Clearing a Patient's Internal Dialogue

by William D. Esteb

Your patient seems distant. He asks a question at the conclusion of your report of findings that you answered during the first three minutes. He doesn't follow through. He says one thing and does something completely different, even counterproductive to your recommendations.

Everyone hears voices

Unexplainable behavior is often the result of something the communication industry refers to as internal dialogue. It's that little voice we each hear as we go about our lives. This "self-talk" keeps us in touch with our belief system as we constantly monitor the world around us. It helps us form opinions and gives us ways to organize our thoughts so we can respond with appropriate actions. Of particular interest is the internal dialogue of the new patient.

Responding to the internal dialogue of new patients is the largest non-clinical challenge facing today's doctor of chiropractic. It's absent when we're relaxed, talking with old friends when our defenses are down, yet it dominates the landscape of a new doctor/patient relationship--especially in chiropractic. Listen in on the internal dialogue of a typical new patient:

"What will the office look like? Do I trust the doctor? Will it hurt? Will I have to take off my clothes? Will I have to go for the rest of my life? How long will it take? Will there be other patients like me in the office? How much will it cost? I hope my insurance covers this. I hope he doesn't break my neck. Aunt Martha said chiropractic helped her. I better not tell my doctor I went to a chiropractor. Will it be expensive? Will I have to wait a long time? What if it doesn't work? If Bob ever finds out I fell for one of those charismatic chiropractors..."

This chatter will go on and on inside the mind of the new patient unless there is an organized method to intervene in this distracting and sometimes self-limiting internal dialogue.

As a chiropractic doctor, among your most frequent battles are those needed to identify and neutralize the internal dialogue among your patients. Dealing with this issue successfully is a common denominator of growing, enthusiastic, and effective practices. And while there are often common areas, every patient walks into your life with a different set of matching luggage containing a lifetime of attitudes, perceptions, and opinions about their health, you, and chiropractic in general.

It happened to me

As a new chiropractic patient, I walked into an empty waiting room at 10:00 a.m. on a Thursday morning in early 1981. Today I understand that Thursdays are often not fully utilized in many chiropractic offices. But as a newcomer walking into a doctor's empty office in the middle of prime business hours was extremely unsettling. Ever enter a restaurant during the dinner hour and find it empty? I almost ended my first chiropractic experience before it began. The way in which the staff member set up my appointment contributed to some very unnecessary internal dialogue; it had not been communicated that "Thursdays are reserved for new patients so we can devote 100% of our attention..." Without the sensitivity needed to recognize my concerns and perceptions as a new patient, the doctor had to work harder to assure me that he was successful, had other patients, and that I had chosen the right doctor. By ignoring my internal dialogue and not being sensitive to my first impressions, the office had to overcome my doubts about the wisdom of even beginning chiropractic care! Needless to say, it is not an ideal position in which to begin a relationship with a new patient.

The solution

I know of only one way to remove negative internal dialogue and begin the process of reversing the misconceptions and objections to chiropractic care: a committed effort to over-communicate with patients. When combined with an aggressive patient education program, the problems of negative internal dialogue can be prevented before they begin.

Over-communication starts with your yellow page advertising, continues through the first telephone contact with a new patient, and never ends. It requires a conscious effort to anticipate and freely volunteer information, rather than waiting for patients to garner the courage or insight to ask their questions. Chiropractic suffers from so much misunderstanding and lack of acceptance, a primary strategy to reverse the process must include over-communication and being ultra-sensitive to the internal dialogue patients might be experiencing as they begin and continue to receive care in your office.

I'd heard chiropractic is expensive

While an adjustment that unlocks one's human potential may be worth a million dollars, that's not what the market will bear. Fees are a factor in any chiropractic decision because the word on the street is that chiropractic is expensive. Decide on a strategy to overcome this misconception--or affirm it. Offices reluctant or unable to articulate their fee structure and its fairness over the telephone are often the same offices with the largest collection problems. Patients who ask about the cost are not necessarily shopping for the lowest rates. They're simply responding to their internal dialogue.

The same holds true for X-rays. The word on the street has it that after falling for a charismatic doctor, you'll be charged for a lot of expensive X-rays. Or so many will be taken, you'll glow. Concerns about radiation exposure can be guises to cover up fear about the quantity and cost of the X-rays. Are your X-ray charges fair? Do you volunteer an explanation of how you minimize X-ray exposure?

Variations on these internal dialogue issues surface during my focus groups with chiropractic patients. It is often the lack of a communication plan by the doctor and staff that creates the most potentially damaging internal dialogue. Every office should identify sources of potential patient internal dialogue by keeping a record of questions asked by new patients and then developing a strategy for anticipating and volunteering answers to those questions before they are asked.

If you're getting a lot of questions from patients, you probably have compliance problems too. In those practices where successful patient education is a primary objective and anticipating patient questions before they are asked is a full-time job of the staff, compliance, retention, and long-term rehabilitative care are also found.

Service to others is the highest calling to which any of us can aspire. And the highest form of service is anticipating someone else's needs. It raises their self-esteem. It clears the air. And it is the basis of trusting, long-term relationships.

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

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