Dear Bill

"I find it hard to present choices in an objective way at my report of findings. Obviously I want patients to choose the healthiest path. So sometimes I feel like my report comes across as, "Smart, attractive patients do this, but stupid, illogical patients choose this.

"So, I get a lot of acceptance at the report, but I have a dropout rate like other chiropractors. How do I get more patients to choose corrective or lifetime care?"

Sounds like you mistrust patients. They may make the "wrong" choice.

Tread carefully. This can be bad mojo.

Once you start projecting your health values onto patients you've surrendered the opportunity to be a trusted resource and crossed the line into salesmanship.

Worse, you've invested your life spirit into something you're actually powerless to control—namely what patients want, what they will do or what they will pay for. Or even if they will tell you the truth.

Which is unsustainable.

Many chiropractors who have been seduced by this trap rarely last more than about seven years or so before burnout sidelines them into rethinking their motives. The result isn't particularly pretty.

So consider this. What if the choices patients make, as to whether or not to embrace wellness care had absolutely nothing to do with what you said?

I know, strange. But hold one. Just pretend for a moment that it's true. (Because it is.)

Whether a patient embraces post-symptomatic care or not actually has far more to do with the value that they place on their health, than what you assert that chiropractic can deliver during your report.

A set of beliefs that were in place long before they met you.

Are they flossing their teeth? Have they had the mercury removed from their mouth? Are they paying extra for organic fruits and vegetables? Do they have a regular exercise program? You know the list.

The answers to these and related indicators are far more revealing than what you think you said at your report of findings or any salesmanship you invoked.

But there's a more fundamental problem. Asking for a commitment for post symptomatic care, before you've even helped them with their presenting complaint, is akin to talking about kids and marriage on a first date.

It's way too early.

Sure, let them know that you have many patients who opt for some type of ongoing lifetime care to maintain their progress and avoid a relapse after they recover, "…But that's something that we can talk about later."

Foreshadow the option, but don't press for their hand in marriage. Because, as you already know, you can't trust their answer anyway.

This strategy requires several additional procedural issues to be mindful of.

1. Make sure patients understand that they will not be "fixed" when they achieve symptomatic improvement. If that doesn't make sense, you may want to read Are You Actually Fixing Patients?

2. You must be rigorous in conducting progress examinations. Because only after you have proven your ability to help patients do you have enough validity to suggest some type of post-symptomatic care. Regular progress exams are the perfect setting.

3. Keep in touch with your inactives. Far too many chiropractors feel like spurned lovers when patients reject wellness care. (Even though patients only floss their teeth a couple of days before their annual dental checkup!)

The good news is, whether a patient embraces lifetime care or not, it's not going to change your care protocol during the first weeks or months of initial intensive care. So relax. Help them with the issue that prompted them to seek care. Drop hints about the value of post-symptomatic care. Realize that it may take multiple starts and stops over several years before patients are persuaded that wellness care has value.

Play the long game. Avoid making the patient wrong. Eventually the penny will drop.

Or it won't.

If more chiropractors would look 5-, 10- and 20-years down the road, instead of trying to save the patient from themselves by using their limited social authority to get patients to do the "right" thing, they would enjoy more reactivations, more referrals and in time, no longer have such a voracious appetite for new patients.

Thanks for the question!

Ask Bill your question.

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