I Have The Stuff, Where Are The Patients?

by William D. Esteb

A doctor called me the other day hoping for insight into his lack of new patients. While I'm always delighted to help those who call, and feel honored that someone with twelve years of practice experience would seek my opinion, I listened intently for clues as he described his situation.

He read off the major statistics; his office volume, collections, patient visits, retention, and average new patients. While there were few clues, it occurred to me that many of the doctors I've talked to would have died for statistics like his. "What adjusting techniques do you use?" I asked. Clearly he had been around the block, with professed proficiency in virtually all the major techniques. He then volunteered his equipment list whose brand names sounded like the advertisers list in Chiropractic Products Magazine. Apparently he had purchased the "Cadillac" version of virtually every type of therapy equipment. He rattled off the model numbers and technical specifications as if I should automatically appreciate the significance of "double pulsed modulated Russian stim" and other esoteric product specifications.

"What about your patient education efforts?" I asked, stalling for time. He was prepared for that question, too. By his description, he may have the largest collection of patient education videotapes, neuropatholators, patient brochures, and lecture charts of anyone in the profession. "And everyone, even the manufacturer of the six foot spine in my reception room, promised their patient education tool would flood my office with new patients," he lamented. "But I haven't seen any measurable change in the last five years or so."

This kind of telephone consulting is a lot like finding squirrels. Remember those pictures your children used to bring home from first grade? You've seen these things. It's an idyllic woodlands illustration with trees, bubbling brook, and bushes. The object is to find all the squirrels hidden in the picture. I wasn't finding too many squirrels with this doctor and there were only a few remaining places to look.

These kinds of practice challenges are almost always personality related. And while few doctors like hearing this news, it's usually at the root of fundamental practice growth challenges. With so much focus on the adjustment, office tools, forms, procedures, and report of findings scripts, one of the most important issues gets overlooked--the doctor. Few will flock to hotel room ballrooms and pay exorbitant fees to be "insulted" by the management company's namesake, claiming that the assembled need personality transplants. Yet, this is the only thing that could unleash many doctors' fullest practice potential.

The history of this major oversight goes way back to when chiropractors first wanted to be "accepted"--before the Mercy Document, before insurance equality, and even before chiropractors went to jail for practicing medicine without a license. It started when religious overtones of chiropractic were removed. Interestingly, a profession that was begun by its founders as a way to "connect the physical with the spiritual," today ignores the spiritual dimension of chiropractic and the healing process.

In the 1980s, Scientologists exploited a renewed interest in spiritual issues with their heavy-handed management programs that turned countless doctors into paupers. While you shouldn't have to change religions to get practical, down-to-earth management help, many did. The result is a profession in which spiritual matters are rarely discussed, and if they are, it is done privately in the most neutral and least controversial tones. Usually it is simply avoided altogether.

If our spiritual health is a mess, it almost certain that our lives, marriages, and practices are a mess too. Yet, this is rarely mentioned or scrutinized among doctors, or between doctors and their patients. In offices in which the doctor is in touch with his or her spiritual dimension there is better compliance, and there seems to be a more profound sense of healing than in the superficial environments of doctors and patients playing the mechanistic "roles" of the healer and the hurting.

But there's so much at risk when mentioning spiritual and religious issues! Some shy away for fear they will offend someone, narrow their appeal, or be dismissed as a fanatic or zealot. Too bad, because it holds so much more promise of healing breakthroughs than purely improved biomechanics, better posture, or repeated application of electromuscle stimulation. I think it may be a spiritual issue that was at the root of the doctor's problem with the office full of stuff. He had state-of-the-art physical tools at his disposal, but perhaps hadn't yet felt comfortable confronting his own spiritual issues or broaching them with his patients. Fear?

Can you be "successful" in chiropractic without dealing with these issues either personally or professionally? Of course. Is life and practice as fulfilling? Probably not. Are your efforts blessed by your alignment with the fundamental power of the universe? Perhaps not as fully as they could be.

By virtue of my faith, I am compelled to make decisions and take action based on an eternal yardstick. The vows I made to my wife before God, give me strength to make my marriage work. By not trying to be all things to all people, I am given confidence. And because of my beliefs I am prepared to die at any time. This is liberating and empowering. Without the two most frequently mentioned fears (public speaking and death) holding me back, I am free to serve others with clarity and purpose. While arguably a subtle element, I believe this characteristic is detectable by others. Especially patients.

Often the first step in making this transformation is the willingness to become more vulnerable. The Norman Rockwell version of the doctor as an all-knowing, omniscient grantor of health is no longer appropriate or effective. Patients no longer put doctors, any kind of doctor, on a pedestal and mindlessly follow "doctors orders." Continuing to expend tremendous amounts of energy to create and maintain the image that you have everything under control, not only betrays the patient, it is counterproductive to the healing process. Increasingly, patients want a mentor, a partner, a coach, a cheerleader. It means getting your hands dirty and getting involved in the patient's life beyond the superficial case history form or measuring angles and the range of motion of spinal joints. It means getting closer to patients than the physical touch required of an adjustment. Often, it means the willingness to connect on the deeper spiritual plane. If the doctor hasn't come to terms with his or her own spiritual health, it is virtually impossible to inspire patients with this most fulfilling and effective "adjustment" in the doctor's healing arsenal.

Telling the doctor on the telephone that he hasn't been facilitating the most complete recovery with his patients is difficult, when his office has the latest healing appliances and high tech gadgets. Explaining that he probably needs to work more on himself than on his patients, is not what he wants to hear. Outlining a "treatment" plan for the doctor is even more problematical. In fact, I'm uncomfortable even identifying the problem without some concrete solution or specific action step.

Perhaps you'd like to finish up this phone call for me?

Excerpted from
Making Change
Originally published in 1995
240 Pages
US $24.95

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