Although you probably don't realize it, the majority of problems in your practice -- besides the acquisition of new patients -- are patient-generated. Problems such as patients not paying, missed appointments, not making up appointments, etc., are the major contributors of stress in your practice.

If you could get patients to be better "behaved" and to follow the rules of your office, your practice would run smoothly, be easier to manage and be more enjoyable to work in.

Problems arise when your patients don't really know what is expected of them. You have to outline your expectations and then train yourself and your staff how to implement agreements with each patient.

You need to have specific agreements established in your practice. Patient agreements are necessary because you cannot simply tell a patient not to miss appointments, or expect them to pay at the time of their visits, just because that is what you told them to do. You have to explain why you expect them to keep their appointments, make up missed appointments, etc.

They have to see how keeping the agreements will not only benefit you and the office, but also themselves -- and other patients.

Explain that patient policies were established to eliminate waiting time. Tell your patients if these policies are followed you will be able to move patients in and out of your office efficiently -- each visit -- so they won't have to wait before they get in to see you.

Increase the efficiency in your office by implementing the following basic agreements.

*** Signing in. Each patient must sign in at the front desk. This lets the C.A. know a patient is there for his or her scheduled appointment, but also who is next, so people don't miss their turn.

*** Going to the adjusting room. Have patients walk to the adjusting room by themselves and complete a Patient Assessment form -- which will allow them to specify exactly where they are having problems at the time of their visit -- allowing you to see more patients and to get a better understanding of what is actually wrong with the patient.

*** Letting the doctor know a patient is ready for treatment. Place the patient's folder or travel card in a tray outside of the adjusting room and have the patient lie down on the adjusting table. This lets you know the patient is ready to see you, and by lying down was able to relax, resulting in a more effective adjustment.

It's also a good idea to set a schedule in your office so there are hours set aside where all you do is adjustments. Also set aside certain times for consultations, report of findings or to answer questions a regular patient has about exercise or nutritional programs.

*** Regular/preferred hours. Explain to patients that since you have compartmented office hours to reduce waiting time, they must adhere to your schedule and book appointments according to the times you established.

*** Scheduling appointments. Appointments should be booked four weeks in advance in order to save time for themselves and other patients. By scheduling ahead, your patients will no longer have to stop by the front desk after every appointment for scheduling -- saving them time and not forcing other patients to wait as they reschedule.

*** Payment policies. Patients are expected to pay on a weekly, monthly or yearly basis. This will reduce the number of people stopping at the front desk to pay or to write checks, while letting more patients move in and out of the office efficiently.

*** Missed appointments. Patients are expected to make up any appointments that are missed. Explain why missing appointments will hinder the results of care. Tell your patients that it's the number of visits they receive a week, not a year, that determines results.

An effective analogy is working out in a gym. Patients can relate to what happens if they miss a day at the gym. They notice the effect missing that one day had the next time they go back. They have to make up for the lost progress.

The same is true with keeping appointments. if patients miss just one, the results of care are affected. If your patients know they are expected to make up the missed appointment, and understand why it is so important to do so, they will be more likely to keep their appointments and make up the ones they had to miss.

After each agreement is made, be sure to ask, "How do you feel about that?" "Does that work for you?," and if not, make changes and ask, "Does this work better for you?" -- which ensures you have their agreement on each of your policies and they are willing to follow each of them.

Your job is to enforce the rules. Similar to being a teacher, you have to establish how the classroom runs. With the proper systems in working order, fewer problems will arise. Your patients will know how to comply with each policy, thus creating an efficient practice, one that not only lets you see more patients, but that provides less stress and is more enjoyable to control.