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The Key or the Car?

A common chiropractic problemDear Bill,

I've been to a couple of your seminars in the past few years and have always come away from them inspired. Recently I've hit upon a couple of problems. Firstly, I don't seem to be able to get patients to realize how important "their job" is and consequently they don't change their behavior or improve as fast as I and they would like. Secondly, I can't get the right approach when it becomes apparent that the patient wants to discontinue care - they want to run away before I can say anything!

I would be delighted to hear your opinion on these two issues.


Frustrated in Dorchester

Dear Frustrated in Dorchester,

Probably one of the reasons these two issues seem like problems is that you may be under the impression that you actually have some type of control over chiropractic patients! Once you accept that you are powerless over what patients do, these sorts of everyday patient behaviors will no longer cause anything more than a passing sadness or a bit of short-lived disappointment.

The first issue, patients not accepting their role as an active participant in the healing process, is to be expected when you consider the experience most chiropractic patients have had with “doctors” before meeting you. People tend to seek a professional only when their situation exceeds their own ability to resolve, whether it’s a leaky roof, plumbing problems or a nagging backache. When hiring an expert (you), the tendency is to expect the problem will be fixed with little more involvement from them than writing a check. You may be experiencing a similar phenomenon.

This may be compounded by how you’ve chosen to show up with patients. If you see yourself as a "fixer" you may be contributing to their illusion. It’s essential that you see yourself as nothing more than the ignition key that starts a car. The key merely unlocks what the automobile manufacturer engineered into the car. The key isn’t the hero, nor is the person holding the key. The hero is their body's ability to heal. Make sure every patient knows that.

You could begin calling patients the doctor.
“Hi Dr. Bob, good to see you!”
“I’m not the doctor,” the patient responds.
“Sure you are. If there’s going to be any healing, you’ll be the one doing it, not me.”
“Doctors don’t heal. Drugs don’t heal. Only you can do that. All I do is help remove interferences to your body’s own natural healing ability. That’s why this is a partnership.”

To make the point further, many practitioners will refer to our 10 Ways to Help Us Help You wall poster or report of findings insert.

As for patients who evade you when they’re making a break for the door to discontinue care, this too is common. It’s often because they sense that you have a greater commitment to their health than they do. You probably never hear patients say, “Hey doc, I think this is my last visit. It’s been great. Thank you so much!” That's because they fear if they were to announce their last visit, you would do one of two things:

1. Melt into a weepy puddle of disappointment and gnashing of teeth since you feel rejected, or

2. Attempt to talk them out of their decision, hard selling chiropractic and attempt to regain a commitment against their will.

Both responses are embarrassing for you and them. So it’s easier to make an appointment, and not show up. Reschedule, and then not show up. Become unreachable, and not show up. Until, finally, someone on your staff (after wasting enormous amounts of energy) breaks it to you, “Hey Doc, I don’t think they’re coming back.”

“What’s his number? I’ll give him a call,” you mutter with indignation.

Please don’t. Confronting the patient like a child who has neglected a household chore is, well, unbecoming. Investing all that attention in someone who doesn’t want to be in your practice is fruitless. (Not to mention it actually serves to attract more such people into your life!) Their behavior may be rude, inconsiderate and sabotage the results that you helped achieve, but there’s nothing you can do about it—except ruin the prospect of a future relationship with them.

Besides the emotional drain this costs you, it suppresses referrals from what should have been a delighted patient and virtually eliminates reactivations. Patients who have to slink out of your practice because they fear your reaction, will go to the chiropractor down the street before ever returning to experience their imagined, I-told-you-so finger wagging from you when they have their subsequent relapse.

Since there isn’t ANYTHING you can say or do to change a patient’s health priority, take a 10-20 year view. Show up each day in your practice in such a way that patients won’t feel a hint of shame or guilt if they don’t do what you would do. Sure, warn them upfront that it will be tempting to discontinue care as soon as they feel better, predisposing them to a relapse. Become the chiropractor they love to encounter unexpectedly in the grocery store. Be the chiropractor that they feel confident referring their friends to. Be the chiropractor they will return to, with their head held high, when they have their inevitable relapse.

I know. Countless practice management coaches will make you feel like a sell-out for not mother-henning the patient enough. And others will claim you'd be delivering inferior care by not being more assertive by imposing your will on patients. But the fact is, you are powerless to get patients to do ANYTHING. The sooner you accept that and embrace the role of a humble, nonjudgmental servant, delivering to patients what they want, so you can earn the right to suggest what they need, the sooner your practice can grow.

(If this makes sense and you have the habit of caring too much, you’ll thoroughly benefit from The Conversation.)

Comments (3)

Tony Russo:

This drives straight into heart of what we do. I exclusively only use your products Bill. And I don't see you calling me when you've noticed that I haven't ordered any more Report of Findings booklets. Or, "gee Tony didn't come to my Toronto Seminar like he vowed to do". The will comes from me. It is the inspiration that comes from you. Thank you for the inspiration. (And I'll try to get my ROF's going again)
"Too Busy".....rrriiight.

I remember 28 years ago when I was starting out, I had a pre-report audio slide show from a well-known practice mgt company. It included a picture of John L Sullivan in a fighting pose while I said," I'll fight for you or with you to get the care you need."

It was a high stress situation.

Now, using Mr. Esteb's products (mostly), I explain that there are different ways to use chiropractic and I'm here to explain your options, answer your questions, honor your decisions and do my very best. That being said, the best way to use chiropractic is to first relieve your symptoms (if any) then fix your spine and keep it fixed with Wellness Care.

If someone chooses relief care only, I say, "Great let's get started." And once they feel better, I tell them how much I've enjoyed working with them and if they wish to return, just give a call. And, if you haven't had any major falls or injuries, you probaby won't need new x-rays.

Saves a lot of stress. And they feel they can easily return.

John Jarolimek, DC:

Amen! I especially enjoyed reading the last paragraph, referencing practice management coaches' heavy-handed "Dr. Authority" approach, where patients are asked to commit to long-term recommendations before their first or second adjustment--when they are most vulnerable and easily taken advantage of. Although a patient's expectations about how much and what type of care is needed, and reality of what it's really going to take (from the doctor's point of view), may differ greatly, it's not my job to win the war of wills by using my position as "doctor," similar to the mentality in sports where home field advantage is used to communicate "Not in our house!" to the visiting team.

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From July 13, 2007 11:18 AM

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