July 2002

A Baseline of Knowledge

by Mark Radermacher, D.C.

President of Total Practice Management

 Dr. Radermacher has been a chiropractor for 22 years and has been coaching some of the largest practices in the country for the last 14 years.

When a person has a toothache, an appointment is scheduled to see a dentist. When a person has a compound fracture of a femur, a trip to the local emergency room is made. When an eye infection occurs, a person schedules an appointment with an eye doctor.

The average person has a predictable baseline of knowledge that determines which doctor needs to be seen for most symptoms that occur.   When a person has a subluxation that produces symptomatology, there is no baseline of knowledge providing the impetus to call a chiropractor. With the general population suffering the absence of a baseline of knowledge in understanding subluxation and chiropractic care, there is a severe fundamental problem for both the general population and chiropractors.   

Without a chiropractic baseline of knowledge, the general population inadvertently and unknowingly poses a tremendous challenge to chiropractors. One challenge is that of frustration. The typical chiropractor graduates from chiropractic school expecting to be welcomed into a community with open arms; to be known as a doctor, one who can cure the ailments inflicted upon the people of the community. What occurs in reality is the antithesis. The chiropractor can open up an office in just about any community completely oblivious to all who reside there. This can be a very frustrating experience. In many instances, the chiropractor begins formulating unreasonable questions and theories such as: “Aren’t these people subluxated? Are my services too expensive? Maybe these people don’t want chiropractic. Perhaps people are too busy for chiropractic.” These questions and theories are unreasonable, because a chiropractic baseline of knowledge is non-existent.      

            Without addressing this fundamental problem, a chiropractor is left to suffer with levels of frustration that often result in unreasonable tactics. Some chiropractors resort to overcharging the few patients who do seek care in order to financially “make up the difference.” Other chiropractors attempt to convince patients to take up care, while the desperate chiropractors indecently scare patients into care.

            While most frustrated chiropractors experience levels of depression, they continue searching for tactics that are, at best, approaching the problem from “the outside-in” instead of the correct approach, from “the inside-out.”                     Intense frustration will find many chiropractors using and experiencing personal emotion throughout the practice. Chiropractors will often become emotionally upset when a patient quits care, doesn’t want to pay for care, misses appointments, doesn’t respond to care quickly enough, doesn’t refer new patients or asks “stupid” questions about health or chiropractic.                After all the schooling a chiropractor has had, it is easy to succumb to emotion when a patient’s response after a report of findings is “I don’t really believe in chiropractic.” Each time a chiropractor stoops to this level, thereby allowing emotion to bubble to the surface, chiropractic is automatically reduced to a useless anecdotal “feel good service” instead of the health care profession it really is.      

            The solution to the non-existent chiropractic baseline of knowledge problem is multi-faceted. Image is an important first step to take. Chiropractors must create, and then amplify, their powerful and professional image. Whereas a medical doctor may speak to patients or other health care professionals on a first name basis, chiropractors must always refer to themselves as doctors. This may seem excessive to some, but it isn’t. The medical doctor has a solid baseline of knowledge to stand on. Remember, people know where to go to get help for compound fractures, burns, lacerations and concussions. They know what the medical doctor stands for and, in concept, what the medical doctor does. There is an undeniable level of respect people have for the medical profession as a whole. Chiropractic cannot yet bask in this light.     

             Image is, of course, more than just a name. Chiropractors must pay particular attention to their physique, their attire, their grammar and their overall presentation in the office. A patient is less likely to respect a chiropractor who is corpulent, who dresses in a less-than-professional manner or who speaks using grammar that is unfitting to the community. No image points will ever increase the knowledge or technical skill a chiropractor possesses. A poor image, however, will often preclude a patient from getting the care a

knowledgeable and skilled chiropractor has to offer. Image will not instill a chiropractic baseline of knowledge to the people, but image might at least invite them to take a look, to start care and to stay.      

            The chiropractor’s office completes the image presentation package. The office should be clean and updated. Most medical doctors could get by with a shabby-looking office just because they have the luxury of people possessing a powerful medical baseline of knowledge. Without overstating the office presentation with marble, brass and crystal, a chiropractor must constantly be acutely aware of office image. The office image includes staff. Staff must also supercede the typical medical model office staff. This is challenging to do. Many chiropractors become very frustrated looking for highly qualified staff. Accepting any degree less than highly qualified will be seen as mediocre. Mediocrity is the very standard chiropractors need to rise above in presenting an appropriate image to the people.      

            Confidence and attitude are probably the greatest challenge for most chiropractors. Frustration problems coupled with emotion and image problems can destroy confidence and attitude. Confidence is “knowing that you know” and “knowing that you will.” Confidence is telling a patient about health and chiropractic in a way that the patient clearly realizes you are the expert. Without confidence, all potential for success is lost.

            Once again, a comparison to medicine: a patient is so convinced a medical doctor “will do the right thing” that a less than confident medical doctor can still develop a successful practice. This isn’t about fair and unfair, nor is it about some bizarre conspiracy against chiropractic. This is clearly about people not possessing a chiropractic baseline of knowledge.     

            Attitude is the expectation of an outcome to a situation. Attitude is especially challenging to chiropractors because many chiropractors expect people to respond appropriately, even when lacking a chiropractic baseline of knowledge. This assumption is completely incorrect. People can only appropriately respond in accordance to what they know.

            The attitude chiropractors need to take is one that offers people the knowledge they need to respond appropriately. This approach can provide the expectation of an outcome to a situation that the chiropractor desires. In other words, teach the patient and then expect the appropriate response. In this way, a chiropractor can consistently exercise a positive attitude with the necessary reward in return. To fabricate a positive attitude will only frustrate the chiropractor into failure. Failure leads to additional failure, and a vicious cycle ensues. It is very important to know that developing a legitimate positive attitude will require diligent and consistent teaching.      

            Teaching patients is integral to creating a chiropractic baseline of knowledge. A chiropractor needs to use image, confidence and attitude to develop a substructure upon which teaching must occur. Most chiropractors developed their skills to “practice on patients,” not to “teach patients.”

            It is accurate to say that most patients will not stay for care unless they first understand something about health and chiropractic. This can be considered the beginning of a baseline of chiropractic knowledge. If a chiropractor stops teaching, soon after the patient stops care. Every day and every visit a chiropractor must  teach.               Teaching patients is particularly challenging because of the tremendous difference between what the chiropractor knows and what the patient doesn’t know. In most instances, chiropractors are teaching intelligent adults information about health and chiropractic on an extremely elementary level. Patients are often intelligent in certain walks of life and have the medical baseline of knowledge previously mentioned while they know nothing about health and chiropractic. Sometimes, the situation is even worse, some patients “think” they have some knowledge about health and chiropractic. This so-called knowledge is often based on hearsay and actually makes teaching all the more challenging. It is easier to teach a person 2 + 2 = 4 if they hadn’t previously been taught that 2 + 2 = 5. A chiropractor must be exceedingly patient when faced with this dilemma.     

            The Herculean task of teaching can seem to be daunting. After all, a chiropractor must know how to adjust, must promote successfully, must hire, train and monitor staff, must run the business by paying the bills, buying equipment and saving for taxes and...in addition to all of this, must teach. To further compound the situation, some patients learn quickly, some slowly and some seem to periodically forget everything they’ve been taught. Only the chiropractor who understands that teaching is a critical component in the multi-faceted solution of rectifying the chiropractic baseline of knowledge problem could ever succeed.     

            The average person has little to no exposure to subluxation and health knowledge. The chiropractic baseline of knowledge is, consequently, non-existent. Most chiropractors struggle with this fact and become frustrated and upset about it. The typical chiropractor dons the attitude of not having to be responsible to solve the lack of knowledge problem. No one forced a person to become a chiropractor; this was done of free will. No one will force a chiropractor to take all the necessary steps to succeed; this will also need to occur of free will. Perhaps if the chiropractic baseline of knowledge problem had been explained, many people would not have finished chiropractic school. For those who expect to succeed in the profession as chiropractors, there are clearly defined challenges, perhaps the greatest of which is beginning to solve the chiropractic baseline of knowledge problem.