"I find new patients frustrating. All they want to talk about is their pain. Why don't they get that there's more to health than being pain-free?"
“It’s so annoying that people only think of us as ‘back doctors’ ”
If you're a chiropractor, you've probably had thoughts like this cross your mind at some point. And you've probably spent a good deal of time trying to come up with a way to explain the other benefits to chiropractic to your patients, or why they shouldn't just focus on their pain.
You just need to find the right metaphor, the right script, or the right mentor to teach you how to explain chiropractic so your patients "get it"... right?
Wrong! The truth is that most of your patients are coming to you with back or neck pain, and they want that pain gone. And the fact is, pain is an emotional state - it's not just a sensation like cold or sharp. When we're in pain, fear, worry and anxiety are all increased. Stress physiology ramps up, and our ability to concentrate, think logically and learn is inhibited (ever tried doing accounts with a hangover?).
That's not a good time to try to educate someone about chiropractic!
And even if they are listening, anything you offer that isn't to do with their pain will be secondary in their eyes. It's a bit like having your car break down on the way to the airport, and the recovery mechanic starts telling you he can also change the oil, check the brake pads, replace that tyre that's looking a bit worn...
Maybe that sounds good to you, and maybe you'll want to take him up on that... just not right now. You need your biggest problem - getting to the airport - solved first. Until that's done, you probably aren't interested in much else.
That's where your patients are at. Until you've offered a path to solving their main problem - pain - they probably aren't interested in anything else you can do.
In fact, you've probably been told this by many patients already: "yeah I do get some neck issues from time to time, but I really want this back pain sorted first." Sound familiar?
A Brief Disclaimer...
Now, I am not suggesting you don’t educate your patients. Education specific to their complaint is obviously vital and should be provided ASAP (e.g. reassurance, active care, things to avoid etc.). I’m talking about what I call “education on chiropractic”: teaching patients about chiropractic itself, not about their issue.
Nor am I suggesting you wait until they are pain free before discussing other things you can help with. But make it clear front the start that whatever their main concern is right now, that’s your main concern too. Let them know you both want the same thing.
Sometimes, all it takes is letting them know that, and they’ll be more receptive to additional information. Other times - particularly if the pain is severe - they’ll need to wait until it’s calming down before they can really hear you. Giving a 10 minute min-lecture about chiropractic care (or even worse, a pre-consult educational video) is a waste of both of your time.
So when do you provide this education?
Well, that’s going to be different for each patient. I’ll often ask at the end of the history if there is anything else they’d like us to take a look at. Sometimes even asking “have you had any knee/hip/shoulder trouble in the past?” might open up a dialogue about another issue.
There’s a couple of other simple strategies I like to use to teach patients:
Let’s start with the easy one first - posters, signs and screens. Every second in the clinic is an opportunity to inform patients, or plant a seed for a future conversation. The waiting area is the perfect place to have eye-catching information for patients to take in.
We have a powerpoint we made ourselves running on a loop on TV in reception, with slides about other things we can help with, general health advice, and more information about chiropractic generally. Patients regularly tell me “I didn’t know you did knees!” or “o had no idea smoking affected the spine!” while I bring them through to the treatment room.
The beauty with a powerpoint is that it’s always changing - screens grab our attention better than paper, and it doesn’t just become part of the scenery by their third visit. And although it takes a bit of work to put together, it keeps paying off with zero effort on your part once it's done.
The second strategy is to use specific anecdotes during “table talk” at regular visits. I like telling patients stories about other cases similar to theirs. People remember stories better than facts, and it’s a nice way to teach without them feeling like they’re “being taught”.
For example, for a patient who wants to get back to golf: “One of my other patients is really competitive golfer, but had chronic back pain that regularly stopped him playing too. Once we got him moving and strengthened his spine and hips up, he was able to play without issues. He always comes in for a checkup before his monthly game with his brother now to make sure he’s on top form!”
A story like that introduces the concept of maintenance, and the importance of rehabilitation, without telling someone “I want you to do this”. It also ties into the goal of this patient - getting back to the golf course. If their goal was to be able to get back to work, this story wouldn’t be so effective and I'd have to use another one.
If I’d wanted to let them know we can treat lower limb and balance issues, I could have mentioned another patient who managed to get back to golf when his back was better...
“... but we also realised he wasn’t balancing on his left leg properly. We got him performing some balance exercises, and it added 20 yards to his drive!”
Stories take more effort, and need to be specific to the patient in front of you, but are more effective at engaging patients and generating a conversation. The combination of passive signage and actively telling stories provides a wealth of opportunities for providing an “education on chiropractic”.
“But what about those who leave after 2 visits?”
Inevitably, some patients are going to leave before you got the opportunity to do much of this. This is why so many coaches and marketing gurus recommend you use their scripts/techniques for “educating” patients at the very start of care - you don’t want to miss your only chance, right?
Just a warning, my advice here is pretty controversial: let them go! The folks who want a quick fix and are only going to give you 2 visits, aren’t going to change their mind in those 2 visits no matter what you say (well, maybe if they have a full-spine X-Rays, sEMG, and an “F” on their health report… but let’s not go there).
Trying to convince every patient to follow your recommendations by “front-loading” their education at the start of care won’t work, will frustrate you, and actually put some patients off. Which would you prefer:
A patient who left happy after 2 visits and talks about you, refers, and comes back when they have a future issue, or
A patient who left after 2 visits feeling judged/”wrong”/sold to, who might be too embarrassed to come back, and certainly isn’t referring?
Ultimately those are the only 2 possible outcomes for some patients. It’s not your fault, it’s not their fault, it’s just how it is. The silver lining is that patient A has the chance to come back and learn more in the future (“there’s still hope for them!”). Patient B doesn’t - that door has closed.
“So what should I do again?”
When it comes to educating patients about chiropractic, “less is more”. Firstly, make sure they know that their main concern is your main concern. Focus purely on teaching them about their specific issue first, and build trust.
Then, you can combine waiting area signs (or powerpoints) with little stories and messages during their care to gradually drip feed them with other messages about chiropractic. By the time you’ve got to their review, you’ve already sown the seeds for rehabilitation, strengthening, maintenance or other aspects of their care you want to introduce.
And remember, it’s okay that some patients leave early. Just make sure you’ve kept the door open for them to return in the future. It makes for a much less frustrating career!
If you’ve got some great patient anecdotes you use during table talk, share them in the comments below!
As well as being a full time chiropractor and dad, Chris also coaches other DC's in patient-centred communication and practice through "Patient Centred Coaching" (www.facebook.com/patientcentred)