The Myth of Patient Management
by William D. Esteb
Perhaps one of the most destructive notions being advanced in chiropractic is that patients can somehow be "managed" into submitting themselves for care.
This is a perspective held by doctors who either distrust patients to respond appropriately or resent the obvious control patients have in the achievement of a doctor's personal and professional goals. So profound is this feeling of lack of control, management specialists have willingly supplied scripted procedures and canned routines to fill the need for everything from asking patients for the names for friends to "Rambo" recall scripts.
Not only do the questionable techniques that precipitate from the wishful thinking of patient management go against basic tenets of human nature, patients ultimately feel tricked or manipulated, and leave the practice with a bad taste in their mouths. Imagine if these approaches were used by Baskin-Robbins, your car mechanic, or barber!
Does this bad taste contribute to negative word-of-mouth advertising? Does it precipitate the need for models that describe the practice as a "bucket with holes?" Does this cause an insatiable desire for new patients and even more gimmicks to attract them?
What a tangled web we weave...
Attempting to control patients is very stressful. So stressful, in fact, that staff members are hired to perform the strong-arm, high pressure recall techniques. The staff hates it. And so do patients. If it weren't for the fact that it often sabotages the potential for a long-term relationship, it would be a great concept. In fact, when you make patients angry by badgering them for one or two more visits, cornering them to divulge a friend's name for a referral, or scolding them for missing an appointment, the effect of negative word-of-mouth can be staggering.
When you buy a lemon
In 1985, Ford Motor Company did a study of their automobile purchasers to discover the impact of negative word of mouth. The study revealed that customers who were happy with their purchases usually told about seven friends. But if someone had bought a lemon, was unhappy with the dealership, or simply upset with the outcome, 22 people heard about it! (Coca-Cola discovered that disgruntled soft drink buyers told twice as many people about their dissatisfaction as did those who were happy when "New Coke" was introduced.)
Negative word of mouth is an effective practice de-builder and it also tarnishes the reputation of the entire profession.
Do these manipulative, negative procedures create the voracious appetite for new patients seen in so many offices today? Many offices end up pandering to the least discriminating types of patients, giving away their services, and constantly advertising because their current patients are unwilling to refer others.
Unfortunately, many doctors seem more interested in these short-term solutions. If a new idea or office improvement doesn't pay off in a week or two, there's a desperate sense of nervousness followed by abandonment and search for a new gimmick. Where is the vision? Where is the excitement? Where is the future of chiropractic?
Myopia
Old school chiropractic, with the "aspirin adjustment" perspective, creates a turnstile need for new patients. Combine this with the false assumption that no one wants chiropractic or that a doctor's self-worth is tied to the bottom line or patient volume, and you have a profession looking no further than short-term practice solutions. This myopic vision sabotages credibility, quality, and the excellence needed to increase the impact of chiropractic on humanity and preserve it for future generations of doctors of chiropractic. And their patients.
Manipulative patient management is a short-term perspective. And in "Short-Term Land," the doctor is unsure wellness care is ethical, even though most doctors themselves receive some type of ongoing maintenance care. Is treatment beyond symptomatic relief over-utilization? Is it worth fighting the insurance company to dictate the length of care? Since no one would want preventive care, it's seldom offered-especially since it requires the communication skills to motivate patients to continue care by paying from their own pocketbooks. Because few patients who come for spinal "repair" work ever understand chiropractic's strong suit-prevention-a self-fulfilling prophecy is created.
Educated patients make better decisions
Enter patient management. With the objective of "improving" patient compliance, fear tactics, manipulative techniques, harassing recall programs, and other procedures are implemented to coerce patients into keeping their appointments or continuing care beyond their own sense of need. It's not surprising that without patient education, patients see these procedures as being financially motivated and only benefiting the doctor. "After all, I'm feeling better now."
Hold onto your wallet!
Whether motivated by financial gain, a statistical goal, real clinical concern, or simply an honest attempt to deliver services the patient should have, the resentment degrades the patient's esteem for the doctor. Whether you're buying a new car, life insurance, or chiropractic care, we all become very suspicious and hold onto our wallets when someone else "has our best interests in mind."
How can you ethically motivate patients to follow through without becoming a high-pressure salesperson? Effective patient education plays a critical role. If patients fully understand the cause, severity, and prognosis of their conditions, then they are no longer dependent upon outside pressure to force them to do what's best. They still may not do what's best, but at least you shed the millstone of monitoring patient compliance because patients have been denied complete information about their conditions.
Isn't the basic issue motivation? Motivation is the technique of tapping into something that is already there. For example, if you go to a seminar and you return home "motivated," you've heard something that struck a responsive chord in you. It was already there. Maybe it caused you to get in touch with some dormant aspect of your value system. Or you heard an affirmation of something you've always believed. The point is, you already had "it" in you and "it" was merely brought to your attention so you could act on it.
Staff motivation works in a similar fashion. If you have a motivated staff, you've created opportunities for them to pursue their personal goals. When you meet a "self-motivated" staff member, you recognize that there's something that makes alignment with practice objectives easy. They already have "it."
Why patients fail
The same is true with patient motivation. Virtually everyone in our culture has been exposed to a health attitude that recognizes that if you have some kind of symptom, you're sick. And when the symptom goes away, you're well. This is an attitude that not only plagues chiropractic, but the medical community as well. Studies at the University of Michigan indicated that as many as 50% to 80% of patients do not follow or complete a treatment regimen.
Why?
Howard Leventhal, in his article "Wrongheaded Ideas About Illness" published in the January 1982 issue of Psychology Today, suggests several reasons why patients do not comply:
1. To avoid confronting the doctor with their own theories about their condition.
2. To avoid feeling awkward or foolish.
3. To avoid the stress of challenging the doctor.
Medical doctors see these problems when medication isn't taken according to the prescription. You see it in missed appointments. Or patients dropping out the moment they're feeling better. And everyone in the health care community sees it in patients who will not change their lifestyles to prevent their conditions from worsening.
If patient motivation comes from within and compliance is the result of the attitudes, myths, and limited information possessed by the patient, education takes on a new perspective. Patient education can improve a patients' understanding of the their problems. Patient education can offer information that can begin the process of changing a patients' health attitudes. Patient education enhances the office's objectives by encouraging an alignment of purpose between the staff and patients. Patient education sets realistic expectations for patients.
Patient education puts the responsibility for patient compliance squarely on the shoulders of the patient. Where it's always been. And always will be.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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