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Talking About Symptoms

symptoms-warning-pixQ: "I am a chiropractor who is stuck on removing a patient's pain. I am moving toward a wellness model, however I fall short at each patient encounter. I ask, "How do you feel today?" or "How are you doing today?" which starts the encounter about their pain, keeping me and the patient stuck there. Is there a per-visit dialog or a few words that you can share to help move the patient away from their pain?"

A: This is a common refrain among chiropractors who would like to morph their practice into something with a greater emphasis on chiropractic wellness care. Yet, how you greet a patient is rarely the problem and merely symptomatic of a deeper, more significant issue.

Chiropractors seeking a wellness orientation often risk pushing patients away, or at least making them “wrong” by attempting to suppress any talk of symptoms. Realize that symptoms aren’t the problem. In the same way that rational people don’t rail against the Check Engine light on their dash, there’s nothing intrinsically wrong with symptoms.

No, it’s what the symptoms mean to both you and the patient that is the real issue.

In the same way we are admonished to “put on our own oxygen mask before helping others,” it’s critical that you have clarity about the meaning of symptoms before you assist patients with a more resourceful way of thinking.

What Symptoms Mean to Chiropractors

How do you ascertain that your chiropractic intervention is working? How do you decide the frequency of patient visits? How do you know when the frequency of visits can be decreased? How do you predict at your report of findings how many visits will be necessary?

If you rely solely upon the patient’s subjective observations instead of some objective measure (such as sEMG or other types of instrumentation) it will be difficult, if not impossible, to escape the pain treatment model of practice.

Thus, the core of this question is clinical in nature and a reflection of your beliefs about chiropractic and its purpose, whether subluxation is a bad thing or a good thing and what an adjustment does. Add to that, how you will justify to patients (and yourself) the value of nonsymptomatic visits? Even more subtle, do you become defensive if patients report that their symptoms aren't improving as quickly as they seem to think they should?

Clearly, a wellness practice isn’t about what you say, but what you believe.

What Symptoms Mean to Patients

Remember, it’s the patient’s symptoms that prompted them to seek you out in the first place! Helping patients attach a new meaning to their symptoms is at the heart of the chiropractic patient education challenge. When patients are immersed in an allopathic, pill-for-every-ill mass hypnosis, this requires sensitivity and creativity.

Because most patients suffer from varying states of disembodiment (read Patients Without Bodies), their body practically has to scream to get the attention of its owner. So, the first objective would be to help patients become more present to their own body.

You might want to use a metaphor to increase the impact of your patient explanation about symptoms. A common household smoke detector would work nicely.

“Mrs. Jones, your (enter symptom here) is a lot like this smoke detector. It detects smoke, but of course, the real problem is fire. Does the alarm sound at the first hint of smoke? No, it takes quite a bit of smoke. Finally when there’s enough to trip the alarm, it sounds. [Press test button and alarm sounds. Continue holding the test button as you say:] Your symptoms are what brought here, but we’re much more interested in the underlying cause of your symptoms. [Release test button] That’s why we don’t judge your health by how you feel. Let me explain a better way of measuring your health…”

What You Could Say…

As you see yourself as something more than a spine mechanic or a natural pain reliever and make the integrity of their nervous system the centerpiece of your practice, new ways of greeting patients can emerge.

“So, what’s better? What’s worse? And what hasn’t changed?”
“Great to see you today! What’s going on for you today that’s worth celebrating?”
“Tell me what your body has been telling you since we saw you Monday.”

The words you speak are signs and symptoms of your heart. Your heart is a reflection of what you believe. Sure, you can change your language. But remember that changing your words without attending to your underlying beliefs is a form of symptom-treating that at best is inauthentic acting, and at worse, a form of ineffective manipulation.

Comments (3)

My favorite thing to say is, "Great to see you!" If they ask how I am I say, "I'm well, it's great to see you!"

I also say, how are you progressing since the last time we saw you?"

Works great!

Richard Hartman:

Thanks Bill,
I have been using the smoke alarm analogy
for a long time and it makes patients think.
I say that taking pain medication and doing nothing else is like being awakened in the
middle of the night, removing the battery
to stop the noise and going back to sleep.
The smoke or fire will finally get you!

Tony Russo:

Beautiful analogy Bill,
Smoke detector, perfect! How I would greet my patients is by asking not, "How are you? " or "How do you feel?" but more along the line of, "What's happening?” Works for me. But that "smoke detector,” perfect. Just perfect.

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From December 9, 2009 9:34 AM

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