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The Buddy Barrier

How do you show up?Last weekend I completed another Debrief for The Conversation. With a half-dozen of these intimate gatherings under my belt, several themes are emerging. By creating a safe place for chiropractors to lower their guard and confront the issues holding them back, participants are able to discard some of the limiting beliefs standing in the way.

One such belief is related to the last couple of posts I’ve made here dealing with the adjustment. What it is and what it isn’t; what it does and what it doesn’t do. The second is a common strategy that some chiropractors use to influence patient behavior, showing up in their practice as the patient’s pal, friend or buddy.

Fixing the Boo-Boo

Based on what I’m seeing, it appears many chiropractors believe that the subluxation, that is, the malpositioned spinal bones revealed by radiographs, is the problem, and that applying appropriate forces along facetal joint planes is the way to make this particular type of “boo-boo” go away. Philosophically, this is pure symptom treating. It’s akin to taking a breath mint rather than resolving the dietary or dental hygiene issue causing the bad breath.

This is just as misguided as patients thinking that their painful symptom is their problem. Just as a headache or low back pain is a symptom, so too is a vertebra that has a distorted relationship with the one above and below it. If you want to carve out an especially frustrating career path in chiropractic, ignore all else and center your repeated interventions on getting patients to “hold” their adjustments. Ignore their inflammatory diet. Overlook their feelings of powerlessness or anger over being trapped in a dead end job. And be sure to look past their sleeping habits and financial stress. Simply pound on that malpositioned bone often and forcefully enough so it will submit to your notion of “normal.”

This trap not only disempowers chiropractors, but reduces chiropractic to a spinal therapy. A patient’s subluxation is a survival strategy. A patient’s subluxation is a defense posture. Simply put, subluxation is the body’s best shot at adapting to, or accommodating, physical, emotional or chemical stress.

If subluxation is the underlying cause of their ache or pain and the underlying cause of the subluxation requires something other than a thrust at the right time and place on their spine, or you don’t have the interest, training, time or tool (or insurance billing code!) needed to make the correction, you’re in a professional pickle. Concentrating solely on the “trauma,” while overlooking the “thots and toxins” (in the words of D.D. Palmer), is a recipe for frustration.

Friends Don’t Let Friends Have Subluxations

The other pathology that I’m seeing is chiropractors showing up as the “friend.” There’s a big difference between being friendly (recommended) and being their friend. Apparently, the thinking goes like this: get the patient to like you and then use this friendship to influence the patient’s behaviors.

Sounds manipulative to me. And exhausting!

Naturally, this approach to patient leadership places a tremendous burden on the doctor’s “emotional checking account.” It’s not a sustainable practice strategy and if it doesn’t lead to burnout, it produces an angry and increasingly bitter chiropractor who sees patients as problems—and attitude that isn’t especially helpful for promoting practice growth! Before long, the practice is either limping along in survival mode or on life support, heavily dependent upon the decreasing generosity of third parties.

The Solution

Interestingly, both issues share a common solution: becoming present to appropriate boundaries—identifying what’s yours and what’s the patients. Blurred boundaries are the source of suffering among all types of caregivers. It comes from attempting to be responsible (response-able) for things that you have little or no control over. Such as whether the patient shows up for their visits, whether your interventions successfully unleash the patient’s healing capacity, whether the patient will take an active role in their recovery, whether they will like you, whether they will get better, etc.

During this past weekend debrief in Denver, we had quite a conversation about these and many other facets of the doctor patient relationship. It was an incredible privilege to be sitting at the table. Thanks guys!

(A few openings remain for the next Conversation beginning October 19th concluding with the Denver debrief on November 17-18, 2007)

Comments (3)


I am in agreement with Dr. Russo here. Time after time I think patients will make the right decision about their health, but it never happens. Playing the role of lifestyle coach would be an ideal job, however as you have said before most patients don't value their health as much as I do. Without proof that lifetime or long term care will make them a healthier soul, most patients quit before the light bulb goes off,and it takes a significant amount of care before someone realizes that they do feel happier and healthier. The only patients I have seen this happen with are the ones with great (for Them) insurance and even then some just don't feel they have the time to visit our office on a regular basis. Where are these patients who want to adopt the chiropractic lifestyle? Most of what I see is patients wanting convenience whether financial or freedom from responsibility. Also, it would be nice to make a comfortable living without having to SELL, SELL, SELL!

This reminds me of the long conversations we interns used to have with Dr. Elmer (Bud) Crowder back at Palmer College. It's always about awareness; ours and the patients. Priceless as sharing time with a guy like Dr. Crowder is, experience was still the great teacher - assuming one is awake. It was still so easy in the beginning to try to be the "friend" and to take on so many responsibilities that were not mine to take on. Every encounter with every single patient is another opportunity: to lead yes, but also to release.

It is great to see that there are still people around who can and do facilitate such adult conversations. Thanks Bill.

Dr. Antonino D. Russo B.Sc. DC:

Hello Bill,
I can follow the process, but what specifically can a chiropractor do to achieve that end. Is it a mindset thing or a "here are some recommendations to do" thing? My concern is that if we leave "what the patient does" to the patient exclusively without providing solid recommendations to a workable care program, then we may lose the opportunity of providing them a viable route to health. It just sounds a bit too open ended though I do see and agree with the logic presented.

WDE: Yes, it’s a “headspace” thing and an “offering direction” thing. Stop kicking yourself when your intervention doesn’t work and look at the patient with the problem, not the problem.

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From September 19, 2007 11:56 AM

This page contains a single entry from the blog posted on September 19, 2007 11:56 AM.

The previous post in this blog was Monday Morning Motivation.

The next post in this blog is Dear Bill Take It Or Leave It Annual Plans.

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