Get Real

by William D. Esteb

You live in a subculture called chiropractic. It separates you from the patients you serve. It insulates you from fully understanding and reading their motives. It distorts your perceptions of the world. It endangers your ability to survive and thrive in the tumultuous years ahead. You are like the fish who is in water, but doesn't know he's wet. Noticing people's posture when you're shopping at the mall is not normal behavior!

Philosophy, technique, and procedures are important. Yet, until you know what your patients are thinking and saying about your practice, every new patient approach is a guess or a gimmick. In the process of speculating why patients do what they do, you sabotage your self-worth, risk your professional reputation, and project a lack of confidence that new patients, who are extremely sensitive and apprehensive, can read loud and clear.

You are inadvertently saying and doing things, or not saying and doing things, that are causing negative word-of-mouth advertising about you and your practice. These patient "pet peeves" are rarely centered around issues like your adjusting style, amount of time spent with patients, your staff, or type of adjusting table you use. More often the issues are more subtle, and quickly correctable--if you knew what they were.

The temptation is to remain isolated and protect our fragile egos from the truth. We kid ourselves and think that by somehow ignoring the truth or "keeping a professional distance" from patients that we can avoid the personal blame of few new patients or poor compliance. It's not just in chiropractic. Restaurant chefs avoid taking the 12 steps over to the dishwasher to see what culinary masterpieces of their's aren't being eaten.

Seminar speakers avoid taking phone calls from attendees. Airline pilots avoid contact with passengers after a particularly poor landing.

Get real.

Look to the cause

When the boss is in denial, the business loses its rudder and challenges strike the practice, seemingly without cause or obvious solution. Unexplained high staff turnover occurs. A lingering illness diminishes productivity. A few unappreciative patients ruin an otherwise wonderful day. The doctor becomes increasingly isolated and uncommunicative. The practice becomes a tiresome treadmill without fulfillment or purpose. Caught in this vortex of uncertainty and frustration, the doctor (like patients) is tempted to become focused outside, at the symptom, instead of the cause.

"Maybe I should hire an associate?"

"I'm thinking about building my own building."

"What do you think about this new advertising program I'm considering?"

"I think I need another vacation."

"I'm going to switch management consultants."

"I'm looking at moving my office."

As a non-D.C., I'm always amazed by doctors who step on the dollar bills to pick up the nickels. Doctors who are so close to chiropractic they can't see its incredible simplicity, attractiveness, and compelling power. Doctors who get in the way of chiropractic. Doctors who inadvertently cover the brilliance, subdue the excitement, and make chiropractic pedestrian and unattractive.

Because we are afraid.

We are afraid to ask. We are afraid to confront. We are afraid of change. We are afraid to try. We are afraid our spouse will leave us. We are afraid our children will hate us. We are afraid of what our friends and neighbors will think. We are afraid of the bank. We are afraid of insurance companies. We are afraid to take post X-rays. We are afraid to call the patient after the first adjustment. We are afraid to know what our patients really think. We are afraid to take a stand. We are afraid to make a 100% commitment. We are afraid to be wrong. We are afraid to reveal our chiropractic identity. We are afraid we won't be able to pay our bills. We are afraid of our own potential. We are afraid someone will find out who we really are. We are afraid of accountability.

What many chiropractic patients meet on their first visit is a frightened doctor. Like themselves. You can't necessarily tell it in the doctor's handshake. The voice seems well-modulated and controlled. However, there's something subtle about the doctor that seems timid, weak, reserved, and lacking self confidence. It sets the tone for the doctor/patient relationship and even interferes with the healing process.

What patients want

Besides the pain relief for which patients seek your office, patients want passion. Not necessarily that of a charismatic cult leader. They want conviction. They want to see commitment. In a world of constant change they want to see confidence and self-reliance. They want to see energy. Not the raw, hyper kind, but the efficient, purposeful kind. They want to see pride. They want a mentor. They want to see a living testimonial of the power and "rightness" of chiropractic.

In an era of antibiotics, organ transplants, and DNA splicing, chiropractic may be too "low-tech" to be fashionable. No one said it would be easy to explain the fact that patients heal themselves (as long as there isn't any interference). In a culture that is drawn to accept technological innovations that make health appear to be something that comes from the outside (drugs and surgery), it requires sensitivity and creativity to communicate effectively. Something difficult to do if you doubt chiropractic, question whether structural changes are possible, don't see any value of chiropractic care beyond merely symptomatic relief, or will only recommend what an insurance company will pay for without putting up a fight.

Efferent and afferent

For too long this profession has focused on the content and presentation of the message sent to (or at) patients. Finding the perfect report of findings, telephone scripts, "Rambo" recall programs, admitting forms, and collection strategies has become the focus of many offices. While all these communication efforts may be necessary, many doctors forget that effective communication is a loop: a message is sent and a feedback loop confirms the message was decoded properly. Most offices ignore this feedback loop except for the crudest statistical measures such as patient volume, patient visit average, and collections. This would be like McDonald's attempting to measure customer satisfaction by weighing the contents of their garbage cans!

Whether you like to admit it or not, your patients control compliance, referrals, and word-of-mouth advertising about your practice. Since patients do what they do, because they think what they think, it's important to know what they're thinking. It can help you predict their behavior--which is helpful since they write your paycheck each month!

Want to have more fun? Confront the great unknown. Find out what psychological and attitudinal adjustments your patients need as you render their spinal adjustments. If you don't know what needs to be modified in their cranium, you'll have few opportunities modify the space between their occiput and coccyx. Get a new sensitivity to the language called Patientese.

1. Hold regular patient focus groups. Invite a group of six or seven patients that share something in common (health attitude, symptomatology, how they pay for care, age, etc.) to lunch. Pick their brains about aspects of your office such as procedures, staffing, environment, bedside manner, and other factors that influence their perceptions, compliance, and ultimately their ability to refer others.

2. Call patients after their first adjustment. Prepare a response in advance to anything they might say. Be ready to explain why they may be sore. Help them integrate this new thing called chiropractic into their lives.

3. Ask patients on their first visit what they hope to do with their newfound health. Find out what's important to them. Discover their key values. Find out what will most likely motivate them to follow through with your recommendations. It's not to normalize their spinal biomechanics or improve their posture!

4. During your clinical routine ask patients, "I was wondering, how do you describe what goes on in our office to others?" Then listen to their answer as if your practice depended upon it. Because it does! As they practice their referral dialogue in front of you, note areas where their chiropractic education is still lacking. Then, get to work on subsequent visits.

5. Ask patients what they think the general public's greatest fear or apprehension is about consulting a chiropractic office. Chances are they may still harbor this concern, pass it along to others, or are ineffective in explaining or defending this notion to others they meet. Find out. "So, when you talk to others about chiropractic, how do you explain this fear or apprehension isn't true?"

Not knowing the truth holds us in bondage. Things happen to us and we become bystanders to our own lives. While it may be painful, the truth sets us free. Without the truth, patients suffer and chiropractic will suffer. Take a deep breath and discover how the world clears a path for the fearless.

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

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