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Take Two and Call Me in the Morning

take-two.jpgI remember my high school economics teacher telling us that if we were ever to fall asleep in class, and awaken, discovering that we had been asked a question that we didn’t hear, answering with “supply and demand” would likely be correct nine times out of ten.

This came to mind last week when I was speaking with a chiropractor who observed that many chiropractors already have their care plan designed for the next 100 new patients—whom they haven’t even met yet! You know the plan. Three times a week for the first four weeks, two times a week for the next four weeks, once a week for the next four weeks, etc.

Passionately repeating this mantra (as if it were handed down by D. D. Palmer himself), or neglecting the critical thinking necessary to see its obvious shortcomings, reveal a few of the underpinnings of struggling practices. Worse, if a patient were to ask, “Why three times a week?” the orchestra tunes up and the tap shoes come out.

This is a trigger point for some chiropractors. Especially those who are exceptionally talented at the “doing” of chiropractic, but not particularly articulate at describing or explaining it, relying heavily on their social authority to induce patient compliance.

Ask chiropractors to describe chiropractic and you get answers that are breathtaking in their diversity and superficiality. Here are a couple of actual unretouched examples I’ve collected over the years from some of your colleagues:

“Chiropractic is a health approach to life which restores the body’s natural ability to function correctly by enhancing its normal ability to health through stress reduction and increased energy.”

“Chiropractic treats the nervous system. Irritations around the joints, especially the spine, cause a drop in the local nerve function. Chiropractors treat the spine to soothe irritated nerves. This affects many different functions in the body, not just back pain or headache. Chiropractic treatment is comfortable and safe, even for newborns or seniors. Most patients get better in a few visits, then we begin to put weeks and months between visits.”

“Chiropractors find and correct nerve interference that causes stress, pain, poor health and dis-ease. Nerve interference occurs when the small hard bones of your spine pinch soft nerves by shifting alignment due to stress, falls and other accidents, causing both postural changes on the outside and blocking/changing messages passed from your brain to all parts of your body.”

Do you see the challenge here? No wonder so many chiropractors are willing to spout the scripted recommendations of a one-size-fits-all canned care plan. If you’ve taken the path of least resistance, offering care recommendations that not only predict the patient’s recovery, but does so in perfect, four-week intervals, you may want to rethink your approach.

By the way, some of the chiropractic masters of the past, including B. J. Palmer, Clarence Gonstead, Major DeJarnette and others might recommend adjusting patients up to three times… a day.

My reason for even bringing this up is that relying on a script, especially this one, is not a place of certainty or power. The result? An underperforming practice and an “I-hope-I-won’t-be-found-out-to-be-an-imposter” fear that keeps many practices small and under the radar.

“Okay, smarty pants, what would you say?”

Fair enough.

Realize that these initial recommendations are based upon my understanding (and belief) of what chiropractic is. This may differ from yours.

“In the same way an airplane uses lots of fuel during takeoff, we’ll approach your issue very aggressively, seeing you three times a week for the first four weeks. Over the years we’ve discovered that that’s the ‘sweet spot’ between visits too far apart—preventing us from getting enough momentum to make significant change, and visits that are too frequent—‘wasting’ the energy added by the adjustment because your body is still working on the effects from the previous visit.

“With your first month’s of care behind you, you and I will have a better idea how your body is responding to chiropractic care and how willing you are to do other things between visits to support your recovery. That’s when we’ll conduct a progress examination, comparing where you are, with where you were, and then together, charting a course for the future that makes sense for you and your health goals. Like an airplane that uses less fuel when it reaches cruising altitude, we can often reduce your visit frequency. It just depends on your progress.

“Shall we get started?”

The point? If you can predict a patient’s recovery before delivering their first adjustment, you should be buying lottery tickets, not sweating over a hot adjusting table.

A formulaic approach that assumes every patient will respond the same way may be convenient, but it’s almost as flippant as the “take-two-and-call-me-in-the-morning” attitude attributed to medical doctors. It’s a prescriptive, linear, mechanistic model that makes your administration of chiropractic more about you and your procedure, than the patient. It suggests that your intervention is the hero, not the patient’s ability to self-heal—doing so at its own pace and based on many factors outside your control. It blurs the distinction between chiropractic and medicine by turning adjustments into a treatment for a condition. It starts to sound similar to the knee-jerk prescription of antibiotics that many in chiropractic accuse medical doctors of so thoughtlessly doing.

Comments (2)

Always good stuff Bill! Insightful, conservative, and always making sense. Much appreciated. Much of my success I owe to your chiropractic books and chiropractic products.

Dr. Aaron Gaily, D.C.
www.chiropractorsmonterey.com

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From March 24, 2010 7:26 AM

This page contains a single entry from the blog posted on March 24, 2010 7:26 AM.

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