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Are You a Meaning Maker?

make meaning for patientsPatient education helps create a common understanding, entice patients to attach new meanings to the experience of their body and embrace beliefs that more accurately reflect the reality of health and healing.

Some might argue that this is even more important than adjusting the patient. However, what makes effective patient education so difficult is that few patients begin chiropractic care with an interest in abandoning their current health care paradigm. Most see their problem as a back problem and dutifully consult a back doctor. You. End of story.

So, between the pressure to get paid by insurance carriers for treating mechanical back pain, and the resistance by most patients to abandon their current beliefs, it’s tempting to take the path of least resistance, devoting little energy to encouraging patients to abandon their germ-fearing, symptom-focused, drug-using notion of health.

I’m guessing that few chiropractors going through a rough patch, wake up one morning and observe, “Eureka! The reason my practice is under performing is because my patients don’t know what chiropractic is! Hallelujah!” After this brilliant insight, they immediately swing into action and turn their practice around with better patient education.


Instead, most of us have a tendency to simply work harder at what isn’t working. Others decide to add some new bell or whistle. Learn a new technique. Get involved in nutrition. The opportunities are endless.

Instead, why not fully commit to assuming the role of being a meaning maker?

Facilitating the process of patients abandoning their old beliefs in favor of new ones is rarely mentioned as an objective or purpose of chiropractic practice. And it’s certainly not discussed within the curriculum of chiropractic colleges! Yet, neglect your duties in the belief-changing arena and your patient relationships will be superficially-brief, symptomatically-focused and lack the intimacy and authenticity that makes practice satisfying to your soul.

During the early part of our lives, especially the first decade, our curiosity is boundless (“Why is the sky blue?”) and we're on a quest to make meaning of our life experiences. What does it mean when Dad is gone all day? What does it mean when Mom raises her voice? What does it mean when I get hungry? Get a spanking? Skin my knee? Get sick?

As we process our perceptions and create explanations of our experiences, we begin to live our lives as if the meanings we create as a child are actually true. Worse, we often no longer dig deeper and become locked into our earliest meanings of the world. And this is what makes the obligation of effective patient education so challenging. Patients already have an explanation of their problem, usually a bone out of place, muscle spasm or a pinched nerve and have little reason to doubt or replace it.

So what is it? Bone? Muscle? Or nerve? Being a meaning maker starts here. But if you’re simply grateful that someone warmer than room temperature wants your help, you may be blind to the importance of knowing their particular model.

Find out what the patient thinks his or her problem is.

Bone out of place. “So tell me, how do the bones in your body actually move? Back in chiropractic college when I studied anatomy we learned that bones were static structures that only move when muscles contract or relax.” And then give it some time. No hurry here. Then you might follow up with still another question. “What do you think commands your muscles to contract or relax?” This is a conversation, not a trap. You’re trying to understand how they see their problem.

Muscle spasm. Patients who seek medical advice first will undoubtedly have their problem minimized and get a prescription for a muscle relaxer. “So tell me, what do you think might be causing your muscles to tense up? Back in chiropractic college when I studied physiology we learned that muscles only tense up or relax based on commands from the nervous system.” And just let your observation hang there for a moment or two. Give it some time. Let it sink in. Then you might follow up with still another question. “What do you suppose is stressing your nervous system to prompt the muscles to tighten?” Get ready for an “I don’t know.”

Pinched nerve. “So tell me, what do you think is actually pinching on your nerve?” I’m guessing most patients have never been asked that question before. Their likely answer will be that spinal bones are pinching the nerve. And that’s when you return to the bone out of place conversation above. (In fact, most patients think the sound created by cavitation is from bones rubbing on bones!)

Now, from time to time you may encounter a fourth answer…

Subluxation. Good news! This is an individual who has incorporated your meaning making or that of a chiropractic colleague’s. Careful. Just because they use the chiropractic term, it doesn’t necessarily mean they “get” chiropractic. So dig a little. “What do you mean subluxation?” Do they appreciate its potential effects both local and peripheral to the spine? Do they understand its biomechanical and neurological implications?

Without knowing (or caring) about each patient’s beliefs, and the meaning they’ve attached to their condition, you’re handicapping your ability to build rapport and install new, more accurate beliefs. More troubling, you may surrender to merely treating their headache or back pain (the practice of medicine) and never enjoy the benefits of practicing chiropractic.

Comments (1)

Thanks Bill! Great post as usual!

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From July 30, 2011 12:37 PM

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