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Dynamic Chiropractic – January 1, 2009, Vol. 27, Issue 01

Rescheduling Doesn't Have to Be Painful

By Francis Smith, DC

Patients cancel their chiropractic visits for many reasons. Sometimes there are reasons beyond your control, such as weather, traffic and family vacations. More often they are of the "my dog ate my homework" variety, meaning some other priority won over a visit to the chiropractor.

However, with proper planning and procedures, you can minimize the frequency of missed appointments and increase your patients' compliance with their schedules of care. If you find your front-desk CA passing out "get-out-of-care" free cards too often, it's time to take action!

Don't Mess With Mother Nature

When the weather truly turns nasty, both you and your patients are better off staying safe at home rather than risking life and limb attempting to get to your office. On the other hand, have you noticed it only takes a Weather Channel prediction of the slightest possibility of a snow flurry or thunderstorm to completely empty your once-full appointment schedule a full day in advance of the storm?

While you can't fight Mother Nature, you can set a policy to remain open to care for patients unless you are certain that a weather event might endanger your lives. Instituting a policy of flexible scheduling during such periods further demonstrates to your patients that you are there to serve them and that you take your responsibility to care for them seriously. Let patients know that even though they had scheduled an evening appointment, in the event of predicted inclement weather you and your staff will work early, late and even over your lunch hour the days before and after the storm to be sure they receive the care they need. Most importantly, establish a policy of requiring patients to make up missed visits.

Let's Make Up

No one likes to "make up" a missed appointment. It sounds a little like a punishment or detention in grade school, doesn't it? Instead of having patients make up missed visits, offer to schedule an extra visit on the day closest to the appointment they missed, even if it means they'll be coming in two days in a row. If you are unable to get to the office due to severe weather, have your office phone calls forwarded to your home or cell phone. Bring home a copy of your appointment book so you can schedule extra visits when patients phone to cancel on the day of the storm, rather than waiting to return to your office the following day, when you'll be confronted by a vacant appointment schedule and the chaos of having to reschedule everyone.

Extra visits aren't only for cancellations due to bad weather. You can schedule extra appointments proactively when you know about a planned lapse in a patient's schedule. If you know that a patient has an upcoming vacation, why not schedule a couple of extra visits before and after the vacation? The stress of travel accompanied by an interruption in regularly scheduled care will inevitably result in lost ground toward the accomplishment of treatment goals. Increasing the frequency of care before and after a planned trip can help keep this from happening.

The Launch Sequence

There is a sequence of events that patients consistently follow before they drop out of care. This is called the "launch sequence" because patients follow it before they launch out of your practice. There are four steps in the launch sequence. In the first step, a patient calls your practice to let you know they are coming in, but they will be late for their scheduled appointment. The second step occurs when a patient phones your practice to let you know they won't be able to make their scheduled appointment, but they would like to schedule an appointment on another day. The third step is reached when a patient becomes a "no show," but keeps their next scheduled visit without calling to advise you. The final step in the launch sequence can occur without you ever being aware of it until one day you stop to wonder whatever happened to the patient; they simply disappear.

The liberating aspect that comes from being aware of the launch sequence is that patients predictably follow the same steps from beginning to the end. This means the first step a patient takes when they are deciding to drop out of care and disappear from your practice forever is to phone you to change the time of their appointment to another, "more convenient" time. You may think the patient is being courteous by rescheduling their visit. In fact, they are letting you know, loud and clear, that a visit to your practice is sliding down their slope of priorities toward oblivion. Bells, sirens and flashing red lights should go off in your office announcing, "This one's about to get away!"

Stop the Insanity

One way to interrupt the launch sequence is to stop it before a patient ever gets to the first step. This means placing a high value on scheduled appointment times in your practice. During your report of findings, let patients know you will be setting up a schedule of care for them so they can be seen at the same time each day they are required to come in. This way, the patient is free to schedule all of the other events of their week around their visits to the chiropractor. Seeing you becomes the priority event of the week. Let patients know that you will save their time for them, and that you will not accept an appointment for another patient during their scheduled visit. Tell them you value their time so highly that you don't want them to have to spend a single second more than absolutely necessary in your office.

The list of excuses patients use to get out of an appointment is endless. You must decide what constitutes a bona fide excuse for missing an appointment in your practice. The typical short list includes the death of a close family member, child or spouse, severe illness requiring hospitalization, calling from a foreign country and physical incarceration. Not having a babysitter, suffering from the flu or a cold, lack of transportation or having to work late are not on the list of acceptable excuses and can all be overcome by a properly motivated patient.

Your Secret Weapon

When a patient calls with an excuse that is not on your list, feel free to use your secret weapon. Politely ask the patient to hold for a moment and then, without any introduction, have the doctor pick up the phone. Most practices involve the doctor in the recall process only after a patient drops out of care. Now that you are aware of the launch sequence, you know that the time for the doctor to get on the phone is the very first time a patient calls to change a scheduled appointment. Interrupting the doctor while they're caring for patients to speak to a tardy patient may seem extreme. However, when the doctor gets on the phone, it sends a strong message to the patient that altering their scheduled appointments is not something to be taken lightly. It is also tremendously empowering to your staff to know you are serious about your recommendations for care. Patients wouldn't give a thought to altering the frequency or dosage of a medication prescribed by their medical physician. They should feel the same way about the care you prescribe for them.

Stay Ahead of Late-Runners

Most practices will find they have patients already at various steps in the launch sequence. You most likely have a group of patients who fall into the category of "late-runners" or patients who consistently excuse themselves from appointments due to their hectic schedules. Even with late-runners, it's never too late to stop the sequence of events leading to dropout.

The next time the patient shows up late for a visit or drops in after missing a visit altogether, rather than sending them for their adjustment right away, the front-desk CA should direct them to a consultation or examination room and politely inform them that the doctor requested a moment before seeing them for their next adjustment. Doctor, it's time to ramp up your confrontational skills. When you enter the room, let the patient know that you are sincerely concerned about being able to continue as their doctor due to their inconsistency with care. Be kind and accept your responsibility for not adequately communicating the importance of sticking to their schedule of care if they are to get the results you hope they will achieve. More often than not, your patient will make the 180-degree change for which you were hoping.

How to Handle Dropouts

You can decrease the frequency of dropouts by objectively documenting your patients' functional improvements with regularly scheduled progress examinations. When you and your patients establish mutual goals for care and a time frame for their accomplishment, you empower them to make better decisions concerning their care. By reinforcing this message with your daily "tableside talk," you'll help develop the bond of trust that motivates patients to follow through with the goals you've set for care.

Even with the best procedures, you cannot avoid losing patients as a result of their own lack of commitment. When a patient chooses to disregard your recommendations, and is irresponsible with their schedule of care, they are placing their health and your reputation on the line. Never take a patient's decision not to follow your recommendations personally and don't be intimidated to discharge someone for noncompliance. Hold yourself and your practice in high regard, and don't tolerate patients who do not value your expertise, time and professionalism.

You are not doing anyone a service when you allow your patients to run the show. Remind yourself of the oath you have taken as a professional to offer your best guidance. Some patients need tough love and will bounce back. Others will not. It's better to let those patients leave until they are ready to resume care than to have them set appointments with no intention of keeping them. Your reputation and standard of excellence should never be compromised by the unfortunate few who don't care to get care.

Dr. Francis Smith, a 1986 graduate of Life University, is the director of Chiropractic Works in Burlington, Vt. He is also a senior coach with Breakthrough Coaching (

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