Dear Bill | Second Visit Adjusting

Posted by Bill Esteb on May 7th 2022

Dear Bill,

For over a decade I've always adjusted on the second visit. Recently, we seem to be getting more push-back from new patients who are unwilling to book an appointment if they learn they won't be getting adjusted on their first visit. I hate turning patients away, but I think patients who follow our established procedures tend to be better patients. Any suggestions?





This is just one of the reasons the doc-in-the-box outfits like The Joint and other low-friction providers have been able to gain traction. As there are more and more patients who have had chiropractic care in the past, fewer are willing to put up with the theatrics of a drawn-out onboarding process and other seemingly arbitrary formalities.

I used to be a vocal proponent of second visit adjusting. Mostly because my in-office consultations seemed to reveal that practices using a two-visit onboarding procedure seemed to have higher patient retention than those who adjusted on the first visit.

But I fell for the “correlation is causation” fallacy.

Turns out it wasn't the procedure responsible for improved PVA. But rather the clarity, focus, confidence and conviction of the practitioner who was able to sustain the two-visit procedure, not the procedure, that was responsible for the improved patient follow through.

As for the assertion that patients who comply with your two-visit procedure are "better" patients, I guess it depends on your definition of better.

Do you mean better as in they haven't waited until they were in such excruciating pain that they could wait and didn't require immediate relief?

Do you mean better as in they don't need you as an aspirin and appear interested in accepting chiropractic care for the purpose of better health and well-being?

Do you mean better as in they have been told your brand of chiropractic is superior to other providers and worth whatever wait you impose?

Do you mean better as in those who comply with your two-visit procedure will be more likely to comply with your other recommendations?

It's possible your two-visit procedure serves as an effective screening tool, eliminating people with acute symptoms, an allopathic mindset or experience with other chiropractors who seemingly didn't require a more drawn-out process.

But since you asked the question, you must have suspicions that a less dogmatic approach might improve your front desk conversion rate.

Granted, you have the right to withhold your care from people you suspect will not be a good fit. And whether their rejection of your two-visit procedure is an accurate proxy for that is hard to know for sure. But one thing is certain: you miss every shot you don't take. In other words, you'll never know if you could have inspired a greater health consciousness or provoked a belief change if you only accept the "easy" patients who are inclined to submit to the policy you have instituted.

You might want to consider a hybrid approach.

Instead of the second visit being a day or two later, how about making it only two or three hours later—on the same day? The consultation and exam would be in the morning and your report and adjustment would be on a second visit after lunch. That way you can maintain the illusion that you're spending precious moments scrutinizing their X-rays and meticulously evaluating your other assessments to ascertain your recommendations for care.

Sure, there are patients who can't get away from their jobs at 10:00 AM. No procedure is perfect. The key is to be customer centered without compromising your values.

Thanks for the question!

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