1. Inability to help the patient understand their condition and how it negatively impacts their overall health — particularly with how it will be in the future.
2. Inability to help the patient understand the difference between acute care, corrective care and wellness care.
3. Inability to help the patient understand how your recommendations handle their current health problems and how other "options" (such as a pain reliever) are different.
4. Poor administration at the front desk with regard to keeping patients on the recommended schedule.
5. Vague financial arrangements.
6. A non-comprehension on the part of the chiropractor and staff with regard to how often a patient needs chiropractic and their condition explained to them—always in simple terminology that they can understand.
7. A failure to re-examine and provide new recommendations. All recommended care must contain a start point and an end point with goals either achieved or not achieved.
8. Failure to have care recommended and paid for in programs rather than one visit at a time.

The solutions to these problems can include (Each number corresponds to the problem above):

1. An exam which is targeted to not only find what is really wrong with the patients, but also is geared to measure related problems that will demonstrate to the patient the relative severity of their health concern. In addition, a well-thought-out report of findings which will allow the patient to have a cognition or multiple cognitions regarding the condition of their health and how it will impact their future.
   
   A good way to bring a patient to understanding on this point is help them to figure out how their condition will be in the future if they do not handle it appropriately. You can also find out from them what goals they have for their future. You may very well have to help them with this as most people do not set goals. Once you have these two pieces of data, allow the patient to see if these match up. In most cases, they will not. The way the patient is currently choosing to handle their health will not match up with the kind of future they want to experience.
   


2. This should be thoroughly handled in a report of findings, since the patient will need to know what type of care they currently need and also where they are headed in the future. This will also need to be reinforced continuously throughout each stage of care. Hold on to your chair, maybe at least every third visit — and only that infrequently because you need time to educate them on other concepts relevant to their care program.
   


3. Number three above should also be thoroughly handled in the report of findings. However, this also needs to be repeatedly brought up during visits throughout the patient's care. On almost every visit the chiropractor should be reminding or teaching the patient how their treatment is impacting the patient's condition or overall health.
   One of the most significant barriers for patients is that they often do not understand how your recommendations differ from other "options" they have, such as over-the-counter pain relievers or going to the gym. Despite the fact that you may have clearly told them exactly how your solution works, it's quite possible that the patient did not get it. In communicating with your patients, keep in mind that the goal is not for you to tell them, but for them to understand. This means you must take full responsibility for their understanding. If you do this, you will achieve better results in the patient education process.
   


4. Poor administration at the front desk must be handled with training, drilling and written policy and procedures. Don't be afraid to drill/train a lot! How often does a championship sports team practice? In most very successful clinics, staff drill or train weekly, even if only for 15 minutes.
   


5. Patient financial arrangements should be well understood at the start of care. It is also important to have standard financial arrangements across the board, with the possible exception of an occasional hardship. It should not be "let's make a deal chiropractic." And you should be collecting whatever deductibles and co-pays are necessary. Patients who don't pay co-pays and deductibles won't likely pay for care once insurance runs out. Not to mention the potential legal ramifications of not playing by the rules.
   


6. The simple fact is, the patient is bombarded with false information regarding health on a daily basis. From television ads to print articles to the internet, the patient's head is full of ideas that will lead them toward ill health. No one, except you and your office staff is promoting chiropractic. You should do it EVERY TIME THE PATIENT IS IN YOUR OFFICE. There are many ways to do this. Pick a few and become really good at them!
   


7. This is one of the most perplexing outpoints to be found in many chiropractic offices. So many doctors "sell" their patients in a report of findings using problems located on x-rays, and then never take follow-up x-rays once a program of care has been rendered. Or, the doctor does take follow-up x-rays but gets little to no change on the films, and the follow-up recommendations have little to nothing to do with the follow-up films. This sort of practice always leads to doctor burnout — usually because the doctor himself feels a bit unethical about the whole thing. The solution is to make sure there is congruency between what you sell and what you deliver.
   
   Once a patient finishes a program of care, over several weeks, or months then the patient should be re-examined and a new program (if appropriate) recommended.
   
   The key here is that whatever method of measurement was used to determine or locate the initial problem, and then used to educate the patient at the start of care, should be used again following a program of care to determine the success of the treatment regiment and also help determine if further care is needed.
   


8. Offer care in programs. If you truly believe that your patient only needs one visit (and the patient is not an out of town traveler), then you could benefit from looking into what other services your office can provide. In most cases, if only one visit is truly warranted from your point of view, then the scope of what you are offering is tremendously narrow. There is nothing wrong with offering a narrow scope of services, but it is also true that it's not overly beneficial to you or your patient to practice in such manner.
   

There are many sources of help for chiropractors in practice — from management companies to patient education product companies to a successful friend willing to share with you. The reason for your success or lack of success is always under your control. You can always do something about it!

Offer your patients only what they need and insist that they follow through. This is a game where everyone wins!

Dr. Eric Huntington is the CEO of Advanced Medical Integration (AMI), a training and consulting group that assists chiropractic practice owners in transitioning their businesses to multispecialty health care centers; and the president of the Chiropractic Business Academy (CBA), a business management and coaching firm for chiropractic and multispecialty practices. Dr. Huntington was both the ICA representative for Maryland and a board member of the Maryland Chiropractic Association from 2002-2013. He also served on the executive committee of the ICA Best Practices and Practice Guidelines, published in 2008. To learn more about AMI, visit www.amidoctors.com.