It's Your Fault

by William D. Esteb

The real tension in consulting work, whether you're a doctor, lawyer, management expert, or interior decorator is that quite often most people don't want to change. The status quo, as uncomfortable as it may be, is at least predictable. Most of us choose the defined over the potential; the "is" over the "what could be."

Someone once described a consultant as someone who uses your watch to tell you what time it is. Other definitions less complimentary exist too. However, this natural temptation to cling to the present order of things, wishing things were different, but feeling secure in the familiar, is what tests the mettle of the best consultants. Ironically, to call a consultant one must first admit that he or she has a problem, which is another stumbling block consultants must face: no one wants to admit they have a problem! If there isn't a problem, why is a consultant needed? So, the consultant's first responsibility is to assure the client that everything is okay. This often unspoken paradox is one of the reasons why few consultants are effective and why many clients openly criticize, sue, or resent their consultant.

A consultant is anyone from whom information or influence is requested. When you read this book, you're asking to be influenced. When you ask for directions from the gas station attendant they become a consultant. When you ask your wait person whether the soup of the day is good, you've turned an order taker into a consultant. Similarly, when patients come to you asking for help with a health complaint and you use your influence and communication skills to shape the outcome, you are a consultant too. Any consultant will tell you one of the greatest challenges is to get the client to accept the advice and make a change.

When doctors hire a consultant to dislodge the status quo or help bail themselves out of a lack of new patients or poor compliance, they are asking to be influenced. Do people change? Slowly. Kicking. And complaining loudly about the new, and at first, uncomfortable procedure or perspective.

Just remember the advice you're getting is merely someone's opinion. No one can predict the future and every consultant makes mistakes. Witness the countless times you've gotten lost after someone says "you can't miss it," or the times you've wondered what anyone saw in cream of rutabaga soup!

There are several techniques you can use to size up a consultant's suggestions. Run through this list when you're confronting some advice that seems uncomfortable at first.

Blaming you. This is the easiest of consultant ploys. Lack of new patients? It's your fault. Can't get your patient visit average above 22 visits? That's your fault. You have high staff turnover? That's your fault too, doctor. In fact, every problem in your office is your fault because other doctors using the same technique, who went to the same school, and practice in the same town aren't having any problems. So it must be you.

What is so convenient about rendering this kind of advice is that it's almost always true. It is the doctor's fault. But confronting the doctor in this way rarely results in change. However, it is the safest observation that can come from the comfortable Herman Miller desk of a consultant who somehow feels equipped to diagnose your problem over the telephone. Without visiting your office they miss hearing the X-ray room dialogue, seeing you stumble through a report of findings, and hundreds of other details. A consultant must be willing to get his or her hands dirty! Before accepting any advice from any consultant it's important that they actually see the context of the problem. Otherwise expect cookie-cutter solutions and suggestions based on someone else's personality, value system, or vision of the future.

Specific action plan. Ever watch one of those movie review TV shows? You can tell these movie selection consultants love their work, jetting to Cannes and mingling with Hollywood's elite. They seem to wield a tremendous amount of influence with their weekly critique of directors, actors, and screen writers.

If you've ever bucked their reviews and seen one of their "thumbs down" picks and enjoyed it, you start questioning their other recommendations. Eventually you'll reach the same conclusion I have. These types of shows are really just entertainment and serve no other purpose except to publicize the latest movies playing on postage stamp-sized screens at the mall!

Oh, it's easy for a consultant to sit on the sidelines and judge others, but what specific suggestions do they have for improvement? Can they offer a step-by-step action plan that accepts where the client is today and can get them to where they want to be? Simply casting blame without a constructive "here's what I'd do" plan for change is merely a judgment call of little value.

"I don't know." A consultant's willingness to admit they don't have all the answers is an important dimension of their character. Even a 20-year veteran of the trenches can't have all the answers. A jack of all trades is usually the master of none. Be careful of any consultant who promises to organize your front desk, sell you adjusting tables, and motivate you and your staff at regular sessions in the hotel ballroom for a single monthly payment!

Providing holistic advice is probably the most effective type of consulting and that usually means being willing to refer. In the same way patients start doubting the recommendations of a doctor who proclaims to be an expert on back pain, nutrition, weight loss, body building, mattress selection, ergonomics, and water purification. Be suspicious of one-stop supermarkets for your practice. Some foresighted consulting firms have financial planners and psychologists on staff, but most do not.

Walk the talk. You'd die laughing if you saw behind the scenes at many of the practice management consultant's offices. Like the false fronts of a Hollywood back lot, most consulting firms are as disorganized as the clients they profess to be able to help!

In offices of the rare exceptions you'll see focus, planning, and attention to detail. Before signing up or accepting the advice of any consultant, visit their offices. Show up unannounced and check out the desk tops, bulletin boards, and the general tone of the office. Ask yourself if what you see is what you want for your office. How do they handle scheduling, last minute changes, or your surprise visit? Are they an example of the type of organization, staff relationships, and internal communication systems you want?

When patients show up in your office they are checking the congruency of your consulting advice too. And while they might not put on white gloves to test for dust on the chrome parts of your adjusting table, they are sizing up countless details about your office, your appearance, your staff, your communications, your personality, and your recommendations. They'll never tell you that they'd be more compliant if you'd lose 20 pounds or that they'd refer their friends if you didn't practice in a pig pen. That's what their unconscious tells them. When a patient comes into your office and asks to be influenced, you become a consultant, facing many of the same challenges the consultants you've hired face.

Patients cling to a medical model of health for the same reason doctors cling to out dated procedures. Patients fail to comply with home care for the same reasons doctors fail to follow their own personal fitness program. And patients decide not to refer their friends to your office for many of the same reasons you don't refer your friends to join your practice management firm.

When you start thinking like the consultant you are, you discover there's more to chiropractic than simply improving a patient's spinal biomechanics. That's the relatively easy part. The challenge is in presenting change in such a way that it will be more attractive and safer than the status quo. The success and personal fulfillment promised in a career of service to others comes by not blaming others, but by providing a specific action plan, the willingness to admit you don't have all the answers, and walking the talk.

How does it feel to be a consultant?

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.