Keeping Patients on Track

By: Kathy Mills Chang

As I’m so fond of saying, a Chiropractic Assistant (CA) is by far a doctor’s most valuable asset. Besides the ongoing support the CA gives on a daily basis, perhaps even more important is the role that he or she plays in reinforcing the doctor’s instructions to the patient. Although there are many ways a CA gives support in reinforcing these instructions, I believe there are two areas that have the most impact:

  1. Keeping patients on track with appointments
  2. Supporting the doctor’s instructions and suggestions for ancillary treatment and supplies

Engineering the Schedule

Keeping patients on track with appointments is one of the most important tasks that a CA has. I believe that missed appointments are among the most severe challenges faced by practices. If patients don’t keep appointments they don’t get better, they blame the office, and then they don’t pay. What a world of problems! Because of this, it’s vital that all appointments are prescheduled. Multiple appointments are like a gift! Once scheduled, a CA’s job at the end of the appointment is to wave and say, “See you Monday at five o’clock.” Take the time just after the doctor’s recommendation Report of Findings to schedule all the visits that have been recommended, at least up to the next re-evaluation. A patient’s willingness to schedule these multiple appointments will gauge their commitment to care. This also shows the patients that you have a plan and it’s not “band-aid” Chiropractic. Patients should make care a priority, just as much as they do their carpool, children’s outings and practices, etc.

Very often, I hear CAs complain that patients are unwilling to schedule out beyond a week because “they don’t have their schedule.” This is a terrible excuse! Here are some ideas that have been very successful in assuring that all patients are scheduled.

  • At the end of the first visit, ask the patient to bring their personal calendar, Palm Pilot, etc. to the Report of Findings. Let them know you’ll be looking at the calendar together to make their appointments once the doctor has accepted their case.
  • Start by asking the patient what days of the week are best for them. If three visits per week are ordered, tell the patient, “Most patients like to keep Monday, Wednesday, and Friday for their appointments at three times a week, so shall we start there?”
  • Reinforce what the doctor has said in the Report of Findings. The patient has just heard what it will take to correct the problem, and is most likely to commit to care at that time. Tell the patient, “We operate on an appointment schedule to minimize your waiting time in the office. I want to reserve your appointment times ahead, and we can always reschedule if needed.”
  • If a patient absolutely cannot make future appointments, have a place in the bottom of the appointment book where you can write in those who should be scheduled that day. Then, you can call them if they don’t call you to schedule.

Perhaps the next most difficult problem with keeping patients on track is missed appointments. The great news is that if you’ve done a thorough job of pre-scheduling, then you’ll know if a patient has missed the appointment, and you can call them. Missed appointments are typically a “red flag” to some bigger problem. Patients lose their commitment to care for many reasons, such as they are not getting better at a rate they expected to, they can’t afford the care, or they are out of pain and want to drop out. Any time a patient has rescheduled three appointments the doctor should be notified. That person may need a review of the care plan with the doctor and a reminder of the commitment they made in the Report of Findings. Team members can also reiterate to the patient that only the doctor has the authority to change the treatment plan.

Directing the Supply Line

Supporting the doctor’s recommendations to the patient within the treatment plan is also vitally important. When rehabilitation, use of cervical pillows, or functional orthotics are ordered, constant reinforcement by the CA helps keep the patient on track.

There is usually more to a treatment plan than just the Chiropractic manipulative treatment. Many doctors also order strengthening, stretching, or other supportive exercises along with the treatment. This supports the patient in the healing process and can bring about quicker therapeutic results. Many doctors order the use of devices for home exercise, such as the NECKSYS®, BACKSYS®, or Thera-Ciser™. When a patient has purchased any of these types of rehabilitation systems, it makes for great “Chiropractic only” talk in the office when a CA asks, “Mary, have you been doing your exercises?” This allows the staff member to communicate a patient’s compliance to the doctor.

Many times, patients look to CAs to reinforce what the doctor has told them in the room. How many times have you had a patient come out after the doctor has ordered orthotics and ask, “Do I really need these?” It’s important to know the scripting ahead of time so when asked, you can support what the doctor has told them in the room. Use staff meetings to role play the different responses your doctor would like you to use.

Here’s one example of a reinforcing response:

“Mary, I’ve seen so many of our patients respond beautifully to having custom-made orthotics. They say that they can feel the difference in how their adjustments hold when they are stabilized from the ground up. I wear them myself, and if Dr. Smith is recommending them for you, I know you’ll be happy with the decision.”

As Chiropractic assistants, we play a vital role in being the eyes and ears of the doctor in the front office and gently nudging patients into compliance with the doctor’s recommendations. Remember the power of your words when spoken in reinforcing the doctor’s orders. It’s a vital role in keeping patients on track to health.

About the Author

Kathy Mills is a Senior Coach with Breakthrough Coaching. She can be reached at 800-7-ADVICE or