The Me in Meaning

by William D. Esteb

Chiropractic, like virtually all disciplines, has its own lexicon and vernacular. Early in your career you began learning the words and their meanings that are used in the detection and correction of subluxation and the advancement of better health through a better-working nervous system. These words are merely sounds we make with our mouths or arrangements of letters we assign certain meanings to. They are symbols, representations of ideas to which those in the chiropractic profession have generally assigned a particular meaning. This "shorthand" can save time among those who share and attach similar meanings to these terms. This can be why communicating with patients is so difficult. They attach different meanings to the words you use!

Those who use the "Injection Method" in their patient communications suffer the greatest patient misunderstandings and the resulting frustration of patients not embracing their message. The Injection Method is the communication approach in which the doctor learns a script or refines an explanation and typically delivers it to the patient at the report of findings. Like a drug loaded into a hypodermic needle, the message is injected into the patient's ears, where the words (drug) are supposed to work their outside-in magic.

The drug reference is especially relevant here. Often, the chiropractors most guilty of this communication style are those who abhor drugs of any kind, avoid symptom-treating and consider their entire practice a pure, contradiction-free example of all 33 chiropractic principles. Their certainty, bordering on dogmatism, fuels the faith of their point of view and overpowers patients who resort to polite listening. Few minds are changed and even fewer patients adopt a chiropractic lifestyle.

There are many flaws in this patient communication approach. These shortcomings have nothing to do with chiropractic and everything to do with human nature.

Confrontation Reinforces

Changing their beliefs about how their body works, the supremacy of the nervous system and the diminished role of germs is a major shift for patients. Most chiropractors fail to recognize the disorienting effect this has on patients. Combine this with the social pressure patients are under to look interested and act politely lest the treatment they seek be withheld, and you sow the seeds of a dysfunctional relationship.

The fact is, when we are confronted with a point of view contrary to ours, it's human nature to reject it and retrench even more deeply into our current belief system. You can hear this process at work on call-in radio talk shows or the post family reunion meal conversations. Few minds are changed when they are initially confronted with a new model.

Patients Supply Meanings

Worse than the rejection of a nerve-based model of health is the patient confusion resulting from the language used by most chiropractors in their explanations.

Probably the one term that produces the greatest source of patient misunderstanding and doctor disappointment is the word "health." It demonstrates the source of most miscommunications--either with patients, children, spouses or countries.

Your professional training has imbued the word health with a particular meaning, usually related to proper bodily function. It is from this meaning that you are able to embrace the idea that vomiting, coughing, sneezing and fevers can be healthy responses. These symptoms indicate the body is functioning properly. When you use the word health with another chiropractor who assigns the same meaning to it, there can be a "meeting the minds" and mutual understanding.

Not true with patients.

Words and phrases like health, subluxation, nerve interference, range of motion, adjustment and countless others used by chiropractors are merely empty vessels. As these words and phrases are uttered, vibrating the air and the patient's eardrums and finally being constructed into nerve impulses decoded by the patient's brain, it is the patient who fills the empty vessel with a meaning. Thus, because of a lack of professional training, patients usually assign a different meaning to the word health than you do!

When you use the word health, a patient might decode the word as meaning feeling good. Or looking good. Or being at the correct weight. Or being in shape. Or who knows what else. You continue with your consultation or report, thinking that the seemingly attentive patient is assigning the same meaning to the word that you do. After all, it's such a basic, easy-to-understand word.

Obviously, this communication train derails before it even leaves the station when you salt and pepper your patient explanations with terms like fixation, degeneration, fibrosis, lipping, function, orthopedic and wellness!

There are two approaches you might consider when attempting to overcome this common phenomenon:

1. Simplify your language. This is the most difficult approach. But imagine giving a report of findings in which you don't use the jargon you learned in chiropractic college. You can dramatically simplify your language without succumbing to "baby talk"!

I'm often accused by the most dogmatic in the profession of not using the word subluxation in certain circumstances, especially in communication tools destined for use outside a chiropractic office. But I'm merely adhering to my keen interest in clear communication. Instead, I'll attempt to use language more likely to be understood by someone encountering chiropractic for the first time. I might describe a lack of health like this:

Aches and pains are warnings that something isn't working right. It's the purpose of your brain, spinal cord and all your nerves that make sure your body works right.

Or a subluxation like this:

Any distortion to the vital nerve messages between the brain and body sets the stage for ill health. The bones of the spine are common culprits, pinching or irritating nearby nerves.

Or an adjustment like this:

We apply a precise force to the offending spinal bones to restore proper nerve communications. With the nervous system working better, the healing process begins.

While these aren't perfect, they are attempts at using language more familiar to the lay public. Use the big words later if you wish, but only after you have the assurance that the patient will assign the same meaning to the word that you do. It's one more reason that chiropractors who successfully work with children are great communicators. If you have the skills to explain chiropractic in an understandable way to a classroom of third graders, chances are you can get most adults to comprehend the value of chiropractic.

2. Uncover their meanings. Like learning any new communication skill, disciplining yourself to apply it is the key. Remembering to stop and ask the meaning patients are attributing to the language you're using is no different.

As you deliver your report of findings or conduct some other patient communication, when you notice yourself using terms that may be ambiguous to patients, stop and ask,

"I just used the term bone spur. What does that mean to you?"

It's just two, four-letter words. What could be so confusing? If you can have the presence of mind to stop and ask, "What does that mean to you?" not only will it help you prevent miscommunications, it'll probably train you to stop using the terms in the first place!

It is always the responsibility of the sender to make sure the receiver decoded the sender's message accurately. If you've been relying on the patient's head nodding, eye contact or polite interest, you're using the superficial cues that work in social settings but not in communication between an educated, highly-trained professional and a desperate patient, distracted by painful symptoms.

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

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