Transition Protocol


By John Whitney

In this context transition protocol refers to the transferring of patients from one doctor to the other. It is most useful when a practice is being sold, but works equally well whenever a patient is being moved from the care of one doctor to another. Loyalty or the doctor-patient bond is what is at stake here.

It has been found that the patients acceptance of the new doctor is more pronounced when the outgoing doctor makes a significant endorsement of the incoming doctor. Additionally, the new doctor can wow or impress the patient by their knowledge of the case, especially the subtle, social aspects, (e.g. knowing their children's names).

Few patients have ever had anything more then a cursory work-up done; no matter what their problem. This assumption provides yet another tactic for the incoming doctor to win brownie points, by doing a very thorough, detailed examination. Generally speaking, patients very much appreciate in-depth physical examinations. One should try to leave the patient with the idea that you now know a great deal about their case (as evidenced by your thoroughness).

If the patient has been doing well under the care of the outgoing doctor it would be unwise to make a significant change in the protocol; even if your training bent motivates you to do otherwise.

If you strongly feel that the adjustive protocol should be changed, only make the changes after a detailed examination, so that a rationale is provided for the patient, as well as yourself.


The real key is you, and your ability to stick to a simple plan. Use the plan and enjoy the benefits: don't try to wing it.

Here's the plan:

1.   Notification:   The first thing to be done after purchasing the practice is to have the senior doctor send out a letter to both active and inactive patients. (see following sample Dr. Wonderful letter ). Be prepared, there could be thousands. You should also negotiate with the senior doctor to have all of these costs incorporated in the sale price.

The letter should state the reason why the chiropractor is leaving (i.e., retiring to Florida). It is also essential that the departing doctor proclaims that he/she could not entrust their records to just any qualified practitioner - only a very specialized one, and now the search is over. The letter should have a picture of the two doctors shaking hands. The main idea is to create confident expectations in the attitudes of the patients so that they are less resistant to seeing a new practitioner.

The letter should also encourage all patients (past and present) to come in and meet the new doctor. One week after the letter has gone out, the new doctor should send out a second letter (see following sample Dr. Buyer letter) praising the former doctor. Also, how fortunate they are to be selected to take over the practice. This basic idea here is to have the outgoing doctor endorse the incoming doctor as repeatedly as possible.

2.   Regular Patient Visit:   Both doctors enter the room and a short introduction is made. he new doctor says something to indicate knowledge of the patient's history, i.e.: "I understand you were injured at work last year". The patient will see that you care and are genuinely interested in his/her well being by the depth of your knowledge of them. Both doctors interview/palpate; outgoing doctor adjusts.

3.   Second Visit :   Both doctors interview/palpate, but new doctor adjusts using senior doctor's techniques, or whatever methods are familiar to patient. New doctor again mentions something in the case history or x-ray to indicate knowledge of the case.

4.   Third Visit:   New doctor goes in alone, interview/palpates and talks about the need to, "re-evaluate the case ", in order to bring the patients chart up to date. Don't call it a re-examination, but that is what it is.

Note:   If the patient has been examined within the last year, the new doctor may choose not to charge for the examination. Quite frankly, we suggest that you don't charge. If the patient has not been examined in quite some time, you should charge them, but perhaps not a full charge. The examination must be the best one the patient has ever had. It is paramount that an extremely detailed examination be made in order to impress the patient with thoroughness. This tactic is the lynch-pin to the transition.

5.   Report of Findings:   After the examination is completed, a Report of Findings is standard procedure. Recommendations will vary from continuing the present program, to a mini intensive care program.

When doing your ROF, be very laudable about the improvements that the departing doctor made; i.e.. he/she has done an excellent job. In fact, tell the patient the job was so good that you must modify the technique; i.e.. use modalities or not; a new therapeutic approach, or favored technique of the new doctor. At this point you can change the protocol technique and justify the new technique (yours) with the fact that the re-evaluation indicates the required changes.

It is essential that whatever changes you make, in the approach to this patient, be rationalized by the recent examination. What you don't want the patient to perceive is that the treatment or technique is being changed simply because you are, the new doctor and that is the way you happen to like to do things. The safest bet is to try to replicate the approach, technique, or treatment followed by the outgoing practitioners as much as possible. This is where the patients confidence or loyalty gets transferred.


Doctor Wonderful Letter: sample only (sent to patients by seller )

Dear Patient:

For some time I have been contemplating (my retirement, moving closer to my family, getting away from my family, moving to a warmer climate, becoming a hairdresser). My greatest concern has been in finding a replacement; someone who is competent and compassionate, someone who I feel will be as concerned about you as I am. Frankly, I've searched high and low.

Persistence pays. Recently, I met the person that I have been looking for. After a little persuasion and an explanation of my needs, this young doctor has agreed to take over for me. She has been very busy familiarizing herself with your case history as well as the case histories of my other patients.

The wonderful thing about youth is the vigor and enthusiasm. I'm happy to report that the new doctor displays a maturity and judgment not often associated with someone her age. I've made a good choice. You'll love her.

Dr. Mary Smith is the new doctors name. Dr. Smith's techniques and general approach is remarkably similar to mine, but she also brings state-of-the-art technology and fresh, new ideas. Chiropractic is developing much faster these days.

Please accept my invitation to make an appointment to meet Dr.Smith now.


{use this (next part) only for your inactive patients.}

P.S. If you present this letter to our receptionist, there will be no personal charge for your next office visit.

 (To be sent by the new owner to all of patient base of newly purchased practice, approximately 10-14 days after the Dr. Wonderful letter.)

Dear Patient

As Dr. __________ has informed you, he has decided to (retire, move to Guam, become a poet) and I will be assuming his practice.

The purpose of this letter is to present my credentials and encourage you to feel perfectly at ease with me in coming into the office.

I recently moved here after spending the last four years in Davenport, Iowa. I was associated with the Palmer Clinic in that city and the experience was invaluable. We chose this town because my wife and I fell in love with the place. It looks like a wonderful area to raise a family. After talking to (Dr. Seller) I knew this was where I should be.

While at the Palmer Clinic, I was engaged in studying various techniques and researching methods to accelerate the healing process. I passed my clinical proficiency tests with flying colors and acted as a consultant to other doctors in the clinic. The methods I studied and the research engaged in lead me to develop a strong desire to develop a family practice.

I am a member of the Alpha Beta Kappa honor fraternity, past president of the Palmer Clinic Research Foundation, a member of the International Wellness Association, the American Wellness Association, the Ontario Chiropractic Association and the Kaiser Permanente Research Foundation.

The methods I use are gentle, to keep the patients comfort upper-most in our therapeutic considerations. Our extended hours and easy payment plans are designed to make compliance to a program, easy to follow. Although some may consider our advanced techniques high tech, nothing has been sacrificed in maintaining high touch.

If you haven't been in for a while, I invite you to drop in for a complimentary update and consultation. If you are a regular, I look forward to seeing you at your next appointment.

My personal philosophy is that we will not only provide relief for your discomfort, but coach you to prevention and high level wellness.

I sincerely look forward to meeting you.

Yours truly,

(what you don't want to say is that you are a new grad. Nobody wants to go to someone who lacks experience)

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