Patient Retention Scripts
Stephen Barrett, M.D.
Many chiropractors tell patients that periodic spinal examinations and "adjustments" will promote and maintain their health. Many also encourage people who recover from a painful condition that "maintenance" care is needed to prevent the problem from recurring. The scripts below accompanied an audiotape called "Overcoming Patient Objections" that was part of a practice-building system marketed during the 1980s by Ron Halstead, D.C.
Ads for Halstead's audiotapes stated that in 1980 he had seen 725 to 769 patients per week and had grossed $786,000. Not long afterward, he was convicted of Medicaid fraud in Illinois. In 1982, he moved to Scottsdale, Arizona, where he set up Practice Systems, a practice-management firm that taught chiropractors throughout the United States how operate high-volume MD/DC practices for rehabilitating injured patients. In 2003, he and two West Virginia chiropractors were convicted of conspiring to defraud insurance companies. The indictment stated that the others had used a script created by Halstead to (a) persuade new patients that they had serious spinal conditions, even if they did not; (b) persuade patients that chiropractic could effectively treat them; and (c) overcome any objections to the type, frequency, length, and cost of the proposed treatment. I don't know whether the script below is identical to the one mentioned in the indictment.
My chiropractic consultants and I advise people to stop chiropractic treatment when they feel better and that there is no scientific evidence that periodic checkups or "maintenance visits" are beneficial. Halstead, however, teaches that neither feeling better nor feeling worse are a reason to stop coming; and most other chiropractic "practice-builders" provide similar advice. The percentage of chiropractors who use such techniques is unknown, but reports from former patients indicate that they are widely used.
OVERCOMING PATIENT OBJECTIONS (EXCERPT)
Patients often feel better after the first few treatments, and although this may seem advantageous, the opposite can sometimes be true as well. Patients often mistake this feeling for a total cure of their condition. They simply do not realize that a relief of the symptoms DOES NOT indicate a correction of the condition. These patients want to discontinue treatment before their complaint has been corrected, and if they are allowed to do so, further complications are bound to develop. To avoid these complications, a detailed explanation of treatment procedures is often the best course to follow. Listed below are some additional suggested patient responses:
Whenever a condition, that usually has lasted for quite a long time, is corrected, discomfort of some sort is usually experienced. Even though this discomfort indicates progress is being made, patients often interpret it to mean the reverse. Patients often feel that going to a doctor means instant com-fort, and when this doesn't occur, they get disgusted and don't return. Patients such as these need to understand how chiropractic works, and once they do, their continuance as patients is almost inevitable. The following list has within it suggested patient responses:
Often, if relief isn't immediate, patients begin to doubt the effectiveness of chiropractic treatments. Even when the patient maintains his/her faith in the Doctor, the patient's spouse may not. In either situation, these doubts may result in discontinued care. The best method of avoiding this loss 1 so obvious that it's often overlooked, talk to the patient, explain as clearly as possible how chiropractic treatment works. Present this explanation right before or just when the treatment begins. Ask the patient to bring his/her spouse. A patient won't discontinue treatment if these doubts never occur. Nonetheless, if for some unknown reason a patient questions the validity of chiropractic, the following suggested responses should be of benefit to both you and the patient:
- Ron Halstead and Two Other Chiropractors Convicted in Health Fraud Scheme
- Indictment of Ronald L. Halstead, D.C (2002)
- Halstead 1981 Ad for Practice-Building Tapes
- Article about Other Practice-Builders
This page was posted on February 16, 2003.