What to Worry About

by William D. Esteb

I rarely feel more disconnected with my audience than on those wonderful occasions when I get to speak with chiropractic students on campus. To some, since I've traveled more than 500 miles, I am an expert. Even if I merely repeat what their instructor have said the day before, it is somehow more believable and likely to be embraced than the "prophet in his or her own town." To other students, I'm merely a patient who has not withstood the rigors of Iowa winters, Texas summers, or Dr. SoAndSo's anatomy class. And to still others, I sense there is merely a mild curiosity due to a change in the normal classroom lecturer. Having never sat in those chairs or learned what the students have learned, I often feel engulfed by the gap in our ages, experience, and focus, making rapport-building so difficult.

Usually I try to offer a bit of context; who I am, how I came to work within the chiropractic profession, and my experience conducting patient focus groups, leading seminars, and creating patient education materials. My only shot at connecting with a student audience is addressing its many perceived fears about the eventuality of practice. I've heard these fears mentioned during the question and answer session I usually include at the end of my remarks. Like most fears, they are often irrational, based on myth, or are the result of illusions that prevent many new graduates from being as resourceful or effective as they might otherwise be. I'm not fully convinced that my remarks eliminate their concerns, but I hope my observations save a few audience members from unnecessary suffering.

Based upon my experience, here's what new and student doctors should be worrying about:

Paying back their loans. It's difficult to serve two masters. Debt is a harsh taskmaster. Today's six-figure student loans can distort reality, or worse, cloud the debtor's vision and result in decisions that will sabotage one's ultimate success and influence.

Ironically, many with huge debts forget that the ability to pay back their loan is a symptom. And like most symptom treating, focusing on symptoms instead of the cause, rarely solves the problem. In fact, it usually creates a set of whole new symptoms which often leads to a downward spiral of reactions (fear) and results (serving the debt instead of serving the patient).

Those whose vision extends no further than paying back their loans and making a decent living, will find their lives are nothing more than a long, strenuous juggling act of bill-paying. There is little joy, and what they find is that they have traded their signatures at the bottom of the loan application for a job. Escaping this Faustian arrangement (like health) starts from the inside out.

Action step: Instead of worrying about paying your loan back, worry about how you can serve more patients, giving them what they want (cause), so you'll have more than enough financial resources (symptoms) to fulfill your financial obligations. Then you'll be rewarded with a lifestyle befitting someone with your talent and willingness to take risk.

Associate or not to associate. Because most chiropractic colleges do such a poor job of acquainting their students with the realities of actual practice (student clinic doesn't come close), I'm a firm believer in internships, externships, and associate relationships. This can be especially helpful for the vast majority of student doctors who enter practice lacking the hands-on skills of running a small business. Working in a busy office beside an experienced chiropractor, and seeing the rhythm, the paperwork systems, and the other day-to-day realities of a profitable exchange between doctor and patient can be invaluable.

Many student doctors chaff at the idea of being exploited and having to do the dirty work. Others are chomping at the bit to get out of the controlling environment of college and spread their wings. Yet, there is great value in an apprenticeship that can show you how the practice of chiropractic really works.

There are several major motives for an established doctor to hire an associate. A common motive is to make money off the new doctor in exchange for teaching him or her the ropes. These relationships are often heavy-handed and rarely last. Many new doctors respond by taking a healthy chunk of patient files with them and opening a competing practice down the street. Another motive is to hire an associate to allow the main doctor to take the time off for vacations, extended weekends, or to spend more time with a growing family. As long as the associate doctor is fairly compensated and motivated to carry the patient load, this can be a long-lasting win/win relationship.

Action step: Worry about asking the right questions when you interview doctors looking for an associate. Ask for references, motives, and the realistic benefits of a long-term relationship.

Picking the right practice location. This worries a lot of student doctors who spend hours analyzing data about the concentration of chiropractors per population. This is a fear-based, scarcity view of the universe. This mentality assumes that there are only a finite number of chiropractic patients in the world, and to get your fair share, you need to locate as far away as possible from other chiropractors.

Nice try.

Check out the density of chiropractors per population within a 10-mile shadow of virtually any chiropractic college! Clearly, the more the merrier. A high concentration of chiropractors merely tells the general public that there is a huge demand for chiropractic.

It doesn't stop there. After they have the state and city identified that supposedly would give them the best chance of success, they use pushpins to identify existing offices. Once they see the neighborhoods least being served by chiropractic, they start looking for an office location! No wonder so many chiropractors end up moving their practices!

Action step: Instead, determine the best place on the planet for you to raise a family and a place you'd be willing to dig deep roots into the community. Worry about finding a location with a likable climate that is either close to or far from your parents, depending upon your relationship. In short, recognize that there is a boundless supply of patients, so pick a location that would make serving them convenient and enjoyable.

Getting new patients. This is a common worry, and well founded, based upon the stories I hear from new graduates who thought that the act of installing their office sign would produce a stream of new patients!

Interestingly, for many practices this constant need for new patients never goes away. New patient acquisition attempts go in spurts from offers of free care, tangos with personal injury lawyers, or pathetic little ads in the newspaper television program guide. While these overtures produce spines, promotions rarely produce true patients. The attitudes and motives of those who show up often sour the doctor and staff, tainting their outlook on the practice and the profession.

What most chiropractors overlook is that many patients first buy a personality before they buy a profession. This is to say that personality is the only way to overcome the cultural stereotype of the chiropractic profession. One way to make chiropractic an attractive option, or to even get it on the list of a patient's possible range of health care choices, is with your personality. This seems backwards to those who understand the simplicity and clarity of chiropractic principles. However, many patients pursue chiropractic care only after they have assurances from first- or second-hand sources that you're not a quack, don't use chicken bones, and you're "not like other chiropractors", issues that I've never seen adequately addressed in yellow page ads, on bent pens, or at flea market booths.

Action step: Instead of worrying about new patients, find ways to bridge the "knowledge gap," the "perception gap," and the "personality gap" by getting out of your office and into your community. Become aggressively friendly, introducing yourself and your profession everywhere you go. If you don't have a personality, go get one! Great technical skills alone will rarely fill your office to capacity. Equip the patients that you do get with the information and pride to explain, defend, and promote your "brand" of chiropractic.

Fear of the unknown. After years of book-learning and seeing chiropractic work firsthand in the school clinic, you'd think that would be enough to kill the weed of fear. Yet, with all that they know, many doctors fall victim to the fear of what they don't know! Since there's always something more that can be learned, overcoming the paralysis this one can produce is serious business!

This is the cruel payment administered to those student doctors who studied hard, did well on tests, and were most interested in third party, scientific validation of chiropractic tenets. How were they to know that they were setting themselves up for fear and self-doubts? It comes down to this: until we can use the five senses to measure and control the spirit (innate intelligence) then we must have faith in the healing process. Everything else is window dressing. It is one of the fundamental differences between mere doctors and true healers.

Action step: Go boldly with confidence. Harness the limitless power of the patient's mind/body connection and be willing to depend less on the seeming predictability of biomechanics or other "knowable" dimensions. Abandon fear, judgment, and limitations in favor of hope and encouragement and you employ the most potent forces in the healing process. Why assume so much responsibility for an outcome of which you have so little control?

The fear of making a mistake, the fear of the unknown, the fear of letting others down; these provide ample fodder for those worried about themselves. Fear is an indulgent and selfish behavior that doesn't wear well on someone who professes to advance health and healing. It clashes with a white jacket, a shirt and tie, a silk blouse, or any other costume you choose. If you're worried, if you're not at peace with the world, if you're looking down instead of up, if you're looking back rather than ahead, if you've seen the truth, but doubt it, imagine how much more lost your patients are. And how much they're counting on you.

Buy the book
Looking Up
Originally published in 1998
240 Pages
US $24.95

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