Dear Bill | Patient Dropout

Posted by Bill Esteb on Nov 24th 2019

“I'm having trouble with patients dropping out of my treatment programs and I want to find where our office is missing the mark. Is it our report, follow up, finances/charges, staff, doctor, or what? I’m open to suggestions. Sometimes it can be a painful awakening but I would rather know what we need to fix the problem(s)."

Dear Dr. Patient Dropout,

Patient dropout can result from many different issues. Here are some to consider:

Agreeing to treat their symptoms – The groundwork for patient drop out is set on the first visit when many chiropractors explicitly or implicitly agree to treat a new patient’s presenting complaint. In other words, if a patient wants you to fix/treat/reduce or eliminate their headaches and you accept them as a new patient on that basis, when they experience enough relief they’re gone. In other words, if patients maintain their medical mindset, there is no reason to continue beyond the relief of symptoms.

Pain relief patients – The most significant and common reason that patients drop out of care is that they aren’t interested in anything beyond a relief of their admitting complaint. Rather than those seeking optimal health you may be attracting patients that merely want pain relief. This is based on the value they place on their health. Little can be done to change this valuation, which was formed long before meeting you.

Lack of financial resources – Related to the reason above, many people have insurance deductibles in the four figure range and don’t have the financial margin in their lives to pay for their unplanned bout of back pain. So as soon as they obtain relief they disappear. If new patients are suffering from this “financial fragility,” there is little you can say or do to change this. And while that probably won’t prevent you from trying, it’s a lost cause.

Beginning care on a trial basis – Sometimes chiropractors will inadvertently minimize the patient’s problem, “You have a little problem here and here,” they observe pointing to the X-rays at the report of findings. Or, they suggest the patient “try” chiropractic on an experimental basis, as in, “Let’s give it a couple of weeks and see how we go.”

Asking for a greater commitment too soon – Overtures or expectations to continue with some type of maintenance/preventative/wellness care before you’ve demonstrated that chiropractic can help with their admitting complaint fall on deaf ears. Yes, let patients know that “...some patients continue their care beyond symptomatic improvement to strengthen and retrain their spine, but first things first.”

Chiropractic virgin – If your new patient has never been to a chiropractor before, they almost always have to experience a relapse or two before embracing ongoing nonsymptomatic care. That could take years. No problem. Warn of the likely relapse without guilt, threat or shame. In other words, your goal isn’t lifetime care, but to get their reactivation some day in the future.

Adjusting technique – And let’s not forget that your adjusting technique can prompt patients to discontinue their care too. If your adjustments tend to be on the forceful side of things, patients may find them uncomfortable—but not enough to complain.

Most people who are introduced to chiropractic and choose to continue their care for the rest of their lives are mostly those who subsequently become chiropractors! Then with everyone they meet they try to recreate the circumstances that caused the penny to drop for them. Understandable, but rarely effective and it creates an unreasonable expectation.

Thanks for the question!

Bill

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