Asking Questions

by William D. Esteb

One of the most frustrating attitudes to deal with in chiropractic is the rejection that comes from indifference, which is the attitude most people have when it comes to the subject of chiropractic. Maybe indifference, with just a hint of suspicious skepticism.

People who are indifferent to chiropractic, or active skeptics, are unlikely to change their minds, even with the most passionate explanation. And while the sparring match may evoke a renewed sense of purpose, confronting the skeptic is usually a waste of time. Sadly, these are the people who garner the most attention and focused concern in many offices. They are the two or three patients who say something to question the validity of chiropractic or a wellness approach to health. They can't be ignored, yet the real excitement is opening the eyes and ears of the indifferent!

You can help transform indifferent patients into champions for chiropractic by "engaging" them. Engagement is capturing someone's attention to communicate the chiropractic message. The rancher who hit his mule with a 2-by-4 to get its attention understood what engagement is all about!

The pain clinic

Pain is the "2-by-4" that initially engages patients, urging them to investigate chiropractic. After attending my first chiropractic seminar in 1981 to research what ultimately became known as the Peter Graves video, I consulted a doctor of chiropractic who had been recommended to me to find out what phase of Subluxation Degeneration my spine was in. Imagine the doctor's shock when I showed up in his "pain clinic" without any symptoms! Every form, every question, and every procedure was oriented for someone suffering from one of the 13 (or is it 14 this week?) warning signs.

Of course you're feeling better

This generation and probably the next, unless more offices make pediatric chiropractic attractive, will seek chiropractic care because of some type of ache or pain. Pain can be a very engaging reason to overcome the fear of the unknown. But as generations of chiropractic doctors already know, the pain usually goes away. And so do the patients. If chiropractic is to become the predominate health care delivery system, relief of pain must be thought of as just one of the several by-products of doing something even more important--stopping, slowing down, or reversing the process of Subluxation Degeneration. Keep in touch with the affirmation that symptomatic improvement affords, but own the idea that it's merely an expected sign post on the higher road of a preventive, wellness approach to health care. If you want to help reposition patients, extending their vision of a doctor of chiropractic beyond a "bad back" doctor, avoid the temptation to rejoice too visibly when patients tell of their newfound symptomatic relief! After all, do you celebrate the light created by turning on a light switch? Do you throw a party every morning when the sun rises? "Of course your symptoms have improved; now we can get to work on an even more exciting aspect of chiropractic--spinal rehabilitation!"

Clearly, without a systematic, ongoing patient education program, a patient's engagement with chiropractic is likely to end prematurely. There are large sums paid to management firms for ideas to re-engage patients, but many are ineffective. Recalls. Reduced fees. Pleading. And the well-meaning but suspicious, "The-doctor-needs-to-see-you-for-one-more-visit" scripts that are interpreted as a desperate move to save a financial resource. It's too late.

If patients must be fully engaged and perceive an appropriate cost/benefit ratio for continued care, how do you accomplish this after the benefits they originally sought have been delivered and their pain is gone?

First, recognize that a portion of the population will not avail themselves of rehabilitative or preventive health care. These are the people who require state mandated automobile inspection programs to detect unsafe mechanical defects in their cars. They refuse to brush their teeth regularly. Or wait to do their laundry until the moment they need a clean shirt. This is a pattern developed early in life and as great as chiropractic is, it's unlikely to overcome the momentum of a myopic lifestyle.

Everyone directly or indirectly connected with the delivery of chiropractic must help each patient remain engaged.

Engaging patients

One way to engage patients to help them internalize their chiropractic experience, and equip them to tell others about chiropractic is to regularly ask them questions. There are three types of questions. The first is the "inquisitive" question. As you would expect, its purpose is to uncover information you don't know. When were you born? How long have you been experiencing this problem? Inquisitive questions give you the basis for making recommendations. Because the information flows one way, relationships based on this type of questioning are very shallow. Think how engaged you are with most salespersons, order takers at restaurants, car mechanics, M.D.s, and others who just ask perfunctory, inquisitive questions. These types of questions are necessary, but limit the level of engagement.

Another type of question is the "surprise" question. Reporters Sam Donaldson and Barbara Walters ask a lot of these. They're used to catch you off guard, upset you, or encourage new ways of thinking. "How come you waited 35 years after falling off your bicycle to come in here?" is a surprise question. It repositions the subject at hand and enhances the creative process. These types of questions can be perceived as confrontational, however, and should be used with caution.

The best type of question to use with your patients on a daily basis is the "supportive" question. The best consultants use these questions when working with their clients. And the best doctors remember to use them regularly with their patients. Supportive questions are questions you ask when you already know the answer! It's a Socratic method of reaching the truth. The answer cannot be provided disinterestedly; the question almost forces engagement.

Supportive questions are often used in courtrooms. Unlike Hollywood's dramatic portrayal, there are few surprises in courtroom testimony. Anyone doing regular PI work recognizes that the court is just a laborious way to expose what is usually already known.

When a consultant discovers a doctor's patient visit average has risen from 30 to 50, he or she knows there are only a few reasons for this increase. So when a good consultant asks, "What do you think accounts for the increase?" it's not because he or she doesn't know the basis for computing this revealing statistic! Something more important is happening. By having to formulate an answer, the doctor becomes engaged, actively participating in the process of diagnosing the practice. When supportive questions become the primary tool in a consulting environment, growth and insights can occur without a dangerous dependency upon the consultant. The same is true with patients. When you enlarge a patient's understanding of his or her health, you create a partner, not a dependent child who must be "managed." Each interaction becomes an exciting growth experience. This teaches self-responsibility and fulfills the doctor's obligation to be foremost a teacher.

When a patient volunteers, "Whatever you're doing, doc, I'm really feeling better," instead of basking in the glory, are you asking the supportive and totally engaging question, "Why do you think that is?"

Total engagement.

Some very important things happen when you remember to capitalize on opportunities to ask patients supportive questions. First, for at least a moment, they are completely focused on their health, searching for the words needed to internalize and describe their chiropractic experience. In a sense, they "practice" explaining their perceptions in front of you so, if needed, you can gently correct any misunderstandings revealed by their answers. When your patients have the chance to share chiropractic with others, they're more likely to be articulate, accurate, and positive in their descriptions.

Patient #1: "Why don't I feel better yet?"
D.C.: "Tell me why you think that is."
Patient #2: "I can't come in next Wednesday."
C.A.: "How do you suppose that will affect the results you want from your chiropractic care?"

Like any tool, asking supportive questions takes practice. It's a powerful way to help patients more fully "own" their chiropractic experience, and also creates better referral ambassadors for chiropractic--and you.

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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