November 2004

Patient philosofooey

by William D. Esteb, Patient Media, Inc.

Few patients consider the philosophical implications of ingesting an over‑the‑counter medication to numb a headache. Even fewer see traditional health care as a bankrupt form of symptom‑treating. And, fewer still come to see chiropractic as a lifestyle. This places the most conscientious chiropractor in a difficult position, which at one end of the spectrum was summed up nicely by a DC passing our booth at a recent convention.

"What do you guys do?" he asked as he sauntered by.

"We create tools to help chiropractors educate their patients," I replied.

"I used to educate my patients," he sniffed. "But I don't bother anymore."

As he disappeared down the aisle, I was struck by the fact that his might be an attitude held by many chiropractors.

Having grown up in the patient education wing of chiropractic, I'd never considered the possibility that to some, patient education might be a waste of time and energy! That a more pragmatic approach would be to meet patients where they are, offer symptom relief, and send them on their way. It certainly would make practice easier.

The fact is, few patients call your office asking for help switching from a symptom‑treating perspective to a cause‑based approach to health care. Instead, most see themselves needing the skills of a "back doctor" to help alleviate an ache or a pain.

In this fundamental way, patients see the doctor/patient relationship as an event ‑‑ an episode with a beginning, middle and hopefully, an end. They don't want to change. They don't want to assume responsibility. And it goes without saying that they don't want to come in for the rest of their lives!

So, what'll it be? The easy way or the hard way?

Your answer reveals a lot about you and how you see yourself. Do you see yourself as a change agent or merely a natural form of aspirin? Do you see yourself as a leader or a follower? Do you see yourself as a releaser or a controller? Do you see yourself as a healer or a mechanic? If you're not sure, or you're inclined to hedge your bet by becoming a professional chameleon, you may have noticed your practice is eroding. It's from not knowing yourself.

If you don't define yourself, others will. If you don't establish an identity, the marketplace will. And if you don't know what you stand for, you can never be the influence you could. Being against medicine or against physical therapy or against drugs or against technique A or against procedure Z isn't a winning position. What are you FOR?

This is where seeking wisdom and discovering of the truth about the nature of things comes into play ‑‑ in others words, your philosophy. If you ignore the philosophical implications of encountering patients in a healing environment, you do yourself and your patients a great disservice by squandering the opportunity to change their minds as you change their spines.

Knowing yourself

In the same way you are unable to love someone else until you can love yourself, you will find it difficult to bring health to a patient beyond what you can bring to yourself. This is why it's so important to be healthier than your patients. Healthier mentally, physically, socially, financially and spiritually.

If you can't show the way to your patients because you're stuck in the same quagmire they are, you aren't very useful. Patients will naturally discard you at their earliest convenience.

True influence comes from being healthier than the patient. Not a pompous "healthier than thou," but an attractive confidence that comes from abundance. Once you come to know yourself, you can begin the arduous task of...

Knowing your patients

Chiropractors seem to lose touch with the patient's point of view about the second trimester in chiropractic college. I'm struck by the pocket reality created on a chiropractic college campus. Eventually, many students come to think patients are merely spine delivery systems!

With a focus on spinal anatomy and physiology, many students find it convenient to ignore the psychology, feelings and perceptions of actual patients. Parents of these first‑year chiropractic students see pronounced changes by the December break.

Generalizations are convenient but often incorrect. However, there are a couple of major issues most chiropractors ignore, are ill‑equipped to handle or both. These "preexisting" patient beliefs virtually preclude significant changes to their behavior:

***  Health care as an event. Rather than seeing recovery as a process and true health as a way of life, most patients see a visit to a health care provider much like an episode of dieting. As soon as they're feeling better, they return to their previous habits.

***  Blood versus nerves. Most patients have bought into the cultural notion that "good" blood is the key to good health. Convincing patients to embrace nerves over blood is an important step. Rather than being perceived as "nerve doctors," most chiropractors have fallen in the trap of being merely bone (spine) doctors!

***  Germs trump subluxations. Chiropractors may be focused on subluxations, but patients are fixated on germs. Until you effectively tackle this one, patients will continue to cancel, observing, "I don't want the doctor to 'catch' what I have."

This is why having a clear awareness of chiropractic philosophy and the ability to relate it to patients in a compelling way is important. Without an understanding of the implications of a chiropractic perspective and making that approach attractive to patients, most patients will have little incentive to examine their own symptom‑treating philosophy.

Helping patients become aware of the underlying beliefs that produce their fascination with blood and germs is overlooked, but crucial.

Knowing your opportunity

Since few patients see their office visits as an opportunity to become acquainted with the philosophical underpinnings of chiropractic so they can abandon their medical model of health, it may be helpful to rethink the purpose of your practice.

Be delighted that symptomatic patients seek your office. It provides the incentive to come into your sphere of influence (your office) and have a relationship. It's only through relationships that you get the chance to influence their thinking, change their attitude and provide a safe place for them to abandon old beliefs.

Imagine perfect patient compliance. Imagine patients doing exactly what you tell them to do. Imagine zero dropouts, no missed appointments and every patient adopting chiropractic as a lifestyle. Heaven? No, hell.

While some yearn for this "King Midas" approach to practice, most would find it boring very quickly.

At some point you finally acknowledge that it isn't technique, protocol, post X‑ray changes, better range of motion, high retention statistics, symptomatic improvement or a great income that make practice fulfilling. Instead, it's getting the occasional glimpse of patients with changed beliefs, changed behaviors and ultimately, changed lives. Not just from your spinal adjustments, but from the cerebral adjustments you administer from visit to visit.

(William Esteb is the president and creative director of Patient Media, Inc., a company providing state‑of‑the‑art, visually‑based patient communication tools from a patient's‑point‑of‑view. To receive a free copy of his 64‑page catalog, and subscribe to "Monday Morning Motivation," a free, weekly e‑mailed practice tip or patient communication idea, visit www.patientmedia.com or call 800‑486‑2337.)