Say It Like You Mean It!

Doctors frequently ask, "How can I keep patients longer?"

The question and its answer is becoming more important as the number of underinsured or uninsured patients increases, and as our practice depends more on "patient pay."

I recently had an experience at the dentist that gave me some fresh insights into the situation. My dentist retired, and I made my first visit to his replacement. At the end of an unusually stressÈfree checkup, he carefully explained that I had several teeth that need attention. He outlined the problems and my options (short-term fix vs. long-term fix) and told me the front desk person would explain the charges and options. Two teeth in particular needed attention soon, even though they weren't bothering me. After a few pleasantries, he left with a parting, "Get back in whenever you can and we'll get things taken care of."

I felt the dentist did a great presentation, gave me good information, but left me dangling. There wasn't enough urgency, or a "Don't you understand what will happen if you don't take care of this?" type of conclusion. I realized that I was feeling sort of annoyed, thinking "Was the problem really that pressing?", or that maybe he really didn't much care what I did. It seemed as if I was supposed to direct my own case! I so seldom get to be the patient that I was interested in trying to figure out what it was that was nagging at me.

Well, here I am 10 weeks later. I did make and keep one appointment, but I canceled another while I was out of town. No one has called me to reschedule. I intend to return, but I haven't. Why? Because he didn't impress on me any urgency for getting it finished! And because there are other things I'd rather do than go to the dentist, I keep "forgetting"! No one has taken control of the situation by calling me back to get me rescheduled after I canceled without rescheduling.

It occurred to me that there is a lesson to be learned here for all of us. If you want someone to do something, tell them, tell them again, and then ask them if there's a reason why they're not doing what you recommended. Then, listen carefully to what they say.

It makes me wonder if one of the underlying causes of chiropractic patients missing visits, canceling visits, and ending care prematurely is a result of failure on the doctor's part to take the lead in actually telling the patient what's best for them from a results standpoint. Not what you think the patient will accept, but what you really think they need for maximum improvement and/or continued good health. I think one of the reasons patients leave is not always that we ask too much of them, but rather that we don't ask enough of them. We don't bother to get them involved in their care.

We need to question the patient after their report of findings (ROF) to see what they have absorbed.1 Too many ROFs are long on technical and short on practical and motivational. Why tell the patient less than what they truly need? I don't mean an hour long lesson in neurology that would impress your friends, but a practical, factual motivational presentation that actually tells patients the truth. You don't have to worry about overselling them. They won't do anything they don't want to do. They also won't do anything we never gave them the chance to do. Are we so afraid of "scaring" the patient that we can't give them the unvarnished truth? Do we have so little confidence in their ability to understand, or our ability to be understood, that we fail to give them what they really need -- the truth?

How would it affect our retention if we told the patient exactly what we felt was going to get them the best results? What if we gave them the timetable/schedule that would give them the best possible chance for good results instead of the one we felt they would accept? What if we said to the patient, "I understand that you may have difficulties with schedules, frequency, fees, etc., but I feel that if I can help you understand just how important this is, you'll find a way."

What would happen if the first time a patient didn't follow recommendations, we didn't just gloss over it but sat them down and said something like, "I'm concerned because I didn't get through to you how important it is to do this the way I laid it out. Let me go over the importance of timing of visits again."

What would happen if, when it became obvious that a patient was going to design their own schedule, we sat them down and told them that if they didn't want to do it our way, the way we feel is best for them, we'll still take care of them (if you will), but we feel an obligation to point out the problems with their way?

What would happen if, after the first week or two, we continued to educate the patient with a planned program, instead of talking to them about "the big game" or something else unrelated to their health care?

What would happen if the next time a patient started to tell you all the reasons they can't come in next week, you said, "I know your schedule is tight, but you really do need to be here next Wednesday. We'll do anything we can to match our schedule to yours.

It makes me wonder if patients slip away from us simply because we don't bother to hold on to them as though we wanted them to stay.