Patient Referrals From the Inside Out

by William D. Esteb

New patients basically come from two sources: external marketing (screenings, advertising and promotions), or internal marketing (word-of-mouth, referrals). What internal marketing often lacks in quantity is made up for in quality. In short, new patients who are “pre-qualified” by someone who vouches for you, tend to be more cooperative, engaged and responsive.

Do you have a referral-based practice? Would you like one?

See the referral process from a patient’s point of view and discover new ways to stimulate referrals. But, what is a referral?

Ask and You Shall Receive?

Chances are you’ve attended at least one seminar at which the charismatic speaker has urged you to ask patients for referrals. And, while this ploy seems doable from the safety of the hotel ballroom, in practice many chiropractors lack the fortitude to make such a seemingly self-serving request of their patients. The good news? Patients generated via this method aren’t referrals. These guilt offerings may produce those who need and benefit from chiropractic care, but they’re not referrals.

A referral is unsolicited, spontaneous, and occurs beyond the walls of your office. Its power and influence is derived by virtue of your apparent inability to control what’s being said (good or bad) about you and your practice. That’s why an endorsement from a delighted patient carries more weight than paid-for advertising. A persuasive patient tends to attract better patients than yellow page advertising, coupons or complimentary exam offers.

So while a referral is out of your direct control, there are many things you can do to increase the number of referrals you get. Here are just a few of the tactics employed by busy, referral-based practices:

1. Deliver the goods. This goes without saying, but it’s unlikely that patients will be inspired to refer others if your adjusting technique is rough, your tableside manner is aloof or your office environment is shabby. There are literally dozens of “moments of truth” patients encounter during the course of their care that are referral boosters, or that convince them that consulting a chiropractor was a bad idea, causing them to keep their poor judgment a secret. The ideas that follow assume that you get great results, you’re a moderately good communicator, and that their being in your presence is a positive, uplifting experience.

2. Have additional capacity. Practitioners sitting on their thumbs at 10:50 AM or surveying an empty reception room at 2:45 PM assume they have excess capacity they could fill with new patients. The problem is, few patients want to come in regularly at those times. Do you have the ability to see more patients at the times patients want to come in? If not, referrals dry up. (“If I tell my friends about you, I’ll have to wait even longer for my own care.”) This means reducing the amount of time you spend with patients, delegating nonclinical responsibilities to others or hiring additional help. If you’re unwilling to increase capacity in any of these three ways, you may find that your practice is as large as it’s going to get and you can stop torturing yourself about increasing its size.

Since referrals are controlled by your patients’ perceptions, it may be helpful to find out how “full” patients think your office is. Ask. During the course of your palpation, leg length checks or other visit preambles, pose this simple question: “Hey, I was just wondering, how full do you perceive our practice to be at the time you usually receive your care?”

Most patients have never thought about it and will respond with, “Huh? What do you mean?”

“Okay, let’s say there’s a widget factory somewhere,” you respond. “This particular widget factory has the capacity to make 100 widgets a day. Days they only turn out 80 widgets, we’d say they were working at 80% capacity. If they strain and put out 110 widgets, we’d say they were working at 110% capacity. At what capacity do you see us working at?”

Most practices find referrals get choked off when patients report that they see the practice as 85% full, or more.

3. Let patients know. Chances are your patients don’t have a clue that you have an interest in growing your practice. After all, they’re getting their needs met, the office seems to function nicely and it appears to be a busy, successful business. Many times, just periodically alerting patients that you have “room for a few more people who are health conscious like you” will generate the awareness necessary for an up tick in new patients. Some offices will hang a referral-oriented poster or place a small sign at the front desk that reads something like, “Thank you for your referrals. The ultimate compliment is when you tell others about our office.”

4. Rehearse the referral dialogue. Since you’re depending upon patients to spread the word about your practice, you might want to find out how well they can do just that. (“I tell all my friends about you, but I can’t get them to come in.”) Many referral opportunities are wasted because your patients lack the language to explain chiropractic in a compelling way.

Again, sometime during the course of a typical office visit, ask patients you’re most interested in receiving referrals from, this simple question:

“I was just wondering, when you tell your friends and family about our office, how do you describe chiropractic to them?”

It’s not rocket science. It just requires the courage to ask and the discipline to listen. If you ask this question, and you’re greeted by a long silence, then you know one of two things: either they’re not telling others or they simply can’t. On the other hand, if you hear language that is less than inspirational, you suddenly understand why so many patients have trouble getting their friends to come in, even though they “tell everybody.”

If patients, even after all your patient education overtures, are unresourceful at explaining chiropractic, create an opportunity to gently coach them with some better language. Which begs the question, how do you want chiropractic and your office described? Until you’re clear yourself, you can’t expect patients to be the referral ambassadors you’d like them to be.

5. Become a Referral Source. Chiropractors who don’t enjoy a steady stream of referrals share one thing in common: they rarely refer their own patients to other types of practitioners in their communities or to businesses owned by their fellow patients.

Chiropractors who get a lot of referrals give a lot of referrals.

Whenever appropriate, and when it’s in the best interests of the patient, make a referral to a good lawyer, an open-minded medical doctor or other practitioner. In the same way you wouldn’t expect your fireplace to produce heat until after you put the necessary fuel on the grate, the referral process works similarly.

This is based on the Rule of Reciprocity. It creates a subtle form of indebtedness that calls others to return the favor. It’s the underlying strategy behind the countless free samples given away on Saturday mornings in the grocery store. And, while you may find a certain crassness in “giving to get,” like it or not, the “you scratch my back and I’ll scratch yours” philosophy has a rich history that has produced powerful alliances between people, businesses and even countries!

Master these simple distinctions and you equip your patients to spread the word about chiropractic, giving them the deep satisfaction of helping you help the ones they love.

Excerpted from
Connecting the Dots
Published in 2005
240 Pages
US $24.95

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