Reporting As Storytelling

by William D. Esteb

Turns out patients don’t have any need or desire for more facts. In fact, most of us are quite comfortable discarding any facts that don’t fit our existing beliefs or model of the world and its workings. Yet, most reports of findings degenerate into radiographic seminars or explorations of disc and nerve physiology.

Patients politely nod.

While these left-brain presentations interest you, they rarely hold the same fascination to patients. And since patients are not inclined to offer direction for a more relevant approach to your reports, the well-practiced strategy you’ve been using is likely to be perpetuated. In fact, if you don’t currently give a formal report of findings, you’re more likely to embrace the following suggestions than those who have their scripting down pat. Change is hard for you and for patients. Yet, change is what the patient’s body is wanting by crying out with its particular set of symptoms. And change is what is needed if your practice is to remain relevant during this time of change.

The “Fix Me” Story

We humans are wired for stories. Our eyes glaze when presented with facts and figures. We like stories because they speak to our hearts and help us make meaning of our feelings and circumstances. Presenting patients with a more meaningful way to see themselves and their health may be a higher calling than the pain relief most patients want when seeking care in your office.

Most of the emotional pain we feel is due to the meanings we’ve attached to the actions of others. Getting dumped by your high school sweetheart. The divorce of your parents. Being chosen last for the ball team. Not measuring up to the expectations of a parent. The list is endless. In an attempt to understand or explain our situation, we can be quite inventive; making up all kinds of stories to give meaning and explanation to our circumstances.

Patients do the same thing. But the circumstances are more likely the nagging back pain, chronic headaches or any one of a myriad of health problems that they hope you can fix. (Hoping you can fix them is part of their story.) The question becomes, will you confirm their story (that you’ll “fix” them) or will you help them acquire a new, more accurate story (they do the healing)?

Choosing to go along with the patient’s story that you’re a fixer offers several advantages. First, you can avoid the confrontation you can imagine that might result from attempting to modify their story. Second, there can be a considerable payoff in the form of admiration and appreciation when you ultimately become the instrument of their relief. No wonder so few chiropractors are interested (or effective) at offering a new, more accurate story for patients.

Giving the Classic Formula a Twist

It’s well known that effective reports anticipate and answer four specific questions that most patients knowingly or unknowingly want answered when consulting you:

1. What’s wrong?
2. Can chiropractic help?
3. How long will it take?
4. How much will it cost?

Most chiropractors consistently address the first two. Most pull a few punches with the third. And the vast majority of chiropractors completely shy away from addressing the fourth. Worse, most chiropractors invest the majority of a patient’s limited attention span addressing the “What’s wrong?” question—the one that’s least interesting to patients!

Effective patient storytelling starts by telling your story. We buy the messenger before we buy the message. In other words, do I trust you? Should I believe you? Do you relate to me? Some of this is communicated by your office environment and how you show up at the consultation and examination. But most chiropractors fail to share their own chiropractic story, and in the process squander a powerful opportunity to build rapport, develop an emotional connection and set the stage for wielding greater influence.

What’s your story? Every chiropractor has one. Were you a skeptic? Do you have a miraculous chiropractic experience that prompted you to change careers? Did you have an injury that finally responded to chiropractic care? Were you originally going to be an MD? What was it that inspired you to snub the cultural notion of traditional health care and become a chiropractor? What were the fears and doubts you had along the way? Did anyone try to talk you out of it? What made you persevere? Did you ever question your choice? When did you receive the affirmation that you had chosen the right career path? That’s your story. And virtually every patient is craving to hear it. Start there.

Just the Facts

When you think patients make decisions about their health with an objective rationality, addressing the first question can sound detached and academic.

“The intervertebral disc is a fibrous tissue with a soft, pulpy center. And while a disc can’t slip, it can bulge, herniate or even rupture. By the looks of this lateral view of your lumbar spine, it appears that you’re experiencing some bulging of the disc that separates the L4-L5 vertebrae of your lower back. That in turn is putting pressure on the spinal cord and adjacent nerve roots that not only service your reproductive organs, but is also responsible for the sciatic pain that you mentioned down the back of your legs.”

Nice. Especially if you were giving a report to a fellow chiropractor. How can you bring storytelling into play and cover the four points of a comprehensive report of findings? This is where your creativity and use of metaphors and clinical experience all come together.

“You have a case that’s quite similar to a patient we saw about six months ago. She too had a bulging disc in her lower back that was starting to put pressure on the nearby nerves. Not only was she experiencing painful periods as you mentioned, but she was getting leg pain as well. It was starting to interfere with the ballroom dancing that her and her husband enjoyed so much.”

“Wow, I’m in the right place,” your patient thinks to herself.

“When I look at these pictures we took, I can tell you’ve had this problem for some time. I know that because I can see the beginnings of bone spurs, which can take months to years to form. Your body senses something is broken and starts depositing calcium as if it was mending a broken bone. Have you, or someone you know, ever had a broken bone?”

In just seconds you’ve begun the process of replacing the “I didn’t do anything!” or the “This started last week when I bent over to tie my shoes” story that patients often bring to your office.

Hope: Essential for Healing

The second and third questions, Can chiropractic help? and How long will it take? are perfect for telling stories and setting appropriate expectations.

“I think you’re an excellent candidate for chiropractic care. We’ve helped many people with problems such as yours. By using a series of chiropractic adjustments we can help your body assume a more correct relationship with gravity. As that happens we’ve seen disc cases like yours clear up nicely. We had a patient in here about a year ago that saw results in about a month. But we’re seeing several cases right now that look like they may take three or four months. I’ve already warned them that since it’s taking so long to resolve, they’ll probably need some type of ongoing supportive care once their symptoms clear up, probably for the rest of their lives, to avoid a relapse.”

By referring generically to other patients you’re able to communicate appropriate patient expectations, your familiarity and apparent confidence with similar cases and in the process instill hope—one of the most essential ingredients of healing. Telling stories about the experiences of other patients is the easiest way to bring this form of reassurance into your patient conversations.

What stories can you use to address the most important question, How much will it cost? Remember, there is more to “cost” than the financial considerations. There are at least three components you might want to address:

• Financial burden—the monetary cost in the form of deductibles, co-pays or the fee-for-service you charge.
• Time and imposition—the cost of having to make room in their schedule to repeatedly show up at your office.
• Beliefs and habits—the cost of confronting and discarding old beliefs and embracing new behaviors.

“Your health checking account is overdrawn,” you begin. “When I was in college I was still a bit naïve about managing my money. I had never been taught how to balance my checkbook, so my strategy was to keep a general running total in my head. That worked pretty well until one day I got five letters from my bank. What’s this? I asked myself. Turns out I had miscalculated and owed the bank over one hundred dollars in overdraft charges. Ouch! That was an embarrassing, painful lesson. That’s when I learned how to balance by checkbook.

“This low back pain and pain down your legs? It’s an “overdraft” charge your body is sending you. Like my college banking experience you have some catching up to do. First, there are some charges for the “bounced checks” you’ve written by neglecting your body. That’s the Relief Care we offer. The fees associated with that include (blah-blah-blah).

“Once your overdrafts are cleared up you’ll want to set up some overdraft protection. Based on your age, condition and lifestyle, I would expect that one to two visits per month would help keep you out of trouble and lay the groundwork for more lasting results. You can pay-as-you-go and those visits are $00 each. Many of our patients prefer to buy 12 visits in advance for $000 and save $00 in the process. It’s your choice.

“The other form of ‘overdraft protection’ we offer is free. We encourage all of our patients to avail themselves of the opportunities to learn about proper stretching, sleeping, nutrition and other guidance we offer. While these programs are offered without charge, there is the cost of changing old established habits you’ve formed. Just as I had to learn how to balance my checkbook, and it took some effort at first, I benefited by no longer getting those expensive notices from the bank.”

Take an inventory of the stories you know and start using them. Chances are you have countless examples that can more powerfully connect with patients than the recitation of facts, figures and recommendations for care. As you do, notice your influence deepen as you connect heart-to-heart rather than merely head-to-head.