Over the years I've formed a negative view of scripting in a chiropractic practice. However, this last weekend, while conducting an in-office training (no masks), an important distinction surfaced. As we were walking through my optimum recommendations for patient-centered procedures, the issue of scripting came up. In fact, I offered up several of my own.
I've come to believe that scripting isn't wrong. On the contrary. Turns out, what's given me the allergic reaction over the years is scripting that has an underlying manipulative intent.
Usually I define manipulation as "a general, nonspecific joint mobilization." Something quite different from the specificity of an adjustment.
However, the other definition of manipulation, the one relevant here, is "an attempt to get someone else to do your bidding—even if justified as being in that person's best interest."
Apparently, that's the off-putting odor I've picked up over the years as I've been confronted by chiropractic practices that have been trained to communicate with patients using scripts learned from various chiropractic management firms. It wasn't the concept of scripting that was at issue, it was the intent behind the scripting.
The Intent of Traditional Chiropractic Scripting
Granted, if you pay thousands of dollars to a chiropractic practice management firm, not to mention the cost of travel, accommodations and meals, based on the promise of learning the secrets of success, there's a strong gravitational pull to implement what you've been taught. Even if you must hold your breath and set aside your common sense.
It's not surprising that many chiropractic practice management companies use the same techniques on their clients (you), as they recommend that you deploy on your patients!
What is their intent?
The first is to help you see enough of an increase in your numbers to justify their monthly fee. The other, not surprisingly, is to get you to reup your contract.
There are several proven methods to do that:
- Make you feel ignorant or less than
- Exploit your lack of business training
- Use shame or guilt as needed
- Encourage comparison with others
- Focus on numbers rather than fulfillment
- Create fear that you'll fail without them
These can be powerful levers. Especially if you've found yourself struggling in practice, either due to personality, risk aversion, lack of confidence or some other self-limiting belief.
The Unspoken Cost of Success
There's no question you can parrot certain scripts and produce the desired patient response. But there's a price that is paid for embracing an "ends justify the means" philosophy. When you tamper with, or attempt to overpower the free will agency of a patient, you can expect one or more of the following:
- Poor word of mouth
- Few referrals
- Even fewer reactivations
- Feeling dark inside
Granted, if you practice in a larger jurisdiction with a seemingly endless supply of potential new patients, the downside may not catch up with you for many years. But use these manipulative approaches in a smaller community and the deleterious effect is obvious far more quickly.
Reduced to its essence, manipulative scripting disrespects the patient ("You're too stupid to do the right thing!") or is merely the most expedient way to overcome the impediment to the financial success the chiropractor seeks.
This exerts a high price, especially among the more principled chiropractors who would never conduct themselves in such a manner among friends or loved ones. But they learn to compartmentalize their feelings, assuming that the chiropractic coach they're paying knows better. Apparently, this is what you must do to be successful in chiropractic, they reason.
Saving Patients From Themselves
Here's a revolutionary idea. How about showing up as a humble servant and facilitator, rather than someone emotionally invested in the choices a patient makes? What if you honored the patient's choices, even if they weren't the choices you would make? What if you were compelled to help patients get what they want, rather than pressuring them into what they need?
"But no one would show up and my spouse would divorce me, and I'd end up living in a cardboard box under the bridge!"
I doubt it.
Being overly invested in outcomes outside your control reminds me of two relevant analogies. The first is a cluster of ants on a log, floating down a river. Each ant thinks they're steering the log! The other is the habit of those who can't sleep on an airplane. They remain awake, even on a grueling 14-hour flight to Australia, imagining that their wakefulness is helping keep the plane from crashing.
This massive self-effort often manifests as micro-managing patients with the expectation that it will somehow compel patients to make the "right" choices, improve retention and increase the likelihood of the patient embracing wellness care. Helicoptering over patients, slapping diet sodas out of their hands and reminding them to lose weight and stop smoking rarely produce the desired effect. Usually the reverse. Instead, it's proof of your poor boundaries and an ego inappropriately linked to what patients do.
Signs You May Be Manipulating Patients
What would be examples of manipulative scripting?
Sorry to say, none have been memorable enough to record here. However, if you suspect that you may be inadvertently relying on manipulation, look for and identify any patient communication that…
- Exaggerates or emphasizes the negative
- Is used with the motive of swaying the patient
- Includes threatening or foreboding language
- Exploits a sense of helplessness or weakness
- Is hoped to produce an emotional reaction
- Requires constantly monitoring their commitment
Health issues that prompt patients to seek chiropractic care rarely rise to the life and death stakes of cancer, diabetes or heart disease. It may be tempting to frame their spinal condition as such, but it's rarely believable. At least not after the symptoms subside that prompted them to seek your help in the first place.
Remember, you get the new patients you deserve. If you use manipulative techniques to get patients to follow through, rest assured those are the type of patients that will manifest for you. Those with a wellness bent will likely find your style off-putting.
What kind of practice do you want?
Bill Esteb has been a chiropractic patient and advocate for over 40-years. He is the creative director of Patient Media and the co-founder of Perfect Patients. He’s been a regular speaker at chiropractic gatherings since 1985. His 12 books explore the doctor/patient relationship from a patient’s point of view. His chiropractic blog, in-office consultations, patient focus groups and consulting calls have helped hundreds of chiropractors around the world. Since 1999 Monday Morning Motivation has been emailed to over 10,000 subscribers each week.