July 2002

Law and Order

by Dwight DeGeorge, MS, DC

The things people’s bodies can achieve under chiropractic care are both amazing and natural.  Without the drive to carry through with the appropriate treatment, they may never experience what chiropractic could do for their lives.

When beginning care with a new patient, and especially someone who has never before been to a chiropractor, I am tempted to share all the great things all at once.

What experience has reminded me is that information has to be delivered slowly, creatively and in the correct order.  When I get overzealous and go out of order or give too much information too soon, things fall apart.

            When looking at progress and success, we must observe that there is an order to all living things, and when we create achievements as living beings, there is always a process to go through as a part of getting there.  Before we run, we must first learn how to sit and then crawl and walk.  By the same measure, we cannot expect our children to get college out of the way early, so they can go through elementary school later on.

            By the same token, we cannot use anatomical lingo with most patients or try and teach them neuro-physiology before they have a basic understanding of how they might get help in our office.  The series of steps we take in life, how we embrace them and how we relate them to our experiences are just a few critical factors in who we are able to be and what we are ultimately capable of achieving. 

            There are processes and systems in place to allow growth, development, functioning and thriving in the environments where we exist.  Any breakdown or deficiency in the system or process allowing us to thrive will cause us to detour from our original path.

            For example, someone who lost a parent at an early age or who spent most of their lives poor versus someone who was poor for only one year of life will exhibit tremendously different traits.  We are the sum total of the order, character, duration, and timing of our experiences.  Relating this logic in practice and understanding how it reflects and dictates the life, attractiveness, and cohesion of clinical practice is an essential part to achieving and maintaining a timeless office. 

            When a patient enters the office, there is a system that needs to be in place to accept that person comfortably to the office environment.  If the new patient does not have his/her expectations met or if he/she has a poor experience because the interaction in the office is confusing to him/her then he/she will likely not stay to take up care and will not become an asset to the practice. 

            Take for example the delicate balance within a chiropractic report of findings. The order of the experience can be more powerful than the experiences of the patient in the office as a whole.  The patient first expects to have the issues he/she thinks brought him/her to the office in the first place addressed.

            If the doctor has spoken for several minutes, and the patient is still wondering if the doctor can help him/her, he/she will be uncomfortable and will likely not listen well to the information being shared.  The questions floating through the back of the patient’s mind will impede his/her ability to focus on this important interaction, and he/she will be set up for failure in his/her care and for the office.

            To avoid this, the doctor must learn to address the patient’s concerns, test the patient that he/she understands and do this in a pleasant and in a very brief period of time.  The doctor must do this without providing extraneous or extra information as these things will serve simply to confuse the patient.

            The second event in a report of findings is presenting a treatment recommendation for care in the office.  Most people like to have options for care and will become distressed if only one option is presented.  The options presented in the report must be communicated as being for the patient and not for the doctor or to please the doctor.                         If the doctor paints the image of one type of care offered as crazy to the patient, when it is the option the patient is considering, the patient is made to feel uncomfortable and is likely to leave the practice.

            Recommendations for care should consist of the duration of care and expected frequency of visits.  Any more than this at this point stands to confuse the patient and will reduce care compliance. 

            The third thing to do in the report is ask for a decision from the patient as to the type of care he/she wants to have.  Keep in mind that the patient may have a different definition of health from that of the doctor, and he/she has had only minimal experience in the office to this time.  This is all new to the patient, and he/she wants to trust and believe in the things the doctor is saying.  The basics are enough here.

            It takes time for the patient to assimilate the information provided.  Asking someone to make a decision rapidly is like asking someone to make a decision based on faith rather than information. 

            Patients entering the office must have the desire to get chiropractic care and then must be willing to make the decision to choose to actively pursue it.  If the patient is confused, bored, or simply uncomfortable in the office his/her motivation will wane.

            Through using pre-established values to create awareness, responsibility, and personal authenticity, we help our patients create personal change.                   Because we help to coach our patients through this change and through education, patients take on some of our own values.  His/her care then becomes an essential part of a successful life. 

            It is much harder for people to see themselves through the eyes of others no less try and understand the insight strangers have about their health and prosperity.  We must be very careful to introduce new concepts to the patients slowly, clearly, and methodically.  It is our job to facilitate willingness in the patient.  The link of responsibility alone to treatment for the patient rests on propositions that:

            1. Responsibility avoidance is not conducive to health, and

            2. Responsibility acceptance leads to success.

            3. Discomfort in the process created by conflicting information will cause the patient to stop making an effort.

            “Change occurs after the assumption of responsibility through the action taken by a person.  Becoming willing to put effort into making a change comes from the part of us with the capacity to make and implement choices (Arietti).” (Yalom, 1980, p. 287)         If change is demanded too fast or if the ideas of change are confusing or threatening, it will likely not take place. The down side to all of this is that excessive enthusiasm on the part of the doctor or staff may be the very thing that drives a patient away.           When patients begin to believe he/she should be healthy in a very short period of time, it is our job to educate them about the time involved with the healing process.  If they continue to expect change quickly, they will be set up for failure.  When someone depends on a professional for the insight about how to achieve his/her desired change, it becomes that professionals’ responsibility to provide an atmosphere conducive to allowing change to realistically and smoothly happen.

            Given the ingredient of time, people may lose sight of the original desires that drove them to make the decision to seek change.  In the face of feeling physically good, they need constant — and not boring — reminders about why the change should be important to his/her lives.  With each patient interaction, the energy in communication must be consistently and creatively renewed.  The doctor must reinvent themselves to the patient each and every day.  Complacency on the part of doctor or staff predispose complacency and failure on the part of the patient.

            It is tempting to neglect the patients who seem to get the big idea and seek regular chiropractic care.  Neglect in the form of boredom for even the best patients can drive them away.  Staring off into the distance when in front of patients is not the best idea.        

            The office itself must be a comfortable place to offset the discomfort of conducting the work necessary to achieve the clinical goal at hand.  In the case of our office, this goal is to correct the patient’s posture.  The work of causing change is challenging enough without the added stress of walking into an office and not understanding exactly what to expect there.          Not knowing what to expect each day in the same office will create discomfort and reduce the patient’s enthusiasm and motivation.  This means several factors MUST stay consistent:

            1. The energy of the office doctor.

            2. The amount of information delivered for the patient to digest on a regular basis.

            3. Procedure times.

            4. Ease of procedure implementation.

            Finally, the clinical office needs to be predictable.  The energy of the doctor must allow the enjoyment factor of the interaction with patients to remain high each and every day.  Tension must not exist between doctors and staff with patients in the office.

            The narcoleptic factor must also be avoided: no staring into the distance!  Where the patient must remain motivated enough and uncomfortable enough with the consequences of not making change, the doctor must remain comfortable to the patient when he/she is trying to focus on achieving the necessary steps of change.

            This means the daily interactions with patients must remain at similar times with a similar type informational content.  They also must be fun and entertaining.  Any deviation will serve to challenge the patients’ ability to focus on the work they are trying to do.

            Deviations in these regards will challenge the patient’s focus and alter his/her ability to hold his/her desire and willingness to continue taking action toward the desired change.  What it comes down to is that the office fundamentals in terms of order, time and atmosphere, are an essential precursor for people to work hard, make positive change and ultimately end up referring his/her friends and family for care.

            It is great to be excited about what you do.  Sharing information out of order, too quickly or even changing the emotionality of the office excitement level on a regular basis will result in a challenge to both the patients and the practice itself.