Dear Bill | Patients Canceling Appointments

Posted by Bill Esteb on Jul 24th 2020

Dear Bill

"I have patients who keep canceling massage appointments, as well as chiropractic appointments. I want to weed out those who lack commitment, do you have a gentle way of approaching this?"




I find it fascinating when chiropractors want to "weed out those who lack commitment." I've encountered this from time to time in my travels. It often stems from a belief that a patient's behavior is a reflection of the practitioner.

Accepting responsibility for the behaviors of patients is absurd.

If you share a common language and you've explained what you're doing, and why, in an understandable way, you're off the hook.

But remember, just because you made a compelling case for the wisdom of keeping appointments to create the momentum necessary for healing, it doesn't mean the patient believes it—even if they give you the head fake of a knowing nod.

But I can assure you that you and I, like patients, attempt to act in ways congruent with our values and beliefs. Every decision we make is run through this filter. Even if we're not conscious of it.

That's all patients are doing.

It's certainly not rational. But when pressed most of us couldn't explain why we choose this over that; now over later or rocky road over cherry cheesecake!

Restricting your practice to those willing to toe the line that you've set for acceptable patient behavior can make for a very small opening into your practice. Granted, this is within your right to do, as is only accepting patients with blue eyes or those with last names that begin with the letter M.

But why?

It might be helpful to see it from the patient's point of view.

First, most chiropractors have little knowledge of the competing demands facing their patients. After all, you haven't requested their last three tax returns or run a credit check. You probably don't know about their aging parent needing an assisted care facility or their home that is facing foreclosure. In fact, it's often these types of emotional concerns that are the root of a most of spinal problems.

Besides the financial implications of continuing care and the investment of time it takes to break their routine and visit your practice, there are two even more obvious reasons why patients miss appointments.

Reason #1 – Delighted With the Results

When the roller coast comes to a stop at the starting point, we know what to do next. When our groceries are bagged, paid for and ready to take out to the car, we know what to do next.

Most patients haven't a clue how the relationship with a chiropractor ends. Worse, many have heard that "once you start you have to go for the rest of your life." And since you haven't explained how to disengage from the practice and exit properly (as if it's never going to happen), patients are left to invent a procedure.

And they do.

I know. Most chiropractors hope the relationship will continue forever, but with a chiropractic first-timer, that's unlikely. (That may have happened to you, but for those who don't become chiropractors, most believe that chiropractic care should have a beginning, middle and end.)

Problem is, patients don't know how to announce their intention to discontinue care. Which, because of the second reason, creates a problem for patients.

Reason #2 – Afraid to Let You Down

Most practices have a brilliant first visit new patient procedure. Which may extend to the second visit. And even to a "regular" visit. But few practices have a last visit procedure.

Partly because they care about the patient's health so much. Often, more than the patient!

Because patients sense that you care so much, they're afraid to mention their intent to discontinue care. They imagine you'll melt into a weepy puddle, or worse, attempt to talk them out of it.

It's a quandary. Either scenario is, well, awkward.

With little guidance other than their own wits, patients devise a strategy. The best way is to make future appointments, but not keep them.

Problem solved.

Then, it's up to your CA to track them down. Which the patient can easily avoid, thanks to caller ID.

Sadly, this charade is totally necessary. All you must do is show up as an adult and treat patients similarly.

"When you've had enough chiropractic care, let me know. We'll celebrate your success, close your case file properly and send you on your way. And if your problem ever returns, just come on back. Your records will already be here along with our concern for you and your health."

Granted, that doesn't mean patients will follow your invitation. But at least you've signaled that you're not inordinately invested in their behavior. The goal is to help patients feel comfortable announcing their last visit.

Weeding out patients who aren't particularly committed to their health is certainly within your right. It's a passive aggressive version of "my way or the highway." Being confronted with the fact that many people aren't interested in true health is sobering. And if you're unwilling to care for them, be ready to refer them to someone who will.

"I don't think we're a good match for you. There are several other chiropractors who I think would be better equipped to help you with your condition. May I make a couple of referral suggestions?"

You'll maintain your standards; the patient will be impressed by your focus on their satisfaction and the chiropractor down the street will be grateful.

Win. Win. Win.

Thanks for the question!

Email Bill with your question.

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