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Do You Have a Goodbye Procedure?

Posted by Bill Esteb on Jun 28th 2024

Most patients know when it’s their last visit.

Do you make it easy for them to tell you of their plans? Or do they imagine your displeasure, followed by an awkward attempt to change their mind?

How you show up influences whether patients will be forthcoming—or inclined to simply stop showing up. If the latter, your support team will exhaust resources trying to track them down. Which often leads to pathetic pleas on their voice mail begging a reschedule.

This off-putting drama plays out in countless chiropractic practices that lack a workable “goodbye” procedure. Ironically, these are practices that have their first visit “hello” procedure down cold, but have neglected the way the relationship ends.

Granted, you can’t be certain when the goodbye will be necessary. Which is why you'd want to attend to it at the beginning of their care. Probably on their second visit.

Otherwise, it's highly likely their care will end without being complete.

An important distinction.

Lacking closure it prompts many such patients to avoid you in the grocery store. Or imagine you’re angry with them. And go elsewhere when their symptoms return, since they only received the most basic relief care.

What makes this even more tragic is that at the very time everyone should be celebrating another chiropractic success, the patient is evasive and the relationship ends with a whimper.

By eliminating the occasion for patients to express their gratitude, you rarely get the emotional payoff you deserve.

Needless to say, this lack of closure negatively affects referrals and reactivations. Which adds to the pressure of attracting more new patients.

I’ll grant you it’s counterintuitive to discuss the end of their care at the beginning. Yet, most patients have heard that “once you go to a chiropractor, you have to go forever.” So, neutralizing this myth is a great first step in establishing patient trust.

Not surprisingly, the most common push-back I get when presenting this point of view at speaking events is that discussing the ending of care somehow will somehow become a self-fulfilling prophecy.

And yet, the vast majority of the patients you’ve seen in your career (with whom you didn't discuss how to end their care) have discontinued their care.

Instead, most patients need to start and stop care repeatedly before ever embracing the idea of ongoing care as a long-term lifestyle adjunct. And maybe not even then.

There’s no downside to raising this issue and nipping it in the bud.

So, towards the end of your report of findings you might broach the subject this way:

“Most consult our practice because they’re suffering from an obvious symptom and want relief. So, that’s where we start.

“There are generally three recovery tracks. Some, see fast improvement. Others, especially those who have suffered recent trauma, find their symptoms might seem to worsen, before getting better.

“Thankfully, most see steady improvement as each visit builds on the ones before and they’re feeling better.

Then you’ll have a decision to make.

“Will you build on the investment you’ve already made and continue your care to strengthen supporting muscles and soft tissues for more lasting spinal changes?

“Or will you coast? The only way to coast is to go downhill, predisposing you to a relapse.

“When that happens, we’ll welcome you back and begin again.

“Either way, when you’ve had enough, let us know. That way, we can celebrate your success, close your case file properly, and archive your records should you ever need us again.

“Our job is to provide the finest chiropractic care possible, and your job is to let us know when you’ve had enough.”

You may recognize this approach from our popular Road to Recovery wall chart and report handout scripting suggestions.

The idea here is to convey to the patient that you’re not emotionally invested in their choice. (Even if you are!) Instead, you’re actually laying the groundwork for a subsequent shame-free reactivation.

By the way, you’re not somehow letting them discontinue care. Every patient has the agency to stop care whenever they wish. All you’re doing by instituting a goodbye procedure is...

  • Reducing the apprehension of an unspoken myth
  • Eliminating patient guilt about discontinuing
  • Officially completing their episode of care
  • Generating a positive impression of your practice
  • Reducing staff energies seeking to extract another visit
  • Making it easier for patients to eventually return
  • Removing the fear of patients being a flight risk

Fundamentally this is about trusting each patient to obtain the care they want, regardless of what they said they wanted. Be mindful that caring too much and wanting it more than they do is not only unhealthy, but unsustainable.