On Being Anti-Medicine

by William D. Esteb

I've met many chiropractic doctors who are actively anti-medicine. Certainly the motive is understandable if you see a constant parade of medical failures and embarrassments enter your office. Yet for the most part, the medical establishment continues to dominate the health care thinking of the general public.

The effects of this distortion are all around us. Television, radio, billboards, even the ads in the magazines of many chiropractic offices bombard us with "solutions" in the form of a pill for everything from back pain to hair loss. And while we know the fallacy of this approach to health, it takes most new chiropractic patients by surprise when they hear their chiropractic doctor get on a soap box and begin M.D. bashing.

Offices most successful in helping patients integrate chiropractic into their lifestyle recognize the following situations or attitudinal patterns created by the medical establishment and develop strategies to effectively deal with them non-judgmentally:

Treatment on the first visit. The book Bedside Manners, The Troubled History of Doctors and Patients by Edward Shorter contains the observation that today's health care consumer often consults their medical doctor simply in order to get access to increasingly more powerful drugs. More and more pharmaceutical companies are marketing their wares directly to the general public so patients can tell their doctors which ones they want. When venturing in to see a chiropractic doctor they expect the same degree of relief as that afforded by the first ingestion of medicine. Yet, adjust without taking the time for a thorough examination and report, and you run the risk of devaluing your clinical skills. Adjust on the second or third visit, and the patient may give up on you or become angry before you get the chance. Instead, consider creating an acute new patient routine that allows you to do an exam, educate, give a "mini-report," and treat on the first visit. Use video to educate the patient while the X-rays are being processed and you're seeing other patients. Give a brief report to assure the patient you have a clear understanding of their problem. Then explain and deliver the adjustment and you've fulfilled the patient's expectations without compromising your clinical credibility. Give a complete report of findings on the next visit.

Multiple visits. Since patients seldom get a prescription for a single pill, returning three times a week or more seems plausible at first. But pills seldom cost $25 each! Yes, insurance can help soften the financial blow, however this pill/visit analogy gets chiropractic doctors into trouble as symptoms improve. Get beyond the often unspoken pill/visit metaphor used by most patients to justify visit compliance and begin to explore the idea of "orthodontic chiropractic" or "muscle repatterning" instead. These metaphors transcend the presence of symptoms.

Reception room wait. M.D.s have taught the public to expect to wait and wait, making it the most frequently mentioned irritant among patients. While this would seem to give chiropractic doctors liberty to subject patients to waiting, the reverse is true because of the multiple visits expected by a chiropractic doctor. A survey of patients suggests that 15 minutes is about the maximum allowable wait. Do you know exactly how long your patients are waiting during the 5:30 p.m. rush?

Doctor on a pedestal. More of today's patients have a college education than at any other time in history. Failing to adequately volunteer the hows and whys of his or her recommendations, many medical doctors still hold to the holier-than-thou approach to patient relations. It is hard to tell whether this stems from the outdated notion that patients don't care or wouldn't understand a doctor's explanation. This condescending attitude makes most patients angry enough to increasingly seek second opinions. Active listening is a useful strategy. Ask more open-ended questions instead of a machine gun series of questions requiring only a yes or a no.

Language. Medical doctors have assumed the name "doctors" and chiropractic doctors have been left with the name chiropractors. This reinforces the misconception that chiropractors aren't real doctors. First, always question anyone who uses the term doctor. "Do you mean doctor of medicine or a doctor of chiropractic? There are many types of doctors." Second, when signing your name always use the "Dr." prefix. Yes, it is redundant and maybe even grammatically incorrect when you must also follow your name with a "D.C." The key to any rule is to know when to break it. This is one of those times.

Cleanliness. The medical profession has a name for it: hospital corners. Hospital corners mean your carpet is cleaned right up to the crevice where the walls meet the floor. It's a standard established by the germ theory doctors and the same one chiropractic must meet, even though there is a difference of philosophy. Cologne or perfume on your hands from the previous patient or a dirty chiropractic office immediately causes the patient to question the doctor's cleanliness, attention to detail, and clinical skills.

Afraid to ask questions. Patients have been taught that the doctor's time is precious, so questions are discouraged. This has forced patients to turn to the nurse, pharmacist, or office assistant to ask questions. Same in chiropractic. Which is just one reason why every C.A. should have a working knowledge of anatomy and physiology and understand the terminology used in chiropractic. And it's not always that patients perceive the doctor as being too busy to bother; its a way of getting a second opinion. Patients expect the "party line" from the doctor, but what does a real person think about this or that? (Make sure your staff understands that they will need malpractice insurance if they are tempted to cross the line and diagnose!)

Health is passive. Taking a pill to restore "health" turns health restoration and maintenance into a passive undertaking. This attitude can be carried into the chiropractic environment as treatment becomes something that simply happens to a patient, with the responsibility on the doctor's shoulders not the patient's. This active/passive attitude determines a patient's level of compliance and is not changed by recall programs, ambitious computer-generated letter campaigns, or wishful thinking. Chiropractic doctors must educate patients and explain the partnership approach required for maximum results.

Spinal care class. Ever hear of medical doctors asking patients to attend a short talk on the benefits of a particular antibiotic or anti-depressant? While there is growing interest in patient education in the medical arena, it is viewed as an expensive luxury or a way to avoid questions and compliance problems. No wonder there is patient resistance to missing an hour of prime-time television to attend an evening spinal care class. Explain how patients benefit by attending the program (get well faster, save money, prevent the problem from returning, a way spouse can help you, etc.).

Specialty. Medicine has become increasingly more specialized. Fewer and fewer medical students are becoming general practitioners, instead succumbing to the allure (and money) of being specialists. This approach has run wild, resulting in countless medical research projects uncovering detailed information about narrow aspects of human health, virtually ignoring the interrelationship of the studied organ or tissue with other organs and tissues. So while we've proudly heralded chiropractic as the only licensed health care profession expressly dedicated to the elimination and prevention of the Vertebral Subluxation Complex, we've inadvertently become specialists in bad backs. We must always attempt to increase each patient's perception of chiropractic to include a more holistic look at health, with an understanding of the nervous system and not just the local symptoms at the spine.

Payment. A frequent myth held by many doctors of chiropractic is that asking and expecting payment for their services will cause patients not to come back. The reverse is more likely. Call any medical doctor as a new patient and you will be told boldly, without asking, that the initial consultation is $50 (or whatever). Medical doctors have already set the precedent that you pay as you go. Patients look to the implementation of your office policy for clues about your expectations.

Discontinue use when symptoms improve. This is the toughest of all. Written on the side of many over-the-counter medications, this single sentence has done more to perpetuate the myth that you're healthy when the symptoms are gone than all the "Marcus Welby, M.D." episodes combined. This sickness care approach to health has resulted in a generation of patients suffering from diseases that don't have recognizable symptoms until the problem becomes so advanced as to be deadly (cancer and arteriosclerosis), or simply lurks in the background unobserved (hypertension and cholesterol).

Being anti-medicine flies in the face of most patients' personal experiences. While they may be seeking chiropractic care because of ineffective medical treatment, they have had an entire lifetime of what they believe to have been medical "successes." From their perspective chemotherapy, tonsillectomies, antibiotics, polio vaccines, and even temporary headache relief from aspirin affirm that medicine "works." When you're anti-medicine, you take a posture that contradicts most patients' experience and puts your chiropractic recommendations in question.

You can't win by being against medicine. You can only win by being for chiropractic. The "enemy" is not the medical doctor down the street, but the health attitudes of the patients who seek your help. If you can successfully "adjust" their attitudes through patient education and a positive chiropractic experience on every level in your office, you'll win. Otherwise, what their medical doctor told them was right.

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

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