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guilty.jpgThe trial ended yesterday. It involved stalking, breaking a restraining order, a childhood romance and the use of psychotropic drugs to control delusions. The defendant served as his own attorney, ostensibly so he could cross-examine the witness he had been illegally stalking!

Messy stuff.

Throughout the testimony, I couldn’t help but notice that most of the problems were caused by misinterpreting what others were saying and doing. Second guessing what others mean, or creating little stories to explain this or that, seems to be our nature. Naturally, there’s a sizable difference between misinterpreting the action of a patient who discontinues care without warning, and misinterpreting a restraining order requested by the 9-year old neighbor girl who now, thirty years later, has her own family and children!

Nevertheless, both scenarios are pathological. It’s merely a matter of degree.

When patients choose to ignore your recommendations or discontinue care, it’s not an attack, it’s not a vote of “no confidence” and it probably has very little to do with you. But there’s a strong pull to make it about you.

“What did I say wrong?”
“What should I have said?”
“What should I have done differently?”
“How can I avoid this in the future?”

If you find yourself frequently being sucked into this delusional state, realize that not only is this line of thinking unhelpful, it actually creates a form of tentativeness and approval-seeking that patients find off-putting. Equally distasteful is when you attempt to overrule their free will, using your social authority to impose your recommendations for continued care. Are you inclined to call the patient when told by your staff that a patient has announced that they’ve had enough?

This form of retaliation is a sign that you have either mistaken the amount of influence you actually have, or falsely believe the patient’s confession of “I want fix care” extracted at the beginning of the relationship was to be believed. Your call is rarely “market research” or motivated by an authentic desire to improve your procedures. Instead, it’s about you either needing closure or worse, a pathetic attempt to talk the patient out of their decision. These, and several related issues, are sure-fire ways to suppress referrals and virtually eliminate reactivations. This creates the new patient problem you have. Which prompts the calls. And so it goes.

Exhausting and unsustainable.

It’s not about you. Never has been. You can make it about you if you wish. Just remember that if you won’t discipline yourself, something or someone else will. That’s what I and the other 11 jurors did yesterday. Guilty on all seven counts.

Comments (4)

I agree with the majority of comments here. The patient should be the one making decisions about their health.

This does not excuse us from the duty of patient education. If we are not making ourselves available to educate patients on health and chiropractic then we are doing something wrong.

The challenge of patient education can and should be met with a moderate investment of the doctors time each week, by scheduling new patients at the same time each week and giving a seminar.

In our office we do two days, one every other week, to give patients the maximum opportunity to get educated. After we have done our best to educate the patient the ultimate decision is then up to them.

The obligation of the patient to take responsibility for their health is independent from the responsibility of chiropractors to educate on health and chiropractic.

Dennis Dilday:

It's a very freeing feeling when you get it that it isn't personal. And so much more difficult to really experience that than to say it.

I took it all personal for years and years and years. Once that weight is lifted, there is space for an entirely different relationship with a patient. I don't blame them for their choices, and I don't blame myself for not always getting the miracle cure (given their choices up to the point that I get my hands on them).

A great post Bill, and wonderful comments... as usual.


Tony Russo:

Good going,
Next time hang 'im.
Very good points and very well learned. You've successfully brought home a point that we should all keep close to our arsenol of "patient management" techniques. Just today, I had a patient have a schedule set up for maintenance care for the rest of the year. He said he didn't want that at all. He just wanted to be out of pain and wouldn't remember to come back. And not that he didn't like me. Besides who wouldn't just love me. Just that he couldn't be bothered with coming in on a maintenance basis. So I immediately noted the slight tension building up at the front desk and immediately quelled it. He's coming in 'till he feels better and then he's gone...'till he doesn't. Great learning experience for him. He knows what I suggest and we leave the rest to fate...and him. Much easier than forcing him to do or not do. I have no doubt where he's coming back to when he does indeed relapse. Thank you for making my job easier and easier.

I have been a practicing chiropractor in Virginia Beach for 26 years. When I give my report of findings, I give the patient the choice of pain control or correcting the problem. 90% of the patients choose corrective care. They understand the benefits and they make the choice. The ones who choose pain control have their reasons for doing so and are happy with that care. Many of those come back when they have a flareup at which time they ask for corrective care. That was their choice as well. We should give the patients the choices and let them choose what is right for them and never feel guilty when they do what they feel is best for them at that time. Many have to overcome the belief that once you go to a chiropractor, you have to go the rest of your life.

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From March 19, 2008 7:59 AM

This page contains a single entry from the blog posted on March 19, 2008 7:59 AM.

The previous post in this blog was Monday Morning Motivation.

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