Maslow's Chiropractic

by William D. Esteb

Are you one of those chiropractic doctors who recognize the value of a chiropractic lifestyle and encourage patients to remain under some type of on-going maintenance or wellness care? Often it seems like an uphill battle. Many patients seem to prefer pain relief over optimal health. Patients respond to the opportunity of maintenance care based on many factors not readily apparent to doctors. These factors include waiting time, cost of care, location, convenience, and dozens of other aspects of personality, bedside manner, and office procedures. If identified, many of these "interferences" to the accessibility and attractiveness of maintenance chiropractic care can be removed or avoided. But there's something much more pervasive that's standing in your way: Maslow and the hierachy of needs.

Remove the trappings of today's busy lifestyle and culture and look at the basics. At the most fundamental level we are motivated by the access to food and water. If these rudimentary supplies are available in a quantity and quality that assure our continued survival, then and only then are we motivated to pursue the next higher level of needs.

Clothing, followed by shelter, followed by security push further upward on Maslow's chart. Just about every patient who makes it into your office has these basics under control. The type and quality of clothing vary from patient to patient, as does their home--some rent some own. But what about security?

What if a patient loses their job or goes through a security-wrenching divorce? Are they likely candidates for non-symptomatic wellness chiropractic care? Probably not. Their security needs take precedence. This is why patients, especially blue collar patients who "make their living with their back," can be quite motivated to follow through during the relief stages of care when their livelihood and mortgage payments are in jeopardy due to an incident or accident! For many of these patients, continuing their chiropractic care beyond the initial pain relief stage doesn't directly advance or contribute to the achievement of their security. Many of these patients rarely feel secure enough to rise any higher on Maslow's hierarchy of needs, continuing to exist month to month, paycheck to paycheck.

Progressing higher up the chart after security, Maslow placed the concept of companionship. Above that, the nurturing of one's self-esteem. Rarely does chiropractic contribute to one's self-esteem sufficiently enough to be a motivator. More about that later.

At the very top of the list Maslow placed "self-actualization" or "self-improvement." Certainly chiropractic can help bring out all of one's potential. That's a natural reaction to having an optimally functioning nervous system.

Maslow suggests that one doesn't progress to the next higher "level" until their needs are met at their current level. In other words, you aren't motivated to develop your self-esteem until the basics of food, shelter, and security are taken care of. What does this mean for chiropractors interested in developing a wellness practice of non-symptomatic patients/clients interested in optimizing their life?

Let's face it. Patients who respect themselves, are inner directed, and want the best for themselves are fun patients to be around. They rarely whine about their sleepless nights or problems paying your bill because their rent is due. When patients hit the higher plains of esteem and actualization they are often more financially secure and pleasant to be around.

The challenge is to help move a patient from pain relief (security) to wellness (self-actualization). It's a big jump. And virtually impossible for doctors to make if they haven't reached the self-actualization stage themselves! That's a key point. Doctors who still have sweaty palms over making payroll or paying their malpractice insurance premiums will find it difficult to establish the necessary rapport to encourage their patients to enjoy the self-actualization that wellness care can promise.

According to Maslow, the step above security is companionship. Instead of a mating relationship, in the context of chiropractic it refers to the doctor/patient relationship. The doctor's bedside manner and ability to establish rapport without judgment are critical. This seems easier for doctors who can concentrate on truly serving their patients rather than seeing them as a $35 adjustment plus $30 for two therapies. On the other hand, doctors who lack an outgoing personality or who secretly resent the control their patients exert over their own security can never help their patients transcend this "companionship" level.

Improving one's self-esteem is the next higher level. Again, this is difficult for a doctor to develop in patients if he or she lack a high self worth themselves! If the doctor is being held back at the companionship level because they want the patient to "like" them, it's difficult to mentor a patient's self-esteem. That's what's so powerful by unconditionally giving in the service of others. It liberates us to see others more clearly. We don't have the inclination to build a public relations campaign, worrying about what they'll think--we simply give. This unconditional attitude of service is powerful evidence to patients that you value them; maybe more than they value themselves. This is the prerequisite of facilitating a patient's self-esteem.

There are many opportunities to help improve a patient's self-esteem in a chiropractic setting. Besides the obvious wisdom of not condemning a patient for missing an appointment, forgetting their exercises, or parking in the wrong place, start using more praise. Make it a habit to compliment every patient on every visit, even if it's just the colors they wear or the fact they were on time. As an exclamation after their adjustment say, "You did great!" or some other form of congratulations. When you're running late, apologize, making them feel their time is more valuable than yours. The key is to respect each patient more perhaps than they respect themselves--while remaining genuine and sincere.

Another consideration is that patients who have a high level of self-esteem have higher expectations of you and your office, regardless of their symptomatic picture. These patients refuse to be treated like a number or to frequent an office with the ambiance of a bus station. The doctor and staff must have high self-esteem and project it in every thing they do, from the types of magazines chosen for the reception room and the type of language used by the staff, to the subtle qualities expressed in telephone manners and millions of little details about the office.

One must first have a relatively high level of self-esteem (a rare phenomenon these days) to be a candidate for the self-actualization represented by the desire to enjoy wellness chiropractic care. The self-actualization required to fulfill one's potential is a tall order for someone still worried about making the car payment and clothing their children. Most doctors are beyond these basic survival needs and can afford to "work on themselves" by optimizing their diet, exercise, and spinal biomechanics. If you have a hard time understanding why patients don't follow through with maintenance care, try to remember back what it was like to take a full course load as a student, hold a part time job, and share the rent with three friends. When one's security is threatened or unstable, it's difficult to selfishly squander one's resources on lofty intangibles such as personal development or self-actualization.

If you want more wellness patients you have to help grow them or begin a concerted marketing effort to attract patients who have high self-esteem and are ready for self-actualization opportunities. There must be a demand for quality chiropractic care among artists, thinkers, and gold collar workers in your community. But perhaps a better strategy would be to help grow more of these ideal patients by helping them reach higher levels of self-development while they are within your sphere of influence. When you help a patient think more highly of themselves and show them the possibilities for them and their family, you change the patient in a most positive way. It doesn't happen overnight. However the trust and confidence they place in you because of the power of chiropractic offers a tremendous opportunity to change the world.

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

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