Making Chiropractic Valuable

by William D. Esteb

Can you remember what it was like not to be able to walk? Not that you couldn't walk, but you didn't know how to walk. It's virtually impossible. Once you know something or experience something, it's difficult to fully appreciate what it was like before you experienced it. Information changes us. It is the result of the information learned from years of chiropractic college that prompts doctors to maintain some type of ongoing non-symptomatic chiropractic care themselves. And it is often this lack of a chiropractic education that accounts for patients' discontinuing care as soon as symptomatic relief occurs.

Your day-in, day-out familiarity with chiropractic can actually create a barrier to patients' getting the necessary understanding and appreciation of chiropractic. Your "expertness" can distance you from "beginners" just starting care. The more you know about something, the more difficult it becomes to communicate it to someone who knows very little.

A computer beginner

I recently purchased a new laser printer for my computer. I hooked it up and it didn't work. I called a programmer I know who works for a large computer manufacturer in our town. "Hey, Rick, how do I get this thing to work?"

"Well, are you using the X-on X-off RS-232 serial protocol or the 8-bit LPT1 parallel interface?"

"Gee, thanks Rick, you've been a big help."

Rick was unable to help me. Ultimately, I had to find a computer "translator" who could. Practically every industry has a technical side to it. A special vocabulary develops that shrouds some pretty basic stuff from outsiders. Maybe some of it is done purposely, although, most of it is created out of expediency or with the honest intentions of saving time or reducing misunderstandings among professionals.

In chiropractic, patients hear terms like subluxation, deductible, MMI, IME, MRI, PI, herniation, spasm, chronic, comp, edema, and the list goes on. These are words and acronyms that doctors and staff use that often insulate patients from understanding and being involved in their care.

Buying patient involvement

This interferes with your ability to motivate and inspire patients. The currency used to purchase patient interest and involvement is information--information that is relevant to the individual patient and presented clearly and volunteered systematically. Clearly, so patients understand. Volunteered, so you don't lower patients' self-esteem by making them have to ask about terms you use so casually. Systematically, so you know what your patients have been told about chiropractic, and specifically their case.

To ensure that the information you share is relevant to the patient, you need to know the patient's wants and needs. It's easy to get carried away and give patients what they need, only to be disappointed later when you discover the patient wanted something else. In the same way the doctor's intentions and prognosis can be hidden behind big words, the patients' desires and expectations are hidden in their underlying values and attitudes.

It is the doctor's responsibility to be the "translator," explaining the big words and helping the patient reveal his or her values and expectations. Until the doctor knows what the patient's expectations are, meeting and exceeding them (creating positive word of mouth) is a hit or miss proposition. The process of uncovering a patient's values begins on the first visit, starting with your new patient admitting form.

Succumbing to the obvious, some offices come right out and confront the new, usually hurting patient, asking whether they want only relief care, relief and rehabilitation, or relief, rehabilitation, and prevention. Besides the fact that many patients don't fully understand the ramifications of these concepts, their discomfort on the first visit can distort their personality and their goals. Plus, having heard that once you start chiropractic you have to go for the rest of your life, patients can be reluctant to offer more than a wait and see answer. Instead, take their health attitude pulse more easily (and perhaps more accurately) by asking two additional questions on your new patient admitting form:

How often do you wear seat belts when you drive? Always, sometimes, never (Circle one)

How often do you floss your teeth? Daily, weekly, monthly, rarely, never (Circle one)

Answers to these questions are less likely to be distorted by their current situation and are barometers of their preventive attitudes in other areas of their life. You'll have a better idea what your new patient wants. Don't expect to grow too many maintenance care patients from those who never wear seat belts or floss their teeth!

This observation is based on the idea that you must first reach patients where they are before you can take them to a chiropractic lifestyle. Overnight conversions don't have the staying power of slow, deliberate, step-by-step, growth.

Making chiropractic sexy

Why not ask how often they exercise? Certainly it's worth asking, yet it doesn't necessarily reflect their health attitude. Patients who regularly work out are often people who either want to look better or feel better. Don't confuse someone with a health club membership with someone who necessarily wants to be healthy! Optimum health is not always the primary objective of a regular workout. A newspaper article titled "Sex appeal ranks higher than health" sums up a Florida University study on this topic. ("Sex appeal ranks higher than health," by Anne V. Hull, St. Petersburg Times, reprinted in the Colorado Springs Gazette Telegraph, January 12, 1991, Page D-4.) Seems that researchers were having difficulty getting patients to lose weight by explaining how unhealthy it is. Instead, they found participants much more interested in dropping the weight at the beginning of a new romance or when motivated by the desire to enhance their sex life. A lowered risk of heart disease and improved overall health and well-being wasn't a big enough carrot. By the way, how are you making spinal hygiene sexy?

Those who provide health care are often shocked to discover that regaining and keeping excellent health is not among everyone's highest priorities. Many chiropractors and their staffs make conscious efforts to live healthy lives and set an example for patients. That's good. Yet, all too often offering bottled water, shunning coffee, crusading against cigarette smoking, expressing shock at vaccinations, and holding up our own lifestyles as examples are counter-productive. Usually this holier-than-thou (healthier-than-thou) attitude rarely makes patients feel uncomfortable enough to rethink the priority they give their health. Anyone who has lowered their credibility by using scare tactics to induce patients to change their ways has been similarly frustrated by a lack of success.

What do patients want?

How do you encourage patients to integrate chiropractic care into their lifestyles and assume a preventive approach to their health? Connect good health with something they value more than their health. It sounds obvious, but if their goal is to feel better, what makes feeling better important to them? Feeling better is rarely an end in itself. Patients often want to feel better for some other reason(s).

If you don't know why each of your patients wants to feel better, you're overlooking an important aspect of the case history. It provides information needed to help patients get what they want, motivate them to do their exercises, modify their lifestyles, follow your recommendations, and continue care beyond just feeling better.

At the conclusion of your examination, when you believe the patient represents a chiropractic case, ask each new patient something like, "Mrs. Jones I believe yours is a chiropractic case and we've helped many others just like you. I always ask my patients what they hope to do better or enjoy more after they regain their health. Why are you interested in better health?"

Patients aren't accustomed to being asked a question like this. If they're desperate to just "make the pain go away," you may need to help them identify specific activities or dimensions of their lives they hope to enjoy when they are pain free. Are they hoping to improve their golf game? Do they want to be able to pick up their grandchildren pain free? Sleep through the night? What are the key values they find important?

Hole in one

With this information, you have a powerful lever you can connect to their chiropractic care. "So, how's that golf game coming?" you ask on the 5th visit. "Lie down here so we can trim a few more strokes off your game," you say on the 10th visit. Virtually every visit becomes an opportunity to discuss chiropractic and its relationship to the patient's important activity or key motivating value. This association helps patients more easily integrate their chiropractic care into their lives. Maybe that lowers chiropractic in your eyes, but it will probably raise it in the eyes of your patients.

Rarely are patients living to be adjusted. Most are getting adjusted so they can go live. When you find out what your patients are living for, you can increase their desire to follow your recommendations and make chiropractic part of their lifestyle. Become the translator between what your patients want and the chiropractic care they need. When you do, you'll uncover their values and the opportunity to make chiropractic a more valuable part of their life.

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

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