Monday Morning Motivation | Lie #11 - Drop Out

Posted by Bill Esteb on Aug 9th 2020

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Lie #11: Patients drop out of care because of something I forget to say or do.

Unlikely. Most chiropractors say and do too much already. Believe this popular lie and one could draw the conclusion that you have a profound disrespect for the intelligence of patients.

Patients aren't stupid. They discontinue their care for either one of three reasons.

1. They got what they wanted. They got the all natural relief without drugs or surgery within the time period they found acceptable.

2. They didn't get what they wanted and they lost hope that you could deliver it.

3. They found you or your approach to be off-putting.

That's it.

Most patients are reluctant to reveal their reason for discontinuing care because they suspect you'll either melt into a weepy puddle or more likely, attempt to talk them out of their decision to discontinue care. Either way, most patients find the prospect unappealing. So they simply make future appointments that they have no intention of keeping. This produces two tragic effects.

1. Your staff will waste valuable time and energy trying to track down wayward patients who aren't interested in resuming care, and

2. You'll miss out on any emotional payoff that comes from their expression of gratitude and appreciation. Instead, patients assume you're angry at them for not embracing chiropractic as a lifestyle, avoiding you at the grocery store.

This could largely be avoided by embracing two things.

1. Stop taking what patients do or don't do personally. They have their own hopes and dreams and value their health differently than you. Show up as a humble servant and help them get what they want. Care, but don't care that much.

2. Discuss how to discontinue their care at the beginning of the relationship. Due to the widely believed myth that "once you go to a chiropractor you have to go for the rest of your life," explain how to announce their last visit when they've had enough so you can properly close their case file. Let them know that you're here to serve, and not like a dentist who shames you for not flossing regularly.

Our popular Road to Recovery chart and handout were designed to facilitate this task.

Granted, talking about discontinuing care at the beginning is counter intuitive. Many fear that by doing so it will actually encourage patients to drop out of care when they feel better or become some sort of self-fulfilling prophecy.

Yet a quick inspection of your inactive patient files would suggest that patients drop out without discussing this key aspect of managing patient expectations! Neglecting this communication obligation merely produces the two tragic effects mentioned above.

Even more counter intuitive: make it easy for patients to discontinue care without a shred of guilt or shame. Chiropractors who do, enjoy two happy results: a greater number of reactivations (patients don't suspect an "I told you so") and more referrals. ("She's not one of those chiropractors who keeps you coming back forever.")

Granted, this may not produce the wellness practice you dream of, but that's a marketing problem, not a patient management problem. (If that's your goal, you'll want to start attracting patients who want health care rather than merely pain relief. A very different problem than patients leaving after getting what they original sought.)

Truth: Patient discontinue care for their reasons, not yours. Similarly, patients remain under care for their reasons, not yours. When you care too much, you can discourage patients from announcing their last visit, denying you the opportunity of celebrating their satisfaction and properly bringing the relationship to a healthy conclusion.

Lie #10 | Lie #12


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Bill Esteb has been a chiropractic patient and advocate since 1981. He is the creative director of Patient Media and the co-founder of Perfect Patients. He’s been a regular speaker at Parker Seminars and other chiropractic gatherings since 1985. He is the author of 12 books that explore the doctor/patient relationship from a patient’s point of view. His chiropractic blog, in-office consultations, patient focus groups and consulting calls have helped hundreds of chiropractors around the world. His Monday Morning Motivation is emailed to over 10,000 subscribers each week.