Patient Education or Patient Teaching?
by William D. Esteb
It's generally accepted that one of the most essential nonclinical responsibilities of today's chiropractic office is a firm commitment to patient education. Few doctors enjoy the often tedious and repetitious nature of patient education, but most offices like the effect of patient education: better patient follow-through, more kept appointments, more referrals and even better clinical results. But most patient education overtures are largely ineffective. And this comes from someone whose career for the last 20 years has been based on creating chiropractic patient education materials!
Most of what passes for patient education is merely patient teaching.
The distinction is more than semantical. Teaching is an "outside-in" process. An individual stands before a classroom (or a patient) and pours forth his or her perspective on this or that, and the student takes notes to capture the pearls of wisdom. This describes the typical public school classroom in America since about 1870. It is a fairly efficient and controlled method for disseminating data, but it's just teaching. Little of it sticks. Just think of all the classroom hours and postgraduate seminars you've attended. Worse, think of all the information that you've forgotten!
Same with patients. Teaching is what most patients experience in chiropractic offices. Standing at the X-ray view box, giving patients a treatise on proper spinal curves and disc spacing, rarely changes patient behaviors--the intent of most patient education overtures.
Education is different. Education is an "inside-out" phenomenon. It comes from the root word meaning "to draw forth." For example, each of us was taught not to touch the hot stove. But it wasn't until we touched the hot stove that we were truly educated. It changed our perception. It changed our behavior. It made an impact on us far greater than any "outside-in" words from our caring parents.
Sometimes true education is painful.
But education is a beautiful thing, especially when it occurs in a health care environment that has such a potential for dramatically improving the well-being of patients. This we can agree upon. However, it is the methodology of creating this change that may be revolutionary: Ask more questions.
Socrates had it right--that the true educator was one who could be the "midwife to a process of an individual becoming self-aware of the truth." It is from this realization that we acknowledge the Socratic learning method, which is fundamentally about asking questions. When you ask a question, something quite remarkable happens. Questions draw forth. Questions elicit new synaptic connections. Questions peel back the layers of the onion to expose the truth. Questions change the world. Answers come from the inside out. Answers that can serve to bring unconscious beliefs to the surface of self-awareness.
Before exploring some of the questions you may want to add to your repertoire, realize that how you ask these questions can dramatically affect the value and quality of the answers you get. List some of these questions on your admitting paperwork, and you may miss reading the subtext revealed by the patient's body language. Overload the patient with too many questions or assume the role of a prosecutor badgering an uncooperative witness, and your results are sure to be counterproductive. Instead, realize that patients are usually unaccustomed to being asked these types of questions and may feel vulnerable or ashamed that they don't have better answers. Yet it is this emotional response that can produce the cognitive dissonance which spurs patients to seek out information, ask better questions, stimulate curiosity and invite you to teach them. So, rather than adopting some hard and fast rule imposed on every patient, understand the philosophy and rationale behind these questions so you can detect the subtle clues that tell you when the patient has had enough!
Here are a few questions you might consider adding to your new patient routine:
1. So tell me, what do you think your problem is?
2. What other methods have you tried in an attempt to solve this problem?
These are questions designed for the initial consultation and the early stages of care. They are questions that encourage patients to divulge their beliefs and the way they think. Moreover, they create opportunities for you to listen--something patients find very attractive.
3. When you get home and you're asked, "What did the doctor say?" what are you going to say?
4. How do you describe what we do here to others?
These are powerful questions to ask patients to find out how effective they'll be at referring others.
5. Why do you think it's called the germ theory?
6. What's your theory about what causes cancer?
These are questions that few patients have been asked. Reserve them for patients who won't take your questioning in a confrontational manner. Ask them in a light, "I'm taking a survey today" tone of voice.
If patients should come up empty-handed, which is likely, avoid the temptation to fill in the blanks for them, spouting your chiropractic dogma! Asking a question doesn't automatically give you the right to answer it for them. That's condescending and disrespectful. Instead, let patients mull it over. Your patience will be rewarded with many patients, days or weeks later, who turn the table, asking you the same question. Now you have permission to spout your theory. But only if asked!
Whether conscious of it or not, every patient has a model or a "story" that they use to explain the most obvious aspects of human physiology. Some patients have a very sophisticated model that is accurate beyond their formal training. Others cling to a simplistic understanding that is based on fear and myth and even lies that they were told as children. When you adjust a patient's spine but ignore these often unspoken beliefs, you do patients a great disservice. By allowing superstition to prevail, you keep them in bondage and thwart the healing power of the mind/body connection.
You practice in a living laboratory. Patients come and go. Most get what they came for, and a few even stay for the chiropractic lifestyle that you and I enjoy. And while every patient enters your office with a different value on themselves and their health, it is the process of asking questions and genuinely being interested in the answers that can give you great insight into what it will take to move each patient a little closer to appreciating the significance of chiropractic.
What a Patient Wants
Published in 2002
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