Kats Chiropractic Consultants CHIROpulse

Podcast 186 Why Patients May Be Quitting You

• Marisa Mateja

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Welcome to the KC CHIROpulse Podcast.  

This week’s topic: Why Patients May Be Quitting Your Chiropractic Practice

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights, and is hosted by Kats Consultants coaches Dr Michael Perusich and Dr Troy Fox.  Both docs are seasoned experts in Chiropractic care and business development.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.


In this episode, we discuss:

  • The numerous reasons why patients may be quitting your practice
  • How keep patients from leaving your practice
  • Why your patient communication may be the cause of patients leaving
  • How your staff can become more engaged in the process of retaining patients
  • …and so much more…


In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.



DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.


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KC CHIROpulse Podcast. Helping Chiropractors keep their pulse on success. Thanks for listening.



Dr. Michael Perusich:

Doctors, are your patients quietly quitting you? Hi, everybody. Welcome to the KC chiropods podcast brought to you by Kats consultants in Chiro health USA. I'm Dr. Michael Perusich, your host for the podcast today. And I'm joined by my co host, Dr. Troy Fox. Troy sometimes, and it's crazy. I know it sounds nuts, but sometimes our patients quietly quit us and just walk away. I want to talk, let's talk about why that happens.

Dr. Troy Fox:

Yeah. And we're not talking about the patient that maybe, cause it happens that sometimes we don't have what that patient needs. Maybe we don't, maybe they need to be sent somewhere else and maybe we're not quick enough to tell them that and they quit. Yeah. I'm not talking about that patient. I'm talking about the patient that got results. That loved what you did, but you're sitting there scratching your head, trying to figure out why they canceled their last appointment or just didn't show and why they didn't accept your phone call when you called to check on them and find out what was going on. And you think they hate you. Now I've had this happen. We've all had this happen at one point or another. Here's the one that got me. Here's what made me really think about this. A couple months ago, my wife was in Walmart. We don't go to Walmart very often. I've been to Walmart twice in the last year and that was cause I had to buy flowers for my wife for her anniversary. I didn't want to have them deliver it to my doorstep. I wanted to pick them out. So there you go. I needed golf balls, that's really important too. So my wife goes to Walmart and she sees a former patient of ours. And that patient could not wait to talk to her. Oh my gosh, Bridget. It's so good to see you. I just love your office, blah, blah, blah. I love the doctor. He did such a great job for me and I've been feeling so good. And then they taught you coming in. Bridget didn't push her much farther behind that. But Bridget asked me, where do you, how do you think that happened? Where was our breakdown? And I thought about it, we all go through lulls and highs in our practice. We go through times when we're really doing a great job of educating our patients and talking with them when they're in office, right? This was probably a little bit of a lull. And I identified it. I thought about, I'm really good at remembering what I do with patients and I could remember that a lot of times we talked about, how's your garden? What are the grandkids up to? And we really didn't get in much deeper conversation than that. Your

Dr. Michael Perusich:

table talk was off.

Dr. Troy Fox:

My table talk was off. So why don't you talk about that a little bit, talk about where it starts and then what are the secondary? So in other words, from the first visit, and then how do we move forward from there?

Dr. Michael Perusich:

So I'm going to be trite. And I say that because everybody's heard this before, especially from you and I, but it starts on the first phone call. So what we have to understand, I'm going to back up on this just a second, what we have to understand is that patients have an expectation when they come to you and how do most patients decide to come to you? It's not just because they're experiencing some kind of spine or joint related pain. It's also because they've asked around. You ever go to a chiropractor? Yeah, I go to the chiropractor. I go see Dr Fox. Awesome. Yeah, he's great. I go once a month. Boom, that's their expectation because most patients forget that they started out coming in three times a week for the first two weeks, or whatever it might be. They forgotten that they started coming in repetitively. And when they tell you people how great dr fox is, they forget that part. So the expectation is, oh, I'll go see dr fox. He's so good. I'll only have to go once a month and you turn around and tell him, nope, that's not what we're going to do. Okay. So we have to make sure that we're from the very minute they contact our office that we're unraveling that expectation. So in your history and consultation, you need to be talking about that. When you do your evaluation, what are you thinking already from your evaluation? We know when we do our evaluation, what are you thinking the care plan is going to look like? We need to be studying it. More importantly, we need to be understanding what the patient's actual expectation was. Okay. Did they come in just to get out of pain? Did they come in thinking they were just going to come in once a month? Did they come in thinking, whatever it might be? So our table talk, to get back to that, our table talk then, each visit has to be about resetting that expectation until the patient gets it. Okay. For years, we've called that chiropractic patient education, but it goes beyond just explaining what the subluxation is or how chiropractic works and that kind of thing. It goes back to connecting the patient back to the reality of what their underlying condition is. And what that means chiropractically as far as care going forward. Is this a patient that's going to need two months of care to get out of pain and back to function and then maintenance care? Is this a patient that isn't going to require maintenance care? Which I can't imagine who that would be. But so what are we doing on a daily basis to set that expectation for the patient and help them understand why that expectation needs to be there?

Dr. Troy Fox:

And I think you have to throw into this as well. What was the patient's not only expectation, but where did they feel like their condition was? Because they're going to make an assumption at the beginning of this. Did this occur two days ago and they've never had this pain before. Did this occur two days ago? And this has been a, an ongoing problem they've had for many years, but it only appears about once every six months to a year. And, it's funny. Especially when you end up in an arena. And when I say arena, in other words, the area that you're practicing in, if you've practiced around docs that have given a lot of what I would call, first aid care or, How we care to where it's sorry out

Dr. Michael Perusich:

there,

Dr. Troy Fox:

but that is really. It's really been about the pain. Those patients really don't put two and two together and say, you know what? I have a chronic condition. So part of your job during history is to determine has this occurred before? That's a really important question to ask. And if they say, no, not really, I have had some low back pain, but it was on the opposite side. Okay. How many times have you had that? Oh, that happens about once every six months. And I just, it, but it always went away on its own. And so when you're talking to the patient and you're discussing that prior history, that's a really good time to talk about chronicity of condition as well, because I think that's very important for patients to understand that most of what happens to us as adults. Didn't really happen yesterday unless you had a car accident. If you have a trauma, sure. When a patient comes in and goes, Nope, I haven't had any trauma. I just got out of bed and it just didn't feel good. So there are a lot of factors involved when we start looking at patient care. Their expectation is very important, but also their understanding of their condition becomes very important when you try to set the stage for what you're going to do with that patient.

Dr. Michael Perusich:

So I want to dive into this a little bit deeper. We need to take a quick message from our sponsors, but when we come back, I want to dive into a little bit deeper why patients quit us sometimes quietly. And I think we've set that stage, but doctors, I want you to make sure you come back because this is important because this happens to all of us and there's a very simple methodology to squelch it. Almost completely. So quick word from our sponsors. We'll be right back. All right, everybody. Welcome back to the Casey Carol Pultz podcast brought to you by Kats consultants and Chiro health USA. We're talking today about how and why our patients quietly quit us. Sometimes we laid the stage of patients come in with certain expectations and patients come in, not really understanding and connecting. Connecting the dots that oh, maybe I have a chronic condition that would benefit from A different perspective of care other than just getting rid of pain and so forth we've brought up this concept of table talk and how important that is and so Troy one of the one of the things that oftentimes happens when patients quit us is We allow them and I say We allow them because we don't really uncover this. We allow them to get by with thinking that You The whole goal of care is just to get out of pain. So the minute they're out of pain, everybody doctors out there, how long does it typically take us to get a patient out of pain? It's a magic trick, really, with care, right here, third visit, fifth visit, six is, it doesn't usually take very long to where the patient at least feels the pain is manageable and if we allow them To have that expectation that we're about pain care, oof, they're gone. And they won't even tell you why they're gone. This is quitting you quietly. This is that whole phenomenon of it.

Dr. Troy Fox:

Yeah it happens during that initial phase. And we all know that. It happens right now. There are other reasons that patients quit. You may have had a patient that was with you for five years that all of a sudden up and quit. There may be a different reason behind that. But when we see those patients that quit shortly after they get out of pain, we somehow missed a step in education or we weren't continually educating and continually educating means some of those things that we talk about all the way back in the history. And when we're doing the exam with the patient, we never repeat it again. And so those are going to be some of the little caveats. I don't want to give it away yet, but those are going to be some of the little caveats that, that really make a change in whether patients follow through with care long term and they actually finally get it. And when they get it, guess what they're going to do? They're going to refer friends and family. And because they understand why they're getting care at that point. So there, there is an added benefit. Not only do they follow through with care, but they now become a spokesperson for your practice when done correctly.

Dr. Michael Perusich:

Yeah. They become a chiropractic evangelist out in the community for you and they sing your praises and you just brought up a great point. I want to pull that out a little bit. A lot happens on day one with the patient, right? Consultation history, they fill out paperwork. We ask questions, our staff asks questions, patients telling us a whole bunch of information. How often do we ever go back? And really look at that information and digest it and bring it into that conversation on a daily basis. When I talk about table talk, this is what I'm talking about and reminding the patient why they came in. So if all you do is let the patient think that I came in because I had five out of 10 back pain. Then guess what? When it's one out of 10 back pain, they're gone. They're gone. They will be in control of that. And you may have treated the patient three times. You get to a long three day weekend. They're feeling great over the weekend. They may or may not call on Monday and cancel all the appointments. But if they, if their expectations been met, regardless of whether they call you, they're gonna, they're not going to show back up.

Dr. Troy Fox:

And a lot of

Dr. Michael Perusich:

times,

Dr. Troy Fox:

I was going to say a lot of times they've forgotten what you said on day one. I don't know how many times I've taken a family member to an appointment. Let's say an orthopedic surgeon. My dad had to have his knee replaced. He goes into the orthopedic surgeon. They go through everything. We come out and the next day I'm talking to him about what needs to happen. He goes, they never told me that. Oh yeah, they did dad. So sometimes the person that's not in pain and isn't listening to hear, because what they want to hear is, can you get me better? How long is it going to take? And what's it going to cost? Those are the three things they care about. Yeah. They're not really concerned about much else at that point. So when you tell them all those things. They're hearing part of it. They're hearing the parts that their brain really wants to digest at that point. Some of it, they won't remember six hours later. And so once they start feeling better, they've completely forgotten that conversation that you had. That's why you have to reinforce. When you're in with a patient on a daily basis, Hey, that's great. That your pain level is down to a two out of 10. Let's talk again about that example that I gave you. Remember, I told you that you were a 1984 Mustang GT and that GT had been driven pretty hard. Cause it was a fun car back then. And so it got driven really hard. And it just doesn't operate the way that it did back in 1984. It's a little rough around the edges. Our goal is really to keep that car running long term. And the example that I like to give, and this is a fun one. I always tell people, so here's the deal. You go into the Hertz Rent A Car place, right? And you rent one of those cool Dodge challengers and you go out and you just drive the wheels off of it, right? You drive it for three days and when you bring it back, you've jumped, some ramps, you have put it up on two wheels. You've probably done, and this will age me a Rockford, turnaround. So if you ever watched the Rockford files back in the day, you did some spins, you did a lot of stuff. You come back in there. I thought you were going to say Dukes of Hazzard

Dr. Michael Perusich:

or something.

Dr. Troy Fox:

Yeah, that would have been good too. But you at that point have. Work that car pretty heavily. Now it still runs great, man. It comes in firing on all cylinders, but there's a little smoke coming out from under the hood. And the tire,

Dr. Michael Perusich:

the insurance

Dr. Troy Fox:

tires are a little bit bald and you walk in. And the guy says, he looks at you with a big smile. Hey, did you have a good time in that car? Oh my gosh, it was fantastic. I had a blast. You hesitate to tell him what all you did in it, but he can probably tell. And he looks at you and said, Oh my gosh, I'm so glad that you had a great time in that car. Guess what? That's your car for the rest of your life. You get to keep it. You can't ever have another car. That's it. Now, all of a sudden, a little remorse starts to kick in of what you've done to that car. It's like our bodies when we're younger. We think we're about eight foot tall and bulletproof by the time we figure out that we're not, we've done chronic damage to our spines. We've done chronic damage to other joints as well, but we're a little bit beat up and a little bit broken and there aren't replacement parts for everything. Yes, we can get new knees. We can get new hips. Now we can even get new shoulders, but you notice that the spine, it doesn't quite work as well. We keep trying. But the outcomes are not great. And patients, even though the outcomes are not great, they'll go get a knee, but they're a little scared to have their spine, have surgery on it. A lot of people are for very good reason, because they know somebody that it didn't go so well or several people. And so when we talk about that and we talk about that longevity, you can repeat that conversation in a. Use short sentences or even one sentence. Hey, remember that 1984 Mustang GT, you pick the car. I don't care, but the 1984 Mustang GT that we talked about and they go, Oh yeah. And I go, remember, so we're not in a sprint. We're in a marathon. We got to try to keep this car functional for the rest of its life. Yeah. Or in other words, your body for the rest of your life. And they go, Oh, I get it. So as you are going through things, you don't have to get deep into the weeds. Talking about, what, what's inside of a disc or how a ferret knee ferret nerve impulses work and what the safety pin cycle is. If you want to great, but you really don't have to. Cause you know what, as a patient, I understand that analogy. Once I have, once I. I give you authority. In other words, once you've done that exam and they're agreeing with you that what's going on is going on. And they're like, yeah, that makes perfect sense. Now you can use an analogy to explain. Here's why we set up care the way that we do. So it's really easy to revert back to that. Now there are many other methods that you can use. That's just one that I like

Dr. Michael Perusich:

just an analogy.

Dr. Troy Fox:

It's an analogy and it's one that everybody laughs at, but yet they get it. If you can get them laughing, usually they will give agreement at that point that, you know what, you're probably right about that. I have been a little tough on myself. I've gone, I've driven myself like that Dodge Challenger, that 84 Mustang GT. So those are things that we look at when we work with patients, but you can't just do it once. You can't just tell'em. You have to keep reminding when you're first talking to'em, you have to keep reminding them what they are. They're an 84 Mustang gt and they'll laugh every time you say it.

Dr. Michael Perusich:

And when you get out to maintenance care, you tell'em, you know what? That Mustang, it's gonna need some gas every once in a while, so I'll see you in a couple of weeks. We'll gas up the engine and keep you running. Yep. It's just simple little things like that help flip that switch so patients understand a little bit better about what their needs are. And far too often we get, and I'll use your term, Troy, we get too deep in the weeds on chiropractic care on the chiropractic philosophy on, on how chiropractic works. And I'm like you, I think it's great if you want to tell patients all that love it. It's fantastic. I love it when patients are deeper educated. About what we do, but the reality is they came to see you, not because you're going to tell them about chiropractic care. They came to see you because they've heard you have experience in helping them with their problem, and they came to you for a personal reason for an emotionally personal reason. And when we can connect that and help them. Understand on a deeper basis through an analogy, through helping them realize that this isn't a new condition you have that recurs every six months. It's the same condition. And over time, it's going to get worse, much like your 1984 Mustang would get if you didn't properly tune it up once in a while. So helping patients make those connections to connect the dots to change their expectations is incredibly important. Reality is, if we don't do that, guess what? You can have all the authority you want, patients will quit care. They will quit care not because they didn't like it, not because they didn't get results, but because We allowed them to keep their expectations intact, thus allowing them to control care. We're supposed to be in control. We're the doctor. I want to dig into this just a little bit more. We got to take a quick message from our sponsor. So we'll be right back.

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Dr. Michael Perusich:

Okay, everybody, we are back and we're talking about why patients quit us. Sometimes secretly, they just walk away like ghosts and we've unpacked that. We've got to reset their expectations and why they come in with those ideas. I want to talk a little bit about as we wrap up here, Troy, I want to talk a little bit about helping people understand that long term mechanism of care because I hear a lot of doctors having a hard time. They do great getting patients all the way through their treatment plan through their 18 visits or 20 whatever it is. When they get to that final progress exam, patients are escaping away and they're having trouble making that jump to maintenance care. So I want to talk about that a little bit.

Dr. Troy Fox:

I think that is an important transition period. And I think there's some pretty simple solutions to that, quite frankly, when you get a patient to the point of maintaining, if we've had the conversation several times already about them being that 84 Mustang GT, we get to the point now and I say, really what we're going to do at this point. And I put two caveats with this, what we're really going to do at this point is we're going to tune you up or, I'll tell them sometimes when they jump off the table, jokingly, Hey, you're good for another thousand miles. And my patients laugh and go, okay, see you, here in three weeks, doc, or whatever it may be. And they already know what they're doing, but I also tell them, I don't want you to have the expectation that you will never be in pain again, because sometimes. What happens is they leave that treatment program feeling really good. And then they go out to maintenance or wellness care and they have a small flare up, or maybe they have an even bigger flare up and they go, Oh that didn't work. I spent all that time and effort and they quit care quietly at that point because their expectation was they were never going to have pain again. So when I'm talking to a patient, I say, listen, you're probably going to have another episode or two or three. Here's what we're trying to do. We're going to back care off. So we're not going to see you as often, but that gives your body the propensity to build up a little bit of restriction. Again, we're going to try to periodically put motion in your joints to keep you functional. But especially over the first year or two years that I'm doing this, you probably have a much greater chance to have a flare up, and it doesn't mean that you couldn't have a flare up 10 years from now you can. So in other words, bottom line is. Wellness or maintenance care doesn't mean you're never going to have a problem again. It means that we're trying to keep you functional enough that you do a, it's really easy to recover from again. And B, that we're not doing permanent damage over time that is going to create a situation where someday there is no help for you. Pretty simple answers. And when I tell patients that and they understand that, they get it and guess what they do? Because here's the last thing I tell them. While we're working with you on maintenance care, let's say that you're every two weeks right now, okay? Now, Mike, when you're coming in and you're every two weeks, if you get three or four days out from your adjustment, and let's say you're out in the garden pulling weeds and something goes awry, don't say I have an adjustment in another week and four days. Call us, let's get you in right now and let's address it real quick. And then we'll jump back out to that two week schedule. So my patients are very well versed in the fact that they don't want to sit and let that thing gel for the next 10 days. And then come in and go, man, it just got worse and worse. And here I am, because you told me two weeks, right? Yeah. And patients will do

Dr. Michael Perusich:

that.

Dr. Troy Fox:

They will. So you have to have an expectation of what they're supposed to do. But you notice what I created for the patient was an expectation, not that they were never going to be in pain again. It's going to happen. I almost guaranteed that it was going to happen at some point, right? The expectation is that the longterm is we're going to keep the function there to try to keep you healthy and functional for the long haul for that marathon. Not for the short and then just disappear. Some patients aren't going to buy into that. They're not going to do it. I have patients, I'm not going to tell you that every patient I tell that strategy to utilizes that strategy. No, they've heard it and they may utilize it the next time they may not utilize it this time. Sometimes I have patients cause I say, okay, what do you want to do? We basically can just quit right here. I never see you again, or we can look at every couple of weeks right now, because I feel like that would be a good cadence of care for you, but if not, we could look out even a little bit farther. It's not really what I'd recommend for you, but I want to give you three options here. I want to give you no care. Not the care I'd recommend and really the care that I would recommend for you. What do you think we ought to do? I'd say nine times out of 10, those patients are like, yeah, or if they're not, what'll happen is they'll say, we're a little tight on money right now. We just had to put new tires on the car. I could we go out three instead of two right now? You know what? Hey, I work for you. I always say that too. I work for you. Let's try it. So let's try it. And if it doesn't work, we can always back it up. But I'm more than willing to do whatever you would like to do at this point, because I think the most important thing is that you're getting care.

Dr. Michael Perusich:

Yep. And here's the bottom line, everybody. It's all about communication. It's all about keeping the ball in front of you. Keeping the topic. In front of the patient and the topic is their care and their need for care and how that helps not only improve their function, but we're going to stick with them for the long term to help them monitor their function and make sure that if something does arise. We're right there for him. So it's, it really comes down to communication. And I hear a lot of docs say, oh that's, that's selling. I don't want to sell the patient. You're not selling the patient. This is about being a good doctor, affecting good, solid doctor authority and telling patients what to do. What they need. Don't be afraid to tell patients what they need. And if part of what they need is long term maintenance care, wellness care, whatever you call it, then tell them that if what we don't want to do is diminish our communication so much that the patient just maintains their own expectations. And they walk away and you said it a minute ago, their pain comes back and what do they think? Chiropractic care didn't work. Let's protect the profession. What we do has incredible value, but it's our responsibility collectively as doctors of chiropractic to protect it. And that's one way that we do. Amen to that. All right, everybody. Don't let patience quietly quit you. We just gave you a whole bunch of great jewels. So if you haven't done so already, make sure you hit the and subscribe button. Tell your friends about us. Our podcast is growing like crazy. I love it. This has been so much fun for us. This is a project we started, oh gosh, I think a couple of years ago. Yeah. And we're having a ball with it, but we just appreciate getting out there and being able to communicate with you guys and thank you. It's because of you guys that we're growing. So if you haven't done so go to Kats, consultants. com, check us out, see all the great things that we're doing to help clients have great experiences in their practice and really be able to. Build the lifestyle of their dreams through their practice. So go check us out. Make sure you check out Chiro health USA. We appreciate them as one of our sponsors and we will see you guys next time.

Dr. Troy Fox:

See you later. Okay.

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