390- Improving Patient Satisfaction by Setting Expectations

Welcome to the Evidence Based Chiropractor where each week we deliver the latest chiropractic research and marketing strategies all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langman.

Hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. This week we are back with research and it is an awesome study that came out just this year came out of chiropractic and manual therapies. It is titled Patient Expectations and Levels of Satisfaction in Chiropractic Treatment for Lumbar Radiculopathy. A mixed methods study. I'm going to drop a link down to this in the show notes if you want to check it out yourself. But there is a lot of great take home messages, communication pearls, maybe more than clinical pearls and just a really good study to understand what drives satisfaction in a chiropractic practice. And then how can you meet and exceed patient expectations? Because when you do that you will drive more reviews, more referrals, more testimonials, more of all of those things that drive our business forward and help more people in our community, which is what it is all about. Before we dive into the study itself, I want to say a few words about Patient Pilot by the Smart Chiropractor. If you have an email list and you are not sending weekly email newsletters at a minimum, you're missing opportunity. You're missing opportunity to drive reactivations into your practice. How do we know that? Because we do more of that than anybody else on planet Earth. We will actually give you a 3x ROI guarantee to prove the fact that we know the money is in your list. And if you're not automating campaigns to that list, you're probably spending too much on patient acquisition. You probably don't have as full of a calendar or a schedule as you should. You're probably stressed out and feeling that roller coaster month in and month out. We can take care of that for you and we literally guarantee it. Head over to and schedule a demo at the smart chiropractor.com again that is the smart chiropractor.com we will drive more reactivations into your practice which gives you more time freedom and gives you more revenue coming in. But as I said at the top, today's episode, we we're talking research and I'll repeat the title one more time. Patient Expectations and Levels of Satisfaction in Chiropractic Treatment for Lumbar Radiculopathy. And this is really not only about I'm Gonna say, setting proper expectations. This is about meeting and exceeding expectations. The level of clinical relief, so to speak, that a patient gets in your practice is part of the equation of leading to satisfaction, but not the whole equation. And I'll take it outside of healthcare for a moment because I think we've all had something like this occur. Maybe we go to, let's say, a restaurant and we don't have the best meal of our lives, but we're so well taken care of that we'll give a lot of latitude there. We'll say, oh, well, I'll come back and give it another try. I'll recommend it to a friend, maybe with a little bit of a caveat, but you're willing to do that because of the expectation, because they met and exceeded your expectations. Which in the restaurant example is not all about the meal. The meal's part of it. But if you feel well supported all around it, you will give people, human beings will give an atronous amount of latitude. Same thing holds true in your practice. This is not just about providing pain relief every single time. This is about the entire experience, meeting and exceeding the expectations that somebody has coming into your practice. That's what's going to drive the highest levels of satisfaction. And when you drive the highest levels of satisfaction, then that's when you have see the side effects. The results of this are more reviews, more testimonials, more referrals. So patient care and clinical results, super important. It's critical, don't get me wrong, but don't become so myopic to believe that's the only factor that's involved in overall patient satisfaction. And we'll highlight that throughout this study here. So patient satisfaction is regarded, it's multidimensional. There's a lot of things that go into it and it ties into patient experience. This comes on through consultation and treatment. And it's quite subjective, to be honest and frank. It's pretty subjective in terms of how is that patient experience. I'm gonna even extend it one step farther. This is how you communicate even before they get to the consultation and treatment. And it is how you market your practice, how you have positioned yourself in your practice, in your community, online, on social channels, with, with the messaging that you're putting out. All of this starts to set the expectation of what somebody is looking forward to when they engage with your business and your practice. So are you setting those expectations purposefully? Are you setting them with meeting? And are you setting them so you know you can meet and exceed them and do you have the systems and processes to ensure that you meet and exceed those expectations every single time. Questions to look at, probably good to put on your monthly checklist, your quarterly however you go about meetings with your team, good idea to take stock on those questions and ensure that you're setting yourself up for success and your patients up for success as well. So this specifically study had patients with radiculopathy and low back pain. And patient satisfaction is measured in an innumerable amount of studies. It's like a really, really core outcome measure in back pain research. And when patients with low back pain visit a new doctor, they expect a couple things. They kind of highlight this in the study. They expect an explanation of the cause of their pain, they expect a reduction in the level of the pain, and they expect improvements in their ability to perform various ADLs or tasks throughout their day. So that's what somebody's expecting when they show up. The question becomes, are you delivering and do you have systems and processes to ensure that each and every time you are explaining the cause of their pain you can setting yourself up for success clinically. So if there's a reduction in pain level, you notice that it didn't say elimination, it said a reduction. And that you are helping them understand the improvements in their quality of life beyond just the pain alone. That's the functional ability, so to speak. Really, really important. So here's the good news. Chiropractic patients generally report ridiculously high levels of satisfaction with the care that they receive. But it is unclear if this reflects, you know, standardized care programs with radiculopathy. And, you know, how, how does this work when you really look at it from a clinical sense or, you know, is it one off, is it, what are the factors? That's what they examine in the study. So they took a look at over 300 patients with lumbar radiculopathy and they were invited to participate. About 238 were included in the final study. The mean age of these patients was 47 years old and 52% were female and almost has had visited another care provider for their current problem, most often their GP or their primary care physician. And around 80% were currently taking pain medication. So let's break down a couple things there. 47 years old radiculopathy, right in the heart of what we would expect in terms of age, 52% female, probably about average to what a chiropractor sees. Or if chiropractic demographics, over half had visited another care provider, this might not be the case. I don't know if it wasn't radiculopathy related, but if they're having shooting pain, over half had already visited somebody else. Now the interesting thing with that is over 80% were currently taking pain medication yowzers. Now it doesn't exactly break down right now what type of pain medication, because I would say there's a wide array of were they taking opioids or were they taking an NSAID over the counter, like an Aleve or something like that? Wildly different things. But the bottom line is with 80% taking pain medication, that's a lot. That is a lot of people and that's a lot of people who had visited another healthcare provider, predominantly a primary care, and almost all of them are taking medications. So I'll save my commentary for that for another day. But clearly things haven't changed. So good opportunity to build referral relationships that will plug for evidence based chiropractor there. If you're looking to build relationships with other healthcare providers to check out what we have going on at the evidence based chiropractor in terms of our MD referral program. But medication's still a huge issue, still being prescribed like candy. And quite frankly, when I look back at the beginning of this study and it talks about a proper explanation of what's going on, hope for perceived improvement, et cetera, I just don't see this happening again. I'm not trying to dog the primary care physicians, but the tool sets are just bad. I just don't see this happening in primary care. I don't see them doing a fantastic job explaining what's going on with the patient. I have yet to see it ever. So I'm sure it's happened once or twice, but I have yet to see it. And if you're prescribing a medication and the patient's going somewhere else, you wanna talk about low satisfaction, they're just checking about 0 of the boxes. Poor explanation. They're doing something clinically in medication that the patient's either gonna become sensitized to or it's gonna have minimal, just a host of challenges. But here's the good news of that. That's not a bad story. It is for the patients that go there and don't go anywhere else but the patients that come into our practices. Man, what an opportunity for us to shine. And to me that's really what we can take away from that in a positive way. So over half the patients interviewed had consulted their GP and had a pain medication prescription which was perceived as a treatment track separate than the chiropractic. So they're interesting from a patient perspective. The medication route was different than what we call the active ro, which is fascinating. So when they took an analysis of these patients over a period of time, they found that patients had high levels of satisfaction with the examination information and overall management provided by the chiropractor, which is great. High levels of satisfaction were explained again with thorough examinations. Good communicative skills about diagnosis and prognosis and the chiropractor, interestingly, and the chiropractor's coordination of care. That is interesting. Now, low levels of satisfaction when reported were related to unmet expectations. Are you setting expectations? Are you setting. If you're not setting the expectations, people are just going to run wild on what they expect. So setting expectations, critical, because if it's unmet, that's going to lead to low satisfaction, ultimately. Lack of imaging, we'll dive into that in a moment. Was met with low satisfaction and poor patient clinician interaction. Is that personality driven? Hard to say that one's maybe a little bit more subjective and difficult to control. So couple things here. Patients valued what they perceived to be a thorough assessment and placed importance on the care taken in constructing medical histories and on detailed examinations. Now, that doesn't mean you needed to spend an hour and a half, but what it does mean is asking pointed questions, having a system and a process that's reproducible and in many cases, I'm going to say, not going tangential and off track, which would be too long, but staying on task, on point and really communicating directly and clearly what's going on with those patients. Really, really important. So 85% of patients surveyed were very satisfied with the examination they received in the chiropractic practice. 87% were very satisfied with the information they received, which is great. 52% were very satisfied with the treatment effect. This is an expectation one, in my opinion. We'll get back to it. And 87% were very satisfied in the overall management. So there was. These are all big numbers except the one sticky widget. There is the 52%. Only 52, quote unquote, were very satisfied with the treatment effect, which was the results, the clinical results. In my opinion, this is an expectation conversation because again, we gotta piece these two things out. There's expectations and then there's satisfaction. And if the treatment effect, if the expectation is not set cleanly and clearly, that's where you're going to see a lower satisfaction rate. If somebody expected 50% improvement and got 75% improvement, I have a Sneaking suspicion that they'd be very satisfied. If somebody expected 85% improvement and got 50% improvement, they're not going to be very satisfied. So I think that highlights the fact of why setting expectations related to clinical outcomes is so, so important. Now, patients in this study, they did, they said straight up, they expected a rapid and persistent decrease in symptoms, which quite frankly does not happen all the time with lumbar radiculopathy. Prognosis to get rid of radiculopathy, lumbar specific, without surgery, without advanced interventions, is really good. But this normally takes some time and there's fluctuations in pain patterns, so it can take some time. This goes back to me saying I am a big fan of maintenance and wellness care because helping people remain well is important. And just because somebody's out of pain today doesn't mean when they go back to doing the same things that brought them into the practice in the first place, when they're a day, a week, a month older, when gravity has been weighing on their body for another day, a week, a month, and if they haven't dramatically changed what they do day in and day out, these things are bound to come back and you're bound to see big fluctuations in pain early on. Now the beautiful thing about what we do as chiropractors is quite often we can see after a couple visits a great relief in pain. But if somebody has radiculopathy, if they haven't changed their habits, if they haven't changed really structurally, they haven't had enough time to make any real changes besides just the pain relief delivered through the hands on care we deliver, which is important, but it doesn't solve the problem at that point in time. Most of the time everybody's a little bit different. You're going to do a thorough examination to determine what's going on. But somebody that's having a radiculopathy, pain relief with chiropractic is not, I'm gonna say, out of. It's not particularly hard. We see it all day, every day, people getting great results. But that doesn't mean that they're out of the woods forever. And keeping a close eye on that and setting the expectation with the patient up front can really set yourself up for success and set them up for success as well by letting them know, hey, there could be some ebb and flow, we hope to get you out of pain very quickly, help to get you functional. Some people it takes a little longer. Some people things happen a little bit shorter time. But the most important thing is going to be Monitoring what's going on week to week, day to day, month to month. Because as you get back to your previous activities, we want to ensure that you're able to do so safely and that you're able to do so as pain free as possible. That's a careful choice on the words there. But some tips to take as you have communication with your patients. So clinicians can help patients by explicitly stressing the clinician's role in coordinating the course of treatment and making sure patients are aware of ongoing communication with the patient's other healthcare provider. So acting as that quarterback really led to a high level of satisfaction. Good little take home message there. So in conclusion, the researchers found, quote, overall, patients were satisfied with the standardized chiropractic care package for lumbar radiculopathy. From a patient's perspective, satisfaction was linked to the chiropractor spending time on the consultation and offering a thorough examination, allowing the patient to feel in safe hands. Now one thing I want to come back around to before we close today's episode was imaging. Patient expected an MRI going right for it there. So patients, when an MRI was not ordered, it led to a higher rate of dissatisfaction. So what's the take home message there? Not necessarily to order more MRIs, but the take home message is to get in front of that conversation by helping people understand, hey, here is the way we go about care, here's what's recommended and here is how you get the best results possible. If we are not hitting our thresholds at X amount of time, we're going to go to advanced imaging. However we know based upon what's going on, et cetera, et cetera, et cetera. So be mindful of that that patients are expecting an MRI quite often if they have traveling and shooting pain and if you're not ordering it, they might have questions in their. The best thing you can do as a great and awesome chiropractor is proactively answer those questions by just bringing them right up in conversation with your patients. The more that you do that, the more that they will understand. And people have to know the process. They don't need to know every intricate detail of what's going on. But what are we doing? What am I doing here? Helping people understand if they have a question, as this study showcases. Why am I not getting imaging is a common thing that people are putting in their minds. Great opportunity for you to discuss it proactively. The patient squash that. Improve their the setting of your expectations so that you can exceed them. So that the result of that is a higher level of satisfaction. A lot of expectations and satisfaction talk on today's episode, but I believe these are great points to understand how to communicate what you're doing and setting up your patient journey for the best result possible. In my opinion, that's what it all comes down to. So as we wrap up today's episode, I want to highlight Kairo Spring again. If you have not set up your demo, please do so. Chiro Spring has been voted the best solution for chiropractors by chiropractors and if you visit Chirospring.com offer and do a demo, they're going to hook you up with $100Amazon gift card. They have AI built in, they have great billing. This Kyra Spring is a really fantastic EHR with some really cutting edge tools. So if you've been frustrated with your current EHR or you know that there could be something better out there, hint hint, wink wink. There is. Head over to kairospring.com offer you complete a demo, they're going to hook you up with a $100Amazon gift card. Well worth your time to see how they can help your practice. We'll drop those links down below. And finally, Power Step Orthotics Pick up your sample pair if you have not yet go pro.powerstep.com samplepro.powerstep.com sample use the code ebc these are the orthotics I use my father uses. They were developed by a podiatrist over 30 years ago. They are awesome. They support this show, you should support them and they're willing to hook you up with a free sample pair. And if you have not left us a rating or review, I would greatly appreciate that for this podcast. I I hope you have a fantastic week in practice and I will talk to you soon.

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