Stuck in a Doctor-Centered Practice?

by William D. Esteb

“Not working up to his full potential.”

I remember frequently seeing that written at the bottom of my grade school report card. I guess my teachers saw something in me that I was unable to see. Apparently, they had higher hopes for me than I did. Guess I was a “slacker.”

I’m reminded of this when I encounter doctors who similarly aren’t working up to their potential and could/should be helping more people. They seem to have the capacity to help more people. They usually have the desire to help more people. But they aren’t. On occasion, with great effort, they can push the numbers higher for a period, only to settle back to their former, comfortable volume. It’s frustrating to continually hit an invisible wall. Especially when the desire is simply to help more people.

But upon closer inspection, many of these doctors have based their practice about something other than patients! This doctor-centered style of practice has diminished appeal to patients and, like a chronically undernourished child, it then suffers from a “failure to thrive.”

The doctor-centered practice comes in a variety of flavors, but here are a few of the ones I’ve seen:

Me-centered, not we-centered. For these chiropractors, practice is about glorifying themselves. Whether or not their name is on the sign out front, spend a few moments with them and you can hear their affliction in the language they use. My practice. My patients. My paperwork. My “girls.” My technique. My procedures. My statistics. Even when they’re struggling (“I need more new patients.”), they think the world revolves around them. It rarely occurs to them that their self-centeredness is the barrier to the growth and success their ego desires!

Chiropractic-centered. While not quite as distasteful as the egotistical orientation above, these practitioners see patients as merely a canvas, the raw material needed to apply the 33 principles and live out the “sacred trust” of chiropractic. Here, the objective is to recreate and perpetuate a pure, if not outdated model of chiropractic. The Society for the Creative Chiropractic Anachronism is foisted upon patients who have never heard of dis-ease, reductionism or the various intelligences that make up the catechism. The report of findings is less of a report and more of an attempt to turn the patient into a chiropractor. The underlying objective is to make sure the chiropractic profession survives—even at the cost of alienating patients!

Adjustment-centered. Fortunately, this seems to be an increasingly small fragment of the profession. The adjustment is the ultimate chiropractic sacrament for these chiropractors. Many of them have shunned all other techniques in favor of a single approach that represents the holy of holies. These are the chiropractors polluting the waters by teaching patients that their technique is the One True technique and that all others are not only to be avoided should they seek care elsewhere, but represent a blight to the profession. Just say the word “manipulation” in their presence, and they twitch with amusing predictability.

Third-party centered. Those who are deeply entrenched in it will deny it, but this practice model is based almost entirely on the process of extracting money from insurance companies, HMOs and government entities. When reviewing a new patient’s case history, they immediately scan the section revealing the patient’s method of payment. A visceral response is recorded based upon whether the patient has a policy with generous chiropractic coverage, represents a juicy personal injury case or is one of those pesky, uninsured, cash-paying patients. By being focused on third-party reimbursement, they’ve put their practice at risk by becoming dependent upon forces out of their control. Patients are perceived as merely “policy delivery systems.” Since they don’t reach into their pocket or purse to pay for care, they can’t imagine that a patient would.

Subluxation-centered. Also known as “principled” chiropractors, these are the practitioners who verbally swat a patient when they mention they’re feeling better, feeling worse, haven’t shown improvement. Or when they say you didn’t “get it” when the adjustment doesn’t measure up in their eyes. Since symptoms are a poor indicator of one’s health, symptoms are not to be discussed. Practice is about finding and reducing subluxations. What many of these zealots overlook is that subluxations themselves are symptoms! Too bad subluxations can’t write a check at the front desk. It they did, the practice would explode. But it doesn’t.

After all the mental gymnastics to justify these practice varieties, each share the common denominator of being something other than patient-centered. The result is a practice that could have a greater impact in their community, but isn’t. And chiropractors who could be experiencing a greater sense of satisfaction and personal fulfillment, but aren’t.

When the practice becomes patient-centered, it becomes more attractive to the people who can reach into their wallet or purse and not only pay you, but leave you with a fair profit and refer others.

What are some of the hallmarks of a patient-centered office?

Patient-centered practices make the office, the procedures, the policies and the chiropractic care that is delivered on each visit, about the patient. And while those with the office models described above usually claim they’re patient-centered, in practice they see their patient relationships through their own unique eyewear that insulates them from the people who write their paychecks.

“It would be a great way to make a living if it just weren’t for patients,” they say jokingly. In their worldview, the patient (or uncooperative third party) is the problem in their idealistic, healthier-than-thou chiropractic ivory tower.

Here are some of the characteristics I’ve noticed in the patient-centered practices I’m familiar with:

Surrendered to reality. Most stress is the result of attempting to impose our view of reality onto the world. With the idealism that many chiropractors bring to their practices, this becomes an occupational hazard. Embracing the notion that “what is, is,” can begin a more productive use of energy.

What is? The patient is the master. Patients hire and fire. They decide to follow, modify or reject your recommendations. They decide right before every visit if they’re even going to show up! The bottom line? Leaders of patient-centered practices avoid making too much of an investment in issues outside their control. And while it may seem counterintuitive, chiropractors capable of maintaining a modest amount of emotional detachment become more attractive to patients than those who assume a parental role in the patient’s life.

Relationship-oriented. Rather than judging the patient’s lack of a sophisticated understanding of health, these offices see the headaches, back pain or other symptoms merely as the reason that the relationship is initiated.

The patient’s ache or pain is the admission ticket, the “honey” that attracts sometimes total strangers into their sphere of influence. With the certainty and confidence that chiropractic principles, when properly applied, will produce results, these doctors focus on the relationship. This is where those with highly refined social skills surpass their college classmates who were good at test taking but lacked a personable character. In chiropractic, as in so many human endeavors, social skills trump technical skills.

The sense of satisfaction and fulfillment comes from the relationship, not the personal achievement of “convincing a skeptic” or moving L4 in a 350-pound patient or some other technical feat. Instead, gratification comes from the sense of profoundly influencing the beliefs, behaviors and the very direction of patients’ lives.

Clear boundaries. To create the best opportunity for a fair exchange, patient-centered practices have firmly set, clearly defined boundaries.

In offices operating out of lack and blinded by scarcity, this is the most perplexing to understand. Fearing that the patient will abandon them, these practitioners modify their fees, new patient procedures, patient education protocols, hours and just about anything else they think necessary to snag the approval of their patients. On its face, the willingness to acquiesce to the demands and whims of each patient appears to be the epitome of being patient-friendly. But it actually sends powerful signals to patients that sabotage the relationship. You’re communicating that you need the patient more than the patient needs you! This is unhealthy for both parties.

Light and fun. The old saying, “It takes a loose arm to throw a fast ball,” comes to mind here. In short, the office tone in patient-centered practices is more casual, friendly and uplifting. What patient wants to pay money to hang out in a heavy, somber and stiff atmosphere?

If the purpose of chiropractic care is to release rather than control; to lead rather than manage; to optimize health rather than minimize symptoms, then the office environment should be similarly congruent. Again, when the practice is heavily doctor-centered, the notion of lightening up feels foreign and uncomfortable, partly because these chiropractors often look to the medical community as a guide for their behavior and office tone. Yet these offices overlook the fact that the purpose of medicine is very different from the purpose of chiropractic. Form follows function.

Safe. While it is the underlying theme of each characteristic, it’s worth mentioning as a separate entry. Patient-centered offices are safe places for patients to lower their guard, reveal their emotional hurts, try on new ideas, ask questions and be accepted without judgment or fear.

True healing occurs at this emotional and spiritual level.

In the doctor-centered practice, this is greeted with, “I don’t want to be a counselor; I just want to adjust!” When the doctors see practice as being about themselves, they assume their job is to “fix” the patient. Nope. Your job is to listen. Ask questions. Be a sounding board. Refer to other practitioners as needed. In short, create an environment of trust and safety.

And most important, create a safe place for patients to fail. It’s how they truly learn. Heck, it’s how doctors learn, too.

Excerpted from
What a Patient Wants
Originally published in 2002
240 Pages
US $24.95

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