Wanting What They Need
by William D. Esteb
Every weekend there is an interesting phenomenon that occurs in neighborhoods around the country. Garage sales. Usually once a year or so closets are cleaned out, the basement is inspected, and the clutter in the garage is emptied of things no longer wanted. The gasoline powered weed eater. The bowling ball no longer used. Clothing that no longer fits. Dishes, knick-knacks, and the now abandoned fish aquarium. The prices applied by masking tape are a bargain. Perfectly good and functioning items for sometimes less than 10 percent of what they were original purchased for. It's a good example of what happens when needs change, people grow, or they have confused what they want with what they need.
I bet many of the items at a garage sale were purchased on impulse or without a clear understanding of the responsibilities or the maintenance needed. Other items may have simply been outgrown. When it was purchased, virtually every item was wanted. "I just gotta have that new-improved-super-charged" whatever. This type of behavior is most obvious in children who go from one thing to another, wanting this and wanting that. These discarded things are rarely "needed" but they are desired (wanted) at the time. Then times change.
There is a tendency among those who are the most philosophically dogmatic in chiropractic to look down upon patients who merely want pain relief. "I don't treat symptoms," they say smugly as their nose tilts ever so slightly towards heaven. "What the patient needs is spinal rehabilitation and lifetime maintenance care," they rationalize to themselves. But what the patient wants is pain relief. "I don't treat symptoms," deadpans the doctor. "Medical doctors treat symptoms, I treat the cause." It seems so clear to the doctor. And while the doctor is able to maintain his or her philosophical "purity," patients don't get it.
When I was doing work for Compassion International, a Christian child sponsorship organization, I saw first hand the importance of recognizing the difference between wants and needs.
In the Third World, poverty is one of the greatest challenges, particularly in the "mega cities" of Mexico City, Manila, Hong Kong, and countless others. In these and other cities, I have seen human squalor and hopelessness that will tug at my consciousness for the rest of my life. Millions have fled beautiful, quiet rural settings for the bright lights and opportunities of the city. What they find is something vastly different. Without education and training, and with their life savings exhausted, they must take up residence in one of the many slums and cardboard shanty towns of the sprawling city. Lacking the resources to return to their families in the country, they become trapped. The objective of Compassion International and many other child sponsorship organizations is to provide educational opportunities for the children who are hit hardest by poverty so they can eventually escape the "cycle of poverty" imprisoning their parents.
Those in this horrible existence need food, shelter, and a job. But that's not necessarily what they want. They want a television. And the things advertised on it. That was one of the most striking impressions I have of one of the worst slums in Manila. Amongst the leaking tin roofs and mud floors in hut after rickety hut, was the glowing phosphorous of television screens. In the comfort of our plush homes and profitable offices we could say that they shouldn't want television. What they need is a good education and to work hard so they can pull themselves up by their bootstraps. Yet, in the midst of this human suffering and starvation is a most extreme example of how wants overpower and obscure needs.
At the most extreme survival level one's wants and needs are usually identical. It's not until we have a disposable income that these two concepts diverge and the implications of our choices become more complicated. Suddenly we want several TVs, cars, boats, the latest high tech tennis shoes, and everything we see in the stores. As our income rises so does our spending. Our self-esteem often becomes entrapped by the things we surround ourselves with.
Parents who really love their children give them what they need. We give them vegetables at dinner, even though they want sweets. We enforce a reasonable bedtime, even though they want to fall asleep in front of the TV. We insist they brush their teeth, even though they may not want to.
When you attempt to give patients what they need before giving them what they want, you're treating them like children. And they resent it. These good intentions often backfire, creating an exclusivity about your practice counterproductive to your calling to help humanity. Why not acknowledge their lack of understanding and accept the opportunity to educate them and increase their awareness? Why penalize them or deny them what they want simply because they should know better?
When this "healthier-than-thou" attitude is exhibited in religious circles, we see the do-gooder who cannot lower himself to rub shoulders with the unclean sinners. This obstructs evangelism. Those smug in their faith can rest assured that their own fragile beliefs won't be tested by encounters with those who ask tough questions or don't understand the religious jargon.
Sadly, medicine has always been quick to give patients what they want. Want pain relief? Take this. Want to avoid polio? Ingest this. That gall bladder of yours giving you trouble? We better take it out. A little depressed? Change your blood chemistry with these. And on it goes. This trains patients that "solutions" come from outside the body. Remember, this attitude is the "pre-existing condition" practically every new patient enters your office with. It doesn't make them less deserving of chiropractic, nor does it preclude them growing in their understanding of health under your tutelage. Wishful thinking or one more chiropractic philosophy seminar isn't going to change this reality.
When patients enter your office and reveal that their health awareness doesn't extend beyond getting out of pain, you have several choices.
Refer out. You can send them down the street because you "don't do pain relief only" chiropractic. This selfish attitude denies chiropractic to patients who have not yet progressed to your high standards. Since patients with this attitude require more work and may demean your role as a doctor and relegate your clinical skills to just a drugless form of pain relief, it's tempting to make them feel unwelcome. They are usually skeptical and not a lot of fun to be around. They are merely the product of a culture that has been weaned on a medical approach to life. Sure, send them down the street until they "grow up." Make them feel like a loser.
Accept with reservations. They completed your admission form indicating they want relief only. You can accept their limited vision, attempt to normalize their spinal biomechanics, and allow them to dismiss themselves. Ignore the personality distortion their pain is causing. Overlook the fact they might not understand the implications of words like rehabilitation or spinal reconstruction. Invite them in to get a taste of chiropractic and keep your expectations low. Educate them so they have a chance to grow in the understanding of what you really do. Acquire the trust and lay a foundation on which you or some other chiropractic doctor can build on in the future. Instead of fixing your eye on the center field fence, just try getting on base.
Accept and educate. Embracing chiropractic is the result of making many small decisions, culminating in the courage to call your office. And while you can complain about the health attitudes of the general population, casting dispersions on their incompetence and shortsightedness from your chiropractic ivory tower is easy, it's wrong. Honor them by accepting their limited view of health and consider it an opportunity while they are within your sphere of influence to educate and enlarge their appreciation of true health.
Waiting for a sufficient number of patients who are "good enough" or who are available for true health is a slow way to grow your practice and influence your community. If you recognize that the understanding and practice of good spinal hygiene is a learning process, commit to helping anyone who wanders into your office. That doesn't mean they'll "get it," however you'll be sowing seeds that you may reap months or years from now. What's the hurry?
Growing a patient's understanding of health requires confrontation, courage, and patience. Clearly it requires clinical confidence and excellent communication skills. Realize that you can't wait for the made for TV movies, a 20/20 documentary, or the medical-oriented media to change and nurture proper health attitudes. If you watch a few Saturday morning cartoons you'll see that another generation may already be lost to a shortsighted vision of health. If there is going to be a change, it's going to happen in offices like yours, one patient at a time. It will mean accepting patients on their terms, giving them what they want and earning the right to give them what they need.
Buy the book
My Report of Findings
Originally published in 1993
240 Pages
US $24.95
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