Addicted to Power
by William D. Esteb
When we use our power and influence to fashion the world around us, we are in a sense playing God. Part of the heady experience of running a business is in the fulfillment of a creation in our own image. This notion has been institutionalized in the countless rags to riches stories that surround the likes of Carnegie, Rockefeller, and other captains of industry in the early 1900s. Building an empire in which dutiful lieutenants stand at your beck and call to execute your every wish makes exciting drama. This sense of power and control is as addictive as any narcotic and perhaps more dangerous. It is especially enticing in the world of health care, surrounded by miracle cures and the proximity to the vital forces of life, death, and disease.
Some might call it "being doctorly" or simply assuming the symptoms of having once been put on a pedestal due to your education and social position. Yet it is this persona, this mask, that serves to separate and insulate you. Not just from possible failure, but from the "connectedness" patients so desperately want from their health care provider.
Abandoning this mask in favor of a more personal relationship with patients is difficult because this persona appears to assist in the control and management of patients. At least in the short term.
This is exhibited throughout the typical doctor/patient relationship in many chiropractic offices. Many of the compliance and new patient shortcomings can be traced to a lack of rapport and trust that is compromised by exploiting the powerful position you purposely or inadvertently find yourself in.
Telephone screening. Can patients actually talk to the doctor? In many offices the doctor is so afraid of confronting creditors or headrest paper salesmen that every phone call is carefully screened. Stop hiding. During your off-peak hours take some calls without screening. Really feeling bold? Answer the second line yourself! The worse that could happen from displaying this attractive quality of accessibility is you'll get tied up for a few minutes with a stock broker. "I'm sorry, but I'm not interested" can put a quick end to anyone's sales pitch. If not, putting the handset back on the phone is guaranteed to work! By taking a few calls you'll become more sensitive to the needs of your patients and get a better feel for how your office functions. This is the same exercise countless Fortune 500 executives experience by spending a day serving hamburgers, handling hotel guests' luggage, or taking airplane passengers' tickets. It's too easy to get isolated in the back room trudging between three adjusting rooms.
Reception room. Many doctors meet patients for the first time in a cramped consultation room. This is disorienting for patients who, after spending 12 minutes completing your admitting paperwork, are just now feeling comfortable with the reception area portion of your office. Being taken to still another part of this strange new place reminds patients they are powerless and are subject to someone else's agenda and protocol. Want to impress patients with your self-confidence and accessibility? Come out to the reception room, be introduced to the patient by a staff member, and lead them back to the consultation room yourself!
The examination. This is often when the doctor is most powerful, using esoteric tests and all-knowing "Hmmms" at just the right time to project a sense of thoughtful assessment and learned understanding. When doctors don't communicate what they're finding as they're finding it, it reminds patients that they're the patient and you're the doctor. If you enjoy this control and suspense to later exploit at your report of findings, please know that it's counterproductive. Oh, sure, patients can hardly wait to see their X-rays, but without foreshadowing your findings at your examination you run the risk of numbing the patient with too much information. Gain greater understanding and respect for your recommendations by letting patients get a basic understanding of positive tests results as they occur. Otherwise, the result is a patient who is resentful and selectively remembers only bits and pieces of your oral report.
X-ray procedures. While taking X-rays in many offices is a fore drawn conclusion, this is where the skirmishes of an intimidation game are frequently played out. Patients walk into your X-ray room with four basic concerns: privacy, necessity, safety, and cost. Since many patients lack the willingness to confront, especially when they are disadvantaged by discomfort, many doctors are lured into thinking these four issues don't even exist! Making the effort to anticipate, acknowledge, and volunteer relevant information about these often unspoken issues will pay huge dividends in less confrontation, better questions, and more cooperative patients. To simply push this or any other procedure down a patient's throat without explanation because, "This is how we do things around here" may put an immediate end to the objections, but it creates a climate of resentment and compliance through gritted teeth.
The report of findings. Besides avoiding the manipulative scare tactics which no longer work with the baby boom generation, the major flaw in many reports is the unwillingness to discuss financial matters with the patient. Too bad. Offices in which doctors help patients fully appreciate the relationship of their visit schedule, fees, and probable recovery time also have higher collections, better compliance, and, get this, more referrals. Is this reluctance because you secretly feel the $30 adjustment fee and the $320 Davis Series is overpriced? Is it because you get your care without any impact to your monthly budget? Or, is it because you live and breathe chiropractic 24 hours a day that you automatically think patients will too? If you think a patient draws a distinction between optimum health care and their pocket book, you're kidding yourself. Health care costs money. And unless you can effectively communicate the cost/benefit ratio of following your recommendations, most patients won't. The fact is, many aren't.
Recall procedures. As patients vote with their feet and discontinue care when they are as powerful as you (symptom-free), the crowning touch of a power-based practice is deployed: the recall. With carefully scripted phone dialogue and an urgent, "the doctor has discovered something on your X-rays," the front desk assistant suddenly turns into Nurse Ratchet. Besides the fact that it's so distasteful that the staff member with the least amount of seniority is given this dirty little task, it's often done within earshot of patients in the reception room! Heavy-handed recall programs are the last gasp of a health care "dictator" and acknowledges a lack of patient education and loss of control. Plus, they only produce short-term results and sabotage a long-term relationship. Live by the sword. Die by the sword.
Besides the fact that using power and control strategies with patients and staff members is so gratifying to our egos, the real problem is it appears to work! Countless staff members are working at a fraction of their productivity because they are in fear of losing their jobs or unsure how well they are doing their jobs. Fear and intimidation produce staff members who lose their ability to make even the simplest decision, requiring constant direction from the boss. This feeds the supervisor's ego, further reinforcing the notion to think for everyone else in the office. The self-fulfilling prophecy that is created makes the boss even less likely to delegate and empower others. High staff turnover, constant use of sick leave, and tardiness are all symptoms of staff-related "power pathology." When exercised on patients the symptoms include low compliance, few referrals, and poor patient visit average.
That doesn't mean babying your patients, becoming their "friend," or striving to be liked by your patients is the solution either! You need to confront patients out of love. You need to present specific recommendations out of leadership. And you need to educate out of the responsibility that comes from knowing the truth.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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