Metaphorically Speaking
by William D. Esteb
Since better communication results in a better practice and communication skills are not innate, but a learned behavior, improving one's ability to communicate can make a dramatic difference in your practice. An increasing number of communication tools and resources are being presented to chiropractors from within and from without the profession. Being aware of these techniques and consistently implementing them are two different things!
Neuro-Linguistic Programming (NLP) has received considerable attention in the last five or six years. Anthony Robins and his famous "firewalk" are perhaps the most visible examples of the popularization and acceptance of this communication technology. His bestselling book, Unlimited Power, describes some of the techniques of mirroring, pacing, swish patterns, anchoring, and others. These and related communication insights recognize how the brain works and organizes the presentation of information in a language more likely to be understood. Doctors and staff can take cues from a patient's language and determine whether they are more likely to be receptive to visual, aural, or kinesthetically encoded messages. The rationale here is that if a patient favors information presented in a visual format (the majority of today's TV-weaned public) and you present information to them solely on a spoken report of findings, the impact and understanding of your message is diminished.
A slightly different twist is offered by author Bert Decker in his book, You've Got To Be Believed To Be Heard. He suggests that all communication from others is filtered through the primitive part of our brain, which decides whether to believe the person sending the message. Decker emphasizes that these decisions are based on the non-verbal portion of the message. This picks up the theme expressed by Marshall McLuhan that "the media is the message." That is, how you communicate is often more important than what you communicate.
Doctors with an analytical bent or defensive posture are often unaware of this and tend to place an inordinate amount of attention in explaining a patient's range of motion in degrees or other measurable details. In fact, some doctors revel in this data, and report it in so much detail they fail to notice the glazed look in their patient's eyes.
Facts and figures rarely convince anyone other than accountants and scientists. Decker suggests that we make all of our decisions emotionally and then justify or rationalize them with facts. For example, if you were a patient emerging from relief care, which reasons would be more motivational: the emotional impact of being able to pick up your grandchildren in your old age or to slow a degenerative process? Would you rather gain a better golf swing or improve a kyphotic curve by 10 degrees? If patients were rational, they'd make the right decision based on your objective clinical findings. Instead, their compliance is often shaped by a much more subtle factor--you.
It takes more than just converting data into usable, real-world information that makes a difference. It's the non-verbal dimension that sabotages many doctors and staff members. Patients desperately want to know that they're in the right place and that they've selected a practitioner that can help. Patients must receive unconscious assurances from the doctor's body language that he or she has the personal confidence and experience to help the patient. Patients are sensitive and may correctly or incorrectly detect or interpret a pause, a glance away, a shifting in your chair, or other subtle movement or posture as a lack of assurance, undermining their compliance and even the healing process! A patient's hope or trust in your recommendations can be dashed by the smallest detail that suggests incongruency or a mixed message. Doctors must broadcast similar messages at all levels, conscious and unconscious. Doctors who practice fearlessly exude verbal and nonverbal confidence that reassures apprehensive patients and enhances their compliance and prospects for recovery. This suggests that whether you're a 20-year chiropractic veteran or just venturing into practice, the first person the doctor has to convince--is the doctor!
Along with communicating a high level of confidence in your chiropractic skills through your body language, it's important to use the most effective words and phrases. Taking a cue from the best communicators this planet has ever seen, doctors should be using more metaphors. The most effective communicators have always used metaphors, parables, short stories, fairy tales and similar devices when communicating new ideas to the masses. In the most simplest terms a metaphor is a way of saying, "this new thing" is like this "old thing." In fact, using the word "like" is an almost guarantee that the concept that follows is metaphorical. By associating a new idea with one already commonly understood helps patients accept it. It not only reduces misunderstandings but it also can equip patients with a ready way of telling others about chiropractic any other new idea. Using metaphors can improve referrals.
After years of schooling and clinical experience many doctors take many chiropractic words and concepts for granted. It's easy to forget that most new patients haven't the foggiest idea what an adjustment, subluxation, or nerve interference is. Overlook this, building your verbal presentation on these words without a proper explanation, and patients don't "get it." Metaphors can help new patients understand these new ideas. Certainly this isn't a conclusive list, but here are some metaphors that many effective communicators use with their patients:
Subluxation: Describe a kink in a hose or what an auto accident does to freeway traffic.
Adjustment: The process of aligning the front end of a car, tuning in a radio station, or the fine tuning of a mechanical device.
Spinal Kinesiopathology: Orthodontics is a good way of describing the affect of abnormal motion or position of spinal bones. Adjustments can be likened to braces on teeth (bones). I like the notion of pelvic tilt causing problems to the spine up above like the settling of a house foundation causing cracks in the walls.
Neuropathophysiology: The concept of nervous system malfunction is like television when your cable goes out--you can see the picture, but there's a lot of static. The dimmer switch works well too. In fact, make sure the room you give your report of findings has a dimmer switch so you could illustrate it during your report.
Myopathology: The scar tissue that changes the elasticity of the muscle is like gristle in an inexpensive steak. Muscles adapt and get used to supporting the spine improperly, like trying to change your hair part. A tug of war. The stronger team (muscles attached to the spinous process) causes the bone to rotate.
Histopathology: A bruise, black eye, sunburn, blister, and jelly-filled donut can be quite effective.
Pathophysiology: I like the mineral deposits in a cave (stalactites and stalagmites) because it suggests that given enough time the bones will fuse together. Barnacles on a rock is an easy way to show the idea of bone spurs. Or lighten up your explanation by suggesting it's like having your house remodeled by an amateur carpenter. The concept of tooth decay works well too. Decay is simpler and probably carries more impact than the word degeneration.
After years of school, making countless drawings of the spine and having a love of its physiology, it's easy to forget that patients have difficulty understanding your chiropractic perspective. Without the proper understanding, patients lack the basis for properly respecting your clinical skills. More significant to those interested in growing their practice, it makes it difficult for patients to explain chiropractic to others.
Improving one's communication skills can do more to improve a practice than all the technique workshops in the world. Using metaphors in your patient communications is like the difference between earphones and speakers. Earphones are more personal and only one person can hear at a time. Like metaphors, a set of loud speakers allow more people to hear your message. Metaphorically, you'll know they "got it" when you see the light bulb go on above their heads.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
Not a reader? Bill reads his favorite chapters from all 10 books on Bill's Best. |
