The Biggest Lie in Chiropractic

by William D. Esteb

The only tried and true way to grow a practice is with patient education. There are countless ways to build a practice (outside-in), but patient education is the only way I know to grow (inside-out) a practice with cash-paying wellness families.

You already know that producing great results doesn’t grow a practice, nor does being especially deft at your adjusting technique. Other than patient education, the only way to grow a practice is to have a charismatic personality, coupled with high self-esteem and the ability to confront patients, which eliminates the vast majority of chiropractors. If you lack these “soft” skills, use patient education to attract and keep patients, but not the kind of patient education you’ve been using!

What You’re Up Against

I’ve been receiving chiropractic care since 1981, hiring and firing nine chiropractors in the process, and at last count, spending more than $36,000 (cash) for my nonsymptomatic care. Here’s what I see:

1. Most chiropractors have a short-term vision of the future. Is this due to the relatively quick response most patients have to chiropractic care? Is it the billing cycles of insurance companies? Or is it a pervasive low self-esteem that prompts chiropractors to live beyond their means, resulting in financial pressures and a hand-to-mouth existence? Regardless of the reason, most patient “management” tactics seem to produce short-term results at the expense of long-term patient relationships. It’s tragic how many chiropractors, even after more than ten years in practice, have a burgeoning trophy case of inactive patient files and an unquenched appetite for new patients.

2. Patients bring a symptom-treating mentality with them. By the time most patients succumb to consulting a chiropractor, they’ve spent their lives acquiring our culture’s notion of what health care is, which is largely about symptom-treating. In fact, most patients equate being healthy with looking good and feeling good. Daily, patients are assaulted with symptom-treating pharmaceutical advertising and a “path of least resistance” approach to living that make the notion of regular chiropractic care seem foreign and strange. The closest model to which they can relate is regular visits to their dentists, and they occur only once or twice a year. Many chiropractors suggest ten times as many annual visits!

3. Patients rarely begin care wanting their world view changed. Few patients call your office asking for an appointment in the following manner:

“Hello. For 52 years I’ve been misled by the cultural notion of what health is, and I‘m wondering if I could come in to meet the chiropractor to see if she could guide me into a more intellectually honest view of health, and coach me on the changes I need to make so I can fully optimize my human potential.”

You don’t get calls like that, because most patients simply want to have their symptoms alleviated so they can get back to something they find far more important than their health. Most aren’t interested in the underlying cause of their problem, how long they’ve had it or why they should continue their care after they feel better. Oh, they give you a “head fake,” nodding at the right times to convince you that they’re listening, but their intention is quite different. (Review the number of inactive patient files of head nodders if you need proof.)

4. Most chiropractors are too invested in patients embracing chiropractic. When you require outside validation, whether from an insurance company, HMO or patient, you’re in bondage. Sure, explain the chiropractic paradigm in a compelling way to a germ-fearing, blood-focused, drug-taking mechanistic patient. However, avoid demanding that patients bow down to the ADIO shrine beneath BJ’s picture in your office. Consider how you felt when you encountered overzealous anti-abortion advocates, gun control enthusiasts or especially determined life insurance salesmen. It’s unattractive and doesn’t advance your cause.

5. Patients don’t “get” chiropractic on their first exposure to it. Few patients, if any, embrace chiropractic as a way of life the first time they consult a chiropractor. Consider everything you’ve tried—videos, brochures, lectures and mini-radiographic seminars you call a report of findings. After all that, patients usually don’t go home, flush the contents of their medicine cabinet down the toilet and bring their families in to be checked! Instead, they go through episodes of starting care and stopping care before they “get it.” Sure, there are exceptions, but take an inventory of your once-a-monthers. Bet they had several brushes with chiropractic before they settled in to their current schedule of routine visits. That being true, show your videos, hand out your brochures, give your reports and plant some seeds. Just don’t slit your wrists when they feel better and leave!

6. Creating a safe place to fail is essential if patients are ever to return. You’ve explained that they have a problem that’s likely to require ongoing supportive care for the rest of their lives. And you’ve explained it’s their job to decide how much chiropractic care they want. And you’ve warned them not to blame you or chiropractic when they have their inevitable relapse. And you’ve assured them they’ll be welcomed back without an “I-told-you-so” when they do return. Even better, you’ve opted for a polite phone call and a postcard when they start missing appointments, rather than forcing them to assume a new identity in the federal witness relocation program to avoid your pathetic effort to keep them under care. Congratulations, you’ve created a safe place for patients to fail.

Why Patient Education Doesn’t Work

Most chiropractors overlook or ignore this reality because they’re “on fire” for chiropractic. Foaming at the mouth, and with a glint of wildness in their eyes, they attempt to inject patients with their “above-down, inside-out” catechism, their “the-power-that-made-the-body-heals-the-body” mantra and the proclamation that subluxations (never heard of them) are the Silent Killer. If patients even so much as mention a symptom, or how they feel, they’re either brushed off or severely reprimanded. Here’s the truth:

1. Patients do what they do because they believe what they believe. The biggest lie in chiropractic is, “If patients knew what you knew, they would do what you do.” Patients know they should be coming in. When patients act in ways counterproductive to their health, they’re merely acting on a conscious or unconscious belief. With clarity of your own beliefs, it’s tempting to discount theirs. Only problem is, their beliefs control compliance, retention and referrals.

2. Changing patient beliefs is the only hope of changing patient behaviors. Attempting to use your words like drugs, “injecting” chiropractic into a patient’s cerebral cortex, may be satisfying, but it doesn’t change their beliefs. Oh, they nod, but that’s what they think it will take to get you to stop yakking.

3. Patients do the belief changing, not you. If all it takes is spouting one’s beliefs, then Rush Limbaugh callers would have long ago turned him into a flaming liberal. Pushing your beliefs onto someone else produces an equal and opposite effect. They push back. In the process, they become even more invested in their beliefs. You may have noticed this at family gatherings when the subject of abortion, gun control or other equally sensitive topics come up.

4. True patient education has the hope of changing patient beliefs. Most of what passes for patient education is merely patient teaching (rhymes with and sounds like preaching). True patient education can occur when you pose questions. It’s not what you tell a patient that makes the difference, it’s what you ask. By asking questions, you help patients identify their beliefs, question their beliefs and test their beliefs. Only then is there any hope they’ll abandon their old beliefs and embrace yours.

How to Have More Fun

Sustaining outside-in solutions requires a continual source of energy. Whether it’s keeping up a regime of drug therapy, constantly reminding your teenager to pick up his room or motivating patients to continue their care, outside-in approaches depend on the more energetic to raise the level of the less energetic. This doesn’t work. The same lie has compelled our government to squander billions of dollars in an attempt to eliminate poverty. Forty years after the well-meaning “Great Society” initiatives, we still have the same amount of poverty.

Instead of wasting tax dollars, you’re squandering your time, attention, energy and passion. No wonder so many chiropractors are in some stage of burnout! Unrewarded effort does that.

Here’s a healthier strategy: Take on a 50-year, or better yet, eternal vision for your practice. See headaches and back pain merely as God’s way of bringing strangers into your sphere of influence. Explore the beliefs that patients have about their bodies, their health and their futures. Plant seeds of doubt and offer a new explanation that is nerve-centered and cause-based. When patients reject your model of health and healing, love them anyway. Thank them for the opportunity to serve them so they leave with a good taste in their mouths. Keep in touch via newsletters, postcards, birthday cards or email so they feel part of your “tribe” even though they aren’t under active care. When they suffer the inevitable relapse and return to your office, water and fertilize the seeds you originally planted. Repeat as necessary.

Later, when you look back on your career, you’ll marvel at the fun you’ve had, the lives you’ve touched and the difference you’ve made. Gosh, wasn’t that your reason for becoming a chiropractor in the first place?

Excerpted from
Connecting the Dots
Published in 2005
240 Pages
US $24.95

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