A Patient's Point of View

Q: "I have more patients self-dismiss prematurely than I should. Do you know of some scripting for the ROF that would help to minimize this or at least change how they go about it?"

A: Depends why they self-dismiss. Here are a couple of possible reasons:

1. You're a rough adjuster, have an obnoxious personality or both
2. They're delighted with the care and don't see a need to continue
3. They're busy and visiting your office is an imposition
4. They don't see the need to continue their care

Need I go on? The list is endless.

Q: On the Wellness Wheel there are categories referring to mental health and spiritual health. If a patient has problems in one or both of these areas, what should a chiropractor do about it? What are you proposing?

A: Naturally, the same could be asked of the financial, family, social and career aspects of wellness. This is because wellness is much more than physical health or regular chiropractic care. Sure, having an interference-free nervous system is the foundation for virtually any notion of true health. But there’s much more to wellness than the integrity of the nervous system!

Q: I just received your latest catalogue and read the article about "Going Spineless.” I find that very interesting because my office went spineless years ago. I take no X-rays, have no spinal models, and I only discuss wellness and the nerve system with people. Your article is nice, yet so much of the products you sell are spine related. If one truly understands Innate Intelligence, the major thought of chiropractic, then these pamphlets and charts become meaningless. We are Nerve system doctors! The spine is merely our mode of approach to addressing the nerve system.

A: You and I are in total agreement. But here's my challenge. There are not (yet) enough chiropractors who know what you know who can support a chiropractic patient education supply company that would be totally spineless. Most of the profession is still in the bone-out-of-place-putting-pressure-on-a-nerve model of chiropractic. No problem. Even with what I think could be a shortsighted view of chiropractic, they are still adding value to patients by helping them avoid drugs and surgery.

I received this email from a chiropractor this morning:

“I plan to open an office in a town of 18,000 people January 8, 2007. I would like to advertise in the local paper and was wondering if you have any example formats or suggestions as to what should be included or avoided. I put together a little description of the spine relating to the nervous system and its effects on our health, without mentioning back pain or neck pain. Do you think that is wise? I didn’t want to be labeled a “pain” doctor, yet I don’t want people to think that I can’t treat those symptoms. I just want to communicate that the underlying problem is more than pain; it’s the nervous system. Thanks for any suggestions you may have.”

The fact is, whether you want to be labeled a “pain doctor” or not is largely outside your control. Because you already have that label. It was assigned about the time chiropractic care became a reimbursable expense under indemnity insurance policies. Decades later, the damage is done.

Q: If someone misses their appointment, how should we communicate with that patient? Any specific questions to ask this person upon contacting them, either by CA or DC?

A: The short answer? Use the telephone. Ask if they’re okay since you were expecting them at such in such a time.

The long answer is considerably longer. But here goes.

Q: We are having a major to do in our office about attire for the staff. What are your thoughts?

A: For some reason, the hoopla surrounding clothing (for doctor or staff) is a common trigger point. You may be asking this question of the wrong person, since I will usually choose comfort over style and I’m inclined to wear blue jeans and tee shirt just about anywhere and everywhere! But here are some things to consider as you resolve this little detail with your team:

Q: I’m stuck in an area where many patients have been trained that one or two adjustments are all they need. I’m trying to change that but it is a huge daily struggle. Any ideas?

A: This is a common complaint among chiropractors who see chiropractic as something more than a short-term treatment (diet) for a particular ache or pain. It’s a situation often created by chiropractors anxious to please the patient, bill the patient’s insurance company, prove chiropractic works, validate themselves or prove how much they “care” by jumping in quickly and obscuring the larger lesson. In the process, they inadvertently minimize chiropractic, reduce it to a therapy and create a communication problem that the chiropractor down the street (you) has to overcome. “Well, my last chiropractor only needed one visit to fix this!”

Q: Late last year I bought your “Converting to Cash” program. I was a bit surprised as it was not exactly what I expected (it was what I needed). I have listened to the “Headspace” CD several times and started regularly reading the articles and other material on your website. I’m embarrassed to say that many of the topics that you have written about hit home.

Q: "You’ve suggested it’s important for a doctor to be there emotionally for patients and that this can be done in an open adjusting setting. How can I keep a schedule and still be charitable? Can you reveal how you'd appreciate your chiropractor handling your emotional need/vent in this situation? What beliefs would you need to hold to keep your office patient-oriented and still be aware of business issues (time per patient, money per hour, etc.) if you were a chiropractor?"

Dear Bill

I've been listening to your new CD set, "The Seminar.” I look forward to getting in my car now because that is where I listen to it. So far, I've been glued to the seminar.

I have a question. I'm very much the type of person who is attached to what people think of me. I get a ton of new patients but hardly any of them stay. My average is about 8 - 10 new patients a week. My average patient visits each week are about 80. I take that a little personally and I want to know why they haven't come back, or they quit their care early. Anyhow, my question is, is there anything wrong with sending out a patient questionnaire, to all the patients to get some feedback? If so, do you have any samples, or ideas of what to ask?

Signed,
Dr. Attached to What People Think

Dear Bill,

I've been to a couple of your seminars in the past few years and have always come away from them inspired. Recently I've hit upon a couple of problems. Firstly, I don't seem to be able to get patients to realize how important "their job" is and consequently they don't change their behavior or improve as fast as I and they would like. Secondly, I can't get the right approach when it becomes apparent that the patient wants to discontinue care - they want to run away before I can say anything!

I would be delighted to hear your opinion on these two issues.

Signed,

Frustrated in Dorchester

Dear Frustrated in Dorchester,

Probably one of the reasons these two issues seem like problems is that you may be under the impression that you actually have some type of control over chiropractic patients! Once you accept that you are powerless over what patients do, these sorts of everyday patient behaviors will no longer cause anything more than a passing sadness or a bit of short-lived disappointment.

Q: After years of take-it-or-leave-it-yearly-pre-paid plans I'm starting to let go. I realized that the patients I look forward to seeing the most are the ones that decided on their own to adopt a chiropractic lifestyle despite my best efforts to "keep them on the bus.” Like you predicted in "The Seminar" I have been rewarded with diminished statistical results. I know in my heart that this is the best long-term sustainable route, but I was wondering if you had any knowledge on how long it has taken other offices to rebound to their former (and hopefully greater) glory?

Q: “I work primarily with Amish people. Since they have to hitch up their horse and come in to town (which may take awhile, since they travel 10 mph) they use excuses like: I'm busy, if I'm still hurting, I might come in, can I wait till next week or next two weeks?, etc. How can I be more confrontational? I do not want the patients to run the practice, but at the same time, I do not want them upset with me, because in the Amish community, word travels like fire.”

Please stop sending me E-mails. I do not need any motivation. After 20 years in the chiropractic profession it is quite evident to me that it is dying. The people in my state organization are likened to the band on the TITANIC; they go to parties and meetings, drinking their fine brandy, wearing their best attire while the chiropractic ship slips slowly into the ocean of obscurity. The only way to squeak by a living in my state is to be a personal injury or workers compensation attorney’s bag man.

I would appreciate you stop e-mailing Monday Morning Motivation to me. Nothing you can tell me will change the fact that the insurance companies are paying less than the price of a cup of Starbucks coffee and pastry, not to mention not letting me do my job. Thank you,

Dr. Had Enough

Dear Dr. Had Enough

I have unsubscribed you from Monday Morning Motivation.

There’s no question the chiropractic practice environment has significantly changed in the last decade or so. More telling is your response to these changes! Apparently, you have chosen to become a victim rather than a victor. It sounds like you’re preparing to withdraw your valuable skills from the marketplace. Too bad you seem so resigned at a time when we’re so close to the revolution that will make chiropractors indispensable.

Dear Bill

I’ve been in practice for about four months and having a really hard time getting patients. I don’t have enough patients to rely on referrals. Please help.

Signed,
Four Months

Dear Four Months,

Naturally, the first thing you’ll want to do is consult the notes from the class you took in chiropractic college entitled “Your First Year in Practice” to revisit the essential action steps that new practitioners must take in order to generate their first year’s worth of new patients.

Don’t have those notes? Don’t remember taking that class? Right. Because it wasn’t offered. And while this would be the perfect opportunity to launch into a riff about the shortsightedness of chiropractic colleges, who, fearful of being perceived as a lowly trade school, often offer little more than a perfunctory class or two about the dynamics of actual practice, here are some suggestions. My guess is that these ideas could help experienced field doctors who aren't getting referrals just as much as a newbie, thrust into the real world.

I just read your response to “4 months” about how to get new patients. Your suggestions are excellent and I’ll be using many of them. How do you talk to people about chiropractic in line at the bank, in a restaurant, in a store, etc.? I have talked with many of my friends and mentors about this, and most of them say that you just need to do it. Realize that it’s not about you or getting new patients, but it’s about changing and helping these strangers’ lives. Any thoughts?

Signed,
The Timid Doctor

Dear Dr. Timid,

Initiating a conversation may seem difficult if you unconsciously feel like you’re stalking some helpless prey or going in for a self-serving “kill.” Obviously, with an intention like that, any encounter is likely to have an unsatisfactory outcome.

So first, give up the notion that there’s some sure-fire “pickup line” that can turn a casual encounter in the Nine-Items-or-Less line into a committed new patient. It’s unlikely that there’s anything you can say or do that will prompt a total stranger to abandon their hand basket and beg you to show them the way to your office. Instead, set your crosshairs on a less ambitious target—such as having a conversation with a stranger who doesn’t walk away thinking chiropractors are jerks or weirdoes.

Q: I have tried all different variations on the theme of new patient orientation classes. The running problem I can’t seem to get a handle on is compliance. Currently we have been doing lunches at my office. We had even thought about doing a room at a restaurant on a weekend. We are just not sure if there is a better night, day, venue, etc.

Do you know what has been working well for others?

Dear Bill,

I value your insight as a patient’s point of view, and wanted to get your opinion on fees. As I move to more of a cash based practice, and cannot rely on riding the tail of the insurance industry anymore, I am having a difficult time re-setting my fees.

My difficulty consists of my new patient fees. I perform a "hands on" exam as well as a sEMG/Thermal scan as well as a digital posture analysis on most patients. I also usually perform a front and side view full spine X-ray (two films 18-36 inch), on most adults and occasionally on a child, depending on the situation. I currently charge $180 for the X-rays and $45 for the exam for a total of $225. I was previously with a management group who thought this was too high and recommended keeping it under $100. They thought it might be a barrier to new patients. Their logic was to remove the money barrier so that they can have more money to give chiropractic a chance.

It's no wonder that my Chiropractic Opportunity weeks (where new patients are free) are so successful, but make me feel cheesy. Bill, what would you charge? And would you do any "free" promotions? I have also done the bring-in-something or charge-a-nominal-fee-and-donate-it-to-a-local-charity thing, but that also made me feel creepy. I would rather just donate on my own. Please offer your opinion!

Signed,
Cheesy and Creepy

Dear Cheesy and Creepy,

Setting fees is suddenly a new experience for chiropractors as they disengage from the “price fixing” influence of insurance companies. Many find themselves in the same place as plumbers, hair stylists, lawyers, consultants and others who deliver services rather than products: “How much should I charge?”

Regardless of what you decide, here are some things to consider.