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Dynamic Chiropractic
July 29, 2008, Volume 26, Issue 16

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An Ounce of Prevention

Lisa Bilodeau is a co-contributor to the “Chiropractic Assistant Corner,” a periodic column intended to help chiropractors and chiropractic assistants improve their practices. For more information on Ms. Bilodeau, including a brief biography, previous articles and a “Talk Back” forum, visit

“An ounce of prevention is worth a pound of cure.” It’s quite possible you have heard this saying. When someone asks me how to do successful reactivations, my first thought is, “What could you have done to prevent patients from falling into the inactive archives?” First, let’s focus on systems that address prevention and then we can focus on systems for successful reactivations.

Educate your patients. If patients have a clear understanding of the reason you want to schedule follow-up visits, they are more likely to comply.

Use proper scripts. Both the doctor and team need to learn and use scripts that support the doctor’s recommendation for care. I use and highly recommend Sherry Hodge’s book and CDs: “Script for Success.” Here is an example:

  • Before sending the patient up to the front desk to schedule their next appointment, the doctor tells the patient they need to return in one week. The doctor also has indicated this on the routing slip and as they leave the patient, they say, “I will see you in one week.”
  • When the patient arrives at the front desk, the chiropractic assistant (CA) looks at the routing slip, sees the doctor has indicated the patient needs to return in one week and says, “You will need to see the doctor in one week. That will be Wed., Aug. 30. Would you prefer morning or afternoon?”
  • If it’s established they would like an appointment in the morning, the CA will then give them two choices, “I have an opening at 10:00 or 11:00; which would you prefer?”
  • These are close-ended statements designed to give directions to the patient and to get specific results. These questions allow the CA to process patients more efficiently and quickly, thus freeing up their time to serve more patients. Quite often, I have heard the CA ask an open-ended question such as: “You will need to see the doctor on Wednesday. When do you want to come in?” They then wait for a reply, which quite often leads to answers they did not want, such as “I will call you,” or the patient requests a time that is not available.

Routing slips. These are a form of nonverbal communication between the doctor and the front desk. (See “Improve Communications, Patient Retention and Cash Flow” in the Aug. 14, 2007 issue of Dynamic Chiropractic.) More times than not, I have been in offices and heard the doctor tell the patient to come back in one week, to which the patient agrees. Unfortunately, the CA doesn’t know what the patient was told and asks, “When does the doctor want to see you again?” or “When do you want to schedule your next appointment?” The patient then says something along the lines of, “I will call you when I want to come in,” or “I will call you when it hurts.”

Once again, the CA must use proper scripts. In situations like this, the CA might say, “Let’s go ahead and schedule an appointment and if your schedule changes, you can call us and we will reschedule it at that time.” If the patient insists on calling in, the CA should then tell the patient the doctor will be notified and may be giving them a call to discuss it with them. Under no circumstances should the CA say, “OK” and let the patient walk out the door without notifying the doctor. The doctor has indicated the patient needs to be seen again. If the CA says “OK,” they are playing doctor and have possibly undermined all the doctor has done to establish the need for care.

Timely missed-appointment follow-up. You must have a system for dealing with these situations. First of all, you should call the patient within 15 minutes of the scheduled appointment and, using proper scripts, determine why they did not keep the appointment. Then get them rescheduled, hopefully later that same day. (I will cover this in detail in a future article.) Careful documentation of all attempts to contact the patient should be noted in the patient’s record. This usually consists of two calls within a couple of days of the scheduled appointment and possibly a release letter.

Now What?

Even though you may have used proper scripts and procedures for scheduling, there inevitably will be some patients who slip through the cracks. Before attempting to contact the patient by phone or mail, you should review the patient’s file and account. You don’t want to contact a patient whose account has been sent to collections, or has asked you not call them or only send information to a specific address per HIPAA. You should also have a goal for the number of successful calls. Here is a plan to maximize your goal to reactive these patients:

  • Every three to six months, you should go through your files and pull out all the files of patients who have not been seen in the past six months. (Don’t be surprised if the patient calls you before you call them.)
  • Send out a re-call postcard or letter. Make it fun. I worked in an office in coastal California, where surfing is popular. Our re-call card was a picture of Garfield surfing that said, “Long time, no sea.” Not only was it eye-catching, it reminded them we missed “seeing” them. Be sure to note in their records you sent the card or letter. It’s recommended you place all postcards in envelopes to comply with HIPAA laws.
  • If you have not heard from the patient within two to four weeks after sending the postcard or letter, attempt to contact the patient by phone. Once again, the scripts and intentions are vital to your success. Remember, it’s your caring attitude that makes you good at reactivating patients.

Here is a sample of one of Hodge’s scripts:“Dr. Needham reviewed your chart today and feels it’s important for you to come in for an examination/appointment. He asked me to call you and schedule an examination/appointment as soon as possible. Would you prefer Tuesday or Thursday for this appointment?”

Remember your intention is the key to your success. Expect these past patients to be grateful for your caring. Many of them were “just going to call you.” If you would like a sample routing slip, please send me an e-mail ( with “RS” in the subject box.

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Dynamic Chiropractic
July 29, 2008, Volume 26, Issue 16

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