Control and Management
by William D. Esteb
We can only control that which is less powerful than ourselves. Controlling dogs, children, staff members, and small electrical appliances is relatively easy. Our experience, intellect, size, strength, or financial power make it easy for us to take control and guide our relationships in the way we wish. This sense of power and control can be quite addictive.
Patients who enter your office in severe pain are certainly less powerful than you. This makes it relatively easy to control patients during the early stages of their care. When you ask patients to complete four pages of admitting paperwork, they do. When you tell patients to stand in front of the X-ray bucky, they do. When you tell patients to apply some ice, they usually do. Because of their symptomatic condition they are compliant and seem to willingly obey your every command. Because of your clinical experience and a true desire to help, you direct patients in a care program that is in their best interests.
The consent to direct and control patients' behavior is a perishable commodity. As their symptoms disappear and they become more powerful, the patients' own "internal doctors" take over, modifying your suggestions; even openly disagreeing with your recommendations. Compliance suffers. Clearly, the patient management techniques that work during the initial stages of care aren't as effective when patients regain their health (and power).
I know a practice that was recently sold. The previous doctor was proud of his mix of patients and had attracted many families and influential white collar workers. In fact, his patients were a lot like him, reflecting his confidence, optimism, and sophistication. As when many practices are sold, the demographics of this office began to change. After the transition period when both doctors were in the office, patient volume began to drop off and then level out. The most striking thing about this sale and transition was what I observed a year later. Instead of a vibrant office of highly-educated professionals seeking wellness care, the practice had become filled with personal injury and blue collar worker's compensation cases. Apparently the new doctor was uncomfortable working with patients who were his peers and found it easier to control those who were less demanding and often less discerning.
In the same way we can feel underdressed in an upscale restaurant, doctors often inadvertently implement procedures or project an attitude or lack of confidence that makes certain patients feel unwelcome. A homeostatic balance is reached, based on the doctor's comfort level, self-esteem, social skills, personality, and energy level.
Where are the influencers of your community? The mayor, the city council, and business leaders? Everyone deserves access to chiropractic care, but the fact is, in all too many offices the doctor has unconsciously or purposely gone after the types of patients that are easiest to manage and control.
Same with staff. Some offices are blessed with independent, self-confident staff members who are free to speak their minds at staff meetings. They have a career attitude and have a sense of ownership in the practice. Other offices have people behind desks who are still looking for a clue as to who they are and why they're on this planet. They are easy to control, especially when they are kept in constant fear of losing their jobs if they make a mistake.
Which office is having more fun and making a greater impact on their community?
If you want to attract more influencers into your office and enjoy a staff that's pulling with you, you will need to recognize the difference between being a controlling authoritarian manager or a coaching facilitator and mentor.
The old school. The control and management school of thought believes that if given the chance people will goof off, make mistakes, and generally can't be trusted to do the right things. Those who ascribe to this Neanderthal way of thinking assume the burdensome task of orchestrating a patient's every move. Even in a day and age that has seen the socialism model crumble in Europe, there are still doctors who scare patients, badger patients for visits they don't understand they need, and make evening lectures mandatory.
The right to fail. If you've ever coached little league baseball you know the frustration (and joys) of coaching. The fundamental truth is that coaches cannot guarantee success, they can only teach the fundamental skills that it takes to win. This is why patient education is so important. You must empower patients with the information, lifestyle skills, and other resources they need to win. Remember though, it's their body, their spine, their health, and their future. Allow them the dignity to fail if they wish. They didn't appoint you den mother!
Set a good example. Patients rarely become healthier than their doctor. In a mentoring relationship based on mutual respect, a doctor must set a nonjudgmental example that a patient can find attractive. A doctor and staff must give patients something to shoot for. They must be living testimonials of the behavior they'd like their patients to adopt. That means physically, mentally, and socially. Your leadership role requires that you expand their vision.
Being liked versus being respected. This can be a most challenging aspect of leadership. All of us deeply desire to be accepted and liked. I don't know anyone who doesn't. The danger of this attitude is that it makes you as weak or weaker than those you are to lead. The best doctors challenge patients in a way that prompts them to want to do their best. Constant encouragement, open feedback, and frequent progress reports are important. Rarely do we do our best work in a vacuum. We all need constant affirmation that we're doing the right thing.
Willingness to delegate. It's certainly more expedient to just do it ourselves rather than explain how to do it to someone else. "In the time I could teach my staff I could do it myself!" wails a doctor in frustration on the phone. Doctors must delegate responsibilities to staff and patients. Chiropractic is participative in this regard. Patients need to keep up their side of the bargain for optimum results. This involvement enhances self-esteem, improves the healing process, and is the hallmark of self-reliance and trust necessary in long term relationships.
Nondefensive posture. Most of us learn best by experience. When you allow patients to fail by dropping out of care early, remind them that you will always be available should their problem return. Make sure they know you'll welcome them back without an "I-told-you-so." Help prevent them from going down the street to save face or giving up on chiropractic because they might be afraid to confront you a year or two later.
Control is a myth. The ambiguity that would result if the full reality of this notion were realized by most of us would cause panic and chaos. The fact that any patient returns after their first visit is a testimonial to your ability to lead and influence. Similarly, if patients drop out after seven visits because they feel better, it is a reflection of your communication skills and leadership ability. You can't have it both ways.
In the end, the only thing you can control is yourself. If you lack the discipline and courage needed to do the right thing, don't expect your patients to rise to the occasion. Patients are watching you. They're studying how you lead your life, your practice, your marriage, your staff, and your daily conduct. Start with the who you see in the mirror.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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