The Chiropractic Performance
by William D. Esteb
One of the most compelling reasons for efficient management skills and the implementation of a business "system" in your office is it allows for a better chiropractic performance for your patients. Many chiropractic doctors fail to realize that the performance; the set up, delivery, and bedside manner, is equally, or more important than the adjustment itself. Proper office management allows more attention and focus on the performance of chiropractic.
Unfortunately, some doctors approach the adjusting table with the same amount of thought as the zealous cook who discovers half way through mixing a cake that they lack a key ingredient. Not only does this sabotage a new patient's perception of chiropractic, it can devalue an established patient's care. In fact, I'd venture to guess that a less-than-optimal spinal manipulation, if rendered as a magnificent performance, can be perceived by the patient as better than a more specific chiropractic adjustment delivered by a doctor who seems detached, distant, or preoccupied. The performance is an often overlooked part of the psychological component of the healing process.
The impact of this shortcoming is especially apparent in the offices of doctors who are not particularly expressive or outgoing. These are often analytical types who have invested heavily in technique seminars, are voracious readers, and have overlooked the "art" of chiropractic and focused instead on the "science" of chiropractic. These doctors are often so focused on their adjusting technique, that the sometimes more important psychological needs of the patient are neglected. The result is a perfectly rendered adjustment on a patient who perceives the doctor as uninterested and uncommunicative. With a lack of communication from the doctor the patient fills in the blanks, interpreting the event in their own terms. They may incorrectly think their case is difficult, that they are not responding as expected, or worse, that the doctor is unsure. This "poor performance" (as perceived by the patient) sabotages an optimum doctor/patient relationship.
The performance here is more than just impeccable bedside (tableside) manners. It has many component parts. An entire book could be written about each part. Until then, here are some ideas you might want to consider as you evaluate your chiropractic performance and look for possible ways of improving it:
Personality. If you know you're not a great communicator, start working on it! It is the single most important aspect of your performance. Doctors who regularly do lectures or welcome public speaking opportunities almost always have better practices. In fact, the common denominator of every successful practice, regardless of how you define success, is a doctor who is a good communicator. You may have to leave your comfort zone. You cannot remain a spectator. Get in the game and test your beliefs, test your values, and share your vision. Confront your greatest fear. Make some mistakes. Grow!
Preparation. What is your plan to fully utilize the opportunity presented by having patients in your office--an environment you control? What impression or outcome do you want today's patients to leave with? What is your purpose for being in practice? What specific action steps will you need to take to better assure the fulfillment of your purpose?
Preparation means you'll need a plan (and a back up) to accomplish your purpose. Magnificent performances don't just happen, they are well thought out. When a musician or gourmet chef makes their concert or exotic dessert preparation look easy, it's because they were totally prepared. They visualized the exact outcome or effect they wanted (not what they didn't want) and their performance was conducted on a more powerful unconscious level.
If you are already practicing on an unconscious level, the challenge is what you do to prevent your synergistic flow of total focus from becoming a boring routine. Yet, this is when you can truly give more attention to your verbal and non-verbal communication in the adjusting room. Set up a video camera to record what happens tableside. Compare the energy and focus at 10:30 A.M. with 5:30 P.M.
First impression. If you've heard the classic line that "your appearance is speaking so loudly I can't hear what you're saying," you know the importance of a first impression. This happens all the time in chiropractic offices. The first impression starts with the quality of any outside marketing efforts (yellow pages) and the location of your office (is the neighborhood on the way up or the way down?) to opening the door to your reception room. Walk in the front door of your office. What's the first thing your eye goes to?
Apprehensive patients size up your office very critically because they figure you had a hand in creating its tone. It serves as a metaphor of the quality of care they think will be rendered in the back room.
Patients gauge the staff and doctor in the same way. This isn't an excuse to be extravagant (unless maybe you practice in Beverly Hills), however invest in quality office furnishings and clothing. Don't expect to see white collar "influencers" of your community consulting your office if you're still wearing polyester! Dress just one notch above your average patient or the type of patient you want. Your appearance, office resources, and increased capacity come first, then the patients come. You cannot perform at your best with an adjusting table you don't like or X-ray equipment the produces unpredictable results.
Audience. The audience is an important component of any performance. The key to any extraordinary doctor/patient interaction is a thorough understanding of the audience. I remember having a seminar audience turn on me in Mt. Horeb, Wisconsin. I was invited to speak on the subject of patient education to alumni and students practicing the Gonstead adjusting technique. Since most new patients could care less which adjusting technique the doctor uses, I didn't give any thought to the anterior adjustments shown in a patient education video tape I was demonstrating at the time!
Knowing your audience goes beyond acknowledging the patient's symptomatic complaint and assuring them you think you can help. On a more powerful level it means to anticipate their concerns. How are they going to be feeling and what are they going to be thinking when they are completing your admitting forms? What's going through their minds as they hear the drop piece on your adjusting table? How much is this going to cost? How long is this going to take? Will it hurt? Will I have to keep coming back for the rest of my life? The internal dialogue goes on and on. Doctors who recognize this voice and volunteer answers (without the patient having to ask!) build strong bridges of rapport that later translate into trust and better compliance.
Timing. Ask any comedian what is the most important part of their performance and they'll tell you timing. What else can explain difference between an "I died out there" performance and a "I killed them" performance using the same material?
How many times have you rushed your report, knowing the reception room was filling up? How many times have you dismissed a patient's intimate revelations? How many times have you cut off a staff member's meandering explanation of a problem to "cut to the chase"? Timing is everything. The key is to have the rapport necessary to match the patient's pacing.
Delivery. Patients look to the doctor for cues as to the proper patient "etiquette" during the actual adjustment. Should I close my eyes? Do I talk during the adjustment? If you're going to "Tango" make sure you lead and you tell your partner (patient) what kind of dance you'll be dancing.
Patients look to the doctor for cues as to how to judge the importance of an adjustment. If you believe it is paramount, and you want patients to believe similarly, talking about the Lakers game while delivering a cervical rotation is probably inappropriate. So is gum chewing, humming along with piped-in Karen Carpenter singing "We've Only Just Begun", and other behavior that would indicate lack of present time consciousness.
The punch line. If after every adjustment your brain produces the sound of thunderous applause, let your patients in on the performance. Praise patients, "You did great!" Educate patients, "Now you have better range of motion!" Motivate patients, "That oughta shave a few more strokes off your game!" Future pace your patients, "Now you'll be able to lift those grandchildren of yours!" It's not so much what you say, it's how you say it. Patients want to sense passion, excitement, and a sense of culmination.
Feedback loops. Part of the performance must include some type of monitoring so the doctor can keep tabs on the relationship. "How are we doing?" Every adjustment with every patient may be your very last. You can't be sure that any patient will ever return again. Part of the performance must include simple questions that can help serve to reveal their commitment and satisfaction. "How was that adjustment compared to the approach I used on Monday?" "Are afternoons still the best time for your appointments?" These and other questions can be asked without assuming a defensive posture or seeming insecure. They are casual, off-handed remarks that project self-confidence and an almost, "I-already-know-the-answer" attitude. Yet, questions like these can create an opportunity for patients to voice a concern or express a frustration that can be remedied before it's too late.
In medicine, a placebo can be part of a performance. Its use acknowledges the important role the brain plays in the healing process. Same with chiropractic. An engaging tableside manner projects confidence and honors the patient's psychological needs. And while chiropractic is so powerful that even the crudest forms of manipulation can offer pain relief, it is the artist who multiplies the effect by his or her performance that takes patients to a higher plane of wellness. That's what patients really want: more goose bumps. The same kind they get when hearing Mariah Carey hit a high note or watching Michael Jordan fly!
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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