On Becoming a Coach
by William D. Esteb
I bet this isn't an exciting time for practice management firms. The good old days of plentiful insurance money has been replaced by an increasingly competitive environment in which fewer and fewer patients have insurance, and those that do have sky high deductibles. What chiropractors have discovered is that the A.M.A. wasn't the enemy, it was the "sickness care" orientation of the insurance industry! The world has changed, and few practice management firms have kept up.
Sadly, most practice management firms are still beating the dead horse of insurance. Supplying "super-duper-can't-fail" narratives and complicated insurance procedures to increase the likelihood of getting paid is simply rearranging the deck chairs on the Titanic.
Since hope springs eternal, some are placing their future in the hands of legislators who will lead us into some type of nationalized/socialized health care (actually sickness care) system for all citizens. "Like they have in Canada," they proclaim. Have you actually talked to any Canadian chiropractors? In Ontario it's called 22 visit-itis. In British Columbia it's 12 visits, without reimbursement for X-rays. Even in light of the Wilk case, the RAND Corporation study, and the 20/20 story, chiropractic care is likely to be capped, severely limited, or shortchanged in some way. Even in the best case scenario, income from third-party payers will never be like it was in the early 1980s. Let's do what we can with the legislatures and national lobbying, but the wishful thinking of most practitioners is not likely to materialize.
Practice management firms have played a valuable role in the profession by helping countless doctors recognize that they are at the helm of a small business, and not merely drug-free healers. Recent advancements and sophistication in the chiropractic profession are partly due to the efforts of a handful of reputable management specialists. Yet the tactics they've taught during the last 10 to 12 years are less effective today. The notion that you can control patients into compliance or manage them into doing the right thing is a thing of the past. The generation showing up in chiropractic offices these days has changed all that.
Teaching doctors and their staff to be confrontive and authoritarian in their patient management is no longer effective. This authoritarian, "do as I say" approach may work during the early stages of care when patients are experiencing painful symptoms, but its effect is counterproductive later as they feel better. The compliance in the beginning is accompanied by the same resentment we feel about government red tape, the intelligence-numbing experience at the Department of Motor Vehicles, or the long, unexplained delays on the runway before take off. Patients resent being "talked down to" and ordered around as if they can't think for themselves. Baby boomers, like their four-year old children have a propensity to want to know "why." Unless you anticipate this "tell-me-why" mindset you are prone to poor compliance, poor word-of-mouth advertising, and less than optimal patient rapport.
Why do I need X-rays? Why can't you do something to help me on my first visit? Why do I have to "sign in"? Why do I have to see a video? Why to I have to take my clothes off? Why do I feel worse than when I came here? Why does a four-minute adjustment cost so much? Why won't my insurance company pay for this? Why can't you prescribe drugs? Why don't you work more closely with the medical profession? Why do you treat children? Why do I need to keep coming back? Why?
This unspoken predisposition to want to know why is hard for some doctors to accept because many patients are not verbal or self-confident enough to even confront a doctor with these questions. They are relieved when the information is volunteered without asking for it, or they'll ask your staff instead. Don't be fooled into thinking that just because they don't ask some of these questions that they are mindless robots, ready to obey every instruction!
No, the old dictatorial, authoritarian bedside manner of the past no longer works with the today's new patients. More appropriate is the doctor as a health care "mentor" or "coach." Coaching is an entirely different orientation. In some ways it is easier than being the all-knowing-omniscient doctor of the past. And in other ways it is much more challenging. Rarely do coaches get the instant gratification that dictators enjoy. Plus, it can be especially frustrating for doctors with years of clinical experience to see patients squander their health potential by ignoring suggested lifestyle modifications or visit frequency recommendations.
Besides taking a burden off your shoulders (that to a patient you didn't ever really have), being a coach requires a new way of thinking. If you want to be a better coach to your patients, here are some ideas to consider:
Sense of team. Being a coach automatically connotes a sense of teamwork. For a team to be effective there must be leadership from the coach and mutual respect for the "players." It also suggests that each individual has a certain set of responsibilities. Make sure your patients know what you and your staff are willing to do as you help them recover their health and what you expect of them. Chiropractic has always been a partnership approach to health. It shouldn't be something that "just happens" to a patient. It happens with a patient.
Teach the fundamentals. This is where patient education comes in. Not only does a coach explain the rules of the game, players depend upon the coach to teach the basics--everything from how to grip the bat, kick the ball, or throw a pass. In the health care arena this means explaining the function of the nervous system, how the body heals, and acquainting patients with the basics of physiology. Most patients are merely guests in their own bodies and have no idea how it functions. Always go back to the basics--it's what makes chiropractic make so much sense!
Have a game plan. Every player needs to know your strategy. What's the line up? What can we expect? What are some areas of concern? If you want patients to abandon their limited notions of health, you must share your vision so they can understand and respond appropriately. Strategies change throughout the season and throughout each individual game (visit). Keep patients in the dark and they become powerless to contribute. Share your plan and watch compliance improve.
Set an example. How's your own health these days? What's your physical fitness plan? What are you doing besides getting regular chiropractic care to maintain good health? Rarely do you find patients who are healthier than their doctor. When patients reach your level of health, or that of your staff, they are prompted to drop out. Coaches lead by example. Don't confuse this with the "healthier-than-thou" attitude some doctors project! Leading by example is quiet and non-judgmental. When the coach has high standards it's more likely players will set high standards, too.
Praise. This is one of the more difficult mindsets to overcome. There was a time when you could order patients to comply or scare patients into submission. That's unsportsman-like conduct. Coaches must continually encourage their players to set ever higher goals and levels of achievement. And while every coach's style is different, find a behavior you want repeated and praise it! Want patients to do their exercises at home? Lavish praise in celebration of their discipline. Praise patients for keeping their appointments, showing up on time, bringing their spouse to reports, referring others, and other conduct you want to encourage. What gets rewarded, gets done.
Heads up. This is one of the other important roles of a coach: watching for shifts in the wind or changes on the playing field that might necessitate a change in strategy. Coaches need to be sensitive to backsliding or off-handed remarks that may reveal internal struggle or doubts that may sabotage performance. Similarly, coaches look for opportunities to ask questions, talking about the health of other family members, and other occasions that reveal clues about issues that may influence compliance or referrals.
Celebrate. The best coaches make the game fun to play. Yet, if the coach isn't having fun, the players probably aren't either. If financial pressures, staff management problems, or a lack of energy or purpose are hobbling the coach, the players are affected. Your game plan should identify certain goals or milestones on a patient's road to recovery. Celebrate when they are reached! Compliment the patient in front of others. Send an encouraging letter or card. Take their picture. Let the rest of your "team" see your Most Valuable Player.
Those who have ever coached a little league team know that coaching is an entirely different way of thinking than that of a dictator. For those who were "ordered around" as children or are accustomed to being spoon fed by others, becoming a coach can be an exciting growth opportunity. For those doctors who have created a successful practice using the old methods of the past are likely to find coaching difficult and uncomfortable. It's hard to argue with years of experience and cabinets bulging with patient files from the past. But that was a different time. Welcome to the future!
It's unlikely that chiropractors will fully assume the role of being coaches until the examples set by management firms reflects this new attitude. In the same way doctors can't "manage" patients, management firms can't "manage" doctors. The awareness of this fundamental shift can encourage responsibility and increase a doctor's self-esteem sufficiently to propel chiropractic into its second hundred years.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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