A chiropractor shares how regular formal check-ins during maintenance care changed patient retention. The speaker explains why patient-centered communication matters and how their approach evolved to keep people engaged in their own care.
Hey, everyone. So today I'm going to share what I found to be the single biggest reason that patients drop out from maintenance care after they've already started. And it wasn't what I thought. I learned this from some pretty brutal feedback I had from a patient once. And I'm going to share that with you so you can benefit hearing it from me and not having somebody tell it to you and just like stab you a little bit in the heart there. So just to kind of give it a little bit of context, my approach to maintenance care has changed a few times over the years. It probably will again in the future, I'll be honest, because I'm still always learning. There's still always new ways to do things. When I first graduated, I kind of thought my job was to recommend and get everyone possible on maintenance care, not like force them. But I thought, I'm not really doing my job if they just come in for a few visits and go. Because maintenance can be better for everybody. Right? That's that. I'm a second gen chiropractor. That's how I was kind of raised. That was my approach to it. And it meant that I always approached the report findings with a slight uncomfortable feeling in my stomach, even when I got good at it, because I was worried it was going to come across like a sales pitch. And I was worried that patients were going to feel like I was pitching them on this because it would suit my bottom line. And I didn't really like that. And what I ended up doing was changing my approach completely. So instead of talking about it there, I just made it all about them. So. So I spent years focusing on how do I make this all about the patient, how do I find out what matters to them, put this in their terms, their goals, talk about the emotional impact it's had for them, make it all about that and show them that I'm going to stand next to you as a trusted guide and we're going to walk through this together and we're going to get you back to what you most want. And then along the way, where appropriate, I would bring up the concept of maintenance care. And I found that work way better because I wasn't talking about this until I'd already earned their trust. You know, wasn't bringing it up right at the start, and I was doing it in a softer way. And patients just had an easier time talking about it because they go, oh, yeah, that makes sense. I'll think about that. Not everyone did, obviously, but a few more people did. And then Fast forward a few years from that and the Nordic maintenance studies came out and suddenly we started going, oh, okay. Like, actually, maintenance care is not right for everybody. There are some people who seem to do better if they just come in as and when, because we're putting them in a passive state when we talk about maintenance care, when we put them on that plan. Unfortunately, they came with this great questionnaire that allowed us to identify those people quite accurately. So I went, great. Patient centered maintenance care is here. And I'm not recommending it to absolutely everybody. And I'm not recommending it right at the start of care. And I'm really focusing on tailoring the initial course of care and making that all about them. And I thought I was doing really well. And then I ended up meeting a patient for a drink. Long story short, they were in the coaching business as well. We got chatting about things that, oh, we should, like, go for drinks sometime. And eventually we did, and we did that. And we met up a couple of times outside the clinic. I'll never remember one time I thought we were just going to meet and catch up. And we ended up talking about my clinic a lot. So they ended up sharing a lot of unfiltered feedback on how things were going. And one of the things they said is, they said, because they'd seen quite a few other practitioners before, four different, both chiropractors, Osterbell, that sort of thing. And he said, he said, because I'm going to be honest with you, when I first came to see you, I thought, oh, wow, like, this is great. This is exactly what I wanted. He's like, and you started out so well, I'm thinking started out so well. Kind of implies I dropped the ball somewhere and I'm listening. He said, you know, because you made it all about me. It was all about my goals. You know, what we're going to do. There was like, reassessments to check that we were on track. He's like, I loved it. I'd not had that before. But then, like, and we started going on to maintenance care and he's like, that was kind of working because I'll be honest, after a bit, you just became like everyone else. I thought, what do you mean? He goes, well, like, it just felt like you were going through the motions. Like, I'd come in, you'd assess something, you do a bit of treatment, and off I'd go, come back in six weeks. It's like it just. It felt like it was routine. It felt like it was just the Same thing you gave to everybody. And that's what I'd have with every other practitioner before. And I stopped and I was like, okay, like, that sounds. That sounds not good. And then the bit that really hit me goes like, oh. And I was so disappointed because I really thought you were different. Like, it started out so well and it was like this, like, stabbed me right in the heart of like. Because I know he'd seen other people and he wasn't that happy with the results. And suddenly I thought, yeah, you know what? He hasn't been in for a few months. He. And it was just like, oh, he's not mad, he's disappointed. Like, that, that hit me. And I'll be honest, I'd stopped and I thought, yeah, he's right. Like, actually, it's not like I don't care about patients that come in for maintenance care. But at that point, once they got maintenance care and once they were on board with it and agreed with it, I was like, great. Like, job done. We can just keep doing this for as long as they're happy to. And I stopped trying to make it all about them. I stopped trying to go, okay, because I figured we had a plan. Like, initially, it's like, right, what do they need? Okay, here's the plan. Here's what I'd recommend to get you where you want to be, and we're going to reassess it at this point and then we're going to reassess it again here. But then once they're on maintenance, I was like, cool, well, they get it. They're happy with that. Let's just keep doing this. And yeah, I'll be honest, I didn't go on autopilot fully, but I wasn't really putting the same effort into the relationship that I was at the start. And I realized this and thought, oh, God, he's right and I can't do this. Like, I'm supposed to be like all of that patient centered care. And yeah, that's not really patient centered after a certain point. Like, it's still beneficial. I wasn't like phoning it in, but I stopped and thought, okay, this has to change because I don't want anyone else feeling this way. And I realized one of the key things, one of the big changes that happened when I went to maintenance care after the initial course of care with the patient is I stopped checking back in with them. Like, I'd ask how they were doing, how was it after last time? But I stopped having a formal sit down with them and Going, right, here's where we were, here's where we are, here's how I think we're doing. Here's what I'm seeing in the tests. What about you? How do you feel we're doing? Are you happy with the progress? Are we still working on the same thing? Are we still working towards the right goal? Do you think that we should bring something back? Do you think we should bring something new? Do you think we should try a different approach? Like, I would do that every time I did a review with somebody. Like, first initial schedule, first few sessions, okay, we'll do that and then we'll review, and then after the first three months, we'll do that and then we'll review. And I was telling patients, there's a start and an end date to this, but then I'd get to maintenance care and it'd be okay. If you want to do maintenance care, this is what it looks like, you know, every month, every three months, every six weeks, whatever it is. And if they went, yeah, okay, I was like, great, job done. They're on board, let's start doing that. Oh, and I stopped checking back in. I stopped formally sitting down with them and going, okay, how do you feel this is going? And it's a really simple change, but since I started doing that, it's made such a difference, and it's allowed me to pick up a few times where actually a patient was starting to go, yeah, it's not really working for me like I thought. Or actually, we used to do this, and actually I didn't talk about it then, but I really like that. And I kind of miss that now, or feels like we're doing xyz, but I feel like there's maybe something more we could add. And I've picked up all these times where, if I'm honest, this patient was probably half on their way out the door if it wasn't for the fact that we would still stop down and review. So I now look at maintenance care as something that has an end point. You know, when I recommend it, I said, let's recommend it. Let's do maintenance care, trial this for the next six months or however long it might be. And that end point doesn't mean that at the end of that we're done. It means at the end of that we're going to stop and have the same conversation again. And I'll check back in and if you're happy and I'm happy, great, let's continue for another six months. It doesn't have to be six, but a set time. So I'm only recommending they do that. So the patient only feels that they're committing to maintenance care in several month trials and that formal sit down review doesn't have to be right. We're going to sit down and do a whole full body reassessment. You're going to fill out a bunch of forms and we're going to sit down and have a long extended appointment. It may be just, this is a reminder for me to check back in and go, are you happy with how this is going? So give that a try so you don't have to have that really brutal feedback that I did that really hit me in the heart. But when you recommend maintenance care, just recommend a trial period, especially at the start, but even then go, right, let's continue on that or let's make a change. And after another few sessions, in however many months, we'll reevaluate it so the patient only feels they're committing to a few chunks of maintenance care at a time. And it will keep you honest and it will keep you more engaged and it will prevent them from ever feeling like, oh, it just became a bit like, see you in six weeks. See you in six weeks. So give that a try. Any questions on any of that, as always, let me know. Otherwise, I'll see you soon for another video. Take care, guys.
