The Chiropractic Underground
by William D. Esteb
You have a patient who has been under care for several weeks and their original complaint is clearing up nicely. In fact, your patient is a little surprised at how well this thing called chiropractic works. Especially in light of the cautious skepticism with which they originally entered your office.
But even with excellent results, the patient doesn't tell a soul.
This frustration faces doctors in offices around the country. Based on the "harder they come, the harder they fall" school of thought, it should be the skeptical patients who experience dramatic results who should be the finest referral ambassadors.
Yet, the Chiropractic Underground flourishes. Millions of chiropractic patients whose low, pre-care expectations of chiropractic are often exceeded once under care, don't share their experience with others. Ironically, the Chiropractic Underground often exists in those offices that are seemingly the most desperate in their search for new patients.
I first learned of the Chiropractic Underground from a patient in a focus group I facilitated. It was a group of six "ideal" patients--patients the doctor had singled out as representative of the kind of patients she would like to fill her entire practice with. This patient explained how after he became a patient, he would often offer subtle chiropractic clues in conversations with others. Usually it involved using the word "adjustment." And if this subtle reference were to go unrecognized, he decided not to reveal his own chiropractic identity. Yet, he was surprised by how many people he knew who were under care but had never said anything until he had brought up the subject.
Why are so many patients afraid to openly share their chiropractic experience with others?
Ashamed of their chiropractic decision
Probing to uncover the answer to this question in the focus group setting is difficult. The most frequent reason seems to be that patients are embarrassed by some aspect of their chiropractic experience. Typically it's an image problem. A patient from a Texas office volunteered that he was ashamed and wished he "could park in back of the office." Another wanted to "wear a bag over his head" so no one would see him. These were comments from ideal patients! Even in the face of excellent results, the poor image of the profession gets in the way of referrals. In marketing terms, the referral process is related to something called "post-sales satisfaction," a measure of an individual's satisfaction after the purchase decision.
These closet chiropractic patients are extremely sensitive to the image of the profession and are reluctant to be identified with it. It is as if the baggage of the past and the image promulgated by chiropractic's detractors carry more weight than the obvious results they have received under chiropractic care. Somehow chiropractic isn't "in." Peer pressure rears its ugly head.
If they can't be articulate, or don't understand chiropractic beyond the image on the street, patients risk being associated with the chiropractic of the past. It's almost as if admitting they are under chiropractic care would be sanctioning the "nonscientific" perceptions of the profession; that they had been "sucked in" for a series of expensive X-rays; or had been "swayed" by a charismatic doctor or had used poor judgment by associating themselves with a non-mainstream health care provider. Compound this perception with a low self-image or poor communication skills, and you have many reasons to keep chiropractic a secret.
Other patients say they are embarrassed by the doctor or office itself. These are offices that have not made improvements in their patient environments since the earth tone 70s or when they began practice. The physical appearance of the office and the quality of its furnishings, color scheme, and total image aren't contemporary. It's difficult to proclaim the new scientific findings confirming the importance of chiropractic on one's genetic expression if there's a time warp when you cross the threshold.
Office procedures can interfere with a patient's willingness to vouch for your office, too. If you conduct an aggressive recall program, use fear tactics, force patients to wait a long time, or pump patients for the names of potential referrals, it can discourage patients to tell others. They, in a sense, decide to protect their friends from the same treatment you've dished out to them!
He's a great doctor, but...
More difficult to quantify is the image projected by the doctor. Getting objective input about this aspect is difficult. It's wrapped up in personalities, dress, and other issues. Among the most expensive image decisions male practitioners make is to maintain some kind of facial hair. Expensive because experts suggest that with few exceptions (folk singers, poets, philosophers, etc.), facial hair can measurably reduce believability. It is unknown whether this is a carry-over from the villain's pencil-thin mustache in melodrama or from the rebellious, "out-of-touch" attitude of hippies. For chiropractic doctors, suffering from a public perception that their healing skills are not scientific and their recommendations for repeated treatments are simply financial-driven "opinions," credibility is an aspect of paramount importance. Facial hair, and for that matter, earrings, outdated sideburn length, polyester clothing with "flying nun" collars, or other anachronisms of personal appearance are costly expressions of "individuality" that reduce a doctor's professional credibility.
But preventing the Chiropractic Underground in your office isn't simply a matter of providing superb clinical skills, shaving your beard, and practicing in a stunningly appointed office. It can help, but that's not the issue.
Vouching for you
When patients refer others to your office, they are often more interested in their own reputation than some altruistic, humanitarian gesture of compassion. The question is, how can one of your patients enhance their own position by referring a friend to your office? Or more to the point, how will my relationship with my friend be enhanced or jeopardized by referring them to you? Before your patients can feel confident in referring others to your office, they must consider how well the doctor, staff, and office will reflect on their reputation. How does your office measure up? Have you created a trustworthy environment? A trustworthy staff? Are your doctor/patient relationships based on trust?
How would you characterize your patient relationships? In the report of findings, are you supplying the good news and the bad news? Are you quick to refer a patient to another health care specialist if a condition doesn't improve as promptly as it should? Do you encourage patients to actively participate in decisions about their care? Do you put the responsibility for follow-through and compliance on the shoulders of your patients? Moreover, do you provide an organized educational program so patients can make intelligent choices without pressure, emotion, or fear tactics?
One of the objectives of a systematized patient education program is to provide a tool doctors and their staff can use to avoid the necessity of repetitious explanations. Because the question isn't, should you educate patients. Every office educates patients. But how well? And what are patients learning? How long does it take to impart the information and how labor-intensive is it? What are the motives? Is the educational effort being driven by the need to boost statistics? Or the fear that it won't? Is the educational effort being shaded by a short-term perspective? Or is it less than ideal because specific procedures aren't consistent?
Arm your patients
Consistently communicating the Vertebral Subluxation Complex, so patients know their problem is more serious than a bone out of place or a pinched nerve, can help prevent the Chiropractic Underground. You must give patients the words and concepts to help them defend their chiropractic decision and convince others to give chiropractic a try. You must equip your patients with information. Teach them how to conduct a leg length check and how to explain what it means. Teach them how to conduct a cervical range of motion test so the next time someone asks for aspirin at the 3:15 break at the office, your patient can become a chiropractic ambassador.
Your enemy isn't the A.M.A., the hospitals, the orthopedic surgeons, or the office down the street giving chiropractic away for free. Your enemy is the cerebral cortex of every patient who enters your practice. They have some wrong-headed ideas about health and even how their body functions. And unless you can empower the brave patients who do venture into your office by conveying the ideas and concepts to promote chiropractic, chiropractic will remain a secret. Forever.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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