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Foisted By Your Own Petard

What does your flag look like?As I was thinking about why so many chiropractors have such brief encounters with patients, and thus an insatiable appetite for new patients, it occurred to me that it might not be caused entirely to the myopic, instant gratification viewpoint of patients. Or even the shortsighted vision of insurance companies. I’m increasingly suspicious that it may be partly due to the “story” the chiropractor is sharing with patients.

Regular visitors here know that when I use the word “story,” I’m referring to the Four Stories: the Pain Story, the Bone Story, the Nerve Story and the Lifestyle Story. These form the basis by which chiropractors communicate their vision of chiropractic to patients.

These delineations ring more true than some of the chiropractor-created stories, which usually involve generous hyphenation. Such as “principled-chiropractic,” “subluxation-based-chiropractic” and even “patient-centered-chiropractic.” These may be convenient for distinguishing one chiropractor’s philosophy from another, but do little to help patients appreciate the purpose of chiropractic care or its optimal usage.

What if patient retention was more about your vision of chiropractic (and how you communicate it) and less about insurance companies, HMOs and the economy?

If you hired a consultant to actually visit your office (rather than safe, high-altitude bombing by telephone) for the purpose of evaluating the “story” your office environment, paperwork, procedures and patient encounters communicate to patients, what story would they detect?

Your story is important. Maybe back when there was generous insurance reimbursement, your story wasn’t quite as important. It was just easier to surrender to the patient's story or the insurance company's story. (Perhaps that’s why so few chiropractors are able to articulate their story!) It may have seemed expedient to go with the limitations of their policy when case averages were $2000 or more and countless more new patients similarly equipped were waiting in the wings. Now that those levels of payment are myths or fond memories, it becomes increasingly important how you communicate your vision of chiropractic.

Consider this excerpt of a recent email I received:


“I'm using a lot of your materials and I like them, but I feel like there's a hole in my ROF. I explain their X-rays and how subluxations affect them and why we need to correct that... but I don't have a care plan to send home with them. I tell them it takes time and mumble something about how it may take weeks or months and how everyone responds differently. The patient gives me that blank stare as if to say, "You explained my condition so well... but I don't understand the solution." What literature will walk the patient (and me) through the progression of my recommendations of care?”

I’m hoping this isn’t a widespread issue among our newest chiropractors! Because if you need literature as much (or more) than the patient, “Houston we have a problem.”

Not only is it important to know your story, but your story can actually define the possibility of any post symptomatic relationship with patients. Based on your story you can see why patients might discontinue care based on it:

The Pain Story. This is the defining aspect of a short-term, allopathic, “catch and release” relationship. Tell this story and naturally patients leave when they’re feeling better—what else is there?

The Bone Story. The bone story is actually a chiropractor story. Few patients call up asking for a restored cervical curve or to improve their posture! If you can get the patient to participate in the home traction assignments and symptomatic improvement occurs about the time their lordosis returns, you have a satisfied patient who feels like they were “fixed.” Why continue care? Hmmm. I know! To slow, stop or reverse degenerative changes. Unfortunately, this subtle artifact on your X-rays is of little interest to most patients once they feel better.

The Nerve Story. In the short term, “quieting” the nervous system (as revealed by sEMG and thermographic scans), especially if symptomatic improvement coincides with the apparent improvement on subsequent scans, you have a satisfied patient. Naturally, the mission here is to help patients understand that they live life through their nervous system. And that the quality of their life is dependent upon the quality of their nervous system. Continued care is about further reducing nervous system disturbances and improving their adaptability to stress, which is largely dependent upon continuously improving scans and an expanded sense of well-being. Unfortunately, this becomes largely an intellectual exercise, overlooking the more compelling emotional dimension of the...

Lifestyle Story. In the short term, the objective is to help the patient return to the activities they used to do, whether sleeping through the night, restoring their golf swing or any one of a hundred reasons patients actually seek care from doctors. Long term, the purpose is to help inspire and lead patients to do and be what they never thought possible. This is the essential ingredient of a true wellness practice. Here, the communication challenge is to create possibilities; seniors who suddenly get the itch to run a marathon; a childless couple who decides to adopt; a frustrated artist who musters the courage to quit a dead-end job. When you actually tell and deliver the lifestyle story, you don’t need slogans like “patient-centered” because by definition, your practice is about patients—not your attempts at looking good.

Chances are, if you’re like many chiropractors, your practice is a smattering of all four stories. At first glance, this appears to be a brilliant strategy designed to make your practice more attractive to more people. Actually, I think it does just the reverse:


1. In the process of attempting to be all things to all people, you reduce your impact. You lose your “saltiness.” You lack an identity.
2. Your patient communications lack clarity and decisiveness. Playing the role of the chameleon is exhausting and emotionally unsustainable.
3. Thinking you can get everyone to like you and what you stand for is not only juvenile, it’s impossible.
4. Patients sense your vagueness and lack of personal conviction; your unwillingness to take a stand, showing up “beige,” undermines their confidence in you.

To attract your tribe, you must plant your flag. And before you can plant your flag, you have to have one. And to acquire a flag, you have to know what you stand for. Because if you don’t stand for something, you’ll fall for just about anything—even the expediency of not standing for much of anything.

Comments (6)

Todd Hackney:

The definition of FOIST, according to Merriam-Webster is: 1 a: to introduce or insert surreptitiously or without warrant b: to force another to accept especially by stealth or deceit 2: to pass off as genuine or worthy.

Interestlingly enough, maybe some Chiropractors should be "foisted by their own petard"!

Pack Miracle, D.C.:

The correct phrase is from Shakespear's Hamlet and is "Hoist with his own petard." Literally, to be blown up (lifted) by your own bomb.

Yes, the Lifestyle Story is a good one, but like all Chiropractic stories it is only as good as the INTENT of the Chiropractor telling it. If your intent is to get more visits, more referrals, more money, more! MORE!!! MORE ABOUT YOU!!!! BOOM!!!!!

So, let us be clear it is hoist not foist and our stories should be about intent not content.

Ken Koehler:

In the words of Steve Covey "live, love, learn and leave a legacy. What do you want your legacy to be?

Why is it that the chiropractic message is so poorly received? Is it because adjustments don't work? No. Is it because chiropractic care is too expensive? No, we are the best bargain in health care! Is it because we don't care about our patients? Yes...yes! How could it be that the chiropractic message is insensitive to the patient? Because the chiropractic message focuses on the subluxation and nothing but the subluxation. The patient becomes involved for the simple reason that subluxations reside within the patient. In attempting to define our "story", we must honestly assess where we stand relative to our patients needs.

I fully agree with Bill's statement in regards to the Lifestyle story. However, I believe that we are living at a true crossroads in time within the healthcare profession. The storm has not hit yet, but it will soon. This storm will be the "perfect storm" as the baby boomers enter retirement/medicare in full force, the current $30+ trillion medicare shortfall is truly felt, the health of our nation continues in its decline and the economy weathers further turbulence. Lifestyle will take on a new definition. Instead of aspirations of completing a marathon or playing 2 consecutive rounds of golf. The new definition will be more simplistic. It will focus more on how to stay "healthy" with a traditional/allopathic medical system that is far less accessible and much more expensive. Individuals will find that they are suddenly responsible for their health on a personal level that has not been seen for a long time. There will be a tremendous demand for healthcare professional who can help these people attain their desired "lifestyle"(within the new definition). The challenge for us as as chiropractors, is to define what we have to offer relative to the patients needs.

Tony Russo:

God I wish I had this stuff in 1995. I was blessed (and cursed) with partnering with one of the most "principled" Chiropractors in our city. He had the story, by golly gosh. He put up his flag and people flocked to him.

Now I see what he was doing. You’ve put into words, what people spend thousands, if not hundreds of thousands, like in my case, in order to achieve. Thank you.

Dr. Brian Deal:

Exceptionally well put. We as chiropractors spend little time on what we want our reputation to be. Our "story" is all we have. It's a fact that patients can see through our stuff. Thanks Bill. Clarity is life.

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From July 16, 2008 9:51 AM

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