienced doctors have a perceived advantage over the new doctor.

"Do I have to take off my clothes?" Even these days this is still a concern among many new patients. Again, rarely spoken, it can be the underlying cause of a resistance to an X-ray examination or even consulting your office!

Action step: Besides mentioning the extent to which new patients will need to disrobe at the beginning of your examination, consider adding locks to the door of the room in which you'll be asking them to change in.

Also, instead of the open back gowns used in hospitals, look at the possible use of surgical scrubs or two-piece jogging suit for X-ray procedures. Even if patients don't seem concerned, demonstrate your respect for their privacy by implementing procedures and orienting your office environment to the most modest patients.

"Will I have to come for the rest of my life?" This is a bigger concern than many doctors realize. The challenge here is that the hidden, or not so hidden agenda of most offices is to collect chiropractic clients that adopt a preventive/maintenance visit schedule for the rest of their lives. Yet, during the first visits, you have not yet earned the right to even suggest this type of chiropractic lifestyle. First you must prove you can help them with the problem they've presented to you. In the same way an increasing number of patients wish to avoid being dependent upon aspirin, pain pills or muscle relaxers, they don't want to be dependent on a doctor prescribing regular adjustments! Ironically, successfully addressing and overcoming this independence issue is important if you want more cash-paying maintenance patients in your practice.

Action step: Reassure new patients that they are in the right place by acknowledging that your first responsibility is to help them with their presenting health compliant. Use the likely success with their problem as a way of earning the right to talk about a bigger vision of chiropractic for their optimum health. During your report of findings give an overview of the realistic amount of time (visits) likely needed to heal and maintain their condition, yet package your recommendations in bite-sized periods of a dozen visits or so. Patient education is critical during this initial stage of care. Explain to patients how your own family is receiving care and how frequently you continue to receive adjustments, even though you're not obviously symptomatic.

"Can I afford this?" Today, with financial policies and insurance coverage in flux, this is perhaps one of the most important concerns that the most responsible patients have. Interestingly, chiropractic is one of the few licensed professional services in which doctors seem able to separate some pie-in-the-sky treatment plan, from what it actually costs the patient. Doctors seem uncomfortable telling patients what the cost of their care will be. "When we're finished here, Barbara will go over what all this is going to cost." And while most doctors don't delegate enough routine office procedures to their staff, this is one area most doctors need to rethink.

Perhaps doctors (who get their care for free) can separate the treatment plan from its cost, but patients don't. So while doctors outline a grand treatment schedule and the benefits of optimum spinal function, patients are distracted by trying to multiply the number of recommended visits by the cost per visit. What many doctors overlook is that most patients walk into the office with a figure in their mind as to how much they think their problem should cost to get fixed. "It's going to cost how much?" roars the skeptical spouse when your new patient returns home with the news. If a patient walks in thinking their problem is a $350 problem, you have two choices. One, is to have such a high entry fee for your examination and X-rays that a large portion of that $350 is used up before any kind of treatment is rendered, or, lower your entry fee so they can afford enough visits to see some progress before running out of money! It's up to you.

Action steps: While few patients will reveal the amount of money they have tentatively reserved for chiropractic care, recognize that they probably have one. (Patients with higher self-esteem and income probably have a higher figure.) Reevaluate your entry fees based on this reality. Create a menu of different financial programs to help patients find one that works for them. Begin discussing the financial implications of your care recommendations. Analyze your fee schedule and determine if it still makes sense in light of fewer and fewer patients having insurance.

"What will my friends think?" Peer pressure and "what will my neighbors think" are still major factors that influence how people act in our society. It takes a brave soul to go against the "accepted" and the "approved" to consult an alternative, non-mainstream form of health care. Besides making the new patient feel even more alone, it can thwart the referral process. The resulting "chiropractic underground" continues to slow the acceptance of chiropractic among a generation always in search of what's hot and what's not. For many, chiropractic isn't "cool" enough. Yet.

Action steps: Equip patients with information that overcomes common myths and misconceptions about chiropractic. Make sure they know your educational achievements, training, why drugs aren't used, the safety of adjustments, why you chose chiropractic over medicine and address the other myths and misconceptions still plaguing much of the general public. Make certain that your current patients have the ammunition to defend their chiropractic decision, so they will more likely divulge their chiropractic experience with others.

Chiropractic, even with the recent advancements, will continue to depend upon the inclination of current patients to tell others. Waiting for the drug-controlled media or your state association fund raising efforts to implement needed public relations programs, is likely going to be a long wait. Make sure the relief your patients experience from your skillful hands is duplicated by the psychological relief of having their fears and concerns anticipated and neutralized.

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

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