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The Limitations of Chiropractic Patient Education

Posted by William Esteb on

Do you feel misled about the promised payoffs of consistent patient education? Many chiropractors do. The unfortunate result is that these chiropractors often give up trying to educate their patients, taking the path of least resistance, surrendering to a patient’s allopathic mindset.

Such a decision is the trailhead that leads to running a stressful “pain clinic” in which you deliver a form of physical medicine to relieve neuromuscular-skeletal complaints among those who think you’re merely a back doctor. And it starts by imagining that an educational protocol will compel them to forsake pain medications and get adjusted weekly, eventually changing careers and enrolling in chiropractic college.

Unlikely.

Chiropractic may be logical, conservative, effective and able to stand up to critical thinking, but even the most brilliant patient communication strategy has severe limitations.

What You’re Actually Up Against

Before I explore the reasonable results that can be expected from an organized patient education protocol, consider these two, almost insurmountable barriers:

1. Patient beliefs. The word belief used to refer only to a form of faith or trust in God. But by the 16th century it was more commonly used to mean a “mental acceptance of something as true.”

Your patients have a set of beliefs. These beliefs, rational or otherwise, form a sort of informal “operating system” that they use to negotiate life. These beliefs are often a combination of old wives’ tales, experiences, superstitions, wishful thinking and even, from time to time, the truth.

They have beliefs about their body, how it works, the meaning of pain, the physiology of muscle spasms, the role of doctors and countless other things relevant to the decision to consult you and follow your recommendations.

Showing a video, making assertions at your report of findings, waving at the gray shadows on X-rays or even producing symptomatic improvement in three visits rarely, if ever, changes their beliefs. In other words, without a patient’s cooperation in probing their beliefs and holding them to the light, the likelihood of changing their beliefs is slim to none.

But you have a far more formidable obstacle.

2. Patient values. Visit websites devoted to human values and you’ll find lists of more than 400 values—from abundance to zeal. Health and hygiene are on those lists, along with comfort, fitness, longevity, relief and vitality.

Each of us has been given the free will agency to prioritize those hundreds of values as we see fit. Because you’ve chosen a career path in the healing arts, you likely place a high value on health. It’s probably in your top 10 values. But rarely is that true of patients.

The challenge for you comes from patients who place 30, 40 or more values above the value they place on their health. They may be motivated to achieve relief and comfort, but once they do, other more highly regarded values take over and they predictably discontinue their care.

It wasn’t because of something that you forgot to say or do. In fact, there is little you can say or do to prompt them to prioritize their health more highly or embrace the maintenance care that you and I embrace. But that probably won’t stop you from trying.

Granted, you can shame them, guilt them or manipulate them with an annual care plan, but this rarely produces lasting behavioral changes.

The Purpose of Patient Education

Does all this mean that typical chiropractic patient education is a waste of time and should be sacrificed in favor of telling jokes, complaining about the weather and discussing the big game?

No.

What it does mean is that you need to appreciate the limitations of your patient education overtures and accept more reasonable outcomes. To that end, here are some realistic expectations for your brochures, videos, reports and patient lectures:

Give your care context and meaning. Because chiropractic care is different from medical treatment, without appropriate explanations patients are likely to superimpose their experience with medical doctors onto you.

Clarify everyone’s responsibilities. If anything, chiropractic care is a partnership approach to better health. Make sure patients know that what they do at home between visits can dramatically affect outcomes.

Set appropriate expectations. Patients are likely to see your “three visits a week” request as they do a prescription (“Take three times daily by mouth”). Explain the healing process (noting that it takes time) and the likelihood of a relapse should they choose to discontinue care once they feel better but before supporting muscles are retrained and strengthened.

You’re not treating their symptom. Though it’s usually an obvious symptom that prompts patients to begin care, make sure they know you’re not treating their symptoms but instead reducing nervous system interference. Tricky, I know. But it may be one of the most important distinctions you can make.

Neutralize the most common myths. Use your patient education overtures to eliminate the wrongheaded ideas they have about their body, their health and especially chiropractic. Be sure to address the “once you go” myth, along with the notion that chiropractic is only for spinal conditions.

Improve patient satisfaction. More generally, as patients have greater clarity about what chiropractic is and isn’t and see what you’re doing (and what you’re not doing), there will be fewer misunderstandings and unfulfilled expectations.

Enhance their ability to refer. Not only can educated patients better explain chiropractic, they’re better at recognizing the health issues of others as being a potential chiropractic case. Plus, they are better able to overcome objections raised by others.

Don’t Fall For the Biggest Lie In Chiropractic

When I explore these and related concepts at The Conversation or during my one-hour phone consultations, chiropractors often express relief. Somehow they thought they were failing at their patient education. Nope. They just had unreasonable expectations. Or they had fallen for the biggest lie in chiropractic: “If patients knew what you knew, they would do what you do.”

There is a huge difference between knowing—and doing! (When did you last floss?)

The message here is to lighten up. Any words you’d use to educate patients are hardly powerful enough to overcome their beliefs or cause them to re-prioritize their values. So, by all means, educate patients. Give their symptoms a new meaning. Create clear boundaries about your responsibilities and theirs. Explain the importance of keeping their visit schedule so you can create the momentum necessary for making spinal changes. But converting them into lifetime, cash-paying wellness patients? Unlikely.

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