Adjustment Etiquette

by William D. Esteb

There is a generally accepted mode of behavior that governs our interactions with each other. These social skills or "rules" can be defined by situation, environment, age, even the time of day. Often this code of conduct remains unspoken, isolating newcomers and making beginners uncomfortable. In fact, these rules can intimidate those with low self-esteem and prevent many from trying new experiences. Encountering three forks at a restaurant, attending a black tie affair, or ordering Chinese food are common examples. The newcomer or neophyte must be extremely sensitive to read the clues to fit in.

When we are in a new and uncomfortable situation, we are always grateful to anyone who will take us under their wing and show us the ropes. This guide and mentor paves the way for us to enjoy the situation and fit in easier. For a new patient, fitting in and getting acclimated to chiropractic can be intimidating. Just what are your expectations of patients in the adjustment room, and what do you suppose their expectations are of you? Do you explain your adjustment room etiquette to your patients--in advance?

Because patients can't consult a book entitled something like, Emily Post For The Adjusting Room, here are some issues you might want to take into consideration with your next new patient.

First visit expectations. Create a simple outline of the major events of a patient's first visit experience. List the typical office procedures, explaining why they are performed and the benefits to the patient. Patient rapport is improved and you'll discover patients become more cooperative. Volunteering this information in a consistent manner will make patients more receptive and in the end, more appreciative of your thoughtfulness.

Adjusting room greeting. How do you greet patients on routine visits? "How are you doing?" "How's your health?" Regardless of how you ask it, what type of response do you really want from the patient? Do you want a listing of purely physical complaints, raves about how wonderful the last adjustment was or wasn't, or a recitation that includes car troubles and weather forecast? Your expectations create the tone of your relationship with the patient. Will you be living and breathing chiropractic on every visit? Do you have other interests? Are you insecure about the progress of the relationship? Explain to patients in advance what type of information--and why--you'll want to know on each visit.

Examination findings. It surprises me how many doctors who do leg length checks, motion palpation, and other tests on every visit consistently fail to tell the patient what they're discovering. Whether doctors think patients don't care, wouldn't understand, or just hadn't thought about it, is hard to say. The more you involve the patient, the more you improve compliance and follow through. Help patients know what you know!

Can we talk? Does one talk before, during, or after the adjustment? Does the doctor need to concentrate--so please no interruptions? Will you be asking questions you want answered while their jaw is wedged between the headrest paper? Let patients know how you prefer to handle conversation during the adjusting process.

Eyes open or closed? Does this matter? Is there anything you want the patients to be thinking about or visualizing during the adjustment? Give patients some guidance, or if it doesn't matter, at least talk about it. Patients wonder, even though they might not ask about it.

I give you a 9.5 Does the doctor want a critique of the adjustment after it is delivered? Do we talk about it? Does the doctor care? This issue may reveal more about the doctor's self-confidence than any other. Do you want this valuable feedback loop, or, do you not care what patients think about your adjusting style? While you probably don't want patients holding up numbered cards like Olympic freestyle diving judges use, some type of feedback is valuable. Patients know what they want, especially if they've been to other chiropractors.

Right side/left side. "Now, I'd like you to turn with your left side up." That's not how our brains work when lying horizontal on your table. How about touching the side you want up? We're generally in a kinesthetic mode while receiving our adjustments and touching would be a big help.

Privacy. Many patients in focus groups mention this aspect. Patients want privacy. That may simply mean having a professional carpenter replace your hollow core door with the 2" gap at the bottom with a sold core door that fits. In open office environments it may mean investing in a pink or white noise generator to mask conversations or reminding patients of your private office for more sensitive conversations. Without privacy the doctor/patient relationship is compromised and is no deeper than that we have with our barber.

Buying time or talent? Is the patient made to believe they are buying a certain amount of time and attention from the doctor? "My last chiropractor spent 15 minutes with me for $30," said one patient in a recent focus group. Are you selling time, which is easy to do, especially when starting in practice when you do have so much time? If you do it's a dangerous trap if you want to be a major influence in your community. Let patients know that because of your experience with hundreds, perhaps thousands of patients, you will only need about X minutes to correct their spinal biomechanics. Since their time is valuable, you're going to help them as quickly as you can so they can get on with their life.

These are just a few of the issues that surround an even broader and more interesting concept I call a doctor's adjusting room "tableside manners." It's based on the doctor's social skills, personality, technique, communication skills, sense of time, appearance, and many other characteristics. Adjusting room etiquette and these other issues profoundly affect a patient's trust in you, their willingness to comply with your recommendations, and ultimately, their desire to refer others to your office.

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My Report of Findings
Originally published in 1993
240 Pages
US $24.95

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