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The Thriving Chiropractor | Chiropractic Marketing & Practice Management | Personal & Professional Development for Chiropractors
TC005 - What Matters Most to Patients
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Dr. Eric Mitz
The Thriving Chiropractor Podcast Episode number five welcome to the Thriving Chiropractor. In this episode, what really matters to patients? We're going to find out by looking at some research and apply it to our own patient populations. Ignore this information at your own risk, giving you the tools and information you need to experience massive practice growth, professional fulfillment and financial freedom. This is the Thriving Chiropractor. Hello and welcome aboard another episode of the Thriving Chiropractor. I AM your host, Dr. Eric Mitz and I'm really glad you've joined me for this episode. We're going to be discussing research that looked at what the patient said was their highest priorities and what they really wanted and what their lower and lowest priorities were. We're going to be discussing the implications of this for our patient populations. But first I'd encourage you to head over to our website as usual, www.thrivingchiropractor.com. there you'll find the show notes for this episode. I'd like to thank all of the new subscribers, particularly those from far away places, especially the subscribers to the podcast from New Zealand and Japan and our 1 subscriber from Zimbabwe. Welcome aboard. It's nice to see the chiropractors in Africa are doing are alive and well. So let's get right to this here. I think that we all would agree that the medical patient or the expectations of patients with regards to their medical experiences, their medical care is maybe somewhat different than what their expectations are from their chiropractic care. However, I would argue that there are significant areas of overlap where the patient's expectations of us as chiropractors closely align with the expectations that they have of all healthcare providers. So let's just dig right in the highest priority items for the patients, the things that patients really said were of highest priority to them with their healthcare. And I'm going in order here from most highest priority to the lowest priority overall. But there were nine items that were listed as as highest priority. Number one was the highest priority for patients was they wanted relief from their illness or symptoms and that this was more important than disease prevention. I think the applicability to this for us is. Well, first of all, this is no surprise to us. I mean if the culture is bombarded constantly, incessantly with symptom relief messages and the marketing that's out there from the pharmaceutical companies and I think it's just basic human nature that if we're sick or ill, our first priority is to be unsick or un ill. But I think the applicability for us as chiropractors with this bit of information is that when patients come to see us, they very likely are coming to us for relief from a condition or relief from some symptoms. And that's what they're there to see us for. It doesn't mean that we shouldn't start walking them toward or down the path of understanding of our particular philosophy regarding health and wellness. In fact, I think that's critical. You're doing a disservice to the patients if you only provide them relief care. However, I think that there can be an arrogance, an intellectual arrogance in our profession that somehow belittles the patient for coming in and wanting relief care, as if to say, well, I'm not here to help you with your symptoms. I'm only going to remove the subluxations and your body is going to take care of the rest. And while I certainly agree with that position intellectually, I think pragmatically, clearly this research points to the fact that patients want their symptoms relieved, they want their illness or conditions relieved. And that is much more important to them than disease prevention. We need to honor that and understand going into the relationship that that is why they are likely there in our office. But we should also, I think, work over time after we've gained their trust and respect, that we should work toward educating them and bringing them to an understanding of disease prevention and specifically how chiropractic can play a role in that. So that's number one biggest priority of the patients, relief from their symptoms or illness. Number two was timeliness. They wanted care immediately and they wanted it on their schedule. And again, I totally relate to that. I'm kind of, I want it now kind of a person. And patients communicated that besides getting symptom relief, this was number two. They didn't want to have to wait weeks for relief. They wanted it immediately and they wanted it on their schedule. They didn't want to have to take off work or rearrange their life around the doctor's schedule. I think the takeaway of this for us is that we need to make our schedules such that they're convenient for the patients. And we also need to address lengthy wait times for patients, not just on a day to day basis. As far as waiting in the office to see us. If they're waiting longer than 15, 20 minutes, I think that there's likely some inefficiencies in the scheduling or, or in the office that need to be addressed, but also how long are they having to wait? As a new patient, I know there are times in my practice where it can be maybe even a week for a new patient to get into my practice. And so they generally will revert to one of my partner's schedules if they can't get in to see me quickly. However, we do need to be aware of this. If you're in solo practice, that may not be an option and so it may require you to rearrange your schedule a little bit, open up some more hours or just improve the efficiencies in your office. So number two ranked highest priority for patients as timeliness. Number three was kindness. Patients are no longer willing to tolerate the God complexes that so prevailed in medicine and still.in some parts. I certainly encounter that occasionally, though, in this 20 years or so I've been involved in healthcare, have seen a significant sort of softening of the attitudes of the average medical doctor. There's no question, however, patients now expect that they'd be treated warmly and that they develop a relationship and that their healthcare providers have kindness, are kind to them, not indifferent and apathetic. So I think the takeaway here for me, and hopefully for you, is that we need to reevaluate how we ourselves are interacting with our patients. And also, perhaps more importantly, because I doubt many of us are rude to our patients. I mean, we understand as chiropractors and business owners that that's not the way to do it. But maybe more specifically, we need to be looking at our staff and how our staffs are interacting with the patients we have, making sure that they are certainly kind and not rude to our patient. Pace is very high priority for our patients, and so we need to. We need to respect that. That's number three. Is kindness number four on the list of high priorities? The fourth highest priority was hope and certainty. Fundamentally, patients want to have hope that they are offered options that might help them and they want to have some degree of certainty that the options are going to help them. So I think honestly that when patients end up in our offices, particularly those who have been around the medical system for various problems and have not gotten the results that they desire, going back to our number one priority. For patients, relief from illness or symptoms is most important. But when they end up in our office, they really are looking for hope and looking for somebody who can tell them that there is hope, that they can be helped. I certainly subscribe to this view that I generally offer my patients hope. I found that in doing so, it creates an environment that's more likely to result in a good outcome for the patient. I would Generally say, you know, I don't know that what I'm going to, to offer you will ultimately completely eliminate your symptoms. But I'm very hopeful that we'll have a good outcome. And I, and I generally try to share with them a story or a similar patient, perhaps that was in our practice or case study, maybe that I've read in one of the journals or something that maybe will give them some hope. So number four, highest priority for patients was some hope and certainty. Number five, highest priority for patients was a continuity or choice in the coordination of their care. They want the same doctor or the team of people taking care of them. Now, in our situations, that's generally what will happen, though I certainly have seen in certain group practices, group chiropractic practices, where they do take a team approach where, where when you come in for an appointment, you may not know which doctor you're going to see. It could be any one of a number of chiropractors that are treating the patient on a given day. So I think that this data suggests that that may not be the ideal scenario, that in fact, we need to provide a continuity of care for the patient, predictable process. And of course, in our offices, that's something we all should be focusing on as well. I know, you know, from my own personal experience, I enjoy predictability, and I don't think I'm alone in that. And I work, I would say, pretty hard in our practice to provide a very predictable experience, a predictably positive experience for our patients from the moment they enter the front door to the time they leave. I think, I believe that their experience is positive and predictable. We all would agree that if we can coordinate care for our patients, that that's a better. Will likely provide them a better outcome as opposed to throwing them to the wolves. And patients, at least in this research, put their hands up and said that that was important to them. So that was number five, that continuity, that coordination of care from the same team was important. Number six on the list of highest priorities was privacy, a private room, specifically. Now, this again was medical research. And very likely they were discussing hospital settings where, and in fact, the patients said that they wanted their own bathrooms, they wanted no roommates. And so it's very safe to say that privacy in the hospital setting, I think we all would agree, is ideal. I think, though this has some bearing in our practices in the 20 years or so that I've been around or been a careful observer of our profession, and certainly when I graduated from school, it was unheard of for chiropractors to have an open adjusting room concept. I certainly have never had one. I don't know that I would and I don't know that it's necessarily a bad thing. I guess it just depends on your practice and how you operate. I know that, for example, operating in a sports environment is very rare, that you have a private room when you're treating the athletes. You might be in the middle of the locker room, in fact. However, I think that's an unusual scenario. And what I'm kind of limiting my remarks to is the typical community practice, the general family practice that 99.9% of us have. I do believe that the privacy, having a private treatment room for each patient is the way to go. I think that you're much more likely to get the patient to open up to you and share information that they may feel uncomfortable sharing, obviously in an open room when there may be several other people around. I just don't think that in the situation, in running a practice the way I run a practice, and I realize that many of you may not run a practice the way I do very traditionally in the sense of doing a full history and physical exam on the patients and finding and clearing subluxations, as well as ordering appropriate lab work and sort of being a comprehensive primary care provider. In that sense, if your mission is purely subluxation removal and there's no discussion about their health in general, you couldn't really necessarily care less. They're going to show up, you're going to put them on a table, you're going to find subluxations and remove them and then they're going to be on their way. I guess an opening, open room adjusting concept makes sense in that setting because you can be a lot more efficient with your timing and see a lot more people. You know, there are several chiropractors in our community who operate with this sort of system and gosh, I think they see anywhere from 60 to 100 visits a day. And that's just awesome for them if that's their goal and they're thriving, obviously, economically. However, for me, you know, I think I'm comfortable operating at around a 35 to 40 visit patient visit number. That's kind of my comfort zone with how I choose to practice. And so private rooms are well within reason for some of the practices like me. But if you were in that high, high volume situation, I do think that it would be more challenging to have those private rooms. But patients have spoken, at least in the hospital setting, that the privacy was very important. However, I Think that that does carry over into every healthcare setting, that they do value privacy. So that's number six privacy. Number seven on their list of priorities was no out of pocket costs. And I guess again this is one of those areas where we all recognize that patients want to pay as little as possible them and they want to know that their insurance or their third party coverage is going to be available for them in our practices and the benefits are going to be taken care of. Now I know many chiropractors run cash practices and I think that there are many chiropractors out there who are successful at that as well as not just as a on a fee for service basis, selling their services for cash, but also in a case management model where perhaps not so much anymore, but you know, recent past the decompression model was popular as a case fee management, a case fee process. And heck, my kids, I've got three of my kids now have braces and their orthodontist has a case fees, he's obviously a cash practice and does very well. And we ended up spending somewhere between 7 to $10,000 on each kid for braces. And you know, we didn't really bat an eye at that. And so because I guess because we know that there are no insurance options available, that's probably a big part of it. If there had been insurance options available and this particular orthodontist was not willing to accept my insurance that covered orthodontic care, I'd probably be a little bit skeptical frankly and I'd probably seek out another orthodontist who would. But because our dent coverage and as far as I know there are no dental plans out there that do cover orthodontics because there aren't, you know, we sort of turn, we just turn, turn away and say, well that's the way it goes and we pay our, pay her bill however we can. And so. But I think it's different in chiropractic because at least here in the United States and here in Indiana where I practice, most people that have insurance have chiropractic benefits. And so there, I think there's an expectation from them that they get to use those benefits. I'll be the first to admit to you that I am no cash practice guru. Many people that I respect in this profession are strong proponents of going to a cash practice. However, I do not find this research, research is finding that no out of pocket costs were important to patients. That's surprising. And frankly, I think unless and until you've established yourself in your Community as the go to guy. It's very hard for a chiropractor in this day and age to make a, to become a thriving chiropractor unless they do accept assignment for insurance. Again, I know there are exceptions out there, particularly very charismatic doctors who maybe are exceptional clinically in some way can carry this off. I just have not found it to be the case for most doctors. And this research points to the fact, I think that patients don't want it that way. They want to use their insurance. So that's number seven. Number eight, patients want to know their doctors are highly qualified. This is specifically the highest priority for patients. Number eight was they want the best available health care, the best available. So they want to know that their doctors are highly qualified. But what's interesting is that they don't want this information conveyed to them. The fact that the doctor is highly qualified. They don't want statistics to verify, to confirm this. They want testimonials from other patients or clinicians they trust. And so this applies to us, I think thusly, number one, if you are selling the idea of chiropractic to the general public based on research that shows a certain percentage of low back pain patients did better with chiropractic versus traditional medicine, I think that that is to some degree lost on the consumer. I think, however, what is not going to be lost on the consumer is if you have glowing testimonials from many people and even better if those testimonials are from people that have the same condition that the person who's reading the testimonials is seeking relief. So make sure that on your website that you have testimonials, that you use case studies in discussing different conditions and that in your marketing strategies that you always keep it personal, that you talk about the successes you've had in treating specific people and discuss those cases and leave the numbers out because evidently consumers are not that interested. I think this also points to the fact that if somebody is referred to you from another provider, that is a big deal to a patient. I know that the patients that are referred to me by existing patients, they generally turn out to be the better patients in the practice, but also patients that are referred to me by other healthcare providers, not just other medical doctors, but dentists and other chiropractors, even which I think is not. Doesn't happen often enough in our profession. But those patients come into my practice and likely come into your practice already having a certain level of respect about you and believing that you are highly qualified, which turns out again to be the number eight high priority for patients. Number nine is the last, this one's the last of what were rated as the highest priorities for patients. Number nine was that the patients wanted treatments that they perceived would require little effort. Those are strongly preferred. So things that require little effort on their part, basically they want the pill. They want to be able to take something that's very easy and get rid of their problem. And they rated clinical strategies involving behavioral changes really low. They didn't like those one bit. And so again, I think we've all observed this in our practices, though I think we are at a disadvantage in some respect in that we are not given the luxury of a passive modality to treat patients. Now, I know technically that the chiropractic adjustment, however, it is a passive modality in that the patient lays on the table and we do something to them that's very easy for them. It doesn't require any effort except for them to walk into the office and get on the table. And these are strongly preferred. But like, I'm sure, like you, with patients that come in, if they're, if they're very heavy or overweight or if they're smokers, I generally have a discussion with them, particularly in patients like the low back pain patients with degenerative disc disease that are 150 pounds overweight. I'm going to have a very intense discussion with them about their need to lose, the need for them to lose weight if they hope to have relief long term from their back pain. So I don't really know how to change the way we practice as chiropractors in light of this data that patients prefer treatments that require little effort on their part. And I'm not sure it's a good thing. So while I'm not advocating that we market the fact that we offer a passive modality, I do think that that is a motivation that we need to understand that patients do rate these passive modalities as strongly preferred high priority versus those that require them to be actively engaged in the process. So we went through the nine highest priority wishes of patients. I'll go through them again in order. One, relief from illness or symptoms was more important than disease prevention. Two, timeliness. They want it on their schedule. Number three, kindness. Patients want warm relationships with their providers. Number four, hope and certainty. They want to be given the hope that the treatment offered might help them. Number five is continuity and choice and coordination of care from the same person or team. It's very important. Six, private room privacy. Seven, no out of pocket costs. They want to be able to use their insurance, they pay for it and they want to use it. Number eight, the best medicine pay. Patients want to know that their doctors are highly qualified, but they're not interested in statistics. They prefer testimonials and case studies about other patients or referrals from other clinicians that they trust, as opposed to making decisions based on statistics. And number nine again, was patients perceive a benefit to therapies that require little effort. Those are strongly preferred. Passive modalities are strongly preferred compared to the strategies that require them to make active choices and behavioral changes. So there you have the nine highest priorities we're going to discuss next. The lower priorities. There were four items that were kind of in the middle between the highest and the lowest, and they are the lower priorities. Number one is efficiency. Patients were really only modestly interested in getting care that delivered the most bang for the buck. I know that we have in our profession always touted the fact that we are a big bang for the buck specialty in that we provide equal or better outcomes to drugs or surgery at a lower price. However, patients are not interested in this efficiency. They couldn't care that much about it. And in reality, the higher priority items take precedence over efficiency. So if your marketing strategy is predicated on touting our efficiency, I think you might be wasting your time with those words. So that's number one of the lower priorities. Number two of the lower priorities, again, these are right in the middle of the look. Between lowest and highest is statistics, aggregate level statistics. In other words, again, patients don't really care that a particular therapy worked 87% of the time. They want to know that it will work for them. So again, it's just as before. Testimonials will trump scientific evidence every day of the week. Make sure that your marketing strategy is heavy on testimonials. So number three on this list of lower priority items is what is loosely called equity, where patients are more concerned with whether or not they themselves are receiving adequate health care than whether everybody in society has a right to health care, regardless of income. This is more of a macroeconomic discussion, and one that's not really in the scope of the thriving chiropractor podcast. However, I think we all would agree that the majority of people are more concerned about themselves than they are about the population at large. And so this doesn't really surprise me in any way, and I'm not quite sure how it even applies to our profession specifically, other than it goes to show that people want to receive adequate healthcare services for themselves. And are not necessarily, couldn't necessarily care whether everybody gets it. So when we go to patients and ask them to do letter writing campaigns or make a phone call to the state senator or House Rep, I think what we're doing is pushing a button that doesn't exist for the majority of patients. And oh sure, some of them will, out of respect or like for you or our profession, will make those calls or maybe write those emails or letters, but the majority of people, frankly just don't care. If they've got access to getting the health care they want, then that's enough for them. So that's number three, is what we're going to call loosely equity Number four. And last on this list of sort of the intermediate priority items was conflicts of interest. And patients are less concerned about the motivations of the provider in prescribing a particular treatment strategy as long as they are confident that that service that they are receiving will help them become better without adding any additional costs out of pocket costs to them. So what does that mean? Well, I think for us as chiropractors it means that we need to recommend treatment strategies to our patients regardless of what we are worried about, the patient's perceptions being if we know that that treatment strategy we're recommending is going to be to provide them the better outcome. In medicine, I think this is a bigger issue where you may have physicians or surgeons who are shareholders of medical device or pharmaceutical corporations and therefore there may be a conflict of interest as far as them prescribing a certain device or drug. But in that situation, patients have said that they're not as concerned about that. What they're concerned with is making sure that they're getting the best clinical outcome and without having to spend more money out of their own pockets. So those are the four lower priority items. Efficiency. Patients are interested in banging the buck, bang for the buck decisions. They're not interested in statistics. They want to know testimonials. They want to know case study information. They want to know that. They want to know how it's going to work for them. They're not interested in the macroeconomics of health care, generally speaking, and they're not as interested in conflicts of interest. Those are the lower priority items. So lastly, the lowest priority items, these are the two things that were listed as the lowest priority items for patients and number one of the lowest priority. So this is the lowest priority item, and this is shocking to me, is real costs. And individual patients have virtually no interest whatsoever in the costs of health care that they do not bear directly. Now this is the gripe, I guess, or the causative feature of the third party payer system that economists would point to to show why the costs are spiraling out of control. And that is that the shareholders, the stakeholders rather in this economic decision, the patients do not have a risk associated necessarily with the decisions that they're making because the costs that they bear are not theirs. So patients have very little interest in costs they do not bear. And I think this all boils back to one of the higher priorities, which was that they didn't want to increase their out of pocket costs. So take that for what it's worth. Patients, if They've got a $25 copay, for example, they probably couldn't care less if you racked up $200 worth of charges in that visit, $400 or $40. They just want a timely clinical outcome. Passive, that they don't have to work at, evidently. And they beyond that they really couldn't care. So lowest priority item, period is real costs. The next lowest priority item was the percent of the gross national product devoted to health care. And again, this just sort of points to the fact that, well, first of all, the average citizen probably couldn't give you a definition of what the gross national product means. But beyond that, that, you know, this is just a number to them. They don't care. That has no relevance to them as individuals. And perhaps in the United States, as we have observed over the last four to six years with the health care debate, one side of the issue was touting the fact that the President was looking to take over 16% of the gross national product. That argument just clearly didn't resonate with a large number of people. And I think the fact that the fact that this issue is so low on the priority scale explains that. So I hope that this has been somewhat interesting to you as it was to me. I think the implications for this are quite simply that consumers preferences are somewhat irrational and unrealistic from an economic perspective. However, this lack of rationality does not mean that these preferences are unimportant or irrelevant at all. In fact, I think that we as chiropractors need to, I won't say exploit them, but I will say we need to be mindful of these preferences and priorities in how we treat our patients and interact with them and how we work with them. I also think that the policymakers out there and within the insurance companies and within government bureaucracies clearly have a different set of priorities. That's almost the reverse of the consumer's own priorities. And that tension, I believe, is perhaps what we are seeing in our healthcare system, at least in the United States, this tension between what the priorities are for the consumers versus what the priorities are likely to be for policymakers and insurance companies. A lot of information covered in this episode. I hope you found it interesting and hope you'll pull out a few nuggets. I know that in reviewing for this the data for this episode, I certainly pulled out a few things that are going to change the way I practice a little bit. I really would appreciate any feedback you have. You can send me an email@feedBACKrivingchiropractor.com or you can go over to the website thrivingchiropractor.com 5 for the show notes page for this episode. Or you can always go to the contact tab at the website and drop me a line there. As always, any reviews that you leave on itunes are appreciated. Those help with our rankings to help people find us when they're looking for chiropractic information. And I would encourage you to subscribe to itunes to our podcast so that you'll get the new episodes when they come out. If you have some ideas of topics you'd like to hear covered on this show, please drop me a line@feedbackrivingchiropractor.com I want to thank you for spending time with me today with this episode of the Thriving Chiropractor. I AM your host, Dr. Eric Mitts, and I am a thriving chiropractor. See you soon. Thank you for listening to the Thriving Chiropractor. Please visit our website@thrivingchiropractor.com and register to receive email updates of new shows and additional tools to help you thrive.