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October 2004 Table of Contents
CBP® Research Update • Conventional Wisdom • Don's Opinion • CBP® and Geriatrics: A Case Report • Enough of Chiropractic is for This Pain or That Pain • Chiropractic Passion • The Purpose Driven Practice • Three New and Important Whiplash Articles • You Hired Me To Do A Job • ACA Lawsuit Dismissed • CBP® Online Cyber Update • Harrisons' and Caillet • ICA Files 'Amicus' Brief • A Response to Dr Fuhr • Life University Achieves Financial Goal • Structural Rehab Tool • CBP®'s Chiropractor of the Year • CBP®'s Annual Awards
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"You Hired Me To Do A Job"
by Mark Radermacher, D.C., 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.
When a person hires someone to do a job, it is reasonable for that person to expect the job will be done. Furthermore, perception often dictates the longer the job takes to accomplish and the more that is paid for a job to be done, the finer the quality in job performance and ultimate outcome. This expectation and perception are also used by patients in health care. The formula is logical, but the variables that exist in health care often prohibit its direct relationship usefulness. Patient variables such as genetics, lifestyle, patient compliance, patient desire, nature and extent of condition and potential for further injuries, all play a role in the outcome of a patients care.
If patients do not understand these variables, they often think that hiring a chiropractor to do a job is analogous to hiring a chiropractor to cure them. In order for patients to glean the maximum benefit from chiropractic care, it is essential for them to understand the responsibilities of the job. They must understand both the chiropractor’s role and the role of the patient. The chiropractor must play the crucial role of teacher and the patient must be willing to become the eager student. The relationship that unfolds will find the patient quite surprised when they learn the truth of the definition of what the chiropractor’s job really is. And, when the chiropractor succeeds in teaching the patient the job roles, the patients’ expectation for the outcome of care becomes tempered with reality.
The task of defining each of the jobs includes a number of points. The greatest challenge for the chiropractor is coming to the realization that this task not only rests entirely on the chiropractor’s shoulders, it is also a task that is endless. Many chiropractors feel this is unfair and quickly grow weary of the responsibility. Additionally, many chiropractors get caught in the familiar trap of taking credit for symptomatic relief in the first few weeks of care. Once the chiropractor fails to teach and takes credit for symptomatic relief, all is lost. This actually positions the chiropractor as supporting the typical patient’s misconception that they hired the chiropractor to cure them. The end result produces stress and frustration for the chiropractor and promotes lack of understanding and low retention for the patient.
Understanding just a few common job role challenges chiropractors face on a day-to-day basis will help immensely. One challenge is the patient’s desire to remain uninvolved with care. This is an easy challenge to understand because people have been raised to believe that when a health problem exists, a person must go to the appropriate doctor and have that doctor cure them. Patients do not believe they have any role to play in regaining their health.
The way in which to rectify this misconception is to teach patients by engaging them in communication. To lecture patients is one method of teaching, but to engage patients is much better. To engage patients is to teach and then ask questions. Asking patients to explain, in their own words, what had just been taught to them, is a deeper method of teaching. Once patients realize that they will be asked questions, they intuitively listen better because they want to respond intelligently. It is human nature to learn through interaction and, what had been the foreign language of health and chiropractic, soon becomes a common language for patients to understand and converse in.
Another common challenge chiropractor’s face is helping patients reinforce their care commitment. This day-to-day occurrence is related to patients keeping their appointments and patients paying for care. Chiropractors will hear patients ask if they are “almost finished” with their care.
To engage patients and teach them, chiropractors might ask patients “what they think will happen if they quit their care?” Or a chiropractor might ask, “What was your original goal in care?” To ask the latter question would require the chiropractor to have offered a replicable objective way in which to monitor care at a specific point in time. Simple questions such as these will often see patients realizing they both chose a specific type of care and made a commitment to complete it. In other words, by engaging patients in this manner allows them to take on their role of responsibility in getting the job done.
A similar dialogue interaction occurs when patients call the office attempting to cancel their appointments. Chiropractors must realize that this is yet another opportunity for them to teach the patient. When chiropractors take patients’ cancellation phone calls, they must realize the ensuing conversation is not one of coercing patients into care but, instead, one of teaching patients to recommit.
To remind patients that their scheduled appointments are in line with the care they had hired the chiropractor to deliver, can be very effective. A chiropractor might say, “Mr. Smith, you hired me to do a job, and part of my job is to teach you about your care. If you no longer want the care you know you need, if you no longer want the care you had originally chosen, then you have to tell me; otherwise, I will never quit in trying to help and teach you...it is my job.” It must clearly be understood that no memorized script will make any meaningful difference or impact. In fact, the previous quote would be too-little, too-late, if patients had not been taught well enough up to the visit they had decided to call and cancel their appointment. When the challenge of missed appointments arises, chiropractors cannot successfully make up for lost time in teaching by attempting to say something clever.
With specific care plans that chiropractors can objectively support, the same job must be done in teaching patients to make up their missed appointments. Unfortunately many chiropractors will tell new patients that a make up missed appointment policy exists in the office, when in reality, no such policy is enforced.
The primary reason many missed appointment policies are not enforced is due to chiropractors, feeling as though they are hounding or chasing patients for extra visits. If science dictates a specific care plan, then that care plan needs to be lived out. It is the job of both chiropractors and patients to do everything necessary to stay with the course of chosen care to determine its level of effectiveness. Making up missed appointments is nothing more than a tool to be used in fulfilling a job.
The last most common challenge chiropractor’s face on a daily basis is collecting money from patients. There are very few people who would request someone to do a job for them yet renege on their responsibility to pay.
There are a high percentage of chiropractors who have a fundamental challenge with collecting money. Some of the challenge has to do with self worth but a fair amount of the money challenge has to do with patient results. If patients get good (or better yet, great) results, then many chiropractors will say they should pay for their care. If, however, patients get poor (or worse yet, no) results, many chiropractors will say the patient does not need to pay for some or all of their care. There seems to be an element of worry, failure and self-pride at stake; yet, a job had been done and it should be paid for. Why?
The variables that affect a patient’s response to care are very real and need to be taught in order that the job of delivering care is understood.
Patients need to realize that they actually hire chiropractors to teach and not only to adjust them. Patients must also realize that they have a job to do in attempting to regain their health. That job begins with becoming an eager student who becomes engaged with the chiropractor in order to learn the essentials of health and chiropractic. This is a winning formula that allows the chiropractor to be hired to provide long- term chiropractic care and see patients happy to pay for that job to be done. Chiropractors must realize they have to learn how to become dynamic communicators in perpetuity in order to engage patients in learning instead of convincing them to get care. Chiropractors must also realize that they fully deserve to get paid for the job they were hired to do, to expect anything less would be to degrade the job that was done. Patients will be surprised by this new relationship of job responsibility but when handled appropriately, this surprise will be a productively pleasant one.
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