Dear Bill | Down Time Freaks Me Out

Posted by Bill Esteb on May 29th 2023

Dear Bill

“How do I stop freaking out when I have down time? I get busy for a while, but when I experience a couple of days of above average patient cancellations and no shows I sit here questioning my ability as a chiropractor.”

The short answer? You’ve created an unhelpful story about what down time means. Unfortunately, you’re in good company.

Your story probably has mostly negative connotations. Maybe something along the lines that you’re an imposter, your spouse will divorce you and you’ll be forced to live in a cardboard box under a bridge, but only after enduring ridicule from friends and relatives for having chosen chiropractic as a career.

That may be an exaggeration, but you get my point: this is merely about the meaning you’ve attached to a circumstance in which patients have acted in a particular way.

In other words, this is mostly a software (mind-ware) problem, not a hardware problem. (This the premise behind our 40-week HeadSpace Coaching program.)

That’s good news. Because you can choose to create and believe a new, more resourceful story.

It’s Your Fault

Granted, it’s possible you may have said something or did something (or didn’t say something or do something) last week that produced this temporary downturn. Unlikely, but this is a popular belief. Let’s pretend this situation had nothing to do with you. As in…

Patient A had an unexpected emergency with an aging parent that produced a cancellation.

Patient B has gotten such great results that he figures further care isn’t necessary but lacked the courage (or social skills) to call and cancel.

Patient C thinks she has exhausted her insurance benefits and to avoid out-of-pocket charges has opted to discontinue care.

Patient D had a friend who offered an opportunity to attend a Taylor Swift concert in Dallas and was courteous enough to let you know in advance.

Patient E achieved better and faster relief than she thought possible and since you appear busy, figured she wouldn’t be missed by simply not showing up.

Patient F was pleased with her care but sensed you valued her health more than she did so to avoid an awkward confrontation, made appointments she had no intention of keeping.

Need I go on?

What could you have said or done to prevent any of those scenarios?

Not much.

But you may be inclined to take the blame anyway. Which may be somehow comforting to you if you’re inclined to make the very rotation of the earth about you.

When Patients Are Precious

But it’s not about you. You can make it about you, but it’s a made up story.

Often this is the result of putting your needs before the patients’ needs.

How? When patients are seen as a car payment or some other solution to your problem, you’ve crossed the line from serving—to being served. The predictable result is an off-gassing so subtle only patients can pick up the scent. Somehow their enteric nervous system is on alert, potentially undermining follow through and even referrals.

Obviously, this creates the very problem you were hoping to avoid!

You’ve created a story and assigned a meaning to what patients are doing, which is nothing more than them acting out their values and preferences which were formed years, maybe decades, before meeting you.

Meanwhile, since patients seem so precious, you’ve created an unhelpful story in an attempt to explain their behavior.

Just remember it’s just a story. And you made it up.

Some Suggested Action Steps

So how do you stop freaking out? Here are some suggestions: 

Step 1: Start with your language. Discontinue calling it “down time.” Which sounds like you’re some type of factory machine that’s off line, unproductive and costly. You’re not a machine. You have tremendous value—even if you’re not adjusting patients.

Referring to the time you’re not moving bones as being "down" gives it an unhelpful negative connotation.

Down in the dumps
Down with a cold
A down turn in the economy
Down to your last dollar

More productive might be:

Opportunity time
A break in the action
Reset time
Still time
Recharge time
Recalibration time

Step 2: Don’t make busy an objective. You can be busy doing the wrong things. You can be busy doing unprofitable things. You can be busy so you can avoid the hard things. You can be busy, so you don't have to be alone with yourself. You can be busy so you can fulfill your financial obligations. You can be busy keeping your emails under control.

The goal isn’t to be busy.

Granted, there are chiropractors who are busy. So busy they have a new patient waiting list. Ironic since their goal was never to be busy—but to serve patients. If the motive is to be busier so as to increase your income, remember your income is an effect, not a cause. When being busier is for your benefit rather than those you hope to serve, look for signs of selfishness or entitlement or both.

Step 3: Get some margin in your life. If you’re living hand to mouth it’s difficult to have the margin necessary to deal with a bit of economic turmoil, unusual weather, road closure or a million other things beyond your control.

Now, consider the multiple effects of all of your patients who may lack margin in their lives as well. It’s not pretty.

And while you can’t solve their problems, you can certainly lean into yours. How? Live beneath your means. That may require a difficult conversation with your partner (or yourself) but have it. Your courage will be repaid with greater peace and ease.

Step 4: Make patients less precious. We tend to place greater value on things that are scarce than on things in abundance. When every patient visit is priceless, we tend to surrender our objectivity and neutrality. That’s what excretes the olfactory assault mentioned above.

A common factor among chiropractors experiencing this stress is a noticeable lack of practice marketing and promotion. Almost as if the world owes them a living.

This is easily rectified, especially if you have sufficient margin. Which, by the way, is likely influenced by the way you pay yourself. If your take home pay bounces up and down based on your practice volume, it’s easy to see marketing as an expense, rather than an investment.

Step 5: Return to the present. The story you’ve attached to cancellations and no shows takes place in a future that hasn't even arrived yet. And most likely won't.

Long before your imagined divorce and relocation to a nearby bridge, you’ll have countless opportunities to make choices and adjustments. But the spirit of fear makes it seem like the calamity is imminent.

Consider this your official invitation to return to the present—the only place you have power and agency. Living in the future is an unresourceful place to be. Ask yourself, “What’s the highest and best use of my time right now?” Worrying about something unlikely to ever happen won’t be on the list.

Step 6: Create a new story. Consider this possibility: what if your alleged "down time" were to became something positive? So when a couple of cancellations and reschedules became something of an opportunity for creating new possibilities?

  • Working on the business—rather than merely in it.
  • Time for planning, making upgrades or simply dreaming.
  • Mentally rehearsing the balance of the day in your mind.
  • Sitting still and simply being, listening to God.
  • Putting energy into your upcoming marketing program.
  • Learning ChatGPT and writing a blog post for your website.
  • Organize and clean your desktop, cupboards and closets.
  • Review the files of inactive patients you’d like to see again.
  • Tackle a project you’ve put off because you were too busy.

Time is your most important inventory. We devote Week 25 of HeadSpace Coaching to the many issues that involve time, from adjusting time, sacred time, door slam time and more.

Thanks for the question!

Ask Bill your question.

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