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Knowing, But Not Doing

Patients know they should stop smoking.While I was on the treadmill this morning, I was listening to an interview with a prominent chiropractic leader. I had heard the lie that he uttered many times in my chiropractic journey. However, this morning it seemed to take on greater significance than at other times. Perhaps because this lie takes such a toll among chiropractors, producing needless pain and frustration. Worse, believe this lie, and you’ll never enjoy the emotional satisfaction of a stable practice and your patient communications are a repetitive, burdensome, ineffective chore.

What did he say? What did he assert that causes so many chiropractors to misdirect their patient education efforts?

“If patients knew what you knew, they would do what you do.”

You’ve probably heard this one before. It’s a lie. It’s simply not true.

It’s tempting to think that patients are merely ignorant, and that if you can just ramrod enough data or information into their cortex, they would behave in a healthy, enlightened way. This is so mechanistic as to be laughable. It suggests that humans are thoughtful, rational beings. If you’ve been in practice for more than a week, you know that’s not true! So, to have an experienced chiropractor utter this old saw that knowing automatically produces doing, is tragic. And a little sad because it obscures the solution that is available to virtually every chiropractor, particularly those complaining about their circumstances these days.

Here’s the truth. Patients do what they do because they believe what they believe. They may not be aware of what they believe, since many beliefs are hidden deep within the folds of the ego and subconscious, but nonetheless, beliefs drive behaviors. Each of us act in ways to remain congruent with our core beliefs and self-image. Beliefs produce behaviors. Behaviors are symptoms.

Patients know they should adopt chiropractic care as lifestyle. But once they are pain free they believe some other priority takes precedence over continued nonsymptomatic care.

Patients know they should bring their kids in to be checked. But they believe your adjustments might produce damage. Or they believe chiropractic couldn’t help their asthma. Or they believe “growing pains” are normal. Or they believe, “Why fix it if it’s not broken?”

Patients know they should quit smoking, lose the extra 20 pounds, exercise regularly and give up the Starbucks addiction. But they believe they “deserve” this little indulgence. Or they believe it’s not affecting their health that much. Or they believe they’ll give it up some day.

Patients know they shouldn’t ingest a NSAID whenever they have a headache. But they do it anyway because they believe it’s too inconvenient to go to your office. Or they believe the stomach-bleeding side effect won’t happen to them. Or they believe that making the pain go away is more important than any potential risk. Or they believe that pain relievers must be safe since they’re so widely available.

Patients know.

If you have any hope of manifesting a stable, cash-based family practice, you must come to grips with the fact that you’re in the belief-changing business, not the pain-relief-spine-straightening-subluxation-removal business.

Naturally, they don’t teach you how to change a patient’s belief in chiropractic college. Nor does your expensive consulting group. This is compounded by the fact that few patients show up in your office wanting a belief change. Yet, without a belief change (which yakking at the patient at your X-ray view box doesn’t accomplish, nor does great results without drugs or surgery), you surrender to being an allopathic spinal therapist. Which may not be a bad job, it’s just not very emotionally fulfilling.

But you already knew that—which may be sufficient proof that knowing has little to do with doing.

Comments (3)

dr. alex dougley, d.c.:

Thank you Bill for making a point very clear, as you often do. I remember going to a seminar and the 'teacher' said, 'Write down 3 things you know you should and can do that would help you build the practice of your dreams." Everyone took 5 minutes and wrote it down. Then he said, “Now go home and do it." That could have been the end of the seminar. He proceeded to explain why we gather more and more information and go home and add the notes to the big pile that 'I'll get to one day." Sometimes we need to stop gathering more information and simply use what we already have and know. Yet somehow it feels good to pay money to have someone tell me what I already know. If my beliefs are such that I feel the information is not worth applying, why do gather more? Answer...activity without results is at least activity to avoid the real issues I know I need to deal with...

Jeremy Tietgen:

Great stuff as usual! I feel maybe you’re saying it’s not so much what the patients belief system is all the time but the doctor's belief system. How can I expect our patients to make the decision to change their beliefs when I don't show up consistent, certain and confident about what I believe chiropractic to be? Why should I get frustrated with them when I’m the one who is uncertain? Or at least my body language and actions may be confusing. As B.J. Palmer said, "A patient cannot anchor to an untethered mind.” Thanks for the insight.

Tony Russo:

Never thought of it that way Bill. You're right. I've been applying these common sense principles and I've witnessed a considerable growth in my practice.

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From July 10, 2008 11:02 AM

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