The "Zen" of Referrals

By John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA)
Just recently, I asked the office manager of my clinic to only accept three new patients a day instead of the usual five I have seen for over 25 years. With my very busy lecture schedule taking me around the country on a weekly basis, I felt reducing my practice intensity would assist me in my professional and personal life.

"To promise not to do a thing is the surest way in the world to make a body want to go and do that very thing," observed Mark Twain in Tom Sawyer. By promising myself to accept fewer new patients, I now have more than ever. Of course, the DCs who practice acupuncture in my community love it, since we refer more and more patients their way.

As someone who spends a considerable amount of time on airplanes, I seem to have more time than most to read through virtually every chiropractic publication which is available in our profession. Something I have noticed for years in almost every publication, is the number of different advertisements for individuals and organizations which promise to help the doctor acquire more new patients. In fact, the advertisements for this type of service seem to be growing as more "experts" profess how to go about getting more new patients in an attempt to "make more money." In fact, any outsider of our profession would surely surmise by the sheer numbers of practice-promoting seminar ads that chiropractors have a very difficult time attracting new patients.

It seems ludicrous that with all of the hype and gimmicks used by the vast majority of these promoters, no one ever seems to mention that the number-one way to attract more new patients is to simply achieve outstanding, incomparable clinical results. If this were the case, the doctor would be inundated with new patients. When a person is ill or in pain, there is nothing more important than easing the discomfort or getting rid of the problem.

Did you ever have to wait an hour or more in a particular restaurant? We don't have to guess it was not the greasy spoon in the middle of the block, or a restaurant with either poor food or poor service. It is usually an upscale spot with unique surroundings, or an old, established restaurant with great food. In essence, the busiest restaurants are not the ones who generally advertise the most. They are the ones who achieve "fantastic results." When was the last time you referred a friend or family member to a less-than-adequate restaurant? The same is true of a practice.

It just so happens that I was fortunate enough in 1971 to begin my practice with acupuncture as one of my modalities of treatment. My practice grew at a steady rate, as more and more people sought acupuncture as a result of often seeing seemingly miraculous clinical responses. Not only did people seek me out for acupuncture, but I also saw people for chiropractic care who would never had sought out a DC had they not come to me first for acupuncture, an ironic twist, as acupuncture has always had better press than chiropractic.

I learned early on that a little help in getting your patients to refer is certainly legitimate, just as the restaurant owner might say on your leaving, "If you had a great experience, tell your friends." Achieving good results in many of your patients is often not enough of a motivating force to get them to refer, even if you're clean, neat, brave, trustworthy, kind, reverent and every other adjective for the perfect person as spelled out in the Boy Scout/Girl Scout handbook. How many times have you achieved a great healing response only to never hear from the patient?

"There goes the theory of the restaurant with the one-hour wait," you say, but sometimes people just aren't thinking of telling others about their experiences unless they're really motivated. How motivated are your patients to refer to you? Why should someone refer their friend, co-worker or family member to you?

Take this quiz! What is the surname of the person who cuts your hair? What's the name of the haircutter's spouse or significant other? Does your haircutter have kids? Think about it, this is a person who may have cut your hair for years. You discuss sports, politics, movies, current events and the usual idle chit-chat. Besides that, this is a great person!

How many people have you referred to the haircutter? Keep in mind that the haircutter's success is predicated on referrals. How many people have you referred to your car dealer, insurance agent, accountant, etc.? Why should someone refer to you? What if you asked them to refer because you are building the biggest and best chiropractic/acupuncture facility in this part of the state? How could they refuse? They couldn't, just as you would give referrals to your haircutter if they asked you. That's the point!

Did you ever stop to think that the greatest compliment people can pay us is not glowing comments about how wonderful we are, but the simple act of referring and entrusting their family and friends' health into our hands? Are you sending your patients personalized, handwritten thank-you notes, or an impersonal, funky form letter? Please don't send me one unless it is personalized with your message and signature.

The essence of a referral practice is simple. Motivate people by impressing them with a clean, well-maintained office; a professional appearance of the practitioner and office staff; and procedures that are explained in an easy, clear-cut manner.

If you have an assistant who is less than perfect, get one that is. A poor assistant will destroy you faster than anything. Years ago, my clinic employed 12 assistants. Sometimes people would never come back because of the way they were treated by one of the assistants. It's like going to a restaurant with poor service. You're unlikely to return.

Strive to achieve exceptional clinical results in the least amount of time. Why do you suppose acupuncture has grown to the unprecedented level of public acceptance it has in such a short time? To me, the answer is obvious. Acupuncture promises exactly what chiropractic used to promise years ago: quick clinical results.

I think B.J. Palmer said it best: "The fundamental of this clinic is to see how little we can do at how few places; how rarely and how quickly it can be done to accomplish the greatest change in the shortest space of time (at least cost to case), and to know what to do and why we do it before doing it."

It's unfortunate that the chiropractic profession could not back up say, 30 years and re-establish its understanding of the treatment of somatovisceral conditions. We have become mired in the muck of being spinal and low back doctors. Every other profession is laying claim to what our forefathers developed in the chiropractic profession. Now people go to acupuncturist for what they use to go to chiropractors for.

Acupuncture usage is growing, with no end in sight. If you haven't become accomplished in acupuncture, it's high time you did. Remember, even if you cannot by state law use acupuncture with needle insertion, electronic stimulation falls under physiotherapy. Acupuncture is a principle not a technique. Therefore, "meridian energetics" is something every DC should be vitally aware of. It is a part of our heritage.

I'm convinced that striving for the quickest, most dramatic clinical response and releasing the patient to maintenance care as early as possible is one of the major keys to a high-referral practice. Remember, everyone has a dentist who only sees patients twice a year on average, unless there's an emergency, but people will see the same dentist for years and years. Wouldn't you love to see all of the patients you have in your inactive file just twice a year? To do so would more than likely give you a closed practice.

The Asians have a philosophy to see their patients when the seasons change. At these four times of the year, the universe is in an energy flux. What a great time to see patients, plus if an emergency arises or as needed in between. Far too often I feel we try and cram a once-a-month program down people's throats. Even though many people need our services that much and more, there are more people who do not. This may be why your inactive patient files are 10-12 times the size of your active patient files.

If you can go to your office tomorrow and tell Mrs. Jones that you are trying to build the biggest and best chiropractic/acupuncture facility in this part of the state and you need her help, I will assure you your success is assured. I personally conduct a straight-cash, no-insurance practice. I accept no personal-injury cases or insurance in any way, shape or form. I do not participate in any HMOs and have no intention of ever doing so. My job is that of a healer, not an insurance pawn. My job is to help patients as quickly and as economically as possible. As a result, patients have always flocked to my office.

Remember, regardless of insurance or anything else, people are going to go where they can get the most for their time and money. If your acupuncture skills are lacking, you're definitely missing the boat.

Click here for previous articles by John Amaro, LAc, DC, Dipl. Ac.(NCCAOM), Dipl.Med.Ac.(IAMA).

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