April 2006, Vol. 16, No. 2
Table of Contents
CCE Recognition by USDE Set to Expire • CCE Response Spurs Follow-up Complaint • Differentiating Neuromuscular from Musculoligamentous Subluxation • Chiropractic Pioneer Passes Away • Early Life Infections Improve the Function of the Immune System • European Spine Journal Publishes PosturePrint® Study • ICA Defending Chiropractic from PT's • Immunization • Letters to the Editor • Life University Teaches CBP® as an Elective • The Ineffectiveness of Over Accommodating • Parker College and Seminars Begin Celebration Preparations • PosturePrint® Used to Determine Stability of Upright Posture • CBP® Hits 91 Publications • Thanks for Helping Your Local HMO Grow! • The Perfect Chiropractic Storm • Three Keys to Practice Success • Building Wealth Securely: Maintenance, Not Pain Relief •
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The Ineffectiveness of Over Accommodating
by Mark Radermacher, D.C., President
Total Practice Management Int’l, LLC
Dr. Radermacher has been a chiropractor for the last 25 years and has been coaching some of the largest, most balanced and profitable practices nationally and internationally for the last 17 years. He is the author of: The 5 Minute Report Of Findings©, The 5 Minute Pre Consultation© (including the invaluable Life Impact Points©), The Dynamic Micro Report© (communication with patients during adjustments), The Fade and Fade Response©, The Minimization and Minimization Response©, Cluster Scheduling© and The 24 Hour Per Week Mega Practice©. He is currently the leader in coaching chiropractors in patient communications and practice building.
When a chiropractor crosses the line from controlled office procedural and patient management into procedural exceptions and patient management decisions based on patient debate and input, that chiropractor is entering the realm of ineffective practice. In the past, most chiropractors trudged through this phase of practice only one time in their career and that was when they began their practice. Currently, third party pay restrictions have caused many chiropractors to revert back to over accommodating their patients. This unconscionable justification for over accommodating is based on the fear of losing patients.
A patient entering a chiropractic office is expecting a professional to take control. The patient wants to follow a clearly defined set of office procedures and wants care to be managed by the chiropractor. As long as the chiropractor avoids over accommodating the patient, a position of respect is established and maintained that is required to deliver care to the patient. If, on the other hand, the chiropractor begins to over accommodate the patient, the patient is invited to take control.
Once a patient takes control and attempts to modify office procedure and manage their own case, all is lost.
A chiropractor who is over accommodating, mistakenly believes that a “softened position” of creating exceptions in procedure would somehow see patients compelled to begin and never quit care. The chiropractor who is deep in the practice of over accommodating patients becomes rudely awakened. This chiropractor acquires fewer prequalified new patients taking up care. Those who start care are expecting, then demanding, the office procedure and patient management be accommodated. Some of the most common procedures open for patient input, debate and accommodation, are: frequency of visits, cost of care, type of care rendered, scheduling of care, length of care, time spent each visit and the nature of discussion during each visit.
When a chiropractor is over accommodating, frequency of care is one procedure a patient will attempt to modify. A patient who senses the chiropractor’s willingness to over accommodate will often begin attempting to modify frequency of care as early as when it is presented in the five minute report of findings.
The chiropractor may recommend a frequency of three adjustments each week and the patient will raise concerns and offer other options, instead. A common patient response might be in the form of a question - “My pain isn’t bad enough for me to come in that often, is it?” or perhaps the patient will be more direct —“I can’t possibly come in here that often, I’m far too busy; I have a better idea, let’s try twice each week for a few weeks and see how it goes.” The chiropractor afflicted with the disease of over accommodation will respond with a tone resembling that of weak salesmanship. The chiropractor’s response might be “three adjustments each week would be better but two might do” or “with only two adjustments each week, your case may take a longer period of time.” In either case, the tables have turned. The patient is immediately and acutely aware of being in control. The patient is, however, falsely under the belief that the chiropractor is in greater need of the patient than the patient is in need of the chiropractor. From this moment on, the relationship is skewed to the extent that neither party wins. The patient loses by receiving much less care than needed, the chiropractor loses by realizing what needed to be said wasn’t said; in other words, the chiropractor didn’t stand the ground for the benefit of the patient.
Cost of care is another procedure a patient might break. Accommodating a patient in the cost of their care is one of the most serious procedural exceptions. When money is involved, emotion is involved. The patient refuses to spend money on a service that isn’t necessary, but the patient might consider spending money on an optional service if some obvious benefit existed. The chiropractor also has emotional attachment to money because money must be collected in order to survive. Yet, determining the “right” amount to charge has been elusive to most in the profession.
Many chiropractors now realize that charging more than a service is worth can lead to insurance audits and disgruntled patients. It is, therefore, understandable that with financial emotion involved on both sides of the fence, the over accommodating chiropractor soon looks and sounds like a fool.
When a patient senses weakness in the chiropractor, money becomes an easy target. Questions like “do you have a payment plan?” or comments such as “I can’t afford that” are the equivalent of a sharp blow to the chiropractor’s solar plexus. After catching a partial breath of this poisonous air, the typical chiropractor’s response is some form of discount discount or discount. The percentage of discount in dollars and cents doesn’t matter, the discounting of the
value of care, does. Patients don’t seek professional care, for a health problem that needs attention, with a discount in mind. Patients are willing to pay for the best care from the best professional. Chiropractors often raise the question “who has enough discretionary income to afford care in my office?” The answer is quite simple, the patient who needs the care and receives it from a chiropractor who does not over accommodate the office procedures or patient management. Rare is the person who, when asked if they have extra money, responds with an honest yes; common is the person who, when desire and need drive them, will create the financial wherewithal that is necessary.
The price a chiropractor charges must meet one very important criteria, that is — the chiropractor must be comfortable with the amount. What another chiropractor charges has little effect on a chiropractor who doesn’t over accommodate. It should be known that a chiropractor who charges a greater amount for services, and succeeds in practice, is comfortable with that price. It should also be known that a chiropractor who charges a very small amount
for services, and succeeds in practice, is also comfortable with that price. Regardless the amount charged for services, the chiropractor who is uncomfortable with their fee will be more likely to over accommodate by reducing that fee. It is this chiropractor who is more likely to fail in practice. Furthermore, if there was any truth in correlating low fee with a volume practice, then all the cheapest chiropractors would be the busiest and all the most expensive chiropractors would be the least busy. Multiple examples disproving these correlations exist throughout the profession.
The over accommodating chiropractor will also modify the type of care rendered a patient. A patient who has taken control of both the office and the chiropractor begins to make demands. Informing the chiropractor when and where to adjust becomes common folly. The patient may say “I don’t want you cracking my neck today” or “you adjust too hard” or “too soft” or “you don’t need to pop my mid-back, my husband popped it yesterday because it was hurting.”
The over accommodating, and now spineless chiropractor, with choke collar in place, responds according to the patient’s wishes. Moreover, patients will even begin to inform the chiropractor if and when they want exam or x-rays as well as informing the chiropractor about administering any other form of care.
Scheduling is another necessary office procedure that should not be modified by the patient. Over accommodating chiropractors find serious and multiple scheduling abuses in their offices. Some of the abuses include the patient demanding care on special days and hours. Expecting an appointment before or after regular hours or sometimes even during a day when the office is closed. Once the chiropractor opens the door allowing the patient the opportunity to modify office procedure, the process begins (and only ends) when the patient prematurely quits care.
Scheduling becomes an easy procedure for the patient to modify and control. The patient simply states that their schedule (which is, of course, the most important schedule that exists) does not coincide with the office schedule.
The request may be “you’ll have to open the office an hour earlier if you want to see me” or “If you want me to come in three times each week, one day will have to be Saturday.” The over accommodating chiropractor will sheepishly obey.
The over accommodating chiropractor also finds patients taking control of time spent during a visit.
Whether the patient feels too much time or not enough time, the chiropractor must oblige. This totally disrupts flow in an office.
Even more offensive is the momentum of patient control becoming so proliferative an infection that there’s no stopping the disease. Patient comments might include “Gee, that was fast. Are you in a hurry today?” or “At that speed you’re earning ten dollars a minute, too rich for my blood”. On the other end of the spectrum, the chiropractor will hear “if you can’t pick-up the pace I’ll quit coming in” or “why do you take so long, aren’t you sure of what you’re doing?” Like a wind-up toy with an on-off switch and a variable speed switch, the chiropractor jerks through each miserable day.
The last area of control a patient might commandeer is the nature of discussion during each visit. The chiropractor who often attempts to talk about health or chiropractic, when the patient simply isn’t in the mood, will often get shut down. The patient will usually respond with “look, I don’t need to hear all that health stuff” or “If you don’t shut-up, I’ll quit coming in.” After getting shut down often enough, the chiropractor often begins to communicate topics believed to be safe and innocent common ground. That is, the chiropractor starts to discuss useless topics such as the weather, sports, television or other nonsense. This type of discussion is usually permitted by the patient, and all seems well. The problem is, this discussion serves no purpose in furthering a patient’s understanding of health or chiropractic.
It is obvious all the control a patient takes occurs only because a chiropractor relinquishes control.
Once control is relinquished, the patient is making the majority of the decisions in office procedure and case management. All of these decisions are then being made by a patient who understands health and chiropractic at the level of an average nine-year-old. Over time, a person who began care as “a patient,” who initially wanted and needed care, digresses.
The digression begins with a patient turning into “a client” who then turns into “a peer,” then “an expert” and, finally, “a boss.” No chiropractor can deliver effective care to anyone other than a patient! To stop this unconscionable behavior, the chiropractor needs to come to a few important realizations. A chiropractor demanding a patient follow office procedure and patient management is not at all the attitude of my way or the highway. The fact that the chiropractor is the expert who knows and understands enough about health and chiropractic to deliver quality care is reason enough to demand the respect necessary to control the office. The chiropractor must also realize that the average patient wants to follow a specific office procedure and is very willing to have their case managed. There is enough to do in creating a successful practice, opening the door and inviting patients to control office procedure and patient management can’t be part of it.
Finally, the fact that third party pay isn’t covering appropriate chiropractic care has nothing to do with care recommendations or getting paid for services rendered. A chiropractor needs to teach, adjust and collect a patient’s money in order to fulfill the successful circle of care. The over accommodating chiropractor is lost due to their own mistakes, fear and the relinquishing of control. The ineffectiveness of over accommodating is unnecessary and, for the benefit of all parties involved, must not occur.
