Two Types of Care

by William D. Esteb

"…and our special tonight is our twelve ounce fresh Maine lobster. Our chef plunges this baby into boiling water until the meat is tender, and then garnishes it with organically grown spinach we fly in daily from our secret source in the San Joaquin Valley.”

“I think I’ll have the Pasta Primavera.”

“Are you sure I can’t bring you the lobster? Our chef salts the boiling water with sun dried sea salt imported from Italy.”

“No thanks, the pasta will be fine.”

“Maybe I didn’t tell you. The lobster tonight is just the tail, cut and ready to eat.”

“Just the pasta please.”

“Now the fresh drawn butter that accompanies the lobster comes directly from a Wisconsin dairy where they feed nothing but high-altitude Timothy grass that is trucked in from high in the Colorado Rockies. So, how about it? Are you sure I can’t bring you the lobster?”

“I just want the pasta!”

“The spinach that accompanies the lobster is prepared in the Italian way, garnished with baby scallions and virgin olive oil with just a hint of basil. It makes our lobster special tonight very special. Can I have our chef prepare one for you?”

“No, just the pasta!!!”

“Well, maybe another time.”

Chances are there won’t be another time. Maybe you’ve never encountered such a persistent waiter, but there are chiropractors who are equally as pushy when promoting nonsymptomatic chiropractic care. As you would expect, it produces similar results: patients who get what they want (pain relief) and then dismiss themselves, never to return or refer others.

“I’m not pushy!”

Oh, it’s not as obvious as the waiter who doesn’t pick up the subtle social cues, and then chooses to ignore the diner’s more directly stated menu choice. Instead, the overtures made by many chiropractors are backed up with such good intentions they don’t see that they’re coming quite close to the zealous waiter.

Patch Care or Fix Care?

Probably the easiest, most frequent and obvious example is chiropractors who use the patch care (symptom relief) and fix care (nonsymptomatic care) metaphor with patients. It’s a great metaphor that patients can understand. Only problem is, when presented to patients on the first or second visit, it produces some unintended consequences.

“So, do you want to put a band aid on this, getting temporary relief with Patch Care that only girly men choose, or do you want Fix Care that the really smart and attractive people choose?”

“Well, Fix Care, of course!”

Okay, that was a bit over the top, but you get the point. By revealing what you think is the superior path, hoping to influence their decision, you accomplish several things. In medicine, these are euphemistically called “side effects”:

• Creates an expectation that sets up the patient for letting you down later.
• Gives you the false impression they’re “buying” your chiropractic story.
• Makes patients wary of answering future “trick” questions you ask.
• Promotes a long-term agenda that often appears financially driven.
• Up selling them so early in the relationship suggests you don’t listen.

Of course, wanting to guide the patient down a particular path is based on the purest of intentions. After all, seeing other patients needlessly suffer a relapse, or the ravages of neglect, it’s natural to want to help others avoid a similar fate. It’s just that the timing is wrong and the tactic ineffective.

Annual Care Plans

In exchange for patients getting “the big idea,” and committing to a year’s worth of care and paying for it in advance, patients can enjoy a substantial discount. It’s a great idea. But when promoted like the ambitious waiter trying to move lobster, it can produce the opposite effect.

Annual care plans make perfect sense for patients who get the idea that chiropractic care is a lifestyle decision. Offering financial arrangements that help advance the choice is win-win for both patient and chiropractor. Again, it’s a timing issue.

When offered at the beginning of the relationship, when chiropractic is yet unproven, it too can produce some unintended consequences. Again, in medicine, these are called side effects:

• Confirms the adage, “once you go, you have to go for the rest of your life.”
• Distorted by their pain, all the patient hears is the lower cost-per-visit.
• Leaves a bad taste later when they change their minds and want out.

Annual care plans make more sense when presented at the progress examination when you have greater validity and rapport. Present it sooner to a reactivating patient, on their second or third brush with chiropractic. But lighten up on the chiropractic virgins! If they want the pasta, honor their decision.

Scare Tactics

The most common tactic used to motivate patients is fear. Early death! The Silent Killer! Phase Three of Subluxation Degeneration! The list goes on and on. The thinking is to get the patient to see their problem as serious and life threatening. If they burst into tears during your report, all the better.

However, unlike the eager waiter promoting how wonderful the offering is, this uses a perverse form of reverse psychology with a half-gainer and difficulty of 5. The careful scripting and practiced delivery of this approach is so habitual, many chiropractors can’t even see they’re doing it, which makes the “side” effects even harder to appreciate:

• Attracts those motivated to avoid pain rather than seek wellness.
• Precludes wellness care and pediatric patients from feeling welcome.
• Insures that patients will discontinue care once the “emergency” resolves.
• Reduces chiropractic to limited scope neuromuscular-skeletal issues.
• Appears to egotistically elevate the role of the chiropractor as hero.
• Requires massive amounts of energy and salesmanship.

When the dust settles, patients understand two types of care: symptom care and nonsymptom care. Symptom care is what prompts most chiropractic patients to show up in your office. They have an ache or a pain that they’re hoping a “back doctor” can help them with. Great. It brings total strangers into your sphere of influence, giving you a chance to help enlarge their understanding.

Nonsymptom care, like bathing, brushing and flossing our teeth, washing our hands and taking supplements, is more preventive in nature. It is often the result of beliefs, priorities and personal decisions that are rarely made as a result of someone’s nagging, threatening or intellectualizing about the consequences of the “wrong” choice. Thinking you can sway patients with your words is not only egotistical, but assumes a burden that isn’t yours. Sure, you have a moral obligation to explain the consequences in the most neutral tone possible, but beyond that, you start getting on the patient’s nerves.

“Now, if you don’t care for our seafood special, perhaps I could interest you in the filet mignon. Aged to perfection, it can be cut with a fork and…”