The Secret of Motivation

by William D. Esteb

Sometimes it seems the harder you try to get patients to understand the value of a chiropractic lifestyle, the less effective you become. In fact, many offices employ approaches to motivate their staffs and patients that are actually counterproductive, creating an unhealthy, dependent relationship.

Recall programs, the hotel equivalent to a morning wake-up call, are a good example of how doctors assume too much responsibility for their patients. Without a thorough understanding of the nature and severity of their condition, patients naturally can't assume the responsibility to value their health sufficiently to show up for care. It's a matter of motivation. How do you motivate patients to take responsibility?

Since 1986, at seminars around the United States and Canada, I have been intrigued by the topic of motivation. Invariably after a seminar someone will approach me, thanking me for a "motivational" seminar. "I don't remember covering the topic of motivation during the seminar," I say. "On what page of the notes did we discuss motivation?" Of course, talking about motivation doesn't result in motivation. All I do is present ways for doctors and their staffs to get acquainted with new possibilities for their offices. Perhaps they have reached a plateau, are in burnout, or feel trapped, thinking they're stuck in the current version of their office for the rest of their lives. All I did was show them new ways to get involved and become rechallenged. It seems that motivation comes from the new possibilities for involvement in one's life. To care again. To have purpose.

The spoiled child

A classic example of assuming too much responsibility and eliminating opportunities for involvement is the child who has been pampered his entire life and then, by some misfortune, inherits a highly successful business venture or a large sum of money. Isolated from the details of actually running the business, even as an adult, the founder's son quickly squanders the fortune and runs the business into the ground. When we assume too much responsibility for our children, or anyone else, we sabotage normal development and the self-esteem necessary for a healthy, balanced life.

Closer to home, the role involvement plays in the creation of motivation is illustrated by looking at the purchase of a new office photocopier.

The parable of the new copy machine

Let's say your office needs a new photocopier. The old one is frequently jamming and it lacks many of the features newer models offer. The staff has been complaining recently about the machine, and it's time for a new one. The tendency for many doctors with Type A personalities is to march out and buy a copier. Want a copier? Here. Suddenly a new machine shows up one morning, surprising the staff. Instead of jubilation, the staff seems distant and depressed. While the doctor's quick response and willingness to properly equip the staff is admirable, it demotivated them. What happened?

By assuming total control of the copier problem, the doctor eliminated the opportunity for staff involvement. Plus, this new machine (that, ironically, the doctor rarely uses) doesn't have the enlargement and reduction features the staff really wanted. Yes, they got their machine, but in their eyes it's the wrong machine. Plus, they didn't get the pleasure and the affirming sense of "team" by researching, pricing, and testing competitive models. Was it more expedient than involving the staff and wading through all the personalities and concerns? Sure. But in the process, the staff was demoralized at a time when a purchase like a copy machine could have been a rallying point for improved productivity. Sometimes the process (involving the staff) is as important as the destination (getting the copier).

More delegation!

Fundamentally, this is a delegation problem. It may be a symptom of a lack of trust or just the desire to prevent staff members from failing at a task. Yet, failure is a necessary part of the learning process and taking responsibility for ourselves. Certainly if failure creates a life or death situation, avoidance is important. That's rarely the case. It's usually an expediency question where it would be just as fast to do it ourselves than to explain it to someone else. When doctors take this tack, they soon find they're doing all kinds of non-clinical activities, stealing responsibility and its resulting motivation from the staff. Learning to delegate is an acquired skill and especially difficult for those with perfectionist tendencies.

Unfortunately, we are all guilty of taking opportunities away from those we work with and stealing their motivation in the process. Staff meetings are good examples. Staff meetings should be organized and run by the staff. After all, that's what they're called: staff meetings. Instead, many doctors turn this valuable team-building occasion into a monologue that siphons off the motivation and energy of the staff. Forget the tirades about statistics and telephone procedures, the real signal being sent by the doctor is "this-is-my-practice-not-our-practice-and-you're-just-employees-here."

Patient motivation by doctor and staff is often sabotaged in similar ways. Here are a few overlooked situations where the intent is usually well-meant, but the result sabotages the patients' ability to get involved and take responsibility for themselves:

Insufficient patient education. "If patients knew what I know they'd become lifetime patients and refer all their friends," wailed a doctor in frustration. And that's true. Since the Vulcan Mind Meld popularized by Mr. Spock on "Star Trek" hasn't been patented yet, a variety of patient education techniques must be used to get the chiropractic message to patients. Without a complete understanding of the nature and severity of their problem, and the truth as to how long it will take to bring it under control, patients can judge their progress only by how they feel. If chiropractic care is something that merely "happens" to patients, they are isolated and shut out from being involved. Information is a way you involve and motivate your patients. Jan Carlzon, in his book Moments of Truth, observes, "Anyone who is not given information cannot assume responsibility. But anyone who is given information cannot avoid assuming it."

Real time examination test results. Many offices model their examinations after the medical model, asking questions, having patients perform certain actions, taking notes, and "Hmmming" in an all-knowing, doctorly way. But this approach angers patients. Tell me my blood pressure now! Tell me what you're discovering now! Is there hope? I want to know! Many patients are begging silently for a chance to be involved and instead are forced to wait for a "super-duper-it-can't-fail-wait-until-they-hear-this" report of findings. No single report will magically transport patients from a symptom-oriented medical approach to health to a preventive chiropractic lifestyle. Use the examination process as a way to involve patients by foreshadowing the recommendations that will follow at your report of findings.

Report of findings. The report is another occasion where involvement and the resulting potential motivation can be thwarted by assuming too much responsibility for the patient. I've heard a doctor say, "I'm going to take care of those headaches" or "Bring your husband in for care and we'll fix his low back pain." Aside from the obvious risk of promising a cure, this style of communication strips patients of their responsibilities, such as keeping appointments, paying their bill, and following recommendations. Try instead, "Together we're going to work on those headaches" and "When your husband is ready, bring him in so we can help him with his low back pain." The health problems patients present when they enter the office are their problems, not yours. That doesn't mean you can't be sensitive, compassionate, and caring. But never take away the patients' responsibility for their role in the restoration and maintenance of their health. It's their health and they deserve the right to fail if they wish.

Asking questions. If patients are interested enough in chiropractic and their health, they may be inclined to ask questions. In fact, the number of questions patients ask is a good indicator of their involvement. Yet, if their questions are greeted with a Mr. Know-it-all attitude, questions will stop coming. If patients are still interested, they may ask staff members questions. A question is a most magnificent thing. It reveals so much about the person asking the question-and the person answering it. If patients don't ask questions, you can help keep patients involved in their care by asking them questions. "Now why do you suppose your right leg is always short?" or "Why do you suppose that when I do this, you feel it down your arm?" Asking questions can help patients think in new ways and discover themselves through their chiropractic experience.

In the heat of battle, the motive always seems right: to save time, to avoid mistakes, or to prevent a relapse. Frequently these attempts backfire and create dependent relationships. A career for the staff is reduced to a job. And a significant lifestyle change for patients becomes merely a "natural aspirin" to be administered only when symptoms are present. Allow patients to fail gracefully, without judgment. Permit the staff to become more fully involved through delegation. Raise their self-esteem by creating new opportunities to be involved, motivated, and independent.

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

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