I Made a Mistake

by William D. Esteb

I've always tried to do my best, perhaps to a fault. Between the flaws of perfectionism and procrastination, I’ve attempted to contribute to the chiropractic profession by creating communication tools to help explain, motivate and persuade patients to embrace chiropractic care. For the last ten years I was convinced that the best way to accomplish this was by basing patient explanations on the five components of the Vertebral Subluxation Complex.

I was wrong. I’m sorry.

I’ve come to realize that few patients were interested in learning about the implications of spinal kinesiopathology or the ramifications of any associated myopathology and the other fifty-dollar words that peppered brochures, videos and wall posters I helped create. My intent at the time was to help patients appreciate that chiropractic care was congruent with the “god” of science that so many worshiped. During the 1990s, this may have been an appropriate strategy for patient communications—the baby boomers weaned on Mr. Science may have found comfort in the terminology and the “complexity” that went with it. I’m sure some did.

Perhaps more important were the thousands of chiropractors who found the VSC helpful, as well as affirming, in describing the phenomena they witnessed with their patients. Whether it was the validation, or just the next new thing, the VSC was embraced by many in the profession.

Except those who didn’t embrace it.

Those, we attempted to win over with perfectly logical explanations: It’s documented. It describes the whole-body effects of improper spinal biomechanics. It overcomes the nonscientific image of chiropractic. It provides a structure for your report of findings. It makes a more powerful deposition. It uses the language favored by other mainstream health specialists. I had the rap down cold. It made sense. Get with the program! Can’t you see? VSC is the way to get chiropractic accepted and respected!

Only problem was, it didn’t. Sure, lots of chiropractors who feared that chiropractic was merely a philosophy appreciated the model. But few patients were interested. They politely watched videos. Nodded at the right times during reports. And even took the brochures handed to them by well-trained staff members. But it did little to produce an “ah-ha” experience or the epiphany necessary to change a patient’s behavior or produce referrals. (“Sounds like you have some histopathology; you should see my chiropractor.”) Not! Perhaps it was a necessary phase we had to go through.

Same with Subluxation Degeneration. Sounds scientific. Nine syllables worth! Using this complicated term with patients to describe the body’s adaptation process of depositing calcium to shore up malfunctioning spinal joints made it sound serious. It is serious. But is teaching patients a new vocabulary the most effective strategy for effecting patient understanding and inspiring referrals? Probably not. Instead, today I favor the phrase “Spinal Decay.”

Now what? Abandon VSC? Heavens no! It’s a great model, whether it has five components, seven components or twenty-seven components. It still appears to be the most complete model to come down the pike. Just don’t annoy your patients with it. Most patients aren’t interested. What do patients want?

Simple. We’ve made chiropractic too complex. Frankly, chiropractic is a simple idea. If the spine distorts controlling or monitoring nerve impulses (subluxation), it can change body function, both local and peripheral to the spine. Chiropractic care reduces subluxations and revives the patient’s healing ability. That’s it. Chiropractic is about releasing, restoring and optimizing what the patient brings with them to the office. Beyond that, you make chiropractic about you, not the patient. No wonder some chiropractors get upset by missed appointments or patients calling them by their first name. They’ve made chiropractic about control and management instead of freedom and self-responsibility.

With so many demands on people’s time, money and attention, it’s naïve to think complexity will breed respect or even better compliance. Simple things last. Complex things break down.

Natural. The boomers are coming. These are the folks who shunned polyester and artificial anything. In other words, get real. The patients who are increasingly showing up in chiropractic offices are interested in natural solutions. Fortunately, chiropractic is natural. But medicine is artificial. Why would you want to align yourself with (and use the language of) those who think health is about feeling good? Acceptance? Reimbursement? If so, you’ve signed your death warrant.

The public wants natural. Sure you’ll have to explain why it takes time to heal. Of course you’ll want to share other things a patient can do to assist their body with the healing process. And yes, you’ll want to explain the consequences of discontinuing care as soon as they feel better. But this would be a better use of your valuable time and energy than the self-indulgent reiteration of the contemporary research affirming the components of the Vertebral Subluxation Complex.

Different. Remember, patients don’t want chiropractic, adjustments or office visits. They want the effect of chiropractic adjustments. If they could get the effect some other way, they would. Most try. This usually involves a brush with representatives of the medical establishment. It is usually only after disappointment with a medical solution that patients seek chiropractic care. Clearly they want something different. So look different. Act different. Be different. Don’t want same. Want different.

This is where many chiropractors will part company if they hold the mistaken notion that patients have some deep reverence for doctors. Frankly, many patients resent having to consult a doctor of any kind. Don’t like the “healthier-than-thou” attitude. The emotional distance. The superficial or nonexistent examination. The impersonal recommendations. As a chiropractor, you have a tremendous opportunity to enhance the healing process when you help patients understand that the chiropractic approach is different.

Conviction. What do you believe? Is your body language congruent with your words? If the VSC and all the research affirming chiropractic has helped you become more confident, great. But if an occasional patient doesn’t respond to your care, do you doubt chiropractic principles?

Worse, are your recommendations or demeanor affected by what patients (or a third party) may think about you? Do you modify office procedures based on the fear that a patient will abandon you? Is your desire to be liked by a patient so b that you’ll bend the rules or abbreviate an exam? You many win the battle but lose the war. You may have produced a patient who likes you but doesn’t respect you. Patients want clarity, conviction and confidence.

Hope. Finally, the most important aspect of all: patients want hope. VSC doesn’t offer hope; it’s merely a complicated way of stating the problem. A fancy diagnosis can do little to enhance the patient empowerment that comes from saying, “We’ve found the cause of your problem and we’ve successfully helped a lot of people with the same thing.”

Patients aren’t spines or discs or headaches. Instead, patients are a mind/body. Ignoring this connection in favor of focusing on the spine because it’s the apparent cause of the patient’s neurological distortions is mechanistic and doesn’t enhance the healing process. True, adjusting the cerebral cortex is more difficult than adjusting the spine. But it is the organ that controls the healing process, patient follow-through, collections and even referrals.

The VSC appeals to those who seek organization amid the chaos and idiosyncratic desires of patients. But patients make decisions about their health emotionally. Research doesn’t produce new patients. Research doesn’t convince skeptical patients. And research doesn’t get patients well. Know the research. Bask in the affirmation that it brings. Enjoy the confidence it produces. But avoid the temptation to base your patient explanations on it.

Excerpted from
What a Patient Wants
Published in 2002
240 Pages
US $24.95

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