For 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!