(Chiropractic Economics asked me to write an article of interest to student doctors, but it probably has relevance to just about every chiropractor.)

What often distinguishes busy, thriving chiropractors from those who are merely surviving is that they tend to ask themselves better questions. When they do, they get better answers.

Spending time in self-reflection is generally reserved for navel gazers, elbow-patched professors and out-of-touch philosophers. Yet this introspection is an essential part of understanding our role in the lives of others and how we make meaning of the world around us.

Lest you become reduced to a meat computer or adopt some soulless, linear flowchart for your patient care, having solid answers to the following five questions brings clarity, focus and something even more precious: a sense of peace.

1. Who are you?

It starts here. Who do you think you are? How are you choosing to show up in your practice? What persona will you be adopting to govern your patient relationships?

There are three ways that many chiropractors choose to show up. These personas are convenient ways to create an identity and guide the interactions you have with patients.

The “Fixer:” From this vantage point, you see patients showing up with problems, and, like a plumber or electrician, your job is to put them back in working order. Be careful. Patients can do (or not do) things that can either help or hinder your hired hand intentions.

The “Boss:” Patients, the poor dears, need to be managed lest they do something that might thwart your carefully crafted intervention. From within this ground of being, patients can’t be trusted. Helicoptering over patients to make sure they do the right things is essential, lest they spoil your artfully delivered adjustments.

The “Doctor:” While in reality limited to arousing the inborn ability of patients to self-heal, chiropractors who embrace a medical doctor persona often do so to hijack any social authority given to medical doctors these days.

There’s a fourth path. You could show up as … you, choosing to be the facilitator, guide, coach or inspirer and a source of encouragement and hope. Thankfully, no acting is required. Even better, it’s far more congruent with the clinical reality that patients do the healing, not you.

2. What is your intent?

Just what are you attempting to accomplish when a new patient manifests in your practice? What outcome are you hoping to achieve by your ministrations? By the way, what part of your imagined outcome do you have any control over?

Often the intent of your intervention is based upon the persona you’ve adopted. Fixers want to see pain relief or at least improved biomechanics. Bosses want to see patients toe the line and show up for every visit. Doctors want patients to follow the “prescription” and perform the home-care procedures as outlined.

Being mindful of what your obligation or promise is (and making sure patients know what theirs is) permits the fledgling relationship to blossom. If there’s a lack of clarity here, expect storm clouds on the horizon.

If your intent is to treat the symptoms that prompted a patient to consult your practice, you have inadvertently swerved into the practice of medicine. Granted, that’s what patients want, but you’re not licensed or insured to practice medicine.

3. What is your purpose?

It shocks many chiropractors to discover that their purpose is NOT to adjust patients. And while I hope you deliver adjustments with that “something extra” that B.J. Palmer talked about, adjusting patients is not your purpose.

Adjusting patients helps you advance, pursue or manifest your purpose.

Confusing what you do with your purpose blurs an important distinction between effect and cause: the ends and the means.

Organic farmers farm. But that’s not their purpose.
Novelists write. But that’s not their purpose.
Preachers preach. But that’s not their purpose.

Adjusting patients is how you help restore spinal biomechanics and nervous system integrity. For what purpose? To produce an income? To relieve suffering? To create a healthier community? To improve human potential? To prove that chiropractic care works? To inspire hope?

In other words, why are you adjusting patients? Taking the time to fully understand your own motives for being a professional caregiver and for having chosen chiropractic as the means is essential. Otherwise, patients become problems and practice is a burden.

4. Where does your responsibility end and a patient’s begin?

Establishing and honoring clear boundaries is essential if you want to help as many people as possible and enjoy a sustainable career.

Many patients, trained by their experiences with a car mechanic medical doctors, are inclined to expect you to fix them. “Here’s my headache, doctor. Please make it go away.”

Accepting the responsibility for relieving a patient’s symptom, explicitly or implicitly, causes many chiropractors to take on a burden that is not rightfully theirs. Because while you can reduce nervous system interference along their spine, whether that produces a reduction of their symptoms or does so at the speed expected by the patient is out of your control. Patients can do (or not do) countless things that can preclude the relief that they seek.

Why would you want to take on that responsibility?

A helpful exercise that I often conduct in my one-hour phone consultations with chiropractors so afflicted is to ask them to draw a vertical line down a page, dividing it into two columns.

Label the top of the left column “My Job.” Label the right column “Their Job,” meaning the patient’s job. And then list a dozen or so “jobs” that each party has.

For example, under “My Job,” you might list the following: perform a thorough examination, report my findings, adjust patients, charge for the visit, document what I did, etc.

Under ‘Their Job,” you might list the following: follow recommendations, show up for care, pay for their care, maintain a positive attitude, tell others, heal, etc.—basically, things that you are powerless to control.

Having clearly defined boundaries (and not encroaching upon the patient’s territory) is absolutely critical.

5. What’s your plan to introduce yourself to strangers?

It’s not enough to get a license, borrow from your parent’s retirement nest egg, open a practice and think that success will be automatic. I frequently have to remind such naïve chiropractors that the “build-it-and-they-will-come” mantra from the movie Fields of Dreams was just that—a movie. Made up. Invented. And while it was entertaining watching Kevin Costner and James Earl Jones, that’s not how it works in real life.

The truth is, you want a practice, but you’ll find yourself in a small business, facing the same challenges of every small business: getting and keeping customers.

Oh, we call it a “practice” instead of a business. And we call them “patients” instead of customers. But this merely obscures the fact that you need a plan to introduce your services to as many strangers as possible.

Or work for someone who can.

And there’s no shame in that. Just realize that your ability to successfully market your small business will be the key to your success—not your diagnostic skills, your adjusting prowess or your student clinical awards. Those are nice, but they’re merely hygiene factors.

Meditating on these five questions and exploring real-world solutions to them will pay off handsomely for you in the years ahead. Thanks for choosing the hard, difficult, narrow path of chiropractic. It’ll be worth it, I promise.