Could Your Chiropractic Referrals Be Trashed By Referral Backfire Effect?

April 10, 2013

Could Your Chiropractic Referrals Be Trashed By Referral Backfire Effect?As a chiropractor, I'm willing to bet that you depend at least to some degree on referrals from patients and other professionals to attract new clients to your office. One frustration you may have is that some people tell everyone they know about the excellent work you do to help improve lives, and others don't refer anyone to you.

A study published in the International Journal of Research in Marketing took a look at how referral success and failure are tied to self-identity and confidence.

The authors of the study found that when a person gives advice to others but that advice is not accepted, the advisor is likely to become close-minded to accepting advice from others, too. In their report, the researchers called this the "referral backfire effect." They hypothesized that the reason this referral backfire effect happens is because people suffer a threat to their self-identity when a referral fails.

The analysis went on to explain that when the referral fails, the referring person may feel he or she has little expertise in the area of advice. If that happens, according to the researchers, the person's ego fights back the identity threat by internally self-affirming, rejecting others who give advice or referrals to repair their own self-esteem.

What would the referral backfire effect look like at your chiropractic office? Let's say you have a patient who you have been helping for several years with her low-back pain. She repeatedly tells you how you have changed her quality of life; she has even linked to your Facebook page on her own timeline. When her brother complains about his back pain, she is quick to give your name and direct him to your chiropractic website. A week later, she asks her brother about the referral, and he says he decided he didn't need chiropractic treatment. Or maybe he went to his primary care doctor and got a prescription. Or maybe he even googled "chiropractor" and just picked one randomly off the Internet. Whatever the reason for the referral failure, your patient now feels a direct hit to her ego. Her brother has treated her like she doesn't know anything about back pain treatment. Her valid experience with her own back pain and chiropractic treatment have been discredited, and this threat to her ego could create a backlash. To boost herself up, she begins to trust only herself. So when you recommend a massage therapist, she may reject your referral in turn.

Conversely, if one of your potential patients is experiencing an identity threat associated with referral backfire effect, he may not take the advice of another happy patient of yours to call your office for an appointment.

While this marketing theory is an interesting one, there may not be much a chiropractor can do when the referral process hits a snag and you're never given the opportunity to work with potential patients. All you can do is your very best work with every referral you are given the chance to meet and treat.


Claus B, et al. The referral backfire effect: The identity-threatening nature of referral failure. International Journal in Marketing 2012; 29(4): 370-379. doi: 10.1016/j.ijresmar.2012.06.004.