Mentoring Patients to Health
by William D. Esteb
A famous psychologist was asked how he got his patients to change and emerge from their psychological problems-why some patients eventually seem to get well and others didn't change. Was it, the interviewer queried, the result of the patients' finally understanding their problems well enough to transcend beyond them? "No," he said, "if that were true, all any one of us would have to do is read books and we would assume the wisdom of the ages." Look at the countless how-to-lose-weight books. Most overweight people own plenty.
Then how do patients change? "Through relationships," he observed. "As doctors, we mentor patients to wellness through our relationships with them." The quality of that healing relationship affects compliance, speed of recovery, and ultimately the referral process.
Isn't it interesting that the patients you especially enjoy serving seem to get well sooner? What does it take to build a relationship that can serve as an effective vehicle to mentor someone through symptomatic relief and into a preventive chiropractic lifestyle? Here are some points to consider when you begin a relationship with your next new patient:
Share common goals. While more and more of today's chiropractic patients have lost confidence in medical solutions to their problems, chiropractic still hasn't shed its "bad back doctor" image. The goal of some chiropractic doctors is simply to improve the symptomatic picture. Others see each new patient as an opportunity to create a lifetime relationship-from symptomatic relief through rehabilitation and into some type of ongoing maintenance relationship. Symptomatic relief relationships are the easiest because it is the relationship most new patients have in mind when they begin care. When doctors take the path of least resistance, they place themselves on a new patient treadmill, always looking for more new patients while overlooking the clinical necessity and patient benefits of preventive chiropractic care.
Doctors with a longer vision in mind recognize that they must acknowledge the patient's limited vision during the initial phases of care. These doctors recognize that they must "earn the right" to discuss maintenance care by first relieving the patient's symptomatic picture. You must give patients what they want before you can ever have the chance to give them what they need. The value of rehabilitative and maintenance care can be shared on subsequent visits.
This is when a patient's familiarity with the five components of the Vertebral Subluxation Complex is so helpful. When patients understand that their problem is more serious than a bone out of place and are aware that muscle and soft tissue damage and calcium salt deposition can be present without symptoms, they can explain the adage, "Once you start chiropractic you have to go for the rest of your life."
When doubt, ask
If the doctor and patient share similar goals because of mutual understanding, there is an increased likelihood that the easy goal of symptomatic relief will be achieved and higher health goals can be set. One way to find out what outcomes your new patients want is to ask.
What results do they want? A temporary patch job? Prevention? Optimum health? How much energy are they willing to give the relationship? Keeping appointments, doing exercises, changing their lifestyle, etc. How long will they suspend judgment and follow through before they expect to see results? One visit? Five visits? Ten visits? Create a relationship in which your new patients feel comfortable in honestly revealing their expectations. Reduce patient drop-out and increase the chance of making a difference by sharing common goals. Get it out into the open. Make both parties accountable.
Share a common language. This is related to goal setting, yet recognizes the difference between the chiropractic doctor's expertise and the new patient's beginner status. Whether it's the relationship between a computer expert and a computer rookie or between a car mechanic and its owner, this difference can cause problems. It's difficult to build a meaningful relationship with someone from a foreign country who has different customs and speaks a different language. It's the same with patients who show up in your office. They speak a dialect heavily influenced by aspirin commercials, knee-jerk tonsillectomies, and bottles of pink antibiotics.
The understanding of bodily functions and the language to describe them are almost non-existent among even the best educated in our country. Yet, many of your "ideal" patients, with whom you can most quickly build a relationship, are very aware of their bodies and well-being. In the same way Eskimos have many words to describe different types of snow, chiropractic must supply the language skills to help patients fully appreciate the nature and severity of their conditions. Certainly this is one of the real values of having a systematized patient education program in your office. Not only does it give patients a chiropractic model for understanding the true nature of health, it should also supply the language needed to describe their health complaint to you, and what chiropractic is to others. Otherwise, chiropractic is simply something that happens to them and a nurturing relationship never happens; never evolves.
Patient education makes better patients. Think back to the acute patient with whom you aborted your normal educational routines. I'll bet he or she dropped out early. Systematize your efforts so you can impart at least a rudimentary level of chiropractic science and philosophy without expending large amounts of energy. Long-term relationships require that the parties speak similar languages.
Fair exchange. A doctor/patient relationship costs money. There is a business relationship as well as a health mentoring relationship. Ignoring this reality sets a doctor up for disappointment and burnout. To continue this type of relationship there must be a fair exchange between both parties.
Patients purchase value from your office. The cost (price, time, inconvenience of repeated visits, etc.) must be less than the benefit received (pain relief, improved self-image, regained abilities, etc.) When this cost/benefit ratio dips below a fair exchange, expect a change in the relationship.
A good example of this is when patients start feeling better and are cut off from their insurance benefits. Money is a factor. This cruel economic reality is often difficult for doctors who receive their care for free to appreciate. Ever wonder why every patient you've ever treated isn't still showing up once or twice a month for a wellness visit? If it's a choice between a pizza and movie with the kids or an adjustment when they're feeling fine, guess which one they choose?
Offices that boast patient visit averages in the 50s, 60s and higher have some type of wellness fee structure in place to accommodate this change in perceived value. This affordable fee structure won't completely avoid patient drop-out; however, it improves the opportunity to continue a healing relationship into rehabilitative and maintenance stages of care.
Set a good example. It sounds so obvious, but is it? It's the 1990s and there is still a sizable contingent of doctors and staff members who smoke! Even worse, there are doctors and staff members who are not under regular chiropractic care themselves. It's the health care equivalent of the cobbler's children going without shoes. Overweight? Lose it. Shabby office? Remodel it. Facial hair? Trim it. Bad breath? Fix it. Patients are incredibly sensitive to the health habits of their doctor. To mentor someone to health, you need to be healthy yourself.
Thousands of patients who could be helped never make it into your office because they don't recognize the role of the nervous system and its relationship to the spine and overall health. And while it's difficult to reach those not in your office, it is the responsibility of every doctor and staff member to use the mentoring process to change the perception and understanding of every patient who does make it into your office. Only then is there any hope for a meaningful, long-term relationship.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
Not a reader? Bill reads his favorite chapters from all 10 books on Bill's Best. |
