November 2006

Focusing and refocusing patients

by Dr. Dennis Nikitow

One of the greatest challenges doctors have is missed appointments and drop outs. If patients stayed in your practice forever, you'd never need another new patient. The biggest practices have the highest retention, but the reality is all practices will always have missed appointments and drop outs. The key is to keep these to a minimum and knowing how to focus and refocus patients when they get off track.

To begin with, focus patients on chiropractic philosophy, subluxations, and their damaging effects to body function and health potential. This sets the stage as to why a patient would correct his or her spine to its normal spinal model. This should be done at the first visit, before the exam begins, to give the patient a direction for the exam.

In the ROF compare the patient's x‑rays to normal ones and establish a systematic correction plan to include exams, re‑x‑rays, progress reports and criteria for the end point for correction care. Explain a maintenance and prevention program. Have a written set of patient guidelines for patients to follow for the correction program. Include "starting with the end in mind" and tell them not to start unless they intend to finish. Next, review the importance of maintenance, consistency, and missed appointment policies.

Remind patients that chiropractic is for correcting the spine to its normal model and not just a symptom treatment. Symptoms may be present or absent during the correction process. They must understand the monitoring process and the end point of correction being posture, and spinal alignment with x‑ray comparisons.

Once these are established, keeping your patients focused should occur each visit by both the doctor and CA. Acknowledge calls for missed appointments and remind patients of why consistency is needed. The biggest mistake that is made is treating a missed appointment as a missed "appointment." It is a missed "correction" or a missed input toward the overall correction.

Adjusting room dialogue should include philosophy, medical research upholding the philosophy, how the correction works, the MPC principle, consistency vs. inconsistency, etc. If daily and worldly events come up, the conversation should always rebound to chiropractic and a category in the adjusting dialogue.

If you do not do these things, patients' focus will begin to drift, and doubt can begin. Remember, a chiropractic correction program is essentially rehabilitation and is done frequently and consistently for maximum effectiveness. However, this repetition could become mundane, boring and lead to burn out. That's why the steps I mentioned are crucial to keep the patient focused.

If you haven't been doing these things, patients will begin to show signs of being out of focus. Common signs include missing appointments without calling, week gaps in the correction program, lowering correction in their priorities by making weak excuses why they haven't come, they don't mention having to make up adjustments, loss of urgency, they seem distant and preoccupied, they seem confused about where they are in the correction program, and how much more care they need, when the end point is, and why they come so frequently.

The solution is to make sure they understand why they are coming by reiterating the philosophy, and the importance of spinal alignment. Secondly, they need to be refocused on how spinal correction is done and the commitment they need to make. Use analogies regarding repetition and consistency that are congruent with their beliefs (kids learning sports or piano). Review benefits and consequences of correcting and not correcting the spine.

Ask questions such as: "Why are you correcting your spine? (for symptoms or health potential). What is each adjustment doing? Why do you need frequency and consistency in adjustments and exercises? How is your end point determined? Do you want to correct your spinal alignment or have you changed your mind?"

If the patient wants to continue, identify the obstacle and explain how it will hinder his or her progress resulting in more time and money spent. Show the patient how many adjustments, exercises and rehab he or she has had compared to the recommended amount. Explain how the program works and the expected outcome if the individual is consistent vs. inconsistent.

If patients want to drop, simply acknowledge it, and then reiterate the patient guidelines that encouraged them not to start unless they were going to finish. Otherwise the work they've done becomes an expense vs. an investment. Future pace them on the benefits and consequences of stopping, then withdraw, and leave an open door should they want to return.

Refocusing is a constant, never ending part of practice life. It can be minimized if you follow these important systematic steps. When you have to refocus patients these procedures will work with great success to maximize your practice retention.

(To learn about the Certainty System, Certainty Practice Products and Dr. Dennis Nikitow's upcoming seminar schedule, call 800‑544‑3884. Outside the US, 303‑721‑6202.)