Chiropractic + Naturopathic Doctor

Keys to Your Practice: May 2013

Angelo Santin   

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I have to admit, when I first encountered the idea of letting your patients go in order to grow your practice at a talk by Bill Esteb, I missed the message.

I have to admit, when I first encountered the idea of letting your patients go in order to grow your practice at a talk by Bill Esteb, I missed the message.

When we make it safe for a patient to leave, it is also likely that they will feel safe to return if they suffer a relapse.



It wasn’t until recently when I came across his online video on this very topic (which is available free of charge on his website) that I finally understood what he meant. The main point in this whole approach to patient care is that not every single person will “get” chiropractic their first time in a chiropractic office. Esteb stresses we must therefore lay the groundwork for the patient to feel safe, and by safe I mean comfortable, in leaving. In this edition of Keys to your Practice, I want to explore how this idea can, in turn, grow your practice.

Before we get into the details, I want to say that it is critical to be as good as you can be in your methods and your mindset and to inspire and demonstrate to every patient that chiropractic is essential to good health. Don’t be afraid to recommend ongoing chiropractic care to improve their function and potential.

Sometimes, however, even if we do everything perfectly, some people will want to walk away from care. This is where I believe we can all use a little help. How can we make it safe for patients to leave even if we believe they need ongoing care?

First and foremost, we must examine our mindset. Do we “care” too much at times? Are we being the hero, or fixer? Are we spending too much time managing, motivating, and parenting patients? Esteb says these are signs that we may be caring too much. This practice can lead to burnout, and believe me, I’ve been there. 

Instead, we should try to “love” the patients more. This involves a different approach and requires the ability to inspire, guide, and lead them, and in turn, respect their beliefs and decisions. This ensures the care is about them and not you. If a patient is wanting to leave your care, but is not saying goodbye on their last visit, this is a telltale sign that we may be too invested in pushing what we perceive to be the best thing for them, and that we are not creating a safe, guilt-free environment for them to have this conversation.

The most effective way to make it safe for patients to tell us they are stopping care is to talk about it! At the report of findings visit, use words like “if you choose to continue” or “you’re in charge.” I personally like to use these phrases at re-examination reports. I make my recommendations for ongoing supportive care but also let them know it’s their choice as to how much care they receive, and that anytime they choose to discontinue, they need only let us know. This immediately puts the patient in charge. They feel as if they are part of the decision, and the tone in the room changes. 

Remember, most of the time, a patient will discontinue care because they are feeling better: this is a positive thing that we should celebrate with them! 

How, then, does this lead back to growth in our practices?  Well, when we make it safe for a patient to leave, it is also likely that they will feel safe to return when they suffer a relapse. Unfortunately, a patient may go through a few relapses in order to finally learn that they need to be more proactive about their maintaining their health.

As well, Esteb mentions that even though patients are inactive, they still refer to us as “their chiropractor.” Is this not so true? We get referrals all the time from patients who continue to tell their friends, “you should go see my chiropractor,” even when they are not actively under care. This type of referral also gives us a key opportunity to keep in contact with the patient who did the referring. For example, having them remain in contact with you through newsletters, e-mails, Facebook, etc, is a great way for them to still feel a part of the practice.  I find I like to send a postcard or make a phone call on major special events like a milestone birthday or some other special time. For the record, I am not a big proponent of forcing

reactivations. In fact, I would caution against making calls to inactive patients for the purpose of getting them back under care.

However, if done genuinely, this will keep you on their mind when it’s time for them to return.

I am a big believer that a proper mindset and excellent communication can go a long way to enable patients to experience chiropractic over their lifetime. This idea of allowing them to fail and return in a safe environment can aid to help our public image and change the old saying that “once you go to a chiropractor, they want you to go for the rest of your life.” Why don’t we lead the way in patient-centred care and let it be up to them?

Remember, when it comes to your practice work from the inside out.

Key to Saying Goodbye to Patients (for Now)
Maintain a safe environment for patients to leave active care, and to return or send others to you if necessary.

  • Action Step 1: Examine your own practices and ask yourself, are you managing versus leading, that is, are you “caring” too much?
  • Action Step 2: Keep communication open and talk about the choice of stopping care from the beginning.
  • Action Step 3: Keep inactive patients involved in the practice through newsletters, social media, etc.

Dr. Angelo Santin is a 2006 graduate of the CMCC. He operates a busy subluxation-based family practice in Thunder Bay, Ont., and is currently serving his second year as president of the Thunder Bay Chiropractic Society. Dr. Santin is one of a small number of international Carter Universal proficiency-rated chiropractic coaches, and draws on his success, along with the experience of the most renowned experts in this field, to provide time-tested, effective and patient-centred ideas for every chiropractor. He can be reached at or 807-344-4606.

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