What They Don’t Teach in Chiro School — Beyond Adjustments Roundtable
Show: Beyond Adjustments | Episode: 45 | Date: 2025-10-01 | Duration: 50min
Dr. Justin Dick joins the Beyond Adjustments roundtable to discuss patient retention, communication, clinical decision-making, and the real-world practice lessons chiropractic school does not cover. Season 1, Episode 45.
Topics Covered
- Why chiropractic patients drop off after visits 3–4 — and how to counter it
- Communication mistakes that reduce patient adherence
- Translating complex concepts like proprioception and neuroplasticity to patients
- When to pivot from protocols and personalize care
- Business mindset shifts seasoned chiropractors wish they had learned earlier
- Balancing evidence-based care with clinical intuition
Episode Transcript Excerpt
HOST (Amin Said): Dr. Dick, let’s start with what you’ve seen in practice. What is the single biggest communication gap you’ve encountered with patients?
DR. DICK: The gap between what a finding means clinically and what the patient understands it to mean. I can show a patient their X-ray, measure a 35-degree Cobb angle, explain that this is a moderate curve with documented progression — and they leave thinking it’s no big deal because it doesn’t hurt yet. Pain is the language patients understand. Structural findings are the language clinicians understand. Our job is to bridge that.
HOST: What do you wish someone had taught you in school?
DR. DICK: That the clinical work is 50% of the job. The other 50% is communication, documentation, and building a referral network that understands what you do. I spent my early career building clinical skills. The practices that grow are the ones that can communicate what they do — to patients, to other physicians, to attorneys, to researchers. I publish research partly because it forces me to articulate the clinical rationale in a way that a general practitioner or attorney can evaluate.
HOST: The patient drop-off problem — what’s actually driving it?
DR. DICK: Expectation mismatch. Patients come in expecting pain relief. The care plan is delivering structural correction. Those are different timelines and different metrics. When patients feel better at visit three, they think they’re done. We have to set the expectation from visit one: feeling better and being structurally corrected are not the same outcome. We’re building toward a documented, measurable structural change — and that takes time.
Frequently Asked Questions
Why do chiropractic patients commonly drop off after visits three and four?
Patient drop-off at visits three or four is almost always driven by expectation mismatch. Patients enter care expecting pain relief. The treatment plan is delivering structural correction. Those are different timelines and different metrics. When patients feel better at visit three, they think they are done. Setting expectations at visit one — that feeling better and being structurally corrected are not the same outcome — is the single most effective retention strategy.
What do experienced chiropractors wish they had learned in school?
That the clinical work is 50 percent of the job. The other 50 percent is communication, documentation, and building a referral network that understands what you do. Early career chiropractors often focus exclusively on clinical skills. The practices that grow are the ones that can communicate their value — to patients, to other physicians, to attorneys, to researchers.
How do you explain complex concepts like neuroplasticity to patients without overwhelming them?
The key is connecting clinical concepts to what the patient already understands about their own experience. Rather than defining neuroplasticity, ask the patient what changed in their body after a previous injury — they already know the nervous system adapts. You are giving them the clinical name for something they have personally experienced. This builds understanding and trust simultaneously.
