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Does the End Justify the Means?

dirty-dishes.jpgFor my last post of 2008, I’d like to explore a troubling telephone call I had recently from a practice management coach. You’d recognize his/her name, but this person’s identity isn’t important, since I’m suspecting that many in the practice/management/coaching/training/consulting space make similar suggestions. At least I make this assumption based on the state of the profession these days.

“...I just tell them at the report that I’d rather not have them as a patient if they’re not going to take their problem as seriously as I do.”

“Really?” I asked. “You actually recommend that your clients say that?”

“I do. And it dramatically improves compliance.”

“Isn’t that kinda manipulative? When you shame them into care, doesn’t that attempt to override their free will?” I insisted.

“I guess so, but people are more likely to act in an effort to avoid loss than to achieve gain,” he countered.

I knew that was so. In fact, it’s a common reason why practices don’t grow beyond a certain plateau of comfort. Once a comfortable living is reached, most chiropractors switch from offense to defense in an effort to keep the lifestyle they’ve obtained. In that, that's where many chiropractors find themselves these days.

But I persevered.

“I know, but using your social authority or fear tactics to hijack the free will granted by their Maker to treat their “temple” the way they see fit is an attempt to play God.”

There was a pause at the other end. He was either reloading or searching the scriptures for an opportune retort.

“All I can say is, clients come to me with underperforming practices and when they use this approach their practice grows. Patients more fully benefit from their care and clients get what they want.”

So that’s what it came down to. Forget about trusting the judgment, priorities and choices of patients! Saving patients from themselves and seducing them into care they may not want is somehow noble? Are these the seeds chiropractors have been sowing behind closed report room doors for the last three decades? Is this why chiropractors have shelves of inactive files that they feel uncomfortable contacting? Because the neuromuscular-skeletal complaint that prompted the patient to see a chiropractor was soooooo serious that it justified resorting to such a sleazy tactic?

How incredibly selfish.

“What would you recommend?” he asked.

I took a deep breath.

“I think you have the obligation to explain the possible consequences of neglecting their problem and the likelihood of a relapse if they choose to discontinue their care as soon as they feel better.”

“Exactly,” he chimed in.

“And that they understand that when their problem comes back there won’t be even a hint of an ‘I-told-you-so,’” I said without dropping a beat.

“If you have a patient for whom this is their first brush with chiropractic, what you’re really doing is laying the groundwork for the reactivation.” I took another gulp and continued. “Most people have grown up with an allopathic mindset and they see a visit to a chiropractor as a short term ‘diet’ rather than a lifestyle decision and frankly, don’t believe your assertion that their problem will return. So, they decide to take their chances, nodding at your claims of disc degeneration, arthritic changes and your arm flapping at their X-rays.” I was on a roll now. “Chiropractors trained during the Insurance Era were convinced to ‘get-while-the-gett’ens-good.’ So, with the short-term strategy of milking every dime from their policy, few chiropractors thought much of the reactivation with so many new conquests waiting in the wings. Instead, bent of permanently “fixing” patients by thrusting into their spine, usually ignoring the psychosocial issues underlying their subluxation patterns. But since they couldn’t bill for psychosocial issues (or subluxations!) they called it a sprain/strain and everybody was happy. Next! Many are waking up 20 years later with a kitchen full of dirty dishes, carpet stains and a hangover from their insurance binge.”

There was an extended silence. Was he still on the line? Had I offend him? Nope.

“That may be true…”

“I knew a 'but' was coming.”

“…But patients are likely to suffer needless degenerative changes if they don't follow through with the recommendations.”

I knew our conversation was over. He had opted not to hear me. Saving patients from themselves was more important than honoring their free will. Distrusting patients, figuring that given the chance they’d make the wrong choice, well, that was just too risky. After all, he was being hired to boost the numbers.

Frankly, I’m glad 2008 is behind us. I think 2009 is going to be better. Much better, actually. And we have a lot of work to do. Thankfully, it’s honorable work. It’ll be exciting to see how it all turns out.

Happy New Year!

Comments (5)

Todd Hackney:

There really is a simple, yet effective rule to follow, that you DON'T need a "coach" (ie-someone who probably is not in practice, yet tries to "teach" others to follow their ideas) to tell you.

TREAT YOUR PATIENTS AS YOU WOULD WANT TO BE TREATED.

It's really that simple. Give them exactly what they need, no more and no less.

And to those D.C.'s who question their patients about the importance of their health; Heed your own advice! In other words, if YOUR health leaves something to be desired, then you have no right to expect of your patient what you cannot follow.

I think it all boils down to what you really believe. Are you just saying a script to manipulate a patient into doing your complete program, or do you really only want to work on people that take their health as seriously as you do. This begs the question, how seriously do you take the patient's health? Are they supposed to know how seriously you take their health?

If someone sat down with you and gave you this ultimatum, how would you feel, would you appreciate it? According to psychological studies, 70% of society would be willing to torture another person if an authority figure told them to do it. It could be also said that 70% of people would be willing to do something healthy for themselves if an authority figure told them to. Do you want your patients to choose care because it is wonderful and compelling or because an authority figure told them to? Is it their health, or their commitment to care that you are really trying to influence? Short term they may be the same, but in the long run we want the world to use chiropractic for the rest of their life, don't we? You may be able to increase initial commitment with this script, but what happens after the initial commitment is done? If the patent is empowered to make their own decision to start care, follow thru is better, referrals are better and you have a better chance at a lifelong patient.

Having said all that, I also am a firm believer in planting your flag, so if you truly believe in what you are saying... then by all means say it, but don't just say something because someone told you it would increase your numbers. Trust me, you can increase your numbers by being genuine.

Tony Russo:

Greetings from the other side of 2008-2009 rollover, I must say you are a distinguished man for not falling for the lure of the same internal bickering that our profession loves to indulge. It ends only there. Your response, your retort, your (mild) attack, is to a position, not to a person. Very well posed and very professionally presented. After being reminded of the tactics that are in use by the "short term gain" focused, I come to the stark reality of the cross we all have to bear.

But all is not lost, for those of us who have escaped the quicksilver temptation and have taken the slow steady route, we are evolving and are stably growing our practices. Our brothers and sisters who will eventually jump off that circus wheel, are in for some very difficult times, very difficult times indeed. We already went/are going through them right now. But if they are impassioned, if they are principled, if they are determined, they too will make it out the other end. And let us be mindful of that famous children’s' tale The Tortoise and the Hare. Every time I read it, the tortoise always wins the race, always.

Good wishes to all and a happy, gratifying New Year.

Dirk Jacobsz:

Interesting comments on both sides... I can see the coach's point of view, and I can see yours Bill. Question .. is his point of view much different from your story on " pick your tribe ". I think not.

I for 21 years have tried to build another ladder for my patients.... the subluxation with all the neurological implications it brings. Education and choices...

Most patients have not had the opportunity to explore their true feelings, goals etc like all the seminars we all have done in personal growth and personal discovery.

Diabetes is increasing in Australia. People still smoke, drink and drive etc . All things we know are not good for us. They have all the information they need about these problems. Yet the lifestyle problems and conditions increase.... maybe a little too much personal choice... with not enough personal responsibility thrown in.

So tell the patient all you want, give them choices and educate them, yet at the end of the day.. say your peace and take a stand. Choose your tribe and stick to it.

If you don't want to accept patients because they wont follow your care plan, then love them out the door. Tell them this is how you do things in your office. If they dont want to play then that is their choice, and they can leave. You will sleep better at night if you act in accordance with your own set of rules.

A chiropractor cannot be all things to all people. Be yourself... and enjoy your patients.


Dirk Jacobsz (Australia )

I think I know who you were talking to, but like you said, the identity is not important. However, I'd like to share a blog entry I wrote about an experience I had at this person's seminar (if it is the same person).

It's NOT Cancer
WEDNESDAY, JUNE 6, 2007 AT 08:36AM

When I was a "green" chiropractor and did not know much about anything dealing with the business aspect of the profession, I went to a practice management seminar on the mainland to learn about how I could run a profitable clinic.

One of the things they taught me kinda creeped me out.

They had us pair up. One person left the room. Then the "coach" on the stage told those of us who were still there that we were to do a role playing exercise; that when our partner returned to the room we were to inform him that we just discovered that he has cancer-- and that he doesn't have much more time.

We were to pay careful attention to the emotions we felt and the strength of message we conveyed. We were also instructed to observe our partner's reaction, their emotional response.

Everyone tried their best. It was interesting to note that even though this was a role play, tears were shed by many at the training.

I mean, come on now, it's cancer! In terms of eliciting fear, it ranks up there with terrorism and hurricanes! Even when pretend, this is frightening stuff!

Then came the kicker. After the role play, we were told that when we give the results of our spinal exams to our patients, we should maintain the exact same level of intensity as the cancer role play. The key, we were told, was to make them have an emotional response!

Like it was cancer?

Now, I know subluxation of the spine is serious. I know subluxation can slowly deteriorate the quality of life of an individual. I also know that correcting subluxation can give tremendous health benefits to all chiropractic patients. Sometimes, in terms of relief, wellness, prevention and health optimization, the benefits of subluxation correction can be miraculous!

Still. It's not cancer, my friends.

Any chiropractor who tries to get a patient to feel emotionally that what they have (no matter how serious) is on the same playing field as cancer is all about one of two things:

1. They want their patients fully concerned about their spines and the consequences of neglecting the care plan so that each patient ultimately commits to COMPLY in full.

OR...

2. They want their patients so concerned about their spines and the consequences of neglecting the care plan that each patient ultimately commits to PAY in full

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From December 31, 2008 4:57 PM

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