When Do Patients Know Enough?
by William D. Esteb
For many patients, chiropractic is something that happens to them. They are bystanders. They submit to care as long as they experience a sense of progress, the treatment is pleasant, and their insurance company picks up the tab.
They are having their body "serviced" and are often about as involved as when they get a haircut or an oil change.
Other patients are more active participants. They ask intelligent questions. They are aware of their bodies and have integrated their newfound knowledge about chiropractic and health into their lifestyles. It's not that they can hardly wait for their next appointment, but they are pleasant patients to work with and can be prime referral candidates.
High self-esteem
There are other distinguishing characteristics that separate these two groups. Perhaps among the most profound is the patient's level of self worth. Does a patient's self-esteem affect the level of utilization of chiropractic? Most likely it does. Strategies to enhance a patient's self-esteem in your practice would likely improve a patient's chiropractic participation. Yet, like health attitudes, lifestyle, or diet, a patient's self-esteem is the cumulative effect of years of programming.
Besides active listening and other interpersonal skills that communicate your interest in the patient's well being, an aggressive patient education program can have a positive impact on the patient's self-awareness. (A survey published in the January-February issue of American Health magazine revealed that medical doctors usually give their patients only 18 seconds to describe their problems before interrupting!) Chiropractic education can help patients better understand their individual potential, place an appropriate value on the care you provide, and give patients the courage to explain and defend chiropractic outside your office.
The utilization of many products and services is a reflection of a customer's understanding. Once you understand the protocol and know what to do with all the forks, you're more likely to be comfortable in a five-star restaurant. Once you understand how a computer works and what it can do for you, you're more likely to use one.
While we're not likely to find a Restaurant 101 class, have you been in a computer store recently? You'll probably see a video presentation, and every machine will be running a program showing its capabilities and the different kinds of software it can run. These same stores practically give away introductory computer literacy classes and provide free tutorial programs that can be taken home and tried. Computer stores recognize that the more customers know about their products, the more likely they are to buy them, use them, and return to purchase software and peripherals.
Empower the buyer
This happens with many types of first-time purchases: our first VCR, our first home, even our first expensive business suit. The more information the salesperson shared with us, the more we felt involved and empowered to make an intelligent purchase decision. Educating the buyer is one of the primary responsibilities of selling high technology and new ideas, or changing a buyer's attitude. Those who buy without a clear understanding of the product, its uses, or how to get the most out of it suffer from what marketing experts call poor "post-sales satisfaction" or "buyer's remorse." This condition inhibits future purchases, causes customers to hold a negative association with the seller, and results in negative word-of-mouth advertising.
Does this happen in chiropractic?
Of course. There is a vast population suffering from misconceptions about chiropractic. And while you don't have the luxury of having the chiropractic perspective vision hammered into the minds of the public as they watch television every night, you do control the environment in which patients receive care. The Herculean task of modifying a patient's belief structure while in your environment is a primary responsibility of every office. Because while chiropractic results may change a patient's opinion, a chiropractic education can change a patient's attitude. It can equip a patient to speak intelligently about chiropractic or cautiously volunteer, "Well, it worked for me." It can mean the difference between a patient actively referring or dropping out at the first relief of symptoms. It can mean the difference between relief care or a patient bringing in his or her family and pursuing long-term spinal rehabilitation.
Consider every known patient management procedure, technique, fee structure, influence of insurance, patient profile, and every other dimension of chiropractic, and it still goes back to communication. How well are you educating patients so they can make appropriate decisions and place the proper value on the care you give?
Acting "doctorly"
A patient's level of formal education can improve your image as a doctor or lower it. As there are more and more college graduates, the high regard previously afforded those in professional services has diminished. In chiropractic, this problem is worsened by the relative quickness and repetitive nature of the treatments, and the misconception that identical care is administered to all patients. "How can something that's done so quickly be so difficult to do or cost so much?" reasons a patient. "That was the most expensive two and a half minutes I've ever experienced," another patient thinks to himself.
Many patients are kept in the dark during the initial examination. Tests are not explained while they are being administered and comments are reduced to a knowing, "Uhmmm," attempting to heighten the dramatic importance of the eventual report of findings. Perhaps this works with some patients, but without an open dialogue, teaching patients and helping them place a value on your expertise, you are overlooking an excellent educational opportunity. Later, patients have a better basis for the doctor's clinical recommendations and the effectiveness of the report of findings is less dependent upon the doctor's ability to present his or her "opinion." Without a clear understanding of how recommendations are reached, patients rely more heavily on their own notions of health.
Similarly, without the proper chiropractic education, patients undervalue post-symptomatic relief care. As patients compare the relief and sense of progress they experienced during Initial Intensive Care with the fee, they are inclined to equate a lower value with Reconstructive Care because the results are not as dramatic. Without a targeted communication plan, this discrepancy in perceived value (cost/benefit) forces a patient to re-evaluate the need for continued care. This problem is compounded because it often occurs simultaneously with discontinued insurance coverage. Patient education, when combined with a thoughtful wellness fee structure, can help combat this perceived decrease of return on their investment.
Aside from the immediate benefits of a well-informed patient base, fewer inappropriate questions, and patients who follow through because they understand a bigger vision of chiropractic, effective patient education creates a legacy. Educated patients are patients who can explain chiropractic well enough and accurately enough to inspire their friends and families.
Patient education is the key
Merely experiencing results is not enough. What about the hundreds of thousands of patients who have gotten results-but have never mentioned chiropractic to their friends? Perhaps their reluctance is based on a lack of information or the inability to persuasively articulate how and why chiropractic works-again, the result of ineffective patient education. Educated patients can be more effective chiropractic ambassadors in your community than expensive television commercials, free services, or other non-therapeutic marketing incentives. Educated patients can personalize their approach to prospective referrals. Educated patients can answer questions. Educated patients have information that gives them a base of power and confidence--not only to continue their care beyond insurance coverage, but to share their knowledge with others.
Even the very first doctors recognized the educational aspects of their profession. After all, the word doctor comes from the Latin, docere, meaning "to teach" or "to cause to accept." Perhaps this has even more significance today in the Information Age. To practice without using every educational tool, technique, or technology to educate patients is to deprive them of information and hinder their understanding of their condition and the motivation to take the appropriate action.
When do patients know enough? When they enroll in chiropractic college, of course.
Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95
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