The Man in the Moon
by William D. Esteb
If it wasn't for the moon, we probably wouldn't have a space program. If all we saw when we looked to the heavens were the faraway stars, the effort to explore space probably wouldn't have been pursued so vigorously. The moon was far enough to stimulate the imagination, yet close enough to be attainable. Setting reasonable goals that push our limits, but are achievable, can serve to motivate and inspire. Goals that are too easy or too ambitious don't fully harness our energy or creativity.
This notion of "reachability" is also important when giving care recommendations. Without milestones and a sense of measurable progress, many patients give up or remain uninspired to pursue a doctor's lofty recommendations and truly benefit from optimum health.
The goal setting process and establishing appropriate expectations of the recommended care program is usually provided during the patient's report of findings. Patients, accustomed to overnight results from ingesting medicine, need to have their expectations modified lest they think chiropractic doesn't work if instant results aren't achieved. Providing achievable goals, giving patients ways of measuring their progress and assigning responsibilities, are key ingredients for giving effective instructions--which is essentially the purpose of a report of findings.
Richard Wurman, following up his book, Information Anxiety, has written Follow the Yellow Brick Road which he details the five important considerations when giving instructions: Giver, Taker, Content, Channel and Context.
Giver: Doctors presenting a report of findings must have a clear objective in mind for the outcome they want from this crucial interaction. Doctors concerned about whether they will be liked or fearful that their recommendations won't be accepted, begin with a strike against them. Similarly, doctors who begin their report suspecting that their recommendations have little chance of being acted upon, may end up sabotaging the communication, creating a self-fulfilling prophecy.
Often these and other attitudes that impair the maximum impact of their report are the result of "owning" the patient's problem. When a new patient has headaches, many doctors incorrectly assume that by accepting the case, the patient's problem is now their problem. And while you should convey compassion and a willingness to help, care must be taken so the patient knows he or she has responsibilities. Health restoration is as much (or more) the responsibility of the patient as the doctor. Assuming too much responsibility for the patient's recovery dramatically affects the effectiveness of the report and the patient relationship.
Taker: In our application of "giving directions" the taker is the patient. They are at the receiving end of the instructions affecting compliance. Ironically, many "givers" have difficulty empathizing with the patient and forget the personality-distorting effects of pain and discomfort, or the judgment-hindering effect of feeling powerless; or the fear-producing effect of anticipating the diagnosis; or the worry-producing effect of the cost of care; or the guilt-producing effect of spending so much money on themselves. The point is, standing in front of your X-ray view box, few patients have their normal faculties. That educated, middle manager with the low back problem may "look" like he is in full control but he probably isn't.
This doesn't mean that you should dumb-down your "instructions" to baby talk. It just means that a large percentage of what you say either isn't being heard, properly interpreted or remembered. The fact that most reports are primarily oral recitations is one of the biggest flaws of the one-time-report-of-findings approach to patient education!
Content: This is what has been the primary focus of management firms; what is said during the report. Sadly, many doctors "learn" a report and with the exception of the patient's name and health complaint, deliver pretty much the same report to every patient. Not only is this a lazy way of communicating to patients, but eventually the report is delivered without the appropriate body language, passion and conviction so critical to encoding the confidence and trust necessary for patient acceptance.
This fixation on scripted words isn't irrelevant, it's just superficial. I wonder how many times I've heard the story of the crusty old veteran doctor showing the same set of X-rays to every patient, growling, "You've got a bone out of place here and here. Now lie down and let's get started!" This may have worked for a previous generation of patients who cowered at the directives of anyone with a college degree, but not today.
Today, the foundation of any effective report of findings today must be the answering of four basic patient questions: What's wrong with me? Can chiropractic help? If so, how long will it take? How much will it cost? The mistake many doctors make is avoiding the financial issues of chiropractic care. Ignoring this matter, or divorcing it from the care recommendations, is a cruel joke played out in countless offices by doctors embarrassed by what they charge their patients. Or, afraid the patient won't comply because of the financial policy. Not that money should be the focus of patient compliance, but it shouldn't be overlooked. It certainly isn't by patients!
Channel: This refers to the medium used to transmit the instructions. Since most report of findings are largely oral presentations complimented by an occasional X-ray with obscure pencil lines and angle measurements, they overlook the best channels for making an impact. They are still relying on the narrow channel of an audio presentation or brochures containing an uninviting sea of gray type. Perhaps this worksfor the generation that grew up in the "theater of the mind" days of radio, but the internet has made most patients expect information to be easily accessible and personally relevant. Something better is just a mouse click away.
This suggests that video has a place in your reporting efforts. Not only has television made the public lazy, it's made them critical of amateur, homemade presentations. A fifteen second clip on America's Funniest Home Videos might be interesting, but a stiff, ten-minutes from a doctor behind his big oak desk is deadly.
Because the channel that is the richest and most memorable is visual, making your report more stimulating to the patient's eyes is your best bet at making your observations and recommendations understandable, memorable and more likely to be acted upon.
Context: The fifth component of effective directions is the context of the message. The challenge here is that most doctors have difficultly seeing their recommendations from the perspective of their patient. It's so easy (and wrong) to explain that their problem will require "three times a week for the first three weeks, then two times a week for the next two weeks, and then..." For starters, you don't have the foggiest notion how the patient will respond, how quickly the healing process will occur or whether the patient will modify aspects of their life necessary for recovery. Second, in the context of a patient's life, the recommendations you make have financial ramifications.
The most effective communicators help translate abstract findings and clinically based recommendations into concepts that are relevant and meaningful to the patient. Here, the use of metaphors and analogies that relate to the patient's occupation, hobbies or key values is critical. Effective communicators are constantly using word pictures, models and visual aids to help patients see their chiropractic care and the results of their chiropractic care in personal terms.
Giving directions to patients is not unlike the ability to give directions and delegate responsibilities to staff members. Come to think of it, doctors who have good patient compliance, also seem to have staff members who rally along side the doctor and almost instinctively know what to do. But it's not instinct. It's the doctor's ability to give clear directions based on the intended outcome.
Whether you're giving patients directions to your office, or your recommendations for care, offering landmarks and ways of assuring patients they're on the right course is important. "If you pass a large shopping mall, you've gone too far." Offer your care recommendations in bite-sized pieces with a clearly defined (and measurable) goal in mind. "At the next progressive examination in four weeks I want to see this improve by ten degrees..."
The notion of having to continually earn the right to render care to a patient is a new idea for a whole generation of chiropractors. The days of making sweeping recommendations at your report of findings spanning months and months of care (conveniently paid for by a third party) are gone for good. Yes, give them the big picture and let them know that some type of supportive, lifetime care may be necessary, but give them smaller, achievable goals that they can support both intellectually and financially. Otherwise, not only are you kidding yourself, you're over-estimating your patients resources and the value they place on their health.
Excerpted from
Beyond Results
Originally published in 1995
240 Pages
US $24.95
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