On the First Visit
by William D. Esteb
We form our first impression of others primarily by their appearance. In fact, some suggest that this process happens in the first 3-5 seconds after meeting someone. This may not be "fair" or "right," it just happens. Combine this with the fact that our initial impression is usually the most lasting, and it becomes very important to give a lot of thought to your patients' first interaction with your office.
To consciously shape the image new patients form of your office requires studying the patient as much as analyzing your office.
Every patient's perception of the world is filtered, evaluated, and judged based on a lifetime of previous experiences. If we are insensitive to this, we overlook the patient's mindsets and inadvertently make several mistakes that sabotage a patient's willingness to fully avail themselves of wellness chiropractic care.
Attitudes affecting the doctor/patient relationship start at birth and are reinforced throughout a lifetime. The first opportunity for chiropractic to confront these cumulative wrong-headed ideas about the nature of health, and to change or confirm them doesn't start until patients make that first phone call to your office. Reviewing the first chiropractic experience of hundreds of patients, I've heard the same story over and over again.
Afraid at first
Hurting for weeks, maybe months, and finally succumbing to the physical and psychological risks attributed to consulting a chiropractic doctor, patients make their first tentative phone call, suffering from a type of schizophrenia. They want help, they think chiropractic might help, but they've heard the rumors, the horror stories and so wringing their hands, they make that first call. I believe this mind-set is the rule, not the exception, no matter how well patients cover up their fears or misgivings. It's a new experience. And they're anxious.
The greeting they receive from the staff starts a dialogue that should be sensitive to and accommodate the "pre-existing condition" (medical model health attitude) that exists in the patient's mind.
This puts chiropractic in the same position as the disfigured invalid. Think back to a time when you met someone who was physically disabled or disfigured. Do we say something? Do we try to pretend they're not in a wheelchair? Do we act as if everything is normal? In these situations we look to the disabled or disfigured person for clues about how we should act. Those who recognize their challenge, joke about it, or indicate that they know that we know, and create a climate in which we can put down our guard and be more relaxed and open in our relationship. This is the opportunity faced by chiropractic. Don't apologize, but acknowledge in subtle ways that you know they know by being sensitive to and anticipating the "health care baggage" patients bring to your office.
Besides the obvious questions about high fees, expensive X-rays and the misunderstood need for lifetime care, many new patients think chiropractors aren't real doctors. Here are some other often overlooked misconceptions and attitudes:
First visit treatment. Conditioned by office calls made to the medical profession, patients expect to receive some type of immediate satisfaction, or at least some movement towards relief. You're between a rock and a hard place. Adjust without a thorough examination and carefully designed treatment plan and you devalue your clinical skills. Delay adjusting the patient and the typical patient can become angry, disappointed, suspicious, or all three.
Action step: Validate the care you deliver by describing the amount of thought and clinical experience behind your recommendations and care program. Consider making your new patient process a two-visit procedure. Even if you can size up a case in minutes, resist the temptation for the sake of the patient's perception of chiropractic. Maybe have them return two or three hours later for their first adjustment.
Treatment is going to hurt. The number of patients who tell of being hurt by "other" chiropractors (maybe you!) is almost legendary. Patients are afraid you're going to move the bones too much, twist their head off, or break their back. For those especially fearful, it can become a self-fulfilling prophecy. Regardless of the cause, the result is a major public relations problem. Like bad breath, the patient isn't likely to tell you it has happened unless you convince them you want to know.
Action step: Explain what an adjustment is, what happens, and the importance of total relaxation during the adjustment so you're not fighting each other. This is a wonderful metaphor for the participative, teamwork needed. You both have a job to do--they give you access to their spine by not tensing up, and you apply the smallest amount of non-traumatic force necessary to restore normal motion and position. Let them know how many thousands of adjustments you've given and that you move the bones "just the right amount."
Treatment is risky. "I'm not going to let a stranger get in there and move my bones around," he says almost belligerently, "especially a chiropractor." Or right before a cervical adjustment the patient offers the play-by-play commentary, "And now the paralyzing one." These are defense mechanisms that reveal a lack of patient education or trust. The adjustment should be aborted until the patient's attitude is "adjusted" through dialogue.
Action step: Before the adjustment, use the X-ray findings to show the projected direction and effect of the adjustment thrust. Demonstrate the thoughtfulness you've given it. Explain how many times you've administered this particular type of adjustment since being in practice. Patients need to know that the type of care they are about to receive is personalized, yet routine.
A chiropractor is a "bad back" doctor. Walk into most chiropractic offices and on every wall you will find a display, poster, or model of some form of spinal anatomy. Some offices look like a paleontologist's museum. No wonder patients think chiropractors are bad back doctors!
Action step: Know when "educational" posters are taking the place of some other form of wall accessory. How often are you actually referring to the poster showing the spinal anatomy of a whiplash case? And what is it telling other patients? You seldom see medical doctors with colorful posters touting the medicine they prescribe or the digestive process that sends the drug through the body! The key to changing health attitudes, which is your major competitor (not the medical doctor down the street), should focus on the brain, not the spine. And the most effective way to adjust the brain is through the eyes and ears. Communicate.
The patient is skeptical. Skeptical patients are almost a chiropractic cliche. Even patients who have experienced wonderful results find it difficult to be enthusiastic when telling others, admitting, "Chiropractic probably isn't for everybody, but it worked for me." That helps justify their seemingly bad judgment for having consulted a chiropractic doctor, and takes them off the hook so they don't have to defend their decision. Or what about the patient who told me that when he goes to his chiropractic office he wants to "park in back and wear a sack over my head so no one will see me."
Action step: Accept that every patient over the age of 18 <MI>is<D> skeptical, especially if they don't refer. On one of their visits, ask what they think makes most people skeptical about chiropractic. Let them answer and agree with them, regardless of how hair-brained their answer is. After they leave, write their response on their treatment card. If you want to increase referrals from this patient, you must successfully put their skepticism to rest, and the only way to overcome skepticism is by offering proof. On subsequent visits you can mention, almost in passing, that you want them to see a new study or read an excerpt of a short article or take a look at some pre- and post-X-rays, or whatever type of proof seems appropriate for their particular type of skepticism. Brainstorm with your staff the types of skepticism and ideas for useful proof. They may be skeptical, too.
The patient feels vulnerable. To top off the skepticism and worries about getting hurt, patients must confess all kinds of health and lifestyle-related information. This exposure, along with the fear of being told that surgery may be necessary after all or they might never be able to live pain free again, is still another source of anxiety. This "white coat syndrome" is also what's responsible for elevating a patient's blood pressure reading 20 points.
Action step: Avoid patients' feeling disoriented by reducing the number of surprises they encounter. Reassure them that nothing will be done without first their complete understanding and agreement. Simplify paperwork, removing references to health-related problems that might be embarrassing, and ask about those in the privacy of the examination room.
The first impression is the most lasting one. And once it's formed, it's difficult to change. Just ask Leonard Nimoy, Vincent Price, Doris Day, or any one who has been typecast after an especially visible success early in their career. Getting new patients through the front door is the easy part. Then the responsibility of changing their perception of health, chiropractic, and themselves begins. When you're successful, you've changed the world in a most important way.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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