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)

Feeling Better

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:

  1. Do you remember that in the beginning the doctor said if you're only interested in relieving pain, it would be cheaper and wiser to take pain pills? You said you wanted your condition corrected. We are just beginning to correct this problem, and if you want this relief to last, the problem must be corrected or it will simply return.
  2. Even though that seems to be your decision, Mr. _______, the doctor would like to talk to you about it, and, if necessary, tell you what you can continue to do to improve your condition.
  3. The doctor must feel you need more treatments or he wouldn't have had you make this/these appointments. Why don't you wait and talk to him about this matter?
  4. Mrs. _______, you are just starting the corrective phase of treatment. Now we are ready to correct the basic problem. To stop now would be like stopping to rest in the middle of the river when you are too tired to swim any more.
  5. Since you haven't been released from the doctor's care, he must not think your condition is stable. If you want to function under normal routine conditions without care,you need to continue treatment.
  6. If we don't go ahead and completely take care of your condition, Your symptoms will come back. Then we'll have to start treatment all over again, and the work we've done so far will be lost.
  7. Your condition is similar to a decayed tooth. You may not feel any pain whatsoever when you have a decayed tooth, but the tooth has a deep cavity and unless it's filled it will eventually deaden the whole tooth. That's the same as your absence of pain. Just because it's gone doesn't mean the condition is corrected.
  8. I'm glad to hear that the pain is gone, but I am doubtful that the underlying condition is corrected. At least keep your appointment today and discuss the matter with the doctor.

Hurting More

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:

  1. Most of the time when a dentist pulls a tooth, the mouth gets very sore, but that doesn't mean that the dentist didn't correct the problem.
  2. I'm sure you've received an innoculation at some time, and as we both know these shots hurt. But what's worse, protection against the disease or the temporary pain of the shot?
  3. Yes, as far as spinal correction, you are much better, although you may not yet feel like you are. The correction process is similar to corrective surgery; It takes time to heel. Right now I'm reminded of a person who is halfway through an operation and looks up at the doctor and says, "I'm not better yet."
  4. Your present condition indicates that we have made progress. The vertebrae have been moved to a new, correct position that they're not use to. It takes time for the muscles to relax and adapt to this new position.
  5. Your body is now starting to make changes, and you might experience a few days discomfort from time to time. This discomfort will disappear as soon as your body adjusts. If any severe or continued discomfort occurs, please be sure to tell me personally.

Doubting Chiropractic

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:

  1. I think you have these doubts because you don't fully understand the effects of nerve pressure and what can happen if this pressure isn't relieved. I'd like to tell you about this so that you can understand what we're doing, why we're doing it and how we'll correct problems that would develop in the future.
  2. I think that your husband/wife may have these doubts simply because he/she has no familiarity with chiropractic. Why don't you bring him/her into the clinic the next time you're scheduled for a treatment. I'd be more than glad to explain chiropractic.
  3. Your condition is such that adjustment is the only way correction can be achieved. Your own response to treatment has already proved this to be true.
  4. We have no intent to cause you harm or discomfort while you are in treatment. In fact, it's our goal to correct the problem and help you feel better.

Additional Information

This page was posted on February 16, 2003.

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