Chiropractic Economics Blog

In my last entry, I shared with you my husband’s experience with our family doctor and her failure to grasp the concept of good patient relations. I have epilogue to that story: The doctor fired my husband as a patient!

A few days after his conversation with the doctor, he received a certified letter in the mail from her office informing him he would no longer be welcome as a patient in her office.

It’s important for doctors and patients to have a good rapport and respect for one another. Rapport, respect, and trust result in patient compliance and satisfaction. So, if these things are missing, the patient-doctor relationship shouldn’t exist.

However, I also feel that a patient-doctor relationship is somewhat like a marriage: Sometimes the two of you disagree. The important thing is to have good, open, and honest communication. That was the point my husband was trying to make to the doctor when he complained about getting a run-around from her staff concerning a medication that was supposedly on back order.

I fully understand why a doctor would fire a patient for noncompliance in a medical situation. I can understand why a doctor would fire a patient who consistently missed appointments or was late or didn’t pay his bills. But firing a patient for expecting good customer service? Somehow I think that was a drastic move.

What are your thoughts? Have you fired patients for pointing out a problem in your office? When would you fire a patient? I’m curious. I hope you’ll let us know.

Late last summer, on her 95th birthday, my mother-in-law came down with a severe case of shingles. Because of her advanced age and lowered immune system, medications that otherwise would alleviate symptoms and pain in younger individuals did nothing for her except give her pronounced and undesireable side effects.

Six months later, she is just now recovering from this painful malady.

When my husband initially took her to the doctor for medical treatment, our family physician told him about a new medication that could prevent the outbreak of shingles in individuals who have had chicken pox and who may be susceptible to it. He asked her to order the medication for both him and me.

Months later, we are still waiting for it. We called the doctor’s office several times to inquire about the medication.  Each time we were told it was “on back-order.” The first time we were told that, we believed it. After several months, we found it hard to believel

Finally, my husband called the pharmaceutical company to find out if the medication was, indeed, in such great demand that it was on back-order for such a long time. The company told him “no.” It had no back-orders of the product.

He then called the doctor’s office and asked to speak with the doctor herself, rather than her assistant.

The doctor finally called him back (three days after his call).  Her explanation for the delay was a misunderstanding about billing between her office and the pharmaceutical company and her staff had not been at liberty to discuss this with us.

We didn’t really care anything about the doctor’s billing problems. All we cared about, as he explained to her, was that we should have been kept informed — and not lied to.

The doctor didn’t seem to grasp the concept of customer service. She kept saying that we should keep calling her office for updates … that “her staff was so busy” it couldn’t call us.

This incident has caused us to rethink who we want to be our primary-care physician. Do we really want someone who does not understand that the success of her practice depends upon good patient relations?

To me, honesty is the single most contributing factor in keeping patients happy — whether it is honesty in admitting limitations of skill and knowledge or honesty in telling a patient the status of a promised remedy.

Unfortunately, my experiences with my medical doctor(s) seem to provide lessons that all healthcare professionals (including chiropractors) can benefit from and that I have shared in editorials and now this blog.

If truth be known, I’d rather not have the opportunity to share those lessons. I’d rather be treated as a valued patient.

Until next time,

When did you write your first term paper? I wrote mine when I was a senior in high school. One of the things I remember my teacher, Miss Lauterbur, emphasizing was that to defend the thesis of the paper, the writer must use strong, credible references.

As an editor and writer I take Miss Lauterbur’s teachings with me to work every day. And, I confess, when I read any work that presents an argument and relies of references, I scrutinize the author’s sources for credibility. If the sources aren’t credible, how convincing can the author’s argument be?

With that in mind, I’d like to refer to you Aetna’s Clinical Policy Bulletin on Complementary and Alternative Medicine (#0388), www.aetna.com/cpb/medical/data/300_399/0388.html. This bulletin is written to defend Aetna’s position on a number of CAM therapies it considers experimental. The list is lengthy, but the first item on it is Active Release Therapy. The list also includes other therapies chiropractors may use, such as acupressure and applied kinesiology.

Aetna cites 126 sources of information as the basis for this bulletin. Look through them carefully: You will find Stephen Barrett’s name, along with his Quackwatcher’s Web site (www.quackwatch.org) or similar sites he owns, listed several times.

Mr. Barrett has long criticized chiropractic and alternative medicine. In June 2007, he lost an appeal to Tedd Koren, DC, in which he said Dr. Koren had libeled him.

Aetna may have legitimate reasons for calling some of the therapies it refuses to pay “experimental.” But, it really should look more carefully at its defense sources in its written opinions. In my book, a Quackwatcher references doesn’t carry much credibility.

Until next time,

All businesses have behind-the-scenes people who are indispensable to their operations. The public never sees these individuals, but without them, companies would fail to function. Our business is no different. One of our key “hidden” staff members is our controller and office manager, Ginny.

Today we say good-bye to her. This morning Ginny lost a three-year battle to cancer.

Ginny was the pulse of the office. It wasn’t unusual for her to order a surprise breakfast to pick up our spirits if she sensed morale was low. Or to put surprises gifts — a patriotic lei for Fourth of July or sparkling bunny pencil for Easter — on each of our desks, just to put a smile on our faces.

Ginny was everyone’s mother-sister-aunt-friend. I don’t think there was a person in the office who didn’t occasionally sit down across her desk, close the door, and talk when they were feeling down. She listened and cared, even when her troubles were literally killing her.

You may have met Ginny at a Las Vegas Parker Seminars or a Florida Chiropractic Association National Convention. She was the bubbly woman who greeted you when you stopped by to say hello, made sure our booth had an adequate supply of magazines, and answered your questions about subscriptions.

“They” say no one is indispensable. I suppose that is true, in one sense. We will hire another person to do the work Ginny did, so accounts will be billed, and payroll will be processed. But the office where that work is done will always be Ginny’s office.

Good-bye, good friend. We miss you.

Until next time,

Sometimes I am ashamed of my fellow journalists. Case in point: A cover headline in the November issue of The Reader’s Digest that reads, “The Vitamin Hoax: 10 Not to Take.”

Scare tactics. The article is written to sell magazines, not to inform the public about vitamins.

The Readers Digest is the most widely read publication in the United States. Most assuredly, a good number of your patients will have read that article — and some of them might ask you about it.

I can “hear” some of their questions based on this single article:

“Doctor, is it true that antioxidants such as vitamins A, beta carotene, E, and C can increase the risk of dying? Should I not take them?”

“Should I take a multivitamin, or am I throwing my money away? Will it increase my chance of getting prostate cancer?”

“Does vitamin C help ward off colds? The Readers Digest article said it offered little protection.”

“How much is too much? What happens if I take more than the RDA of some vitamins? Can too many vitamins hurt me?”

“How can I be sure that the vitamins I am taking have pure ingredients?”

“Which vitamins should I take? Are there some I should stay away from?”

A few years ago, I sat in on a teleconference on understanding research studies, conducted by Anthony Rosner, PhD, who was then director of research and education with the Foundation for Chiropractic Education and Research (FCER). I no longer have the notes I took, but I remember Dr. Rosner cautioning participants to not accept all research findings blindly, but to look at how the research was done. Some research, unfortunately, is biased, just as some writers (and their writing) are biased.

In the case of this article, I would recommend you read it yourself to decide if it is biased against vitamins. Then, I would suggest you brush up on the facts about supplements, including reviewing the latest research (including the studies cited by the Readers Digest). Keep in mind, though, Dr. Rosner’s advice on looking at the construction of the research studies.

It is unfortunate that the Readers Digest would revert to scare tactics to draw readers in. On the other hand, perhaps this is an opportunity to turn a “sow’s ear into a silk purse,” as the saying goes. Arm yourself with the facts and be prepared to answer questions — or even to bring up the subject of the Readers Digest article yourself, especially if you carry nutritional products and recommend them to your patients.

Until next time.

Blogging is not an activity that comes naturally to me. In fact, a year ago, I only had a faint idea of what blogging was. Today, however, I see blogging as a way to share with you some thoughts and observations that I would not be able to share in the magazine.

I love magazine publishing. There is something very satisfying about working with contributors, helping them polish their ideas so that readers can quickly grasp new ideas and information, and then finally seeing the finished product printed on paper. Every time an issue is published I get the same rush I did when I published my first article almost 30 years ago.

Although I get the opportunity to write for the magazine — including an editorial message in each issue — I find that the magazine can sometimes be limiting. There just aren’t enough pages to say what needs to be said.

That’s why this blog is important. I hope to share with you ideas and observations about chiropractic, business, or just life, regularly. Sometimes what I write might border on profound or at least serious; other times, it will be light.

A blog is similar to a column in a magazine, but it has one huge difference: The format and delivery of the magazine does not allow for instant feedback and interaction from readers. A blog does. If you want to reply to something I have written, or to an issue, you can do so, instantaneously. No waiting.

I hope you will comment — frequently. I am always interested in knowing what is on your mind.

Until next time,