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Mark Sanna, DC, ACRB Level II, FICC

You have just given a new patient a report of findings and your recommendations.  You expected to hear a sigh of relief and thankfulness from the individual sitting across from you, but instead, you are confronted by crossed arms and the scowl of skepticism. We’ve all experienced it and we all try to avoid it as much as possible. It’s called a moment of truth. How well you handle the situation will lay the groundwork for your future relationship with the patient.

Patients are human beings with complex emotions, especially in regards to their health. And although you’d like them to, not every patient will finish their first visit and happily leave your office ready to follow your plan of care verbatim. As chiropractors and CAs, we face moments of truth with patients on a daily basis. However, you can minimize frustration on both ends by following some simple suggestions.

Listen Between the Lines

What should you do when a patient exhibits the signs of non-compliance? You can diffuse the situation by asking the patient questions designed to draw out the underlying cause for their behavior. Ask about the goals and expectations they have for the care they are receiving. Here is where your listening skills become paramount. Be empathetic to your patient’s needs, concerns and fears. Create a dialogue that solicits their feedback so that you can uncover the real reasons for their resistance to follow through with your recommendations. Often, behavior that appears as indifference or defiance is really an indication that you and the patient have some important communication that has yet to be completed. More often than not, this communication involves financial concerns.

Have a “Toward Health” Conversation

It is vital to discuss any concerns about the cost of care up front before money becomes a major roadblock to receiving care. Handling patients’ financial concerns is something that many chiropractors struggle with. The best way to change the energy of a conversation about finances with a patient is to shift the emphasis away from cost and on to value. There are two highly effective methods to accomplish this goal. One method is to have a toward health conversation. Focus on the valuable benefits that will come when the patient makes the financial investment in their good health. Find out those hobbies, family activities, or other enjoyable pastimes that your patient truly loves to take part in. Be sure to emphasize how much more of these activities your patient will be able to participate in once their good health returns. Focus on how much easier it will be to swing a golf club, lift a grandchild or whatever activity your patient holds as a priority in their life.

Have an “Away from Pain” Conversation

The second method of diffusing financial concern is to have an away from pain conversation. This discussion is actually easier to have than a toward health conversation, as pain is a powerful motivator. Psychologists have found that more individuals are motivated to move away from pain than toward health. Acknowledge how much more serious the patient’s condition can become if not addressed conservatively in the early stages. Emphasize your concern that if your recommendations are not followed, their condition can take a turn for the worse, their body’s ability to respond may weaken, getting better will take longer and the cost to get better will increase.

Maintain a Parental Attitude

The doctor-patient relationship has often been compared to the relationship between a parent and a child. Patients come to you seeking guidance and support in the same way that a child looks to a parent. While you respectfully express the value of following your recommendations to your patient, be sure to avoid showing signs of uncertainty. Letting the seeds of doubt seep into your conversation is another movement of truth. Remain in control of the conversation and always maintain a professional attitude while you diffuse their concerns. Let the patient know that you have based your recommendations upon their examination findings, past history, special tests, goals and other methods of objective documentation. Exude confidence while explaining how you can assist them. This helps to reassure the patient that you have only their health in mind and no other hidden agenda. Let your patients know how much you care. Show them the same courtesies that you would a loved one and in most cases, they will respond in kind.

Don’t Allow the Past to Destroy the Present

In some instances, patients have a preconceived notion from their past chiropractic experiences.  They bring these preconceptions to your practice and expect only what is familiar to them. For this reason, it is important to find out if the patient has had an experience with chiropractic in the past and to determine if it was positive or negative. You can move beyond this moment of truth by avoiding long, drawn-out discussions comparing your skills and practice procedures to the patient’s previous experience. Acknowledge that every chiropractor has a unique approach, but that all chiropractors share a common goal of returning their patients to their highest state of health in the most efficient and cost-effective manner possible. Let the patient know that if you truly believed that they were not in the right place and that you didn’t think that you could be of help to them, that you wouldn’t hesitate to refer them to a colleague who could.

Your Good Reputation is Everything

A friendly reminder: your reputation is on the line every moment you are with a patient. Every time a patient has to make the decision to show up for their next appointment is another major moment of truth. Cultivate loyalty by striving every day to make patients feel great about coming in for care. Great word of mouth is the very best advertisement you can have. The more positive feedback you receive about the quality of your service, the more loyal patients you will have. People most closely relate with others who have had a similar experience as themselves. This is why a testimonial from a satisfied patient can have the greatest impact on convincing someone to try your service or even to remain under your care. If your state law allows, create a HIPAA-compliant book of testimonials to serve as reading material in your Reception Room. Encourage your patients to browse all of the wonderful comments you have received from your patients over the years and ask them if they’d like to add one of their own.

Parting is such Sweet Sorrow

Every practice has a group of patients who love coming to your office so much that it seems like they never want to leave! This can be a challenging moment of truth for a doctor or Front Desk Receptionist who is faced with the multitude of tasks required to deliver care in a busy practice. The best way to respectfully dismiss a chatty or lingering patient without making them feel short-changed is to gently explain how important it is for you to focus on the work at hand so that you can be your very best for each and every patient you see. The worst thing to do in this situation is to appear as though you’re being rude, standoffish or dismissive in any way, so be sure to be cognizant of your non-verbal cues. In essence, you are responsible for training your patients to be mindful of your time constraints. When you intently focus your attention on the patient you are with as though they were the only patient in the world, they will experience the time-warp that comes from quality rapport and present time consciousness.

Create a Solution-Oriented Practice

There will certainly be other moments of truth that arise during the course of your day. What matters the most is that you and your team create a solution-oriented practice. Role-play challenging situations during your team meetings to keep your team in top problem-solving shape. Problems only remain problems if a solution is not set in motion. You can even create an award of acknowledgment for the team member who most effectively diffused a moment of truth and present it to the winner at your next team meeting. The possibilities are endless when your team makes it their goal to turn moments of truth into moments of fun!


Dr. Mark Sanna is a member of the Chiropractic Summit, the ACA Governor’s Advisory Board and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com/MDP 1-800-723-8423).