Dear Bill | Patients Ignore Treatment Plan

Posted by Bill Esteb on Jan 26th 2021

Dear Bill

"I have a hard time getting people on treatment plans. Many think they just need to come once or twice. I would like to fix that without having to spend a lot of time trying to educate them."




This seems to be a growing problem, compounded by the financial duress many are experiencing these days. Thankfully, there are some things you can do to reduce attrition and more importantly, lay the groundwork for a post-cerveza hangover recovery.

Getting People on Treatment Plans

By "getting" do you mean presenting an appropriate care plan? Or persuading patients to follow it? These are two very different issues.

Presenting Your Care Plan – If you're not delivering a formal report of findings, you'll want to begin, since patients won't take their situation seriously unless you do. Besides an aggressive initial visit schedule to address a patient's presenting problem, you'll want to set a date for their first progress examination. This is a commonly-overlooked procedure. "That's where we'll conduct some of the same tests we performed this morning, comparing where you are with where you were. Then, together, as we see how your body responds to chiropractic care, we'll chart a course that makes sense for the future." Neglecting this milestone, leaving their care plan open-ended, abdicates your responsibility and requires patients to self-direct their care, practically guaranteeing that they'll discontinue care when their symptoms subside.

Following Your Care Plan – Most patients want to please you and secure your help to resolve their problem. However, with little savings and their credit cards maxed out, they have few resources to tap for their unplanned bout of back pain. They'll likely agree intellectually with your logical, well-justified care plan. But they have a problem. They have the shame of knowing that they cannot fulfill the financial implications of your recommendations. Their plan? Get the most minimal amounts of care until they start feeling better. Which, after all, is why they consulted you in the first place. This is human nature—not a shortcoming of your clinical explanations or persuasive powers. Or, as the famous breakup line goes, "It's not you, it's me."

Just Need to Come in Once or Twice

Of course. This is the prevailing medical model of "treating" a condition. "Why would I keep taking aspirin if my headache is gone?" a patient reasons. Changing this belief (if even possible) must start with you (are you getting regularly adjusted?) and each member of your team (do they see chiropractic as a diet or a lifestyle?) It begins by making distinctions about how chiropractic care differs from medical treatment. Not to disparage medicine! But to explain how the purpose, intent and outcomes are different. It's a distinction that has allowed chiropractic to co-exist beside medicine as a separate and distinct healing discipline.

That means proudly using the language specific to chiropractic. That would include terms such as vertebral subluxation, adjustment (instead of manipulation), care (rather than treatment) and referring to nervous system integrity (rather than merely biomechanical dysfunction).

I also means making it clear that you won't be treating their symptoms.

You'll want to avoid any reference to "fixing" their spine. Because unlike an infection or some other self-resolving health issue that runs its course and is gone, they likely have a problem that will likely require some type of ongoing supportive care for the rest of their life.

When their problem returns, which is highly likely if they discontinue care prematurely, they'll have less reason to blame you and assert that "I tried chiropractic but it didn't work." Because the results didn't last.

These approaches are unlikely to change a patient's deeply ingrained medical model of symptom treating. No matter. Stand for the truth—even if they give you the head fake. (Nodding in agreement, but unconvinced.) You're laying the groundwork for the post-Covid world to come. More about that in a moment.

Now, if the specter of patients using you as an aspirin is abhorrent, another option is to begin a full court press to begin marketing your services to those who value their health—rather than anyone who shows up wanting pain relief.

Without Having to Spend a Lot of Time

No question yakking at patients is time-consuming, thankless and largely ineffective. So, you'll want to implement systems and use technology to save time and reduce repetitious explanations.

That includes your marketing system, your pre-care interview approach and your onboarding process. The key is to no longer accept patients without first explaining what you're responsible for and what they're responsible for. Most patients, trained by the medical culture, expect you to do all the heavy lifting. They assume that all they need to do is show up—without having to change anything else in their life.

You'll want to add a first-visit patient orientation video to the mix. Probably a pre-report video as well. These should contain the basics you'd want every patient to know. Video will be faster, more consistent and free you up for more profitable activities.

Trying to Educate Them

This may be a deal breaker. Patients do what they do because they believe what they believe. Even if they're not aware of what those beliefs are.

Beliefs are based on values. Since most people rarely value their health (until they lose it) you can be pretty sure most will discontinue their care when their obvious symptoms resolve so they can return to activities that they value more highly.

There is nothing you can say or do that will cause patients to reprioritize their health over other values. This assertion probably won't stop you from trying, but it's true, nonetheless.

So, by all means, educate patients. Explain what you stand for. But don't take it personally when patients give you the head fake and ghost you once they feel better. It may take a series of fits and starts over several years before a patient embraces the lifestyle implications of chiropractic. And maybe not even then.

Practicing in a Post-Covid World

I suppose it's possible the media will continue to fuel the fear about the germ for the rest of our lives. But I doubt it. For many people, fatigue is already setting in. Even with the threat of a new, more virulent strain. And while I can't predict when, at some point this is likely to be behind us.

Keep your eye on strategies to not only survive until then, but to thrive in its wake.

Here are a few:

1. Avoid discounting your fee. One way to maintain the value of your care in situations of financial hardship, while offering a discount, is to buy a visit if the patient buys a visit. "You buy one, and I'll buy one." That way you avoid the awkwardness of raising your fees when everyone is back to work.

2. Disengage from third parties. If you have patients who still have great coverage and low deductibles, enjoy it while it lasts. However, someday (soon) when enough patients show up waving their insurance card with a $5,000 deductible you may want to finally disengage from accepting assignment. Many practices already have. And if this obvious move doesn't make sense in your jurisdiction now, at least join a medical discount plan (such as ChiroHealthUSA) so you can legally have greater flexibility when setting your fees.

3. Enroll in CareCredit. Granted, if patients can't even qualify for this option, they have bigger problems than their back pain. However, it's one more option so you don't have to bankroll their care and serve as their banker.

4. Turn up the compassion and empathy. This is entirely headspace. If you're living on fumes yourself it may be a difficult ask. But you and your team must increase your demonstration of caring and understanding. The key is to avoid even the slightest hint of shame, condescension or judgment. Think long term. Your gesture will be long remembered after this comes and goes.

5. Improve telephone skills. Today, with every new patient lead more precious than ever, better handling of incoming telephone inquiries can make a big difference. Countless new patients are lost at the front desk due to simple, easy-to-correct oversights. By listening in on thousands of new patient phone calls, the pay-per-click team of our sister company Perfect Patients discovered 10 important lessons.

6. Keep in touch with inactives
. Those most likely to come to your practice are those who have already been. Make sure every patient knows that you'll never, ever, be angry with anyone who chooses not to follow your optimum care plan. And more importantly, mean it. Stay in touch with your inactives, but keep overtures to return for care to a minimum. They know what you do and where you are. They'll call when they need you. Trust them.

7. This too shall pass. Today, more than ever, your patients and community seek confidence and direction. Avoid getting sucked up in the fear mongering and germophobia. Be in, but not of. Project confidence and certainty in everything you say and do—from your website to your consultation and report. This is a time for creativity and innovation. Stay sharp. Those who do will emerge stronger and have an advantage over those who waiver or allow doubt to get a foothold.

Patients Who Ignore Your Treatment Plan

While it may be disorienting, for you, patients and prospective patients, most of us are adapting the best we can. Which means a lack of patient follow-through should not be judged the way you might have a decade ago. Nor should the solutions you implement be similarly outdated.

Thanks for the question. Hope that helps.

Email Bill with your question.

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