Doctor or Mechanic?

by William D. Esteb

Having entered the chiropractic profession by helping create patient education tools for Renaissance International in the early 1980s, I sometimes forget there are chiropractors who do not educate their patients. At a recent chiropractic convention I asked some of the doctors why they didn't educate their patients. The excuses and rationalizations surprised me.

"My patients are uneducable." Oh really? How did he attract an entire practice of learning disabled patients? Further questioning revealed he had a practice that was largely Worker's Compensation and personal injury cases of Hispanic descent. "Their care is paid for by insurance and they don't want to learn anything about chiropractic. They want to get fixed and back to work," he said flashing his gold capped teeth.

Detroit has made driving a car so easy you don't even have to know how it works to use one. One pedal is for "go" and one pedal is for "stop." Use the big round thing to turn to the right or left. You don't need to know how an internal combustion engine works, how an automatic transmission works, or how the turbo works. Yet, drivers who know how these items work find their cars get better gas mileage, last longer, and require fewer repairs.

It's the same with basic physiology. Patients who understand how their body works are less likely to get sick and when they do, get well faster. Ask your most disinterested patients, if they'd be interested in learning some ways of saving money, getting well faster, and preventing their problem from recurring in the future? Watch their eyes light up!

If patients don't care it's because the doctor isn't sensitive or creative enough to find an entry point. Remember the best teachers you had in school? They were the ones that made learning relevant. The less effective teachers were too philosophical, egotistical, not practical, or so uninterested in the material themselves they were unable to make it interesting for their students. How are you making chiropractic fun and interesting for your patients?

"It's too much work." That's what one tired doctor said. Apparently at one time he had recognized the need, but it became too labor intensive or the rejection from patients (because it wasn't relevant) wore him out. Without experiencing the rewards of your efforts, it can seem like work. Hauling out the lecture charts, begging patients to attend, shoving brochures at patients, and all the other means can test anyone's patience.

I have an uncle who is a dry wheat farmer in Colorado. He cultivates the ground, plants the seed, waits for the seed to germinate and green buds to poke through the soil. In the early part of spring that can take weeks. But that's just the start. How about the insects, diseases, lack of rain, damaging hail, and all the other challenges? If you require instant gratification, don't become a farmer.

Patient education is a lot like seed planting. The difference of course is that you don't know when or if your efforts will germinate. If you want to avoid disappointment, simply don't plant any seeds.

"Not enough time." This is the "I'm-so-busy-putting-out-fires-I-don't-have-time-for-fire-prevention" school of thought. This type of practice makes doctors feel important and valuable. Because it is largely a practice of symptomatic patients who respond to the pain relief aspect of chiropractic, the doctor can rest assured that "chiropractic works." This medical approach to chiropractic (symptom relief only) fits the insurance model perfectly as patients discontinue care when they feel better. Forget about the soft tissue and underlying muscle damage that predisposes them to a relapse. Ignore the value of some type of on-going maintenance or wellness care like you enjoy! After all, you're running a pain clinic.

What are these doctors going to do when their highly-leveraged lifestyles and cluttered insurance departments regularly encounter $1000 deductibles or patients without insurance? "By then, the nationalized health plan like Canada's will be in effect," they respond smugly. How chiropractic will fair is anyone's guess. However, if you think Canadian chiropractors are delighted with the 12 visits or 22 visits doled out in the various provinces, you need to meet a few of them. Better yet, talk to a few chiropractors in Oregon, Colorado, and Minnesota who, in the early 1990s, felt the cost-containment moods of their legislatures. This is a wake up call! Changes are coming. Big changes.

"I already educate my patients." I was intrigued by his confidence and Mr. KnowItAll attitude. Prepared to learn some new technique or gain some fresh insight into patient education I asked him about his various approaches. "It's basically at the report of findings," he said without blinking. "I show them their X-rays, explain my examination findings, and make my recommendations for care."

I was caught off guard, expecting some systematized patient dialogue, innovative brochure presentation, or "topic of the day" program he was using. "So you feel that your report pretty much acquaints patients with what they need to know?" I asked regaining my composure.

"It seems to be working," he smiled.

"Great," I said.

This is the "magic pill" school of thought in which patients are expected to abandon a lifetime of medical/germ theory/aspirin-popping orientation after a spellbinding 15-minute patter in front of the X-ray view box!

If you're feeling confident of your current patient education efforts, give some of your brightest pupils a pop quiz:

1. Would you rather feel good or be healthy?
2. If you throw up after eating food that has been improperly prepared are you sick or are you well?
3. Why is it that when 10 people are exposed to a cold virus only a few people get one?
4. What controls the function of every cell, tissue, and organ of your body?
5. Describe what a chiropractic adjustment is and what it does.

Offices that invest heavily in patient education tools and techniques do so because they understand the huge return on their investment. Here are some reasons why patient education pays off in today's most successful practices:

Faster healing. Researchers in a Minneapolis hospital studied two groups of cardiac patients. To one group they volunteered a complete explanation of the procedure and discussed the possible post-operative reactions. To the other they took a more traditional approach, only answering questions asked by the patients. The result? The "educated" patients recovered twice as fast.

Better compliance. Getting patients to do the right thing to participate in their own recovery is enhanced through patient education. Blindly following "doctor's orders" is no longer the standard protocol. Today, patients want to know why it takes more than one visit, why it feels sore after their first adjustment, why they should bring in their children, and answers to countless other "why?" questions.

More referrals. The most enjoyable patients to serve are those your current patients refer to your office. When your current patients vouch for you, new patients are less critical and skeptical. Your patients could generate even more referrals if they could more accurately describe what chiropractic is and adequately defend the value of their chiropractic lifestyle. If your patients can't explain to a friend why someone with headaches or some type of systemic problem might benefit from chiropractic care, they won't.

Less stress. When patients understand their chiropractic care there is less confrontation and fewer inappropriate questions. This allows staff members to better choreograph patient flow and tend to the interpersonal and non-clinical needs of your patients. When patients have a clear understanding as to why they are in the office, there is a genuine sense of family that makes coming to the office a real joy.

More respect. Education gives your patients a greater appreciation for the skill required to be a chiropractor. Without proper education patients are likely to devalue the importance of the adjustment and to assume that all patients receive identical care. "Something so repetitive and quickly rendered must not be very difficult to learn," reasons the patient. Combine this with the word on the street that chiropractors are poorly educated and you have a practice in which patients have little more respect for the doctor than they do for their barber or car mechanic. Educated patients hold chiropractic doctors in higher esteem than uneducated patients.

More families. Parents who understand chiropractic are more likely to bring the rest of their family in for care. Parents who understand chiropractic are more likely to bring their newborns in for a chiropractic check up. Often these families show up together, get adjusted together, and make for a very efficient office visit. Measure how well you're educating your patients by counting the number of children receiving care in your practice. Few 6 year olds will call your office for a free spinal exam! Only educated parents who trust you will bring their children in for care.

More wellness patients. Educated patients are more likely to continue with some type of maintenance care. These are fun patients to be around because they recognize the value of something you've given your life for. These are generally cash-paying patients who provide a stabilizing influence at a time when insurance deductibles are rising. Better still, educated maintenance patients can schedule their visits around your vacations and long weekends with your family. Patient education allows you to have a life.

More chiropractors. Educated patients are more likely to see the career path represented by chiropractic and become chiropractors themselves. I can always tell how well a doctor educates his or her patients by how many patients they have sent to chiropractic college. Patients who have not been educated can't get excited about your profession unless they simply envy your house, your car, or flashy jewelry. Patient education ensures that there will always be enough chiropractors to respond to the increasing demand for chiropractic.

Patients do what they do, because they think like they think. Changing the way they think is a major responsibility of doctors and staff. Not just because it's the right thing to do, but because improving a patient's spinal biomechanics without educating them ignores the most potent part of their nervous system--the brain. This important part of the nervous system controls patient compliance, retention, referrals, and the less statistically measurable aspects of perception, respect, and trust. Ultimately it is the condition of this organ that will decide if they are seeing a doctor or merely a spine mechanic.

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

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