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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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The Problematic Decison Spectrum
by Mark Radermacher, DC
President, Total Practice Management Int'l, LLC
Dr. Radermacher has been a chiropractor for the last 25 years and has been coaching some of the largest, most balanced and profitable practices nationally and internationally for the last 17 years. He is the author of: The 5 Minute Report Of Findings©, The 5 Minute Pre Consultation© (including the invaluable Life Impact Points©), The Dynamic Micro Report© (communication with patients during adjustments), The Fade and Fade Response©, The Minimization and Minimization Response©, Cluster Scheduling© and The 24 Hour Per Week Mega Practice©. He is currently the leader in coaching chiropractors in patient communications and practice building.
Many decisions people make can be measured on a spectrum that spans the gamut from a “minimal effort of choice,” all the way to a “serious level of commitment.” Once a decision is made, however, the initial position taken on the spectrum between choice and commitment often changes. In other words, a minimal effort choice can, over time, turn into a serious level of commitment. The reverse can also occur. A person can make a serious level of commitment that over time diminishes to a minimal effort of choice.
Patients and chiropractors alike make decisions that dynamically span the spectrum from choice to commitment ... but for completely different reasons, reasons that are often functionally out-of-step with each other. A chiropractor who doesn’t understand the dynamics of this spectrum is often bewildered and upset with all the patients who seem to waffle in their care.
A sale is often predicated on a “one time spike” in emotion. Chiropractors cannot “sell health.” A patient making a decision for care that is based on a “one time spike” in emotion is not a patient who is committing to long term care. Patients will often make a decision for care, and initially, at least, act as though they commit to that decision. The driving impetus behind starting any type of care is the sheer pain a patient is in. Pain is a great motivator. Many chiropractors place too much belief in the patient’s decision when pain is driving their choice. When a decision is made in a chiropractor-patient relationship, trust is necessary. For a chiropractor to trust in a patient’s decision is, in fact, essential in order to develop a meaningful bond in the chiropractor-patient relationship. The problem is that most chiropractors believe that a new patient’s decision to commit to care is sincere and long-lasting. The decision may be sincere, because new patients sincerely want to get rid of their pain, however, it is often not long lasting because once the pain is diminished, the commitment often disappears.
Chiropractors are too often upset, confused and worried as to why this challenge exists. This is understandable. The way in which chiropractors respond to the challenge varies greatly. It is the chiropractor’s response that matters greatly, to both the patient and the practice. The chiropractor will typically attempt to respond to the challenge one of two ways: 1) With excitement, hype and charisma or 2) With education, sincerity and confidence.
By default, a chiropractor who isn’t cognizant of the second option will muddle through the first option with limited and superficial success. When a chiropractor responds to a patient who has made a minimal effort choice by using excitement, hype and charisma, the end result is less than optimal. For a limited time, a chiropractor may be able to “muster up the energy” to re-motivate a patient to continue with care. When “successful,” this extended motivation is also limited in time. Once the pain is gone, the impetus to continue care is dramatically diminished. Patients quickly want to return to their regular lives, lives that include spending money only for material goods and services that are “needed” or “wanted.” Chiropractors falsely believe that excitement, hype and charisma will somehow functionally replace the impetus of pain in a patient’s decision making. You can only fool some of the people some of the time... and even then, not forever.
The disingenuous re-motivation attempt is often performed by chiropractors amaliciously. Many chiropractors are sincere when it comes to helping patients with health problems. Yet, at the same time, most chiropractors resort to this default approach out of desperation and ignorance. Absent of a better approach, the default approach of using excitement, hype and energy has sadly become all too common.
Chiropractors, like most people, will look for the path of least resistance. With a multitude of office challenges, ranging from staff to paperwork to keeping up with third party pay shenanigans, there seems to be no time for anything else. Yet, this “easier” model of practice is built on a house of cards. Contrastingly, it is the very essence of education, sincerity and confidence that builds a powerful and sustainable model which diminishes most of the multitude of challenges that exist in many of today’s practices. It is, therefore, essential for chiropractors to expose themselves to the understanding and dynamic development of this model.
It has been said that nothing worthwhile is easy to attain; this model of practicing chiropractic is certainly no exception. To learn how to simply and consistently educate a patient, to espouse a decent level of sincerity, and to develop an admirable and solid level of confidence are all tasks of significant undertaking, each yielding amazing opportunity and results.
The challenge posed to a chiropractor is similar to the challenge most patients face, that is — on the decision making spectrum will a chiropractor make a minimal effort choice to change to a better practice model, or will a chiropractor instead make a serious commitment to change to a better practice model? Every successful office needs a leader of consequence. When the chiropractor commits to reasonable change in the office, then the staff and the patients follow that lead. Change supported with consistency produces a new direction in practice. The practice model using education, sincerity and confidence is a practice more likely to experience higher levels of sustainability.
To wait to respond until a patient’s decision moves from a pain motivated serious commitment to the level of minimal effort choice is akin to closing the fence after the cows get out. The chiropractor’s level of commitment to the patient’s ongoing care unfortunately rises at the wrong time. In this manner, the chiropractor is out-of-sync with the patient. This knee-jerk response is often perceived by the patient as ambulance chasing. If, instead, the chiropractor’s serious commitment is driving education, sincerity and confidence, then the patient’s level of commitment to care will often remain intact long after the great motivator of pain is gone.
Chiropractors offer the finest health care on the planet — a health care that has yet to be discovered by the masses inhabiting the planet. The research supporting chiropractic care is definable, defendable and replicable. The greatest challenge chiropractors face is seriously committing to a model of practice to educate, to be sincere and to espouse a high level of confidence throughout a patient’s care. The greatest challenge patients face is to refrain from allowing an initial pain driven decision of serious commitment to care to become diluted to an insufficient decision of minimal choice. Patients see no reason to make any effort to change their models of behavior. In fact, the patients are oblivious to the fact that more than one model even exists. The responsibility falls completely on the chiropractor’s shoulders to not only develop a better model with which to practice but to share that model with a patient one visit at a time. While chiropractors discuss and fret over meaningless third party pay visits, fundamentals in practice should not be cast aside as outdated or old fashioned. To be a chiropractor of consequence and to be a chiropractor of integrity certainly necessitates the use of a practice model that includes patient education, chiropractic sincerity and confidence.
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