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- April 2001
Practice Building: Quality Experience in the Quality of Care
by Dwight DeGeorge, MS, DC
I sometimes stare awake at night wondering why, when I
asked five successful chiropractors which procedures are necessary to
provide quality care in practice, I get an equal number of completely
different answers. Over time, I have come to realize that the technique
practiced by a chiropractor has a lot to do with the steps they need to
implement in providing quality care. Techniques concerned merely with
the relief of symptoms must have a completely different set of steps to
provide quality care than those interested in actual structural
correction of the spine. Nevertheless, it is common to find two doctors
providing quality care for patients through the eyes of the technique
they choose to practice, and still there remains a tremendous difference
from one doctor to another with regard to the number of visits or number
of patients seen in their office.
How do two doctors provide the same quality of clinical care for
their patients while one of those two doctors manages to maintain a much
larger practice using the same effort; often with less stress? What do I
mean? Well, one of these doctors might not find him/herself running
after patients to get them to make their appointments. The doctor might
find the patients show up excited for care and become distressed when
their life forces them to miss a visit. These patients refer! The
chiropractic practice grows in spite of advertising and marketing
efforts whereas the other doctor has to conduct constant external
marketing to bring in new patients all the time. One doctor exists in
peace and seems content with life, whereas the other exists in constant
turmoil and frustration. They utilize the same technical and clinical
skills while caring for their patients. Why are their practices so
different?
It would seem that the distinguishing factor is not so much the
quality of care provided, but the experience of chiropractic care
perceived by the patients. Instead of being concerned with the actual
physical adjustment and the techniques used, the experience is more
dependent on the consistency of effective communication to encompass the
caring, clinical know-how, and patient-specific information necessary
for patient satisfaction and confidence that the doctor is addressing
their specific needs. It would seem that the bond of trust and
understanding between doctor and patient is essential for the
achievement and maintenance of a timeless practice.
Considering there are hundreds of factors to be aware of in this
chemistry of doctor/patient interaction, three items seem to stand out
as being of paramount importance in facilitating a powerful
doctor/patient relationship.
FIRST: The communication agenda of the doctor must be able to
constantly adapt to meet the specific concerns of the patient on each
and every office visit. I have spoken to many doctors who choose to have
daily agendas for their entire staff to relate to the patients. Some
call it the topic of the day and others name it something else. In
theory, this is an excellent way to cause effective patient education.
Nevertheless, in my opinion, this semi-scripted agenda for the patient
is bound for failure when it comes to practical application.
Communication-relevance is important. When Sally comes into the
office for her adjustment and complains about her low back pain, she
expects her specific complaint to be addressed on the same day. What
Sally doesnÕt yet know is that the topic of the day in the chiropractic
office is headaches. When the doctor mentions how the adjustment should
address her low back and then proceeds on to tell a story about
headaches and subluxation, the patient becomes suffocated. The doctor
proceeds to get into great information about headaches and goes through
elaborate and meticulously thought out discussions regarding headache.
Unfortunately, the patient is waiting, and immediately only open to
listen and discuss her low back and how subluxation relates to her poor
health and discomfort. Instead of addressing her direct concerns, the
doctor and the staff choose to speak mostly on headaches. Sally is
discouraged and gets so caught up thinking about her low back that she
does not even listen to what the doctor and staff are saying. Meanwhile,
the doctor and his/her staff have just missed a great opportunity to
educate Sally about subluxation, chiropractic, health and address her
low back concerns at the same time. Because the doctorÕs agenda for the
patient was different from the patientÕs agenda for him/herself,
everybody loses.
Each patient in our care wants, needs, and expects to be
addressed on an individual basis every time he/she comes in for a visit.
Once this is achieved, the patient will be open to being educated about
the need for chiropractic care and how it impacts his/her life. This
works as long as it is communicated in a way relevant to the patient
that day. When communication happens this way, the patient becomes able
to remain interested in the material being discussed and tends to retain
it as well.
Listening is key. If the doctor is to have any hope of addressing
the patientÕs immediate concerns, the doctor needs to develop finely
tuned listening skills and needs the ability to pick up on non-verbal
cues from the patient. In the short time most of us have with the
patient on or around the adjusting table, we need to be extremely
efficient at identifying the patientÕs relevant concerns for the
current day very quickly.
SECOND: Observe the patient! This is a tremendous tool, and tends
to be underutilized by most doctors. Our office is mostly in a large
open room and affords us great opportunities to observe patients. Early
in practice, I was told to wait until the patient was lying on the table
before beginning to work with him/her. I was told this would eliminate
wasted time waiting for the patient to prepare for the adjustment. It
was true. The adjustments were faster and I was able to minimize the
time it took to get into the adjustment. Unfortunately, there was a lot
of information I was missing with these people. Greeting the patient
when he/she was already face-down on the table prevented several key
things. I was not able to make eye contact or observe the patientÕs
facial expression or body language. I could not make efficient use of
personal space and I was unable to recall the ease with which his/her
body moved through simple tasks like taking a jacket off or the level of
exertion he/she used to stand or walk. I found that when I began
addressing the patient face to face instead of face to face-down, the
responsiveness of patient increased dramatically.
“John, last week when you took off your jacket you were wincing
with pain. Today, you smiled through the process and walked over here
without a flinch! IsnÕt it amazing how pain and stress on the body can
complicate even the simple things in life? Now we get to adjust your
spine and keep this body on a more positive track. “
Instead of talking to a patient face-down, I now use observation
to communicate to the patient. I can use direct eye contact, body
language and appropriately acknowledge the patientÕs progress in
his/her care. This observation allows my agenda in practice to be
dictated by what I see in the patient and not by something I thought up
while the patient was still on the table or before the patient ever even
made it into the parking lot. Furthermore, I am able to discuss things
with the patient that are of immediate concern and the patient becomes
interested in what I have to say. The patient listens and while he/she
is listening, I have the valuable opportunity to educate him/her
effectively while participating in his/her positive experience. These
factors all play a vital role in strengthening the doctor/patient
relationship. Most importantly, the patient was made to feel the doctor
was dealing with him/her as an individual from a place of caring,
concern for his/her progress and enthusiasm for his/her specific
success.
THIRD: The doctor must not speak a foreign language to the
patient! Be aware of the patientÕs personality style. Different people
learn and internalize information differently. Some are intent on
working with numbers and statistics,while others listen through emotion
and a level of enthusiasm. One person might demand he/she be given
choices to participate in any decision-making processes and still
another merely needs to experience an unwavering level of confidence
from the doctor. The trouble comes when the doctor addresses the patient
in a way the patient is not accustomed to. Quoting statistics to someone
who keys in better to information related through emotionality will
likely be similar to speaking another language to the patient. The
information is good, but is useless if the patient can not grasp it. We
all know someone who hates to hear about numbers and someone else who
lives for them. If the doctor fails to identify the manner in which the
person internalizes information, then the doctor might find he/she is
communicating through the blank-stares of the patient.
Throughout the decade and a half I have been in practice, I have
been on a quest to constantly learn and grow for the benefit of my
personal self, my practice, and the patients IÕve had the honor of
caring for. I have found these three points to be cornerstones in
developing a successful timeless practice, which is able to withstand
constantly changing outside influences such as the economy, and
insurance. Applying these time-proven factors along with a host of other
relevant ones have afforded me the luxury of a loyal and satisfied
patient base. They have enriched my life and empowered me to have fun
where other doctors feel they have to work.
Back to CBP® OnLine
CONTENTS
1. Another CBP® Research Porject Accepted At Clinical Biomechanics
2. Cleveland Chiropractic College Kansas City Teaches CBP®
3. Holder / Harrison Settlement
5. Chiropractic Ethnic Cleansing Alive and Well in Saskachewan
6. Has CA Board overstepped Its Bounds?
7. Neuromechanical Research To Understand Chiropractic Adjustments
11. Chiropractic Tx of Calcific Tendonitis
12. Our 30th and 31st papers at JMPT accepted
13. Should we call it Medicare or No-Care?
14. Practice Building: Qauility Experience in the Quality of Care.
15. Correction of Lordotic/Kyphotic S-Curves Without Extension Traction
16. Subluxation and the Stock Market