Educate Your Patients!

Does your practice suffer from a stagnant number of patient visits each week? This problem is symptomatic of poor practitioner-patient communication. Most new patients know nothing about how acupuncture works, but have high expectations about the results. Because they are more familiar with the immediate effects of pharmaceutical products and surgical interventions, they bring those expectations with them into your office. Compound this with the fact that most insurance companies only cover a limited number of visits, and you'll find that most new patients expect you to cure them within an unrealistically short period of time.

However, this is only the beginning of the problem. Many practitioners take on these unrealistic expectations as their own, and begin to think that they have to "fix" everyone within six or eight sessions. The message given to the patient then supports this notion, and the revolving-door cycle begins.

If you are like me, you may have wondered why your treatment numbers had reached a plateau even though you seemed to have an abundance of new patients coming into your office. After an analysis of my charts, I found an average of six treatments before patients stopped coming, with some disappearing after only three or four sessions. I know they were getting good results, because I documented their progress. I know it wasn't a personality issue, because we had good rapport and they frequently referred new patients.

I decided the problem was in the message I was communicating to my patients. If I tell them it should only take a short period of time for them to heal, then that is what they expect. When they get to the sixth or eighth visit and are 60 percent improved, they often decide that that's all they are going to get, and it's better than nothing, so off they go. They had learned to live with a lot more pain than this, and considered it pretty good improvement.

You and I both know patients can experience much more improvement than that a majority of the time. Our experience tells us it might take a while, and their progress might occur over a longer series of treatments. So, why does this false expectation dilemma manifest in the first place? Think back to your training in the school clinic. How many supervisors modeled good patient education practices for us? By emphasizing proper expectations to prospective patients right from the first phone call, and continuing to reinforce the message throughout treatment, you will find your patients staying with you longer and getting more significant results from your care.

One concern voiced by many of my colleagues regarding the implementation of patient retention practices is that they have an aversion to the appearance of "milking the system" to increase profits. While having a patient come in for 30 sessions for an ankle sprain might raise ethical issues, treating a fibromyalgia patient 30 times shouldn't. That simply is what is medically necessary to reach maximum medical improvement through acupuncture. It's better to help someone heal more completely, even if it takes longer and costs more money, than it is to give mixed messages and shortchange the patient's health potential just because you are uncomfortable giving a straightforward message.

Acupuncture is not an inexpensive modality for the average patient, but when the discomfort of living with a particular symptom exceeds the discomfort of paying for treatment, you will be surprised how compliant patients can become.

You do not have to "sell" your services like a used car. Simply tell them what your experience is with their type of condition, give them a realistic range of treatments to expect, and tell them the cost. If you are uncomfortable setting boundaries around your financial practices, that issue definitely is worth exploring with a business coach or counselor.

After exploring these issues for myself, I have created a simple yet effective system for educating my patients. I have seen a significant increase in the number of visits most patients come for, and I experience the satisfaction of witnessing more lasting results from my care. I briefly will describe the steps I have implemented, and encourage you to explore the resources that are increasingly available to help us build more successful practices. Take what you like and leave the rest.

The first step in getting a new patient on board is to develop a short, scripted monologue that you deliver on the phone during the first call, and again at the first visit. Tell them that natural healing is a process that unfolds more slowly than taking pills or surgery, but that the effects can be longer-lasting. Most conditions require between 10-20 sessions -- sometimes more, sometimes fewer. Tell them they can expect to see changes by the fourth visit just to let them know you are heading in the right direction. Let them know what they are in for, and they won't be surprised later. Give them a copy of your financial policy and fee schedule so there is no misunderstanding.

At the first visit, I give patients a brochure explaining how acupuncture works according to the traditional concepts. I also set a date for a re-evaluation so it's not an open-ended proposition. On the second visit, I give them another brochure explaining acupuncture from the scientific model and outlining some current research. I again reinforce that the process will unfold over time and the importance of sticking with it. On the third visit, I start to reflect back to them changes I am beginning to see, and compare their subjective symptom ratings with the first visit. On the fourth visit, I give them a brochure explaining the steps of care necessary to take a patient from an acute symptom to wellness care, and explain where they are on the continuum, again reinforcing the need for compliance with the treatment plan.

At the fifth visit, I re-evaluate the patient's main complaint and am able to give them a more specific idea of how many sessions, how frequently, and over what period of time they can expect to continue treatment. By now they are more fully on board with the treatment plan and understand the bigger picture. This is a good time to bring up the option of prepaying for a longer treatment series (if this is legal in your state). It helps if you accept credit cards. If you do this, however, let them know they must stay on schedule and not start "straying" too far in between visits so you can keep the momentum going.

One other thing I try to practice during every session is to "think out loud." Many practitioners are more introverted, and the patients never get to hear our rationale for what we are doing because we keep it to ourselves. There also is a mystique propagated by some of our teachers that we must be silent during insertion of needles (for some reason that was never explained).

If you are one of the silent types, you are missing out on a fantastic opportunity to further educate the patient about what you are doing so that they can go home and tell their family and friends what they are experiencing beyond "just having needles stuck in me." This is potent referral-building time; often a patient will bring up conditions that people they know have, and you can give them information to pass on to a new potential patients!

By implementing something similar to the steps outlined above, you will see an almost immediate change in your patient retention pattern, increasing results for your patients' health and corresponding referrals of new patients. The net effect of this is that your income will increase, and you will gain a deepening sense of satisfaction with your practice.