Talk Is Cheap

by William D. Esteb

In huge underground vaults, billions of dollars worth of diamonds, sorted by size, weight, color and clarity, are being stored away by the DeBeers diamond cartel. By removing these diamonds from the marketplace, they have successfully controlled the availability, price and value of "a girl's best friend." In fact, if all these diamonds were to be dumped onto the market, that expensive diamond engagement ring that took the first year of marriage to pay for would be worth just a couple of dollars. Apparently, the universe puts little value on things which are so abundant, such as sand, opinions and especially words. Which is why most oral efforts at educating patients produce such dismal results. Spoken words are mere pennies in the currency of communication.

A great deal of importance is placed on our ability to speak. Like learning to walk, most parents record the hour and day of their child's first utterings. The joy of this early vocabulary is quickly supplanted by the child's ability to communicate their wants and desires, and later by thoughtful, intelligent conversation. And while sociologists remind us that more than 70% of a message is communicated by our nonverbal articulations (body language, hand movement, tone, pace, facial expression, etc.), most doctors depend almost exclusively upon the words from their mouths as a means of communicating chiropractic to their patients.

There's a reason why "talk is cheap." Just about all of us are effective at arranging words into a fashion that resembles rational, thoughtful social intercourse. As others talk to us, we nod our heads and appear interested. We make and then break eye contact for the socially correct length of time and appear as if we are carefully weighing the speakers words and drinking in their meaning and implications. When, in fact, we're actually distracted by the effort of composing our response! Most "conversations" are merely two people talking at each other. Instead of listeing we're waiting for the other person to finish so we can talk.

The ineffectiveness of "talking" as a communication modality is heightened in doctor/patient relationships. After the initial give and take of the consultation and information gathering phase of the relationship, the patient education and report of findings communication becomes a decidedly one-sided affair. With the exception of the sometimes subtle body language of a wary patient (potentially distorted by physical discomfort), there is little feedback that the patient is understanding, believing or accepting the words uttered by the doctor. But this does little to slow the torrent of words flowing from the doctor's mouth. If anything, it often serves to accelerate the pace and number of words used. If patients are not assertive to ask for a needed clarification, they are steamrollered into a care plan that seems designed to address the issue they understand perfectly--how they feel.

Unfortunately, the consequences of ineffectively talking to patients doesn't show up for months later. This passage of time serves to cover up one reason why many patients decide to discontinue their care. Like a patient in his or her 40s who is unlikely to see the connection between their headaches and falling off their pony 20 years earlier, the lag time between the orally delivered report of findings and the resulting patient dropout obscures the connection. Instead, many doctors are misled into believing the patient accepts and remembers the orally presented report because of their almost perfect compliance during the early stage of care.

Yet, when doctors find that their well-rehearsed reports or "can't fail" lecture no longer produce the results theyonce did, they often go out in search of a new script.

How many chiropractic seminars have you sat through? How many audio cassette programs have you listened to? How many hours of classroom lectures have you endured? How many radio newscasts have you listened to? How many sermons have you heard? More importantly, how many do you remember? The spoken word is not only hard to remember, even when delivered by an excellent speaker, but it is hard for listeners to recount what they've heard to someone else. In a chiropractic setting, this makes it difficult for patients to recreate your report of findings to a spouse who can't (or won't) make it in, or for patients to share with others what they've learned at your new patient orientation.

If chiropractic is so misunderstood and the spoken word so ineffective, how do you communicate effectively with patients? How do you give a report of findings and perform all the other communication chores necessary to inform patients, obtain their consent to begin care, and motivate them to continue?

This overdependence upon the spoken word occurred to me while I was speaking with a doctor on the telephone who has a stuttering problem. After painstakingly discussing several other topics, he asked for suggestions on how I would deal with the patient communication challenge he faces if I were him. Good question. After discarding the notion of singing his report (country singer Mel Tillis stutters when he speaks, but not when he sings) I tried to offer some practical solutions.

I suggested that he start filling the walls of his office with pictures. Pictures of Crest toothpaste users with braces, smiling from the pages of a women's magazine. Pictures from the Midas advertisement of a car receiving a front end alignment. A suit of armor. The Tin Man from the Wizard of Oz. And on and on.

Pictures that could metaphorically demonstrate or illustrate virtually any chiropractic concept from adjustments to X-ray exposure. With an extensive library of visual resources on the walls of his clinic, all he needed to do was point to an appropriate picture and speak just a word or two. Sure, obtain the best chiropractic wall posters and show the patient's X-rays, but create your own library of visual tools that can serve to enhance patient understanding without a long, drawn out verbal explanation.

Pictures don't have the ambiguity that the spoken word does. If you've ever tried to assemble something as simple as a bicycle on Christmas eve, or follow the directions for your new barbecue grill before your dinner guests arrive, you're already familiar with this limitation. With the exception of optical illusions, Escher prints, people with color blindness or individuals from significantly different cultural backgrounds, pictures are pretty much the same thing for everyone.

They say a picture is worth a thousand words. This document has about 1200 words. I could have given this message greater impact by showing you a picture of a doctor's words going in a patient's ear and out the other while the patient is day dreaming about their recent vacation, followed by a picture of an adjusting room filled with pictures torn from magazines. Get the picture?

Excerpted from Chiropractic Patientlology

Excerpted from
Chiropractic Patientology
Originally published in 1996
240 Pages
US $24.95

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