Creating Strong First Impressions

So, I think if I were to walk into an office and I see, you know, you've got water station, a coffee, little Keurig station set up with light snacks, I'm like, okay, these people care, and I'm probably gonna hang out, if not for the awesome chiropractor, for the snacks, for sure.

Hi, everyone, and welcome back to ChiroCast, brought to you by ChiroTouch. I'm Dr. Stephanie Brown, and as always, I am joined with my co-host, Danielle Javines. And today we're diving into a crucial topic for every chiropractic practice, which is how to optimize your new patient's initial visit.

That's right. First impressions matter, and the way you structure that first appointment can set the tone for patient retention, trust and overall satisfaction. So we'll walk you through best practices before, during and after the visit, covering everything from setting expectations and office presentation to handling different patient scenarios.

Plus, we will tackle a pretty big debate whether or not you should adjust on that first visit. And of course, I'm sure we'll sprinkle in some real life experience that have shaped practices and how everyone approaches that new patient care. So let's get started.

So before your visit, very important to set expectations. I always found the more information, the better. Maybe some of this, you will present to them at some point, like during the first visit or after, you don't wanna overwhelm them at first, but even down to as specific as where they should park.

So you wanna give them directions. So when I practiced, we had two locations, depending on where the patient was going. We did have an email that went out, and depending on what office they were at, there were directions on how to get there.

We did tell them exactly where to park, which was super important because one of our locations was in like an urban area, street parking, the limit was one hour. We would tell them not to park there. If it's gonna be more than an hour, we did have patients that got tickets.

But we did have a small lot in back, so we would just make sure they knew that was there and how to find it. Also, what to wear. We did share that with patients too.

So we preferred that they did wear something comfortable. My least favorite things would be really tight jeans or like, do people wear these anymore? Like wind pants, you know?

Guilty.

Really slippery. You do?

I do. Just around the house. It's just around the house.

Not to a chiropractic appointment.

We won't tell anyone. But yeah, that might be custom to you. So people who are going to take pictures of posture, maybe they want you wearing something more fitted.

Or if you have people moving around a lot, or you want them to just have that freedom of range of motion, you might tell them, you know, wear something loose, fitting and comfortable, because you're going to move around a little bit. So I think it's important to set that expectation.

Yeah. And how do you recommend they get the message out? I know you mentioned emails.

Are they getting a text or is it frequent to put it on the website as a what to expect on your first visit? Like how, what's the standard?

I don't know if there's a standard per se. That might be good info to have if you have a new patient section on your website, maybe. Some people like knowing what they're walking into ahead of time.

And so if they can kind of read that information, maybe before they've even made an appointment, that might tell them, like, you're organized, you are focused on what they need to know. And people might feel more comfortable coming to see you because you are detailed and you have that information on your website. But that's kind of passive and it's up to the patient to find it.

So, yeah, we did always have an email, I still do to this day. And maybe you put a link to your website so you're not reinventing the wheel or having to update something in more than one spot in the future if it changes. But the email, I think, is helpful because you can personalize it then at that point, whereas on your website it's just going to be more applied to everybody.

And then not for nothing, but it would be really great to have a text message, I think, that goes out. Especially, you know, it might depend on your patient demographic. But if you really want to reach, I think, certain populations better, that text, even if the text just references the email and tells them to go look for it, having a text message that goes out, I think, too, is going to be really important.

Yeah, I know. I've seen that just on the patient side, getting that text, whether it is the full shebang in the text or, hey, you got a welcome email, make sure you review it before your appointment and always letting me know to arrive 15 minutes ahead of time, just for whatever reason, was super helpful. Often, I would get the email the day before my appointment because I would frequently forget the appointment.

It was twofold, letting me know what to expect and it reminded me that I needed to be at the office the next day.

Yeah, so let's talk about that briefly. Whether or not to have people arrive early and where they're doing the paperwork, so you needed them to show up early to do the paperwork. The problem was often they wouldn't or they couldn't or they were running late.

So then what? Because then they don't have the paperwork done. It sucks.

And then if you have a reminder service, they're getting a text message telling them your appointment is at noon. But if you now you're telling them to show up 15 minutes early, then you want them to remember on their own to come at 1145. So none of that made sense to us and it just caused conflict or confusion or mistakes or whatever.

So what we did was we worked, we wanted the patients to fill the paperwork out in the office because then there's no chance they're going to forget it at home or didn't have a printer. Or I mean, I remember back in the day, we would mail the paperwork to patients, you know, what if they didn't get it in time? So we just took that out of the equation completely and we make patients fill out the paperwork in the office.

And then maybe like, let's pretend that new patient appointment is 60 minutes and you want it to start at noon. We would actually make it an hour and 15 minutes in our system and we would start it at 11 45. And we're telling the patient to come at 11 45.

And then the reminder says 11 45. But we built that the arrive early time into the actual appointment time so that there was no confusion on what time and they were doing the paperwork when they got in and all of that. Yeah.

It helped so much when we started doing that because there was no more, it was just less confusing and more straightforward, I think.

Yeah. And I think that helps with the patient experience. Patients don't want to be confused or show up when they're not supposed to show up or they show up, you know, 15 minutes prior to the 15 minutes.

And yes, they feel like they're waiting forever. But I mean, yeah, 15 minutes.

So that would happen too. Sometimes like when we transitioned and our staff were getting used to not telling people to come early, sometimes they still would by mistake or the person thought they were supposed to come 15 minutes early anyways, even if we didn't tell them. And then they, yeah, and then they show up early anyways.

They get the paperwork done in 10 minutes and then they're sitting around for another 20 or something, perhaps. So exactly, yes. But it's good.

I mean, if you got to transition, you just got to communicate and then expect there to be hiccups. And that's just like anything when you're trying to make things better. Cancellation and no-show policy, I think, is super important to communicate that to a new patient.

But maybe check with your state law. We always aired on the side of caution and we did not charge a missed appointment fee if a new patient had to cancel or no-show. Because technically, they had not signed and acknowledged our missed appointment fee paperwork.

So they hadn't been advised ahead of time or we didn't have proof that they had been told. So, I don't know. So that might depend on your state law.

Do you have to notify them ahead of time in writing and they have to sign and acknowledge? Like at what point are you allowed to institute charging that fee? It usually was not a problem with us.

There was only a handful of times where it happened three times. And if that, you're done. And we did have to tell some people, I'm sorry, like we have saved this time for you three times now and you've never made it in.

And so we got to suggest that you find someone else basically.

Yeah, I was just, I was about to ask since you, I mean, you can't charge them, but how many attempts do you give them until you have that conversation where you're not a good fit for the practice? Because I, I think it does set a precedent, like you can kind of tell this is the kind of patient they're going to be. And when they do become a patient, sure, you might be able to charge them, but also they're going to interfere with your other patients and they might be the ones that cause you to stay late frequently.

So you don't want that.

Yeah, most definitely. But yeah, setting that expectation out of the gate when it's appropriate, when you can, I think is helpful.

For sure.

Okay. And then what is even a first visit, right? Because everybody defines that differently.

You know, there's some practices that say they'll take a hundred new patients a month, but that might just be the people who showed up to their lunch and learn, and they captured their information and entered them into the system. But did they become patients that started a care with you or whatever? So everyone defines that differently.

But, you know, what does that first visit look like? And telling them what's going to be done. So when I practiced full time, we did a consultation first.

Very small form they would fill out, letting us know what was going on. And then they would just sit down with us and we would talk about what's going on. Get enough information to figure out if we can help them or not.

Because if we can't, I'm not going to waste their time. I don't want to waste mine. But then get and tell them like, oh, you need to go to see your medical doctor or whoever might be more appropriate to help that person.

You can help get them there without that investment of a long first visit where you can't help them.

So question, are the consultations scheduled similarly to a new patient? Does that count? This is a new patient consultation versus a new patient visit?

We didn't count them as new patients now. We would count them as a new patient if they moved forward with their next appointment for an exam and whatnot.

Got it.

But we were very clear, this is a consultation. You are not being adjusted.

How many angry folks did you get when you told them they wouldn't be adjusted? None.

Usually none. No. That's the thing too.

It depends on what kind of practice you run and your marketing and your funnel maybe. What kind of patients are you attracting? If you're a heavy PI office that is helping a lot of people with acute situations, they're probably not going to be okay with that.

Right. Yes. Again, it's that communication.

But we just positioned ourselves a little bit differently. That wasn't necessarily the expectation. To be honest, it was definitely a disqualifier.

If someone called up and they're like, I need to be adjusted today, our staff would explain how things work in our office. Often if that wasn't going to fit for that patient, then they would just say, thank you very much. I'm going to keep calling around and that's okay too.

Because they need to get what they need and we need to do what we need to do. More often than not, if someone did come for a consultation, they did schedule the exam. There wasn't very many that didn't, I guess you could say convert into becoming a patient.

Rarely, they didn't come back.

I feel like that just goes along with setting expectations. The consultation, it's an opportunity for you to get to know the kind of patient that you're going to be welcoming into your practice. But also, they're going to understand how the practice works and what else they can expect moving forward.

Because they walk in thinking they're going to be a brand new patient. And then they find out they're not the ideal patient and you can't help them. They're probably going to appreciate you not dragging them along and scheduling all these one-hour visits when you can't help them.

Exactly. The other thing I liked about it was this. If they had a complicated thing going on or they had already seen other providers or there was history there, at that point we would have them fill out our records release and we would send that off so that we could get copies of whatever imaging reports or notes from other providers or whatever we might need, right?

And don't quote me on this. Everyone should look it up and make sure this is what the rules are. But when they redid the CPT coding definitions for new patient exam codes and whatnot, I believe there was a component on whether if you were doing it for medical necessity and complexity or versus time, but there was a component in one of those where you were reviewing other like medical records and whatnot.

If you have a first visit and on that first visit, you're like, oh, I need to review these other records and you don't have them that day. It doesn't count. Like you can't bill a higher level code because you asked for the records.

You have to have them in your hand and you're supposed to be reviewing them as part of that visit and that day's chart note. So if we did a consult and we knew we needed those other records and whatnot, we would have them in hand by the time they returned for that exam. We would have already reviewed them before we did an exam and the rest of their history.

And we would be prepared with that information as we stepped into starting to check this person out and take care of them. And then we could justify billing those maybe higher level services in certain situations if it was warranted because we were following the rules and doing it all that exact day. So I don't know how often that would impact other practices and it depends how they practice, but it worked out really well for us.

Also on that consult, if we felt they did need imaging and they didn't have any, we might order that then. And that way it's done before we're going to put hands on them.

That's awesome. Yeah, that makes a lot of sense. I mean, for the billing side of things even.

I mean, because I can't imagine getting into the first appointment and you're like, well, now I need the records. You have to then you would need another appointment to review them, or at least you have to take extra time out of your documentation to review this patient's records when you've already seen them for that first visit.

Yeah, it was just more efficient to have it all there already and like get to look at it all together all at once when you're writing that first note. And I liked it. And I will say, when we switched to doing the consultation, it felt weird and like, oh, people are going to hate this.

And they really didn't. Yeah, they really didn't.

Yeah, I can only, I say I've only been to one practice where there was a consult first and it was very informative. It didn't feel rushed. It didn't feel like everything needed to be done that day.

It was really setting the tone for what was to come. And determining if I am the type of patient that would fit in with the practice. Almost like an interview type.

But I appreciated it because I got a lot of information from that appointment to determine, am I going to move forward with this or do I need to keep looking around? But I thought it was awesome.

Honestly too, I felt like it was better for our, it was better for us because we felt like we had more time to explain who we are, what we do, how things work. Then the patients are more informed moving into things. And honestly, it felt like, like I said, not many people didn't follow through with the exam, but it just felt like over time, we had better quality patients because they were not looking for a quick fix and never going to come back.

And some people practice that way, which is fine because it works for them and they like it. For me personally, I didn't want to do that. So, I feel like it helped.

I don't want to say retention, but I mean, it helped have better patients. Not a good way to put it either, but we'll just go with it. It helped us have better patients who understood better what we were doing and why, and they seem to care more and stick around better.

Yeah, I think it makes sense. I mean, that's what you're looking for. Every business has what they consider the ideal client.

I don't think it's any different for practitioners. You have an ideal patient, not that they're easy clinically, but someone that's going to adhere to their appointments. They understand the workflow and they want to bring their friends and family.

Yeah. We would bypass the consult sometimes. If we were already taking care of a husband and the wife wanted to come in and he had already been talking to her at home about how great everything was or whatever, we might bypass it.

Parents are already coming in and they would like their kid to come in. I mean, the kid has a choice, right, but kind of didn't because mom and dad were like, we're going to do this. There were scenarios where it wasn't an always all the time thing, but by and large, it was someone brand new with no connection to the office.

It was indefinite.

Okay. That's a good segue. You mentioned kids.

What are some things to consider when it comes to families and children and what to expect when you get there or you've already been a patient, what to expect in the office?

Yeah. I think this is important too because even if you are not a pediatric chiropractor or you don't adjust kids, your patients probably have kids or at least some of them do. So I think it's really important to communicate and set that expectation on whether they're allowed to come or not.

That sounds kind of mean, but we would say that for that exam visit, like we'd have to talk on the consult, but on the exam visit, we would just make it known ahead of time that if you have kids but you could get child care, it might be better for you because you'll not have to be worried about what your kid's doing or whatever essentially. Because we don't have a built-in babysitter in the office. We would put it out there that it would be easier for the patient if they had someone to watch.

But if not, we've never turned anyone away, we would just make it work. I had a patient literally show up yesterday. She's an established patient.

She has grandkids, okay? She doesn't have her own children that are toddlers, and she showed up with a toddler. I was like, where did this child come from?

Like, I'm not pregnant. But she was helping a neighbor out with some child care, which was fine. The neighbor's daughter was very cute and kind and polite, and it was really fun actually.

But she knows that I'm okay with that. And I mean, I don't know, my feeling is that you should be okay with kids being in your practice because it's going to make it easier for the patients to get in to see you. Like, I don't ever mind at all if someone had to bring their kid.

But if there's certain visits that just require more focus or interaction from the patient specifically so that they're not distracted, I think it's okay to make that ask ahead of time.

Yeah, like x-rays, x-rays or I know at my office, there's the traction machine where my hands, my neck, like I'm out of commission. So those are the visits where I know having my kids running around is not ideal. But I will caveat that with they do have a separate room in the office that is dedicated to children for, you know, books and toys and whatnot.

Not saying that that's, you know, every office should have that. But it does help, especially for single parents that they might not have that additional childcare, but they do really want to be seen. It's just that extra level of your kid's going to be okay for the 15 to 20 minutes that, you know, you can't really do too much with them.

Yeah.

Or imaging. I mean, I want my kids in there when I have to have x-rays done.

Yeah. One thing that's huge with kids, and I do see people asking on social media for tips on this, is like when the kids are out of control, like, I think that's a judgment decision. Like my default is always let the parent do the parenting.

Yeah. But I will step in if it's like out of hand or the kid is like either about to get hurt or break something or do something like really bad. It's funny because I don't have kids, but anytime I would speak up, I think they were just like, oh my God, she's talking to me and sounds really serious.

Because normally I would be like, hey, Henry, how's it going? Playful and fun with the kids. But as soon as I got serious, they were like froze.

It's another stern voice. They're like, maybe I shouldn't destroy this office.

I haven't seen this before. Yeah. But that gets really hard in general if they're out of control.

But yeah, we didn't have a heavy pediatric practice, but we still had the kids' chiropractic books and some toys around. That was usually enough to just give them something to be interested in. But we did have a flexion and distraction table with the pedals and it did go up and down.

And so if they were in the room, in that room with us, like as parent was getting settled, always tell the kid, like, you are not allowed to touch this. It's like basically like an outlet, like you are not allowed, do not touch this table. My preference, I wish I had gotten like some red tape and like put it around the table and be like, can't cross the red tape little Johnny.

That's a great idea. If you have a ton of kids around, I just don't know long term what that, you know, once it gets walked on, it's going to get gross and stuff. So I don't know how practical that is, but I mean, it's, it's an idea.

We never did it, but I always wanted to.

Kids, I think kids love, I mean, just having those visual markers, I mean, it works in like kindergarten classes. They know like circle time, everybody's on the circle, right? And you know, areas where you're not supposed to go because of red tape.

I mean, it's worth a try if you're listening and you have that issue with children running around and a little bit uncontained, maybe try the red tape.

The other thing too, is it's often very innocent because they just, it depends how old they are, but they see you doing something and their kids are sponges and they copy, right? They imitate. And so like they want to go push that pedal with their foot and they want to pull the handle for that drop piece or whatever.

And the kids would pretend to help like they're adjusting their parents all the time and start doing leg checks and stuff. So it's very cute, but you definitely need to set that expectation so that they don't get hurt or break your equipment. So when it comes to those pieces, I would just right out of the gate be like, okay, here's the rules for when we're in this room.

Like, do you have any questions? Do you understand? And they would be like, yeah, it's great.

It reminds me of a funny story. So when I was going, it was, when I was going to the joint, I hadn't established at like a private practice yet. And so I was going there pretty frequently.

And this one day, I had to bring both of my children because school was, they were off school that day. So I was getting adjusted and my five-year-old son, he's watching the chiropractor. And of course he has my daughter, who is four years younger than him, lay on the table.

And I just, as I'm turning so that my doc can do what he needs to do, I look over and he is about to like full throttle adjust her on this table. And I was like, no, no, no, no, like, please stop. And so the doctor kind of stepped in and was like, here's why that's not safe.

Here's why you shouldn't do that. He's like, you can sit on the table, but, you know, don't try to adjust anybody else. So they are 100% sponges.

They see that, you know, it's helping mom. I want to do that. And they think it's fun to hear, like, the audible piece of getting adjusted.

So from that day on, they didn't come to those appointments, unless they absolutely had to. And I had to reiterate at home that we don't adjust at home either until they graduated chiropractic school. And they have their degree and they learn, but they still do try to push those limits just from what they see when they go to their own appointments and learning how x-rays work and why we don't have an x-ray machine at home.

But I thought that was hilarious that day. But had we not caught them, I don't know what would have happened. But yeah, kids are, they're hilarious, but can also cause trouble if they're not watched closely.

Yeah, I've had little ones who they're just like too small and not strong enough and they'll grab like the handle for the drop piece and it has a little gift to it so they can sort of move it up and down and then suddenly one day they are big enough and strong enough to like crank it up and so, you know, that's a good point for me. I shouldn't even let them have that behavior when they can't lift it up all the way. But yeah, so it's a kid, but setting that expectation with the kids out of the gate when they're in the office sometimes can be helpful for sure.

And also it's nice to do it in front of the parents or tell them ahead of time because then they understand what that dynamic is going to look like. And not only it's okay for you to bring your kids, and when they're here, we usually have a couple things we tell them, you know what I mean? Like I would do it, the patient would be face down and I would be starting to work, but I would be talking to the kid the whole time because I found that too, like if you're engaging with that child and having a conversation or whatever, often they're just going to pay attention to you.

It depends on the kid, but they'll pay attention to you and interact. And if you can include them in a positive way, so I have this one family, so they don't do it here, but when I was in the office, they loved cleaning the table, the kids and all three of them, they would like get the squirt bottle and they would squirt it down and then I would hand them the paper towel and they're like cleaning and then, like they thought that was the greatest thing ever. And so it's nice to include them with little stuff like that, if it's appropriate, because then you're keeping them doing something that's fine versus them finding, like leaving them to their own devices and finding something to do, which might not be what you want them to do.

Yeah. And as you were talking about it, speaking of kids and setting expectations, let's say you have mom and dad, they come in, they're getting adjusted regularly, and then they have a baby and they bring baby with them and they're like, hey, it won't take that long. Can you just adjust my baby?

How do you handle that?

I would say for me, that more came up ahead of time, right? So before mom gave birth, she wasn't literally standing there with the infant, or it might be slightly there after she was in by herself, and would bring it up like, oh, can you see the baby? And I would say, yes, they will need an exam appointment.

They're smaller and have less health history, so we probably won't need as much time as what your first visit was. But I just make it clear that they will need a longer appointment with paperwork for their, I don't say safety, if it is for their safety, it's also the legal thing. But yeah, I guess try to handle that ahead of time.

There were times where I did have a pregnant patient, and I would bring it up myself. Like, if you wanted to get the baby checked after they're born, like, this is how it would work. So, I mean, because I have had established patients, and this will come up when they're bringing their kids, but established patients who came for their appointment had to bring the kid with them just because, you know, they picked him up at school or whatever.

And then they were like, oh, can you adjust little Johnny since we're here and he had to come with me? And you have a waiting room full of people. And I mean, honestly, I guess we usually just said yes, and made it happen.

And then you just roll with it. I don't know.

Yeah.

So existing, I usually try to squeeze them in because how long does it take to adjust someone depending on how you practice. But yes, that was always kind of tough to handle. It wasn't usually a brand new kid or a brand new baby because I try to like phrase that ahead of time, but yeah.

It just makes me think of going to the emergency room. You've got, you're going for one kid, but then while you're there, you're like, actually, I have this issue and so does my other. Can you just see all of, I know I came for him, I registered him, but can you check all of us out?

More often than not, they're going to be like, no. Yeah, it's a lot of emergency. Right.

I just write you a prescription for that rash or whatever.

Just trying to double up on your time there. I imagine it happens probably more frequently at the chiropractor because they're like, you've got an extra five minutes, right? Surely you can do my entire family that I brought that wasn't on the schedule.

Yeah, that's tough.

Yeah.

Let's move on. This is one I don't think a lot of people think of until it happens to them, fragrance. We didn't warn people ahead of time about fragrance, but it would be part of what we talk about on those first two visits.

We did ask people to refrain from wearing heavy perfume or cologne. This is true. We have patients that are coming to see us because of different headache disorders, and trigger for them might be fragrance.

Not only is it unpleasant for some people and it's very difficult to clear it out of that room when they leave, but it can really negatively impact a patient depending on what their sensitivities might be. We did make sure that was known, but it was usually after the first visit or during, I should say, their exam. After the exam appointment or during that exam appointment, we work it into the conversation basically.

Yeah. Not just on the patient side, but I think for the practice side as well, I know there are practices that love to have their oils going or the medical disinfectant spray, like spraying it all over. Keeping in mind that some of those are extremely strong and might be pleasant to office staff, but not so pleasant to some of the patients coming in.

I think it works both ways where you want to have a calming, welcoming scent in the office that maybe is hypoallergenic. Don't know if that exists. But I know as somebody that is sensitive to smells, I have to be very mindful of the different oils that I use, but also knowing what to expect when I walk into the office, which usually isn't ever an issue.

It's a very mild smell, but there have been some offices that it hits you in the face as soon as you open the door. But usually that's like the super overwhelming disinfectant, sterile smell that-

That's like spray in commercial bathrooms that goes off every 10 minutes or whatever it is.

Yes. And I mean, it could be state, there could be laws that govern that, where you have to have it, which is unavoidable, that's fine. But if it isn't, just be mindful of that, because it can leave a lasting impression, or in some cases, patients might not want to return because it's too heavy.

On that note, let's talk about bad smells that aren't artificial. So just as a piece of advice to anyone who might be building out an office or looking at locations, just do yourself a favor and make sure the bathroom is not centrally located. I mean, it should be in the back, okay?

I know there's opportunities, I think, to get office space where the bathroom is like shared in the building and maybe it's out in the hallway or something. Honestly, some people see that as a negative, but I don't. I really don't.

It's not bad if it's not in your office. There is a benefit, obviously, to having your own bathroom, but there's benefits to not having your own bathroom as well. But yeah, if you're in a position to be planning and just you do not want the bathroom, even having the door to the bathroom, like in the waiting area, you'd think like, oh, it's easily accessible.

I mean, that's true, but like there will be other things that are easily accessible as well that go with the bathroom that involves smells. And it's not a good time. It's a very bad time.

And if something bad happens in the bathroom, then you know, it's there for everybody to experience.

Suddenly, your afternoon is free. You have no patience.

I shadowed a doc once, actually, who had two bathrooms in their office in two different spots, and they literally kept them locked. And if you had to go to the bathroom patient, you had to ask for the key, so you would get the key, and then you had to return the key, and then the staff would immediately go lock it again, and make sure that it was left in okay condition, because this particular office had just had too many occasions where it was not left in okay condition. And, you know, so that was their way of controlling it.

Yeah. And I mean, I don't know how big of an issue this would be in like private practices, but I imagine there are some cases where if you do have those bathrooms that maybe are shared, they could be used by folks that aren't patients, that just come in because they need to use the bathroom. I mean, I think locking them, if you have the ability to do that, that can kind of eliminate some of the unnecessary patrons that want to use the facilities that maybe aren't patients.

Yeah. And if the bathroom is a part of a shared common space, it's I think in most cases going to be most likely that you are not responsible solely for cleaning it, which is also nice if you don't have to clean the bathroom. Now, I would always be prepared to pick up the bathroom if you had to, just like there were lots of times where I picked up a shovel and shoveled some snow outside, even though our landlord had a commercial snow removal contract.

But if it's snowing and they haven't come yet, I would go shovel snow. I'm not above that. So anyways, in the same vein, if the bathroom isn't yours and you don't have to clean it, that's great.

But you still want maybe the patients to have a good experience if they have to go to the bathroom. So anyways, there's just my note on bathrooms because I've witnessed various ungreat things related to the bathroom in the chiropractic office.

Yeah. And I know like bathrooms, it makes me think of break rooms.

I witnessed I wasn't like...

You weren't the culprit.

After the fact.

So when you said centralized bathroom, it made me think of the break rooms, lunch rooms. And with setting expectations, making sure patients know. I know some offices, they have like vending machines in there that maybe aren't for the general public.

Making sure patients know that it's employees only, because I've been in a few where it doesn't explicitly say employees only. It was more of a, it's implied. And then there were a few occasions where you could tell what was put in the microwave or on the stove that day, and it lingered for a few days.

Yeah, I hate that. So just best practice with what you're bringing for lunch and being mindful of those smells as well.

That's a good point. Yeah, if you have restrictions to based on how you practice, whether or not someone can have caffeine before they come for their exam or their re-exam, or even just their regular visits, like you need to advise them of those things. Also, on the topic of food, this is a side note, but I don't, it's not a bad idea to have some bottled water and like some snacks around.

It's like granola bar or something. I mean, there was a lot of occasions where like people needed water. I mean, I would just say always have a bottled water in your office, unless you have the thing out in the waning room with the big gallon thing.

The jug, yeah.

It's more than a gallon, but it's the little dispenser. You got to have water for people. I mean, you never know when they're going to need it.

Yeah. And like having some snacks is not a bad idea. If somebody is, there's been occasions where I gave someone like my snack.

All right.

And that sucks because then I didn't have one, but I just like have some snacks in the office in the event that somebody needs it. So that was kind of unrelated, but always good supply to have.

Yeah. I mean, it's along with what to expect. I think walking in visually, you're going to take things in before you even talk to somebody.

So I think if I were to walk into an office and I see you've got water station, a coffee, little Keurig station set up with light snacks, I'm like, okay, these people care and I'm probably going to hang out. If not for the awesome chiropractor, for the snacks, for sure. I don't think anybody would ever not appreciate having something small while they're waiting in the waiting room.

Yeah, for sure. Definitely. I think it's a great idea.

I mean, I even always have, I don't really drink bottled water, but I always have it here for that exact reason. I mean, I'm in my house, so even I want that. I don't think I would have any snacks to give them, though, because I need to go to the grocery store, but I hope no one needs a snack today.

We'll update everyone next time. Also, just before that first visit, make sure you've also let them know anything else they need to bring, whether it is images, whether it's other records maybe that they just have already or can get easier than you can. Their insurance card if you take insurance.

I talk to offices on a pretty regular basis and it amazes me how many people don't get the front and back, like a copy or scan the front and back of an insurance card. You need the back. Bring everything back, please, but make them bring it so that you can get that, please, for sure.

And I think asking, again, when you're setting those expectations prior to that first visit, asking them explicitly or breaking down what you're looking for. For example, Medicare patients. I have come across this more times than not, where Medicare patients, they think they just have the red, white, and blue card.

But really, they have a supplement or a replacement and had no idea that they needed to bring that. So if you're a Medicare office or even just insurance, whatever, even cash, I mean, asking if they have Medicare is always good practice. And then making sure they know even if you have the red, white, and blue card, anything else that you might have, just bring it in.

And I know I've seen-

Bring it all.

Bring it all. They'll bring their vision, their pharmacy.

We'll be like, okay, not that one. What else you got? Bring everything.

If you're not sure, we'll help you figure it out.

Yes, absolutely. That's something that I think is overlooked. You kind of just assume when you say bring your insurance card, everybody knows what you're talking about, but they don't.

Yeah, they don't. Also, we should start being prepared. If you tell a patient to bring their insurance card and then they're like, why didn't get one?

Because that happens now. So a lot of insurance companies are not issuing them anymore, and the patient needs to really get like the virtual card. So hopefully, they have that, and then you guys should be prepared with a way to capture that.

So I have the iPad. I will take a picture of people's cards front and back, and it uploads directly into their documents. It's not being saved locally at all.

So I, you know, no issues there, but I'll take a picture of the front and back of the card, or I'm taking a picture of their phone, if they pull it up on their phone. So I think people need to start being prepared for the fact that like you might not be able to physically take, I mean, can you put a phone on a flatbed scanner and scan that? I don't know.

I've never tried, probably. But we need to start being prepared for people that don't have cards anymore, because it's going to start being virtual more and more, I think.

Yeah. And now that you mentioned that, that is exactly how my dental card is. I was waiting for one in the mail, got something in the mail, but it was them saying, hey, here's your code.

You're going to go online and go get it.

I was like, here's a paper, not the card anyway.

Yeah. Here's a paper that directs you to where your card is online. And I was like, all right, cool.

And I think more and more payers are going that route for cost effectiveness, but also efficiency. So being mindful that maybe those, what are those scanners called? Those two-sided scanners where you could just stick the card in and it scans it into your computer, that could eventually become void, won't even be able to use it.

So patient arrives at the office, what are we doing during the visit initially? And those impressions that they're going to get like right when they walk in the door. So I think it's really important.

No one's going to disagree that you have a clean and organized office. And all I'm going to say about that is if you yourself know that you are not a clean and organized person, that's okay. You know, be who you want and you're going to live your life and we're all busy.

And there's probably something dirty in my house I need to clean right now. But if you know that you're like that and you don't have time and it's not your forte, you've got to hire someone to be cleaning your office. I know docs that want to clean their office on their own because they think it's a good way to save some money, which might be true if you're good at cleaning and attentive to that.

But if you're not, it's going to be worth every penny that you pay to somebody to clean.

I don't ever think about those things. When you walk into any office, you don't think, hey, they cleaned this really well, or whoever they hired to clean this did a great job. It's just kind of expected when you walk into an office setting, it's going to be neat, tidy, and trash cans aren't overflowing.

Definitely. So do that, be clean. Also though, your staff is really important if you have staff.

The staff should be ready to warmly greet someone. I know that some offices will have them walk out from around the desk and shake the patient's hand and welcome them by name and whatnot. So you can do that if you want.

But I think a really good idea is make sure you have a formal, written out dress code that they acknowledge.

I think everybody's interpretation of business casual, it's on a scale. So setting those expectations with staff is going to be incredibly important. Or I know some offices, they're like, everybody's going to wear the same scrubs.

No matter what position you're filling, you will be in the same exact scrubs and usually like a custom jacket if it's cold, just to maintain continuity across the practice. But also it eliminates your staff, one, having to go buy a new wardrobe or trying to piece things together, and two, hoping that your staff understands your vision of business casual.

Exactly. I don't want to say the word uniform, I guess it is. But having a uniform really takes a lot of that off the table.

And yeah, if they have a name tag on or if they have a shirt where their name is embroidered on it, I think that's nice for patients too because they're not going to remember everybody's names at least at first and they want to be able to reciprocate when you call them by name sometimes then if it's written on their shirt, then the patient has a chance of trying to know what that person's name is in your office.

And for reviews, if you're an office that is advertising, hey, we want to hear from you, Google reviews, whether you're sending it out to their phone or you have a plaque at your desk, them seeing the name tags or having it embroidered, it's going to help them be able to leave those more authentic reviews when they can name your staff and how welcoming they were in the practice.

Definitely. Also check-in, so like for us, our staff would guide the patients on what to do for check-in. And after the first visit or two, everyone just knew what to do when they came in.

So I think that's a pretty simple one, but it is nice if you have staff that they can be prepared always. Like, you know, it's hard because this is health care and it's not literally a actual retail environment where the customer comes first. But you sort of have to have that mindset in certain pieces of this year, I think.

So their priority should always be the person in front of them. And yeah, I mean, if they can direct them how to do a check-in and help them with it, that's going to be good. If you don't have staff, I don't.

So I have to have those conversations with people like, hey, if you can check in before you get here, that's great. I put the link in your reminder text message, wink, wink, like, do it when you get the reminder maybe. So that's what I do, but I have that conversation so that they know what I need them to do either when or before they get here.

Yeah. I think and having a system that is going to support whether you want a fully stacked staff model or you want to run it solo so that maybe you don't have a front desk, you don't have a dedicated office manager, you want to have these pieces in place that are intuitive for your patients to be able to walk themselves through the practice, be able to check in and have all of those things done digitally to make your life easier as well as the owner.

Yeah. Really random side note, but we did this during COVID. I thought it was so cool.

We had two locations and we had staff turn over. Eventually, it got to the point where there were times where we had a staff person at our second, like the main office downtown, but I was by myself at the other location. I don't remember how we did this.

I think we used Skype. I don't remember, but we used the iPad or my laptop, depending on what was going on. Our staff person downtown running the desk would just be on an iPad at the front desk to greet my students and say hi to them.

We had a centralized phone system, so I didn't have to answer the phone. It would ring to her at the other office and she could grab it. But she was still there to greet them and say hi and make sure they were okay with this check-in, which was not ever a problem.

And then the credit card terminal was just sitting on the counter. And so if I was standing there, I might type it in for the patient or whatever. But so many of them just wanted to pay as soon as they walked in and they would just do it themselves and set the receipt on the desk because our terminals put a receipt out and they would just sign it and toss it down on the desk and we'd get them later.

It was cool. It was a cool way to still have that personal touch with a human being but in a virtual way. You got to have the right person to do it and sometimes our staff person downtown had to run in back for something so maybe she wasn't there waiting.

I'm picturing this is like a painting in Harry Potter when the wizards are in the paintings or not.

I'm just picturing this tablet or computer set up and you don't think there's audio but then they're like, hey.

Yeah.

That's awesome.

But it was really well received and I think patients, at least my patients, they just thought it was clever. You know what I mean? But it was a way to have someone there.

I mean, you don't want to overwork your staff either, but it was a way to have somebody there to welcome and greet them and help if they had a question instead of nobody.

It's like you're in two places at once and you're able to do your job at both locations. I call that efficiency.

I thought it was cool.

You know what?

Our staff people, they have kids. What if your kid is homesick? Shoot, could she just work from home and run your front desk?

Probably.

There's a thought.

If you have a cloud-based electronic health record system, she certainly could. And then, you know, you just stick her on a tablet. Heck yeah.

It's fine.

That could be the new model for these offices.

So I don't know. I thought that was cool. I thought that was cool.

If I walked into someone's office and they had a setup like that, I would also think it was very resourceful, obviously, because this is my idea. But I would appreciate that they were making an attempt to have that contact but also efficiently, right?

Yeah. I think it works both ways.

It's the way of the future, I think.

Yeah. You walk in, at first, without knowing, I'd be like, is this AI? Is that a person?

But then you get to know the staff. So it's like if you're at this location these days, you're also able. So you could be at both and you could go back and forth.

I think it makes it super easy. Yeah.

So if you have multi-location or just staff situations, especially it was during COVID, it was like, oh, I might have been exposed. You're not allowed to be in public. Well, they could still work from home on the template.

That's awesome. So those were different times. It had a great application then.

Do other people want to do it right now? I don't know. But it was good for employee, like staff morale also because they had that flexibility if something came up and they had to be at home or whatever.

So anyway, it's a side story, but I want to know if someone else does this and they do it really successfully.

Yeah, email us. We want to hear all of your stories and how you got through COVID and what you've adopted from that time. So I know there were things that, I mean, I'm sure people thought it was annoying to have to do, but I think a lot of practices from like best practices, not like physical practices, they've carried on some of those things that were implemented during COVID to this day because it made it more efficient in the office, which I think is cool.

Oh, yeah. Just having memories. Okay, anyways.

Memory of work from home.

Yeah. Okay. So what about open and closed adjusting slash exams?

I think this is a big topic. I've kind of done semi both. So when I started practicing, everything was just closed door or we were in a room by ourselves.

It was not open adjusting. We did make a practice to, for the most part, I would keep the door open. Unless something sensitive was going on or during that initial part of the exam, when you might be discussing more of their health history and whatnot.

But from a safety and malpractice standpoint, it's a really good idea if you can keep the door open or a jar somewhat, or you have someone in the room with you, like a scribe or a staff person who's there to help take notes or whatever. So it depends on your situation in your scenario, but those are options there. But especially if someone's never seen a chiropractor before, it's probably a really good idea to explain to them how things work in your office, especially if you have open adjusting.

For sure. It could be, I mean, for me, my first exposure as a patient seeing an open bay, I had no idea what that was. And coming from the mindset of this is a medical building, like this is a medical physician type, like is this even allowed?

Like, why are other patients able to see my treatment? So until I was educated on the subject, it was alarming to me. So I can imagine maybe elder patients that aren't familiar with it having the same mentality where it's like, why are other patients able to see what the doctor is doing to me or talking to me about?

I found it very valuable to have the education behind it, but also being given the opportunity to go into a room, if that was something that I was looking for. They did offer that in every office that I either visited or was a patient. They always let me know that it was an option with the door.

They did let me know, again, the door would have to remain open, but having those options I thought was incredible.

Yeah. And there's different reasons why different people do things. So yeah, I like both open and closed adjusting from a provider and a patient standpoint.

Whatever is going to work best for you is good, but especially if you're doing open adjusting, I think it's really important to make sure the patients know that and you explain it well to them so that they understand and so that they know that it's not a HIPAA violation. You are protecting their privacy and like all the things. The option to have that closed adjusting is always important, I think too.

Same for exam. I can't imagine doing an open exam though. That would be too much for me personally.

But I guess it depends how big your space is and how busy it is at that time.

Well, let's get into the big one. To adjust or not adjust on the first visit?

Yeah. Kind of like we talked about earlier, it depends what you consider your first visit. But let's just pretend you don't do a consult, that's a separate appointment like I did and do.

Patients coming in, it's their first visit literally, and it's that exam appointment, and maybe it's 30 minutes or an hour or whatever. Are they getting adjusted or not? I think a really good way to approach this.

Listen, I have had patients before, way, way back. I've shared this story before. This guy came in and he was in rough shape.

He turns out he had an acute disc herniation and there was zero chance that he was getting adjusted that day. Zero, none. I literally sent him directly to the hospital from the office and I called the emergency room like when he left, okay?

You did not get adjusted. There's always a chance that you are not going to adjust that person. Always.

Now, more often than not, you're going to adjust someone when they come into your office in general. But for new patients, I think it's very important to make it clear that, and if it's appropriate, you'll get adjusted that day. So even if you are someone who does plan to adjust on that initial visit when you do your exam, after your exam is done, even if you're doing that, that's great.

But what if that person comes in and has every red flag in the world, and you really need a, I don't want to say punt, but you need to get them someplace else. That person is not eligible, we'll call it, to get adjusted. So you don't want to scare people and be like, well, if I think you have cancer, you can't be adjusted.

It's not that. But there are also other occasions where you just might not be sure if it is safe for them to be adjusted. Do they have something different going on?

So it's just, I just think it's always good no matter what, and no matter what your default is, even if your default is that you adjust on that first visit, it is always good to frame it that usually you would get adjusted on the first visit as long as it's appropriate. As long as we determine that it's appropriate. Because you're leaving the door open in case it wasn't, something weird is going on, that you will cross that bridge when you get there.

Then if you definitely never adjust on that first visit, you should tell them. So when it is your consult, like we did a consult, you don't get adjusted then, we would tell them that. But if it's the exam and they're not getting adjusted on it, however you have it set up, if you are not adjusting, I do think that they should be advised of that.

And that's just a thing within the profession because some people do and some people don't. So you're communicating to them what your default probably is.

And have you ever, I imagine this may come up or maybe it doesn't, but have you ever had a patient that maybe tried to game the system? And they're like, no, I see a chiropractor. I just saw one yesterday and now I want to be seen by you.

Or maybe they want to continue seeing two different offices, two different docs concurrently. How do you go about that?

So in my experience, more often than not, they don't tell you.

Okay, they just lie.

They just keep it to themselves. So in my career, I've only had one person who has told me straight out that depending on, and for her, she just sort of said, it depends on who can get me in, is established at multiple chiropractors' offices, and she'll sort of end up with whoever can see her. But with that person, again, I don't get the sense that, like, say she came to see me, she would stay with me for whatever the thing is that she had going on.

It's not like she's going to see me today, but to follow up, she's going to see Dr. Joe around the corner or whatever. So maybe she's seeing me for this instance because I was available right now, but a month or two from now, if something different happens and someone else could see her sooner, I don't know what her logic is, but I think that's what's going on there. My take on it is this, at the end of the day, you absolutely don't know for sure what anyone's doing unless they literally straight out tell you.

So that's one thing. Then therefore, if they have straight out told you, you have a decision to make if you are going to care for that person. I feel like it is a malpractice issue.

And if you can control it, they shouldn't be seeing multiple chiropractors at once. An exception to that rule could be, let's pretend I practice functional medicine, but I have a chiropractor, and patients come in to see me for that, and I'm not adjusting them, perhaps. Then they have a chiropractor they see who does adjust them.

Okay, fine. That's different because we're not doing the same thing. We're not providing the same intervention.

But if they're seeing chiropractors that are providing the same interventions, I think that that is something that I want to stay as far away from as possible. It's not because I don't like the other chiropractors or I don't trust them, but if you go see Dr. Joe yesterday and it turns out he actually hurt you, but then you come see me the day after that, I mean, I don't know what a jury does with that or a male practice insurance company, who hurt you? No one can know really necessarily.

It's just, listen, if I hurt someone, I just would like to be held responsible for it. Great.

Yeah.

I don't want to be held responsible for hurting somebody when it wasn't me and it was someone else that they saw within a week previous to that.

Yeah. I mean, so what brought it up is I've worked with chiropractors at an account management level where they are insurance practices, and like you said, patients are not forthcoming with who they're seeing and when they're seeing them. One of these offices ran into where the patient, they ran the benefits and she had no visits.

Of course, these things pop up, but she did not expect the office to confront her about, hey, you have no insurance covered visits left. Of course, she tried to play the system a little bit, but when it comes to insurance, staying on top of those things so that you can have constructive conversations with patients. And it could bring that to light as well, because maybe this patient thought she could get 12 visits at one, 12 visits at another, and so on and so forth.

You can empower your staff to look at those things ahead of time, and then giving them what to do in those situations when patients think they'll use one insurance at one office, use those visits, and then maybe another at another office. It can get tricky, but having those tools is incredibly helpful.

Yeah, for sure. Yeah, I just, I don't like it if someone's chiropractor hopping. If it's for the same intervention.

If someone's seeing me to get adjusted, but they're going to a chiropractor for decompression or rock wave, like a service I don't provide, that might be different. But when it's the same, it just gets too messy and there's too much liability involved. Again, I'm not ignorant of the fact that you won't always know.

You're not going to know. I bet a lot of people do it.

If you're all cash offices or a patient is all cash and they're office hopping without them telling you, and of course, you can't talk amongst your colleagues because you know, HIPAA, but you would never know if this patient is being seen Monday through Friday, getting adjusted Monday through Friday, and yeah, it leads to what if something happens? Who's going to be called in the question?

Yeah.

It could get messy. Maybe something to think about when you're, you know, having these conversations with patients. When's the last time you saw a chiropractor?

Are you currently seeing one? Right now.

Great question. New patient exam. First thing I ask them is, have you ever seen a chiropractor before?

Yes or no. When estimate when the last time was that you were adjusted? Right out of the gate.

Yeah.

If it was a few months ago or whatever it is, that's fine. But if it was some time in the last couple of weeks, I'm probably concerned. But I will ask politely, are you comfortable sharing with me why you don't want to go back there?

Or why did you stop going there? Yeah.

I mean, just asking, I think, is incredibly useful for you and from the patient side as well, understanding why you're not, or maybe you are still seeing them and you thought maybe it'd be a good idea to be seen by.

No one's ever said, oh, I just want to.

Uh-huh. As many as I can get at one time.

So that, not for me anyways. But yeah, I ask straight out and I sometimes I'll just try to pick up on the vibe in the room on if I should say, why aren't you going back there anymore? I've probably skipped asking a couple of times, but more often than not, I'll say, oh, you know, do you mind sharing with me why you decided not to go back there or whatever?

So yeah, I definitely find that out on their first visit for sure.

Nice.

Okay. What about after the visits? So I think most offices do that or do this, schedule their next appointment.

Example, this would happen to us all the time. We often, we would time taking new patients at the end of the night because they could come after work. Say they came at 5.30, I don't know.

They could come after work maybe. The staff would be there while they came in and then the staff could leave by 5.45 or 6 o'clock. They're not having to stay the entire time that we are back there with a new patient.

But so after that visit was over, the staff is no longer at the desk and we would still go out. The calendar would be open and we would still make their next appointment even though the staff was gone. So, you know, if you are running that kind of practice, it's a really good idea to have that next appointment scheduled so they stay on their care plan.

When it's a new visit, I think I've always been impressed and I think it's really nice when the doctor calls that night or in the event you took them at night, like they call the next day and say, I just wanted to check in on you or whatever. I've always thought that was really great and it's never something that I've ever done. That's something to think about adding to your routine potentially, like are you going to do those little check-in calls?

Yeah, I always appreciate, not only that it's a check-in, whether, for me, I didn't care whether it was automated and everybody got the same message or not, but having the, how was your visit? Then sometimes I would get a video of here are exercises. It might not be all the exercises I was prescribed, but it's a video showing how to do them, a reminder, or if I was given DME, how to use those things, because it's a lot of information during your first visit.

So having those recap texts, emails, videos, I thought were a really nice touch, and just another layer of patient care, patient experience.

Yeah. I mean, even if people are doing those things, if the doctor also calls, I mean, no, for sure. I do think that I've had that happen before.

I don't remember who it was though. But anyways, I was literally like, oh my God, the doctor called me. And then I listened to the voicemail and I was like, oh, they were just, you know, calling to check on me or say hi or whatever it was.

But I was like, whoa. I mean, it couldn't have had that much impact if I don't remember who it was. But I do.

I think that's nice in addition to any of the other stuff you're going to do. But I think that's huge too. Like often, we are guilty, I think, of, you know, everyone has the worksheet of exercises that they have in their office and they hand it to the patient maybe.

Yeah.

I mean, that thing is going to get lost, trampled on, thrown out by mistake. I don't know. It's good to, and that's not how humans learn, right?

It's usually not, let me show you this thing once and then just assume that you're going to A, remember to do it, B, do it correctly. So having that stuff that lives with them, it's sticky, they can go search their email to find it. I don't know how easily they can retrieve it from a text message, but email I think is great or it's on their web.

They know that they can go find the exercises maybe on your website or something, whatever. I think that those are really important for them to make sure that they are doing it correctly and doing it at all. Because, listen, I will tell people straight out, there are some exercises I can give you that might help with this.

Will you do them? And people will look at me dead in the face and say no. And I will say, I'm not going to give them to you.

I'm not going to waste your time. And I'm not going to waste my own asking how the exercises are going when you come in next, because you're just going to tell me that they're good probably. And I don't want to make them feel like they have to lie to me.

So I'll just ask them straight out, like, are you going to do these? And it's so refreshing how honest people are, because they will either say yes or they will say no. And I will be like, perfect, it's okay, you don't have to.

And I'm not going to make you feel bad about it. And they love that. I don't know.

I think they like it because, yeah.

Well, it saves you time. I mean, if you're four weeks into the six week care plan and you're not seeing as quick of a turnaround as maybe you thought, because you assumed they were doing their exercises and their at home treatment, them telling you straight up, I'm not going to do any of this auxiliary work that I need to do to complement my adjustments, then you know, like, hey, this care plan might need to be extended, or maybe we're going to roll right into another one because you're not going to see the results as quickly as you would have maybe if you were complementing your adjustments.

Yeah. So, I mean, I'll have that conversation with them so they understand. And sometimes a few weeks down the road, they might be like, so about those exercises you mentioned, that has happened before too.

So, yeah, and people get scared of the word exercises, I think. And I've used different verbiage over the years, but I always explain to them, like, it's not the kind of thing you have to, like, change your clothes and you're going to get sweaty, you know. You could do them at work, well, maybe.

And just work different things into your routine. And I don't know, I try to make it remove barriers so that they think it's going to be simple to work these things into their routine. But I mean, but if they do have to change their clothes and get sweaty, then you should make sure that they know that.

Set that expectation.

Yeah, make sure they know. This is going to take a lot of time to do these exercises.

For sure.

Yeah. All right. Well, that wraps up today's discussion on optimizing that new patient's first visit.

So whether it's setting the right expectations before they arrive, creating a welcoming environment, or whether you decide to adjust on that first visit or not and how you communicate all those things to them, it's just all about making that first experience a really great one.

Yeah. And speaking of experiences, we love hearing from our listeners. So it's time for our Mail Call segment where we answer your questions and share your thoughts.

All right. The question was, I love my patience, but some talk so much that it throws off my schedule. How do you keep visits on track without being rude?

There's a couple different ways you can do this, but it's all about creating structure and you guiding the conversation in body language. So when I know I have a chatty person, I'm basically just prepared to talk the entire time. I don't love talking all the time during my visits because sometimes I like it to be quiet and concentrate, but just whatever.

It depends on the patient. So I will guide that conversation. I will be in control of what we're talking about as much as possible the entire time because it prevents them from going off on this tangent where they just keep talking forever.

So that can be helpful and try to keep it about them, why they're coming in to see you chiropractic and what the goals are here. Don't structure the conversation so that you're talking about the weather or the most current event because that's more conversational and easier I think for the patient to like take over and get crazy. I found over the years to body language super important.

So after visits, when people are getting up, I might be sitting down like working on a note or doing whatever, but I have found like if I stand up and start walking to the door and I do this till this day right now, I will literally walk out of this room so that they have to follow me and I'm like leading them out. So it's not rude. I don't think that's rude.

I try to do it in such a way that it's like, oh, this is just the next step of the obvious progression of what we're doing here because you're leaving. Or they're leaving the adjusting room that you're in or whatever. But so that body language is really important.

So don't park yourself and just sit there and listen attentively. I mean, it is important to do that when it's appropriate. But if you got to wrap things up, just standing up and putting your hand on the door and starting to open it, if there's a door involved, those are all those body language things that will start giving them cues that like, you got to go.

So that's just what I've done over time.

And I think, I mean, it doesn't hurt that there are some folks out there that social cues are lost on them. So if you have to gently just say, hey, I would love to continue or let's pick up at the next appointment, but I've got to get to my next patient. I don't think that would ever be received like disrespectfully at all, because I'm sure that folks are self-aware perhaps, that they are more on the chatty side and small talk is their superpower.

But letting them know, hey, I've got to get to my other patients, but being warm about it so that they know that you're not uncaring. You want to hear about all 12 of their grandkids and their favorite sports team and what they're cooking. But you've got to keep it moving along and let them know that you'll talk to them the next time they come in.

Good tips. Good tips. Yeah, it's all about balance to maintain that good relationship.

Love it.

If you found today's episode helpful, don't forget to like, link, and subscribe so you never miss an episode. If you have any questions or wanted to touch on anything, we talked about, send us an e-mail at chirocast at chirotouch.com. We would love to feature your question in the upcoming episode.

All right. Well, thanks for joining us everyone today and we'll catch up soon.

Take care.

Thank you for joining us on this episode of ChiroCast, Insights for Modern Chiropractors, brought to you by ChiroTouch, hosted by Dr. Stephanie Brown and Danielle Javines. Produced by Debbi Brooks, Editing from Matthew Dodge. Our theme song House Five is from Scott W.

Brooks. If you enjoyed today's show, don't forget to like, link and subscribe. We appreciate your support and we'll catch you next time.

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