April 2005, Vol. 15, Iss. 2

Table of Contents

Altered Cervical Lordosis and DJD • Chiropractor Invents Car Seat Headpiece • DACBRs Cause Professional Embarrassment at RAC • Eight Major Aberrant Forms of the Lumbo-Pelvic Spine • European Spine Journal to Publish 6th CBP® Clinical Control Trial • Evidence Based or Not • Glutamate/Aspartame - Pain and Your Brain • Greg Buchanan Donates $30,000 to CBP® Nonprofit • Inappropriate Characterization of CBP® Technique • Missed Appointments and Patient Education • Money, Taxes, Life and Practice • Palmer College Takes Alumni Group to Court • PosturePrint™ Research with ICA • Presenting Defendable Care Options to Patients • Published Papers Near 81 • Resign or be Terminated • Thermography: Renewed Interest • Using Silence to Communicate • Whiplash Injuries: Pathophysiology, Diagnosis, Medical Management and Prognosis

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Using Silence to Communicate

by Dwight DeGeorge, MS, DC

Dr. DeGeorge graduated from Palmer College of Chiropractic in Davenport, Iowa.  He has been in for 13 years. He was past president of the Pettibon Biomechanics Club at Palmer College and he has taught spinal biomechanics/biophysics throughout the country for the last nine years. He is responsible for the first research papers ever published in JMPT by Palmer College students.  He practices CBP® technique and is CBP® certified instructor.  Presently, Dr. DeGeorge is the inventor of the Compression Extension Traction Table as well as the Spine Aligner adjusting table. Three studies have been published (one at SPINE and two at JMPT) from studies done at his office.  Dr. DeGeorge has now implemented program to help other doctors gain more from their own practices.

               How does silence work during conversation? Is it threatening? Does it cause a sense of panic when we run out of things to say? Silence can be uncomfortable but when used wisely in interacting with a patient, it can be a powerful communication tool. We’ve all heard the saying, “Music is made beautiful by pauses between the notes.” Silence is one of the more dramatic tools we can use with patients. It can intensify the expression of excitement, shock, anger, disappointment, and can motivate, persuade and educate just to name a few. All these emotions can be conveyed when sound and voice are omitted with appropriate timing.

              The doctor dilemma in communicating often becomes one of to talk or not to talk. When we talk too much or about things not interesting to the patient, we can be boring or annoying. When we don’t talk, the patient might get sleepy or worse, they might not realize why they are under chiropractic care for their health! The following are several points of timeless knowledge about the powerful use of silence for both chiropractic and interpersonal interaction. There are many ways silence can be implemented in the office to make greater health impact on patients and strengthen patient retention.

              Listening skills are essential for effective doctor-patient interaction and communication. Healing begins with faith in the doctors’ abilities to help the patient. When a new doctor works with a patient, trust is not yet established. More times than not, patients do not like new clinicians. Trust and faith in the doctor are very important. Trust in the doctor begins when the patient forms a sense that the doctor understands them. This requires listening. Hello! Are you listening? The problem is, we can think about 5-10 times faster than we speak. Because of this, listening requires discipline and focus. Some of us must constantly remind ourselves to go out of our way to give patients non-verbal cues (body language) that we are genuinely listening to their concerns. This is important because even if we are listening, the patient might get the feeling we are not. If a doctor has the answer to a patient’s concern or question even before the patient is finished expressing themselves, the doctor was likely not truly listening to everything he/she was being told by the patient. Effective listening requires harnessing one’s attention and concentrating on the patient. Doctors who fail to use silence in listening, fail to effectively communicate. “Nature has given to man one tongue, but two ears that we may listen from others twice as much as we speak” — Epictetus

              Silence can be used powerfully in a micro report. Since we only have a few minutes on each visit to educate our patients, micro-reports are an extremely effective way to communicate the chiropractic message to the patient. Using silence within or on occasion as a complete micro-report, can be powerful to make a strong point quickly. For example, in the case of a patient who has been treated over several consecutive months and has become accustomed to being verbally educated on each visit, a silent adjustment stands out like a neon sign. The patient might spend time trying to solve the puzzle of silence. Questions will begin to run through their head... What’s wrong? Is the doctor ok? Are they angry with me? At this time, the patient begins yearning for information and is ready to hear whatever the doctor has to say. Whatever the doctor says will now hold greater impact for the patient. If the silence breaking statement is one about the patient’s progress or need to take better care of something, do exercises, about their great improvement, to stop conducting neglectful lifestyle practices... whatever it may be, the patient is ready to listen and be captivated by it. A second silence enhances the impact of whatever the doctor has stated on breaking the original silence.

              On breaking the first silence, the doctor might look the patient dead in the eye and say, “I’m at a loss for words... Your spine adjusted beautifully! It adjusted better than it ever has since I’ve been working with you! You must be doing something right here.” Taking the same opportunity the opposite way, “We have some work to do. What time can you be here tomorrow?” Silence may be used to maximize impact in many ways to carry a variety of important points to the patient.

              If the doctor conveys a non-verbal and a verbal message simultaneously, the non-verbal one is generally more influential. This is because people trust their interpretation of non-verbal behavior in communication more than words themselves. The doctor must be acutely aware of both types of communication (verbal and non-verbal) at all times. If the doctor provides contradictory body language to the way he/she speaks, the patient will become confused and will not know how to accurately hear the doctor. For example, during an argument with someone close to you, that person smiles and leaves the room. The body language of a smile contradicts the argument and causes confusion. If the same person were to scowl and leave the room during an argument, the body language is consistent with aggression, which is an emotion generally intermingled with verbal argument. The resultant emotion of changing one facial expression in the same action can be completely different! Body language is especially powerful in silence.

              During an adjustment when a generally talkative doctor becomes silent, the patient might look up to gauge the body language of the situation (considering it is a stronger communication device). If the doctor were to smile, the patient would be reassured that everything was ok but would remain in their confusion about the silence and be ready to hear what the doctor had to say. If the doctor were to shake their head when the patient looked up, the patient would feel something was wrong but would still be anxious to hear what the doctor had to say. From this point, there are many powerful communication tools at the doctor’s disposal but explaining them in this short space could not do them justice.