When Patients Don't Come Back: Why It Happens and How to Fix It

"What we've got here is failure to communicate." — "Cool Hand Luke," 1967

In any health care practice, be it allopathic, chiropractic or somewhere in between, a certain percentage of patients walk out the door following a visit or series of visits, never to return. What's the driving force? Why do some patients stay and some go? Determining the reasons – and then doing something about it – is critical to supporting your patients and keeping them engaged in your practice and chiropractic care in general.

To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic like you for ideas and solutions that have been tested in real-world environments. Our latest question: "According to the inaugural Gallup / Palmer College report, one-fourth of the U.S. adult population have not visited their DC for more than five years. What do you feel is the primary reason for this – and what can be done on an individual practice level to help solve it?" Here's what your colleagues said when asked for their insights.

Communication Breakdown

According to Dr. Chris Cotton of Atherton, Calif., "The No. 1 reason for lack of retention is somewhere or somehow, the doctor failed to communicate to the patient what chiropractic is all about."

Deer Park, N.Y., DC Sal Principe also mentioned communication as a potential reason, stating: "Just because the insurance industry looks upon chiropractic as a therapy for pain and dysfunction of the spine, doesn't mean you should let your patients think that way. Remember your philosophy. We make adjustments to improve the brain-to-body communication, which allows the body to perform at 100% one hundred percent of the time. We are not there just for the absence of pain and symptoms; we are there to help the body and mind.

"If your patients don't know this, it is your fault and why you don't hear from some of them for years."

Contact Counts

"If the patient hasn't been in your office for a long period of time, it is due to not staying in contact with them," said Dr. David Timperley of Lincoln, Neb. "You must periodically stay in touch, whether it is by email, newsletters, birthday cards or other promotions. It is also very important to educate the patient about maintenance care after they have gotten through their initial acute-care phase of treatment, explaining the benefits and letting them choose."

According to Dr. Timothy Vyrostek of Conneaut Lake, Pa., "Fighting this uphill battle is a Herculean task at the individual office level. I believe having an attentive staff, and systems within the office for the staff to follow, is the only way to keep your clients engaged. All offices have a dedicated cabinet of files that are inactive. Having everyone in the office on the same page to give the message to the people on the value of health. Then, challenging the individual to realize what that value means for them specifically, will allow the masses to seek out wellness healthcare (and want to pay for it)."

"Patients do not have a 'top of mind' attitude concerning chiropractic," stated Dr. Michael McIrvin of McPherson, Kan. "They must continually be bombarded with messages concerning chiropractic. That is how the drug industry and dental industry have done it. We need a unified voice to speak to patients. Something along the lines of what the dental profession has done with its emphasis on a checkup every six months."

Insufficient Value

For Nebraska DC Dr. Rodney White, when patients don't come back for years, it's "because something has happened to cause a perceived indifference in probably 75% of cases – either through staff rudeness, inefficiency in the clinic, or especially dogmatic preaching by the doctor instead of listening and connecting with the person's 'why.' The others probably didn't have enough value created for them or their needs have simply been met."

"Chiropractors must be more than what the general population deems is the place of a chiropractor," said Celebration, Fla., chiropractor Dr. Roland Cayer. "A chiropractic physician must have abundant knowledge of diet, exercise, nutrition, supplements and simple remedies. He must be capable of more than only adjusting."

Selling Too Much, Explaining Too Little?

Said Idaho DC Ryan Kain: "The most common complaints I hear from other DCs' patients are: 1) I kept having to go back [with no clear treatment plan with attainable goals that reflect daily life, demonstrated by re-exams and ADL questionnaires]; 2) Lack of thoroughness; too many 'slam bam, thank you' DCs, with no perceived value; 3) Always trying to sell something, including what I think was supposed to be patient education.

"Stop trying to sell patients, and just explain in a clear and succinct way what is wrong, what to do about it, options, and how long and how much it is going to cost," Dr. Kain continued. "If they understand, within layman's terms, and they feel they are getting value, they will come back ... but not if they think you are just trying to sell to them."

A Question of Education (Patient and Doctor)

"Let's face it: It is the pain that brings the patient into our office in the first place," said Dr. Doug Stucki of Franklin, Tenn. "It is pain that causes them to seek out our services and make that initial appointment. Once their pain is gone, why would they stay for treatment? It all comes down to how well we have educated our patients about the benefits of ongoing chiropractic treatment. ...

Whatever your philosophy is, you should make your treatment recommendation match what you believe. You should not have a philosophy of pain relief and then recommend a 60 visit care plan. Likewise, do not have a philosophy that every patient should have lifetime care and then recommend 10 visits because that is what the insurance company will pay for. The doctor needs to be honest with himself and with the patient and make those two align with each other."

Dr. Vyrostek emphasized the need to educate patients on the value proposition. "We as a profession advocate health and maintenance, but the third-party payer system is not set up for the chiropractic lifestyle," he said. "Therefore, we are on the outside looking in. Bottom line: Patients have already paid for benefits, and don't want to pay any more. Unfortunately, I believe our profession is to blame that we did not have a louder voice back in the 1990s on the maintenance of health and how important that is. How much that is worth. [We need] a louder voice that speaks about the value to the individual, to the family of that individual; what that value is to the workforce, and the value of the effect on the economy as a whole."

"Too many chiropractors are only minimally competent. In my opinion, the solution is to increase doctor competence and expand patient awareness of the potential benefits of chiropractic care," added Dr. Ken Kasian of Gilbert, Ariz.

Don't Be Afraid to Ask

In your practice experience, what do you think causes some patients to resist returning - for years or forever? Perhaps it's one of the reasons illuminated by your colleagues; or perhaps it's something completely unique to your patients and practice. After all, as Michigan DC Dr. Robert Potter stated succinctly, "You need to ask the patients who have not come back. Anything else is speculation."

Editor's note: Interested in joining our focus pool and sharing your perspectives on chiropractic practice with your peers? Email . Every few months, we send out a new question and request your input / insights.