Chiropractic Management Challenges: The One Year Mark for Patients

By Dr. Russ Rosen | Patient issues

I had a great conversation with one of my one on one chiropractic coaching clients and thought you might enjoy hearing about it. We were discussing chiropractic management challenges and he said,

“I have implemented the procedures and have no problem getting people to finish their first year of care… but at the end of the first year many of them think they are done. What am I missing?”

The good news is this doc is clearly doing something right. When we first started working together, they used to have a tough time getting patients to stay for 12 – 15 visits. Now, the vast majority are staying for an entire year of care.

Obviously, the bad news is too many of them think they are done with care at the end of their first year.

This is a common problem.

There are a few ways to address it, though. I promise: if you implement these strategies very few of your patients will think they are done at the end of their first year and the majority of them will want to continue care at one level or another.

Key Pieces of the Puzzle

In our program we make sure:

In visit 1 we help them see that there is more often than not more than meets the eye. During our consultation we help them realize how it is affecting their lives and how they have had stress and that it is an accumulation of stress over time that can lead to subluxations and these types of HEALTH problems.

During the examination, our TTAT, and Whole Story, we help them fully understand that NOT ONLY do they have their chief complaint, but they also have other motor, sensory, and AUTONOMIC health challenges that they did not tell us about (i.e. they have headaches but they also have sinus issues. Or they have mid back pain but they also have digestive issues etc.) In essence they for the first time in their life see the IMPORTANCE of a HEALTHY functioning nervous system and they WANT to be free of subluxations.

When we effectively do our TTAT and Whole Story they usually say something like, “Wow! I had no idea!” This is a CRITICAL piece of the puzzle. If we are not doing a great job at this they will most likely not sign up for the first year of care.

In our ROF, we get extremely clear with them where they are and where they want to get to on the path to optimal health scale where -10 = near death, 0 = Comfortable but not FUNCTIONING at their optimum and +10 = not only FEELING great but also FUNCTIONING at their optimum.

Once they realize that they are maybe a -4 and they really want to get to optimal health or + 10 where not only are they feeling great but they are also functioning at their optimum, and we find out how long they think it will take to get there.

We then find out once they are at that level of health how long they would want to keep their nervous system functioning at its optimum and how long they want to stay at their optimal health. OBVIOUSLY most people say, “FOREVER!”

Again this is a huge piece of the puzzle in getting people to commit to long term care. It plants the seed that they will want to make chiropractic a part of their healthy lifestyle. In fact, when we give our recommendations we let them know how much care they most likely will need over their first chunk of time (could be 90 days, could be a year etc.) and we also let them know how much care they will most likely need once their nervous system is working at its optimum to KEEP their nervous system working at its optimum. I.e. if we believe it will take a year to get to optimal health, we would let them know that the following years they most likely would need X amount of care to keep their nervous system functioning at its optimum and we discuss why most people choose to do that.

During our Daily Interactions we MUST keep monitoring how they are doing and what is next for them. We do not want to cause “Old Spouse syndrome”. Remember we want to take them from IN-1 to IN-8 (innate) over a lifetime! So it is critical to keep meeting them where they are at in their healing process and keep helping them see and experience what is next as they continue to get healthier. We go into great detail about how to do this in our daily interaction module and it is one of the serious weak suits for most doctors!

Achilles’ Heel

Now comes the Achilles heel for most chiropractors: the re-evaluation and re-report. The fact is most doctors don’t do one or if they do it is terrible! These do not need to take long but they do need to be done right!

A few of the critical pieces of the re report are that:

    • We ALWAYS check back in to the -10 to +10 scale.
        • Where were they when they started?
        • Where are they now?
      • Do they still want to get to optimal health or are they happy just feeling better knowing that we have not gotten the nervous system at its best yet?
    • Now that they feel better how would they know they are still getting healthier?
  • What are their new health goals and how often do they feel they need to be in for care etc.? (Clearly we end up telling them what they need to get to the level of health they want to get to, but it is CRITICAL to find out what level of health they want to get to and how much care THEY think they need!)

Later in care when they are really doing great, feeling great, and their nervous system is really clear, we MUST ask the question,

“Now that your nervous system is functioning so well, and you feel so well, and you can leap tall buildings in a single bound (whatever they had hoped for), how long do you want to keep your nervous system functioning at its optimum and how much care do you feel you need, how many visits per month do you feel you need to keep it functioning at its optimum? What do YOU feel can cause more subluxations? With your present lifestyle how much care do you feel you need to keep your nervous system functioning at its optimum? Do you feel you want to make any changes in your lifestyle at this time and possibly need less care from me?”

We could spend an hour on that once concept. But needless to say most chiropractors do not do this, and this chiropractor that I was having a conversation with was not doing the daily interactions as good as they could and were not doing re reports the way we just discussed. This is why they were having the problems with people stopping care at the end of the first year.

Hope that helps, always love hearing your comments and we are always here to help!

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