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Terms of Commitment

commitment.jpgI’ve asserted that sloppy language is a sign of sloppy thinking and sloppy thinking produces a sloppy practice (and life). Chiropractors sloppy with their own language are often unable to detect the subtle clues and nuances in a patient’s sloppy language. Language that not only predicts their behavior, but reveals their lack of commitment.

Combine sloppy languaging with poor listening skills and you have a practice that never gets out of first gear. Such practices are a constant struggle, rife with superficial relationships and only rare glimpses of the deep, personal satisfaction that was promised by helping others. All this self-effort produces an emotional drain that makes practice burdensome and leads to burn out.

Consider the following exchange between a chiropractor and a new patient during the course of a report of findings:

“Do you really want to fix this thing so it doesn’t keep coming back?”


“Does the care plan I’ve laid out make sense to you?”


“Are you prepared to do your part by following our suggested home care procedures?”

“Of course!”

“If we help you with your headaches, would you feel comfortable telling others about our practice?”

“You bet!”

“If you can’t make one of your visits, will you call Barbara and let her know so we can reschedule and keep the momentum of your recovery moving forward?”


“And finally, we hold seminars for our newest patients that help them save money, get well faster and avoid a relapse. It lasts a little less than an hour and our next one is next Wednesday evening at 6:00 PM. Can I count on you to attend?

“No problem.”

If portions of this imaginary scenario sound familiar and you can’t see the poor patient follow through that the patient revealed, before reading further, please reread the interchange above. Now, can you see what’s missing?

Chances are you were drawn to study the words of the chiropractor. “Oh, that’s a great way to say that,” you may have thought. “Never thought of wording it like that,” you may have noted. “I’m going to start asking it that way.”

True, the mythical chiropractor in the example above uses clear, precise and direct language. But that’s not the significant part! It’s the language used by the patient that’s so revealing. At first glance, it appears the patient is on board. But dig deeper and you’ll find one important word missing from all of the patient responses. The word?


Think about it. Sure, absolutely, of course, you bet, certainly and no problem all sound as if there’s agreement. But each one falls short. Each one is a "dirty yes." It leaves an out. It permits an excuse. It reveals that there are one or more barriers to their full commitment. Overlook this, and you’re needlessly surprised later by half-hearted compliance or unexplainable drop out. When you hear these “less-than-yes” responses, you might want to ask,

“What are some of issues or concerns that might stand in the way of you being able to fully embrace our recommendations?”

That’s when you may learn about the skeptical spouse, the financial pressures at home, the transportation issues stemming from your three-times-a-week visit recommendations or other barriers the patient has already accommodated (and revealed if you were listening) in his or her “yes-like” answer.

There may not be solutions to their challenges. However, you’ll discover a new level of clarity when you acknowledge that “sure” doesn’t mean “yes.” In fact, it rarely means yes!

Comments (5)

Mike Headleee,D.C.:

This is a super reminder to live consciously. I am guilty of not being 100% present all of the time and then wondering why things didn't work out the way I had planned. Thanks for the reminder to pay attention to what everyone is saying. As the saying goes we have two ears and one mouth so that we can listen twice as much as we talk.

Although the patient is not quite saying yes, I still beleive it is important for the to let the patient know that part of the healing process is their responsiblity, and if they choose to shirk that responsiblility the only person that will pay for that choice is them. Some patients will not change their long term health ideas without many exposures to the true way to achieve health, this does not mean we should give up trying to teach, on the contrary we should use every opportunity to teach. Some patents will embrace this, some won't, but this does not change our roll. Even though the patient above is just trying to get through the ROF and mabie does not intend to follow through with the things she kind of committed to, she still understands that there are some things that are her responsiblity and if she does not do these things and does not get the desired results then the only person she has to blame is herself.... of course if her only goal is to "make the pain go" then this is very easy and does not require going to the seminar, making all her appointments or telling her friends. The patient excited about participating in the process will do all of the above. Chiropractors that are not inspiring their patients about the care should not expect people to "follow orders" just because they are the "Doctor", this does not fly anymore (at least where I live). The excited patient will do the things you recommend because they want to, not because they feel they have to.

Tony Russo:

How many lost commitments have trickled through every Chiropractor's hands by accepting an "almost" yes? A good one I've heard was, "Doc, I'll do anything you recommend, as long as you make this pain go away." Then I "make the pain go away". And then he's gone. Why? Because he did exactly what he said he was going to do: "do anything I recommended AS LONG AS...until...the pain goes away". Been there, done that, got the T-shirt for it. Right on Bill. I guess we just gotta be more mndful of what we're saying and what they're saying. Sound like a pain in the rear? That's why we chose Chiropractic.


As you predicted, I was drawn to the D.C.'s words. Upon further reading, I continue to interpret the patient's "yes-like" responses as "yes" answers. I'll have to give this further consideration to see if I can discern the difference.

Talk about clarity!
In our attempts to have our recommendations accepted by the patient, we take any sign of agreement and turn it into what we want. Validation. I have come to learn (with help from Patient Media) that patients are in control of their health. Not me. I must try to remember, I serve the patient and not control the patient.

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From February 15, 2008 8:29 AM

This page contains a single entry from the blog posted on February 15, 2008 8:29 AM.

The previous post in this blog was Willingness to Confront.

The next post in this blog is Monday Morning Motivation.

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