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Doorbell or Battering Ram?

Posted by Bill Esteb on

If your patient education results have been less than stellar, would you be available to participate in a little thought experiment?

Imagine for a minute that what you believe about patient education is not true. Relax. You can go back to your current beliefs anytime you wish. But for the purpose of this experiment, consider the possibility that the strategies and tactics you’ve used with patients are based on a faulty premise.

What if there was a more effective way? And what if this new way would require forming new habits and thinking patterns? Still available to play?

Speaking Rarely Changes Beliefs

The incorrect belief held by most chiropractors is that if they say the right words at the right time, it will prompt patients to see the light, accept the wisdom of the chiropractic premise, embrace lifelong care and tell everyone they know about their incredible discovery.

Problem is, if all it took was to speak with passion, eloquence and repetition, Rush Limbaugh would have converted America to his point of view decades ago.

Winning someone over to a new belief and point of view doesn’t work that way. Granted, that hasn’t discouraged Limbaugh and it’s unlikely to stop you from continuing to yak at patients, but it’s the truth nonetheless.

The Price of Old School Patient Education

Besides being ineffective, relying on the spoken word—your mouth to their ears—produces a variety of symptoms you may recognize:

Fatigue – It seems like you repeat the same explanations that make perfect sense to you, but they fall on death ears.

Alienation – Since few patients seem to “get it,” you feel increasingly isolated and alone.

Unappreciated – Patients don’t seem to understand the price you’ve paid to become a chiropractor and stand for the truth.

Misunderstood – You seem to want better health for them more than they do, so your passion is often seen as financially driven.

Resignation – Patient education isn’t worth the trouble, so you bite your tongue and assume the role of being an over-educated physical therapist.

When you speak your truth in the direction of patients at your report or while hovering over them on the adjusting table, patients can easily feign interest, even acceptance. A knowing nod or affirming harrumph from them is often just enough to get you to believe they agree.

Later, you’re surprised when patients act in a way incongruent with the “meeting of minds” you thought you had reached. Patients continue unhealthy habits. They don’t bring their children in to be checked. They discontinue care once symptoms subside. “Don’t you remember we talked about your symptoms not being an indicator of your health?”

Belief Changing is an Inside Job

Turns out, when you speak, you are mostly affirming your own beliefs—not changing theirs. Expressing your beliefs is rarely enough to prompt patients to change theirs. First, they don’t feel the need or desire. Second, the critical thinking required to change their beliefs takes far too much work.

What does it take to change someone else’s belief? Better yet, can you?

You can’t. But they can. Your mission is to create an environment in which they might feel safe and supported enough to abandon an old belief and embrace a new one. But they’re in control of that.

Updating Their Operating System

About once a month, the folks who created the operating system for my computer announce that they have an update that I should install. I don’t have to install the update. However, it’s generally wise to do so for improved security and functionality.

Your patient education efforts are somewhat similar. Only problem is, many patients are choosing not to install them. You keep sending well-intentioned updates, but patients see little benefit in them.

This isn’t your fault. My experience suggests that somewhere around 19 to 24 years of age, we discontinue much of the critical thinking necessary to make sense of the world. Our worldview becomes fixed by then and our attention is directed to other pursuits. That’s what your patient education overtures are up against. It’s a rather formidable obstacle. And I only know of a couple of strategies that have a prayer of competing successfully.

Beliefs Produce Behaviors

Before I suggest a plan to address this practice challenge, remember there are people who, for whatever reason, are uninterested in understanding their bodies, growing their knowledge or having a more accurate notion of the world. That’s okay. You’re not about to change that either! Simply cultivate a group of patients who are interested in exploring ideas. All you need is one or two.

Just remember, if you have any hope of practicing chiropractic and not getting seduced into treating symptoms or being responsible for the speed of their recovery, you’re actually in the belief changing business. When your practice consists largely of people who want you to use adjustments to treat their aches and pains, you’ve allowed the cultural notion of what chiropractors do to become the primary motive for seeking your care. (This is actually a marketing issue too complex to cover here.)

Do You Use a Battering Ram?

Socrates figured this out 2,400 years ago. The way to prompt critical thinking and arrive at the truth is to ask questions—of others and of ourselves.

Your mission is to ask questions of patients in such a way that they feel emotionally safe to engage in conversation by sharing their points of view. Your questions, when respectfully asked without agenda or judgment (that’s the hard part), are used to provoke critical thinking. Your genuine curiosity about their model of the world and the meaning they’ve attached to their experiences can set the stage for reaching new conclusions and new beliefs.

When you ask a question and a patient engages beyond “I don’t know,” they’re inviting you in. They’re opening the door a crack to see who rang their doorbell. But when you spout your beliefs and assertions into their ears, exploiting your limited social authority, you’re using the equivalent of a battering ram rather than respectful knock. Big difference.

10 Sample Questions

Here are a few sample questions to get your imagination going. These are the type of questions you might ask a patient while you’re palpating their spine, conducting a leg check or whatever you do prior to your adjustment.

What’s your theory about what causes cancer?
What’s the difference between a good drug and a bad drug?
What is the purpose of a surgeon’s mask?
Why do certain foods cause heartburn for some people but not others?
Why do some drugs require a prescription but others do not?
What is the purpose of pain?
How does the medication find the headache?
How do you “catch” a cold?
What does an adjustment do?
What do you think is the greatest stress on your body?

You might preface these questions with, “Hey, I’m asking every patient today the same question. Ready?” or “I’m taking a poll today and asking every patient this question. Ready?” The key is to make it light, almost playful. This isn’t a pop quiz. It’s not an interrogation. And it isn’t about making the patient appear stupid. It’s about trying to understand each patient by seeing the world as they see it. (Explore the Socratic Method in more detail by mastering Million Dollar Questions.)

Important Disclaimer

These and any other questions you might be inclined to ask are not a technique, a manipulation or an attempt to get patients to answer in a particular way. Even more important and counter-intuitive is having the discipline NOT to share your answer to the question you’re posing unless asked.

In other words, asking a question first isn’t a license to ear rape them with your “correct” answer! Only offer up your point of view if asked.

You won’t be asked very often. At least not at first.

This will begin to reveal how few patients are actually interested. That’s okay. Build on it.

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