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Willingness to Confront

confront.jpgThere seems to be quite a buzz in chiropractic about confrontation. As in confrontational tolerance; specifically the ability, willingness or emotional fortitude to volitionally elevate the tension in the doctor/patient relationship. When you Google “confront” you get synonyms such as to “oppose,” “accuse” or to “criticize.”

And this is somehow a desirable trait?

I’m guessing that people who advance the notion that practice success is the result of confronting patients are good at it. In fact, they are so good at it they can fill hotel ballrooms with those who lack it and apparently want it. It’s easy to look down one’s nose at those who lack certain gifts, whether it be organizational skills, intellectual prowess or the ability to bully patients into doing something for their own good.

And isn’t that really what confronting patients is all about? If you believe that the “ends justify the means” you can embrace all kinds of tactics that use your social authority or personal power to overrun the doubt, reluctance or financial resources of a patient. This is such an unattractive, reprehensible behavior I’m not sure where to begin. This is what it takes to be successful in chiropractic? Yuck.

Besides being the ultimate expression of mistrusting patients, using your power as a doctor to compel patients to act in a particular way is as pathetic as the comb-over neighbor for whom winning at tennis is so important he arranges to play the seven year-old next door who is unable to even return his serves. In short, you make the interaction about you, instead of the patient. So much for humble servanthood.

But that’s not all. When you have such a fundamental mistrust of patients and the decisions they make, I’m sure you reveal your misgivings in other ways. The most profound is probably a sense of isolation that comes from your healthier-than-thou mindset. You feel unappreciated. Misunderstood. Like the haranguing parent, the unreasonable taskmaster or the demanding boss, you tend to push others away with a self-righteousness that chills the air. You win the battle, but lose the war.

If the ability to confront is the key to practice, then how do you explain what the little man in India did that brought down the British empire? Or the effectiveness of Martin Luther King?

Turns out, what you resist, persists. Your resistance to the sovereignty of each patient and his or her free will choices actually serves to create more resistance. And resentment. When you insist on being the boss, you tend to attract people who want to be bossed. Which is a high stress practice whose size is limited by your ability to meddle in the lives of those who show up. It’s not exactly the stuff that prompts enthusiastic referrals or a celebratory return of inactives.

Confront evil. Confront a defiant teenager who lies. Confront your fears. But confronting patients is a luxury few chiropractors can afford.

Comments (7)


Greg Stanley addresses confrontation in more of a respect of doing what you need to do to be profitable. Usually it is turning the confrontation on the practice itself and doing things that may not be comfortable but are necessary, not trying to force the patient into what YOU want.


I am a little late on reading this, but I agree. Having just finished my sentence with AMC, I found no benefit in trying to strong arm the patient into comprehensive care. Let's face it, chiropractic is a great healing art, but no one person is the same and no one subluxation is the same. You cannot pinpoint exactly the timeframe for a condition to be corrected. It is a visit-to-visit/week-to-week thing in most cases, monitoring how the patient is responding to care. How can you say at the beginning that it will take "X" visits before you have even adjusted the patient and had an opportunity to see how the patient is going to respond to adjustments? I have to think of how I would want to be treated in a doctor patient relationship and being told that I was not welcome in the office because I did not follow all the rules, would send me right on down the road to the next guy.

I sincerely believe in Greg Stanley's philosophy of telling the patient exactly what they need and then CHEERFULLY giving them exactly what they want. If they want comprehensive care, great! If they only want pain relief, knowing that things will not be fixed and it will probably come back, great. If they only can come in once a week, great. The idea is to build trust and a rapport with the patient. This will lead the patient to let their guard down and trust you as a doctor and not just some guy trying to hustle more money from them than they are capable of or prepared to spend.


I think the hardest thing to confront is our own fear. For me it used to be telling the patient the whole truth from A-Z. Now I tell it like it is and let the patient decide if they want what I have to offer and it is exciting because most people want what we have to offer when we educate them on Chiropractic instead of try to scare them and confront them into care.

There are softer ways of teaching patients than confronting them... perhaps using socratic method to challenge faulty beleifs and incorrect assumptions about health. Patient: "That asprin really worked on that headache"
DC: "Do you think the asprin got rid of the cause of the headache or did it just mask the pain?"
Patient: "What do you think caused the headache?"

Not confrontational, yet thought provoking. There is no doubt that we need to help people think diffrently, but if we embarrass patients with confrontation you can bet that patient eventually will find a chiropractor that won't, namely me.


Dear Bill, I would have to respectfully disagree. While I am a firm believer in delivering what the patient wants, I also think it is our responsibility to tell them what they need. I'm sure that we all agree that it is our responsibility to base recommendations on need alone so whether it's the loud patient who knows it's a muscle and just needs a "crack" or a patient that looks like they can't afford this visit, let alone a course of care, confrontation of the issues and at times the beliefs of the patient is required to best serve the patient.

WDE: We agree on the "why" but apparently not on the "how." No problemo.

Tony Russo:

And how, and how. Anyone who's been a Chiropractor for any length of time has been to the "rah rah shish cume bah" seminars where such an attitude is preached wholesale. Though exciting, I have found that attitude not to work after 15 humble years of experience. In fact, there are a couple of skeletons, not many, who voiced just that. Very few though. I learned your lesson early on in my career. Bravo Bill.

Bryan Siegel, DC:

One of your most incisive and ever relevant posts yet Bill! You truly are on the pulse of what has been happening inside the trenches. A lack of trust and faith in the process as well as not allowing others to exercise their choices, which is their right to do, leads to more lack, distrust and frustration. Many have left the profession and many more continue to leave; a good portion of those entered into chiropractic to make a difference for others. It seems like you are the only one i see and hear of talking about the reality of what is happening in the profession. Thank you.

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From February 14, 2008 6:20 PM

This page contains a single entry from the blog posted on February 14, 2008 6:20 PM.

The previous post in this blog was Cat Food and Patient Dropout.

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