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Medical Deprogramming

How do you create obedient patients?If you have any hope of making lasting change with patients beyond the relief of their most obvious symptoms (inviting a subsequent relapse) you must facilitate a patient’s belief change so they see chiropractic as a lifestyle decision, not just a short term diet for pain relief. I use the word facilitate because you don’t have the power to directly change anyone’s beliefs but your own. In the same way I cannot change your beliefs, you cannot change a patient’s. We can attempt to make a compelling case for what we think is a more enlightened perspective (as I’m trying to do here). And we can make it emotionally “safe” to abandon an old idea and embrace a new one. But like healing, it’s an inside job that you can’t do for someone else.

The beliefs I’m talking about are the prevailing cultural notions about health. This mass hypnosis causes our nation to waste trillions of dollars on symptom treating in the hopes of creating health. Without producing this shift in patient beliefs, your office is seen as part of vast medical-industrial complex in which you’re merely a spinal specialist with a limited, non-drug approach to headaches and back pain.

What is the best strategy for deprogramming the beliefs acquired from patients brushing up against the traditional medical model? What’s the most effective way to reverse the effects of watching an endless stream of “ask-your-doctor-about-_____” television commercials? How do you turn patients, who often see themselves as victims, into proactive partners in the healing process?

Those have been some of the questions I’m asking myself these days. So I looked around. Is there anyone else in the belief-changing business? And if so, how do they do it? Are there approaches chiropractors could adapt and apply?

Cult Deprogramming. Those who rescue adolescents from the clutches of a religious cult use several approaches. The first involves forcibly abducting the son or daughter who has fallen prey to the group. (That’s not going to work in a chiropractic setting!) This is followed by exposing the weaknesses and fallibility of the cult leader. Without a specific personality representing the medical mindset, this offers little traction for changing a patient’s beliefs. Anyone else?

Boot Camp. The various branches of arm forces are able to take young adults and in six weeks turn them into fighting machines who take orders without question. Long days, physical and emotional exhaustion, peer pressure and the threat of punishment (“Give me twenty!”) work well when combined with a deep desire to serve their country and a cause greater than themselves. Doubtful that a chiropractic boot camp for patients would grow your practice (or avoid a run-in with the board).

Scared Straight. This graphic 1978 film was designed to be shown to out-of-control kids by depicting the horrors of prison life. Yet, studies have shown that the high rate of recidivism suggested that this was not an effective way to reform the behaviors of at-risk juveniles. Does that mean that even less-threatening patient education videos are a waste of time? No, but it means that expectations of what a video can do must be tempered with reality.

There are probably other examples, but due to the volitional nature of the doctor/patient relationship, they offer few ideas worth adapting.

What if changing a belief about one’s health took years? What if personal experience (by suffering one or more relapses that are predicted in advance) was the only way to produce a new belief?

If that were true, you might want to acquire a few new beliefs of your own:

1. There’s little you can say or do to induce a patient to abandon an old belief. There is no magical script, no red slippers to click and no genie lamp to rub. Your job is to merely present a different explanation and offer a new meaning to what the patient is experiencing. After that? It’s their choice.

2. Expect first time chiropractic patients to dismiss themselves when symptoms subside. Because of the medical programming virtually every patient has received prior to showing up in your office, they have one goal: relief of their presenting complaint. When that happens, they’re likely to leave. That’s how they’ve learned to utilize health care. Make it easy for the patient to return when their symptoms return!

3. Focus your explanations on the differences between medicine and chiropractic. We only learn something new in relation to what we already know. Patients know germs, blood, drugs, symptoms, insurance and doctors. It’s crucial you put them into context from a chiropractic worldview.

4. Express your profound trust in patients to do what they think is right. In the same way the body may resort to a survival strategy (subluxation) that in the long term can have devastating effects, patients often do the same thing. Embrace a 10- to 20-year vision for the relationship. Their Maker granted them free will. Why won’t you?

5. Your office environment must be a living example of vitalistic principles. Do away with all the bone models in favor of talking about the integrity of the nervous system. Avoid the traditional trappings of doctors, such as the white lab coat, the emotionless aloofness and distant preoccupation. Make sure they know that they’re doing the healing not you!

6. Enhancing the possibility of reactivations is an essential practice-growing skill. After seven or eight years you should have little need for new patients and be enjoying a constant source of reactivations and referrals from previous patients. If not, you’re likely making patients feel guilt or shame when they try to discontinue care and rarely contacting your inactives and cultivating the dormant relationship.

If any of these beliefs seem foreign, even counterintuitive to your current beliefs, you have a taste of what it must feel like for a patient entering a chiropractic practice after a lifetime of believing that “health” care is merely symptom treating!

Comments (2)

Tony Russo:

This excerpt is the answer to every chiropractor's dilemma. I've been in practice 13 years now and have seen every passage mentioned above just ring very true to my ears. Clearly, it's frustrating, but as my daughter's piano teacher once said to me when I commented on how hard Grade 6 piano was, she said, "If it was easy, anybody could do it." Well chiropractic isn't especially easy. Just as the secret to getting rich quick is by doing so very, very slowly. So too, the secret to a full practice is slow and patient. The question really remains, "Do you have the patience?" If you don't, well then you have your answer. And don't feel bad either way.

Rick Humiston:

Hi Bill,

I can only speak for myself, so I will reveal that after 10 years in practice the issues with recommendations for patients has been very difficult for me (and still is). I know what I have been taught and have a good grasp of those things relative to clinical concerns and express to each patient what I can do to help. And as a person wanting to help people avoid medical mishaps, or getting them to see their health from a chiropractic perspective (because this is my own belief structure), I get caught up in the reasons why someone wouldn't agree with me. Then, if the patient doesn't agree, I begin the "let's make a deal" relationship" which is where I feel uncomfortable. Now I am in the realm of treatment versus general care for the spine regardless of symptom. How can I release my internal dilemma without losing a patient to another "DC" that treats pain, etc.?


WDE: Don't let a patient's doubt infect you with doubt. Patients want rock solid certainty. Only when you become clear of what is true for you and have the courage to plant your flag and stand for something, will these symptoms be controlled. Know who you are. Know what you do. Know what you don't do. And then, live it!

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From August 24, 2007 5:32 AM

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