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July 2006, Vol. 16, No. 3
Table of Contents
Autism and Glutathione • CBP® Nonprofit has 24 publications in 12 months • CBP® Research Presented at the International Spine Conference in Norway • CBP® to File Lawsuit Against Quackwatch • CCE Weathers the Storm • Chiropractic Culture • Dr Don Harrison is ICA's Chiropractor of the Year • Dr Jim Gudgel to Co-Instruct With Neuromechanical Innovations • Dr Deed Harrison Speaks at Palmer West • Experimental or Medical Necessity • Fine Tune Patient Communication • From Screening to the Value of Proper Posture • ICA at the Table • ICA's Newly Elected Board Members • Instrument Adjusting's Mechanical Advantage • It's Don's Opinion • Letters to the Editor • My New Whiplash Text is Available • Patient Expectation and Retention • Principles, Ethics and Other Bygone Ideals • Problematic Decision Spectrum • Research Corner • Triano and CCGPP's Will Give You Six Visits
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Patient Expectation and Retention
by Scott Heun, DC
Dr. Heun practiced chiropractic very successfully for over twenty years. As a second generation chiropractor he has a unique perspective on the profession. At various times he has owned and operated single and multi-doctor offices, managed multiple office locations, as well as a physical therapy and rehabilitation center. Dr. Heun successfully implemented an intern program in the last 8 years of practice and was a preceptor for Palmer College of Chiropractic-West. Dr. Heun is a Certified Chiropractic Sports Physician (CCSP), taught the CBP® II elective at Life-West and is a CBP® Certified Fellow and CBP® Instructor. Dr. Heun retired from practice in 2004 and is now a full time practice consultant with Total Practice Management International, LLC.
The person seeking help from a chiropractor has undergone an internal process of evaluation, introspective question and answer, and perhaps a bit of investigation with others before ever contacting an office for help. I contend that by exploring what is in the patient’s mind during this discerning process, we may gain insight into how to do a better job of meeting the patient’s expectations, if not exceeding them.
Pain and fear share a great deal. Fight or flight: an elevated heart rate and or increased respiratory rate, anxiety, desperation, and at times, anger. A patient seeking your help is often driven to you by this combination of physiological responses and emotions. The conventions of society, though less rigid than in generations past, still demand people maintain a dignified countenance, even in the face of personal physical challenges. This battle between our primal human tendencies and expected social bearing often increase a person’s stress level to a very high degree. This is the person and situation that presents to you for help; a frightened, anxious, irritable but constrained individual.
“It’s a great day at Back Pain Chiropractic, my name is Windy (are you sure you want this person’s name to be Windy?), I can help!” The underlying conversation playing itself out in the patient’s head is likely to be something like, “it may be great where you are, but right now my life really stinks!” However, though many think similar thoughts, only a few will actually state something out loud or be demonstrably irritated. That said, doctors must never think people aren’t listening to the words used in their office. The length of a telephone call can be unbearable to someone in pain, and the words used can also be a challenge to their patience. Even if a call goes without a hitch, it may seem to go on forever to the person barely able to stand to make the call in the first place. Being considerate is a must for all involved with patient care. And beyond that, listening to the patient’s voice inflection, speech rate and the way they phrase their sentences and responses is critical to connecting with them. This call must address the patient’s state of mind, and allay any fear or anxiety the patient has in calling the office. The staff must be fully trained for this interaction to be fruitful.
What is the patient’s expectation? “Who is this doctor I found in the phone book?” “Can I really trust this doctor?” “This is scary, I wonder if I am doing the right thing?” “How the heck much will this cost me?” “I wonder if my insurance will cover this?” At the same time, the person may be thinking, “will this doctor hurt me?” “Will he ‘crack my back’?” “What about strokes?” These and a myriad of other thoughts may be in the patient’s mind and all have an impact upon the psyche of the patient. Doctors must anticipate these questions and concerns in order to begin to create the all-important relationship upon which true patient retention is built.
The manner doctors use to approach patients to begin the process of welcoming them into their offices and care is critical. Retention is based upon the relationship the doctor creates with the patient in need of their care. The trust that develops in the patient’s mind is comprised of feelings, intellectual evaluation, and acceptance, as well as the belief that the doctor has the potential solution to their immediate problem.
The mistake many doctors make is to assume that because the patient is vulnerable and in immediate need of assistance, that they can create commitment with the patient merely as a result of the patient’s desperation. The doctor is taking advantage of the patient in this scenario. What then does this all-too-common practice do to the relationship between the doctor and the patient? I contend that the desperate patient who agrees to the cleverly presented demands of the doctor for cost and duration of care feels taken advantage of, and therefore, upon realizing a relief of pain, they take back their personal power and quit care. Abuse of power is a serious mistake in the doctor-patient relationship; it destroys trust. This position of advantage creates a circumstance that ruins the potential of the patient to form a new paradigm of health care involving chiropractic care. (can you get rid of one of the “care”s? health care/chiropractic care)
The doctor, who truly connects with patients, is naturally empathetic, confident, but never cocky, and willing to personally engage the patient. This effective doctor is the one who engenders confidence in the patient, and therefore begins a solid relationship based upon honesty and trust. This doctor creates the opportunity to teach the patient a new perspective on their problem and their health. The doctor’s communication skills are very important, however, how the doctor communicates and the impressions their communications convey are equally important to the doctor-patient relationship.
When a doctor has created a relationship based upon trust, the patient has a greater potential to succeed with care. When the inevitable challenges inherent in patient care present themselves, the patient trusts that the doctor, always putting the patients needs and feelings first, will advise them honestly. When choices are provided to the patient, they invariably choose to work with the doctor for their benefit.
What are the primary qualities that impact trust formation in the doctor-patient relationship? The patient’s first impression is critical. (See “Creating a Great First Impression” AJCC July 2005) Empathy, and a “patient centered approach.” (Wherein you obtain the information you need to fully assess the patient’s problem, while all the while involving the patient in the process.) Asking questions to define the scope and extent of the patient’s pain and the effect this pain or lack of function has on their activities of daily living (ADL). Planning your initial meeting, explaining what the initial visit will entail, your line of questioning, your physical touch, and explaining what you are doing and why during the exam is important to build the patient’s trust in you. (See “The Start of Something Big, The Initial Patient History and Exam” AJCC October 2005)
The doctor who enters the consultation office to present the results of the initial history, exam, radiographic and PosturePrint® studies to the patient, and who has developed a trusting relationship with the patient is given the benefit of the doubt when it comes to a decision to take up care or not. If the patient’s initial expectations have been met or exceeded, more often than not, the patient chooses care. Therefore, the patient’s opportunity for a brighter future with chiropractic care is realized.
Once a solid trust based doctor-patient relationship is established, it must be cultivated during each and every doctor-patient interaction. Relationships require constant attention to develop, and this particular relationship has many variables. The successful doctor is constantly vigilant and responsive to the patient’s needs, wants and expectations. Only then is a successful, productive relationship realized.
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