Dear Bill | Chiropractic Patient Education During Covid-19

Posted by Bill Esteb on Oct 30th 2020

Dear Bill

We're struggling with our patient education. Patients seem rushed and uninterested in our videos, pamphlets and other materials. What do you suggest in today's fast-paced life (and Covid-19 protocols) to properly and simply educate?



Yes, patients seem busier than ever, and few are interested in anything more than getting relief and hurry up already.

This can create an environment in which patient education is seen as an imposition or needless remnant from an earlier time. And maybe it is. It just depends on your goals.

If your interest is in having a pain clinic, serving patients who want pain relief without drugs or surgery, your educational burden is modest. Patients pretty much self-direct their care based on their symptoms. Light your hair on fire if you wish, but these individuals rarely embrace chiropractic as a long-term lifestyle adjunct. If they do, it generally takes several episodes before considering some type of ongoing supportive care. Maybe not even then.

If you have been attracting these types of patients, and your desire is to have a wellness practice, I can imagine your frustration.

In many ways this is about attracting people who value their health. But not shunning or giving up on those who don't.

Just to maintain your own sanity, realize that there is little you can say or do to change the priority a patient places on his or her health. Not a lecture. Not a video. Not a brochure. That may not stop you from trying, but I've spent the last 40 years searching for the holy educational grail. Nothing.

Does that mean you should resign yourself to practicing physical medicine, delivering the most minimal amounts of care possible to produce pain relief? I suspect some chiropractors have. They've found overcoming the allopathic headwind too difficult, rarely successful or both. There's no shame in that. You can help a lot of people with drug-free chiropractic. But it's frustrating if you have a higher calling.

Let's imagine for a moment that you didn't choose chiropractic as a career merely to blaze a trail along the path of least resistance. Instead, you saw it as an opportunity to advance the truth, promote hope, save people from irreversible surgery, change lives and make the world a peachy-keen place.

Then, here are some things to consider in light of today's patients and practice environment.

Attract the Health Conscious

First, you have a practice marketing opportunity.

Most people in your community think of chiropractors as back doctors. You're not on the radar screen unless they have a back condition. That means people who value their health, pay extra for organic produce, take nutritional supplements and actively maintain their physical fitness don't seek care in your practice unless they have a spinal problem. Instead, they're doing yoga, hanging around the Pilates studio, meditating, working out at the gym and doing the things that healthy people do.

If you want these types of people in your practice, it may mean you may need to modify how you promote your practice.

The Purpose of Patient Education

Why even bother trying to educate patients?

Medical practitioners rarely spend the effort to explain how the blood pressure medication works. Or show a video about the physiology of acid reflux. Or ask patients to attend a seminar on antibiotics. So, why is patient education even a "thing" in chiropractic? I know of five:

1. Supply a new meaning for their symptoms. Most patients think their ache or pain is their problem. Yet, aches and pains are rarely the problem.

2. Give context for your intervention. Most patients assume your adjustments are treating their symptoms. Cervical adjustments for headaches. Lumbar adjustments for low back pain.

3. Set appropriate expectations. Most patients expect almost instant relief from your "dosage" of three visits a week. Many expect you to do all the heavy lifting. They expect results from doing little more than merely showing up in your practice three times a week.

4. Establish trust and produce hope. Most patients want you to shoulder the burden of the relief they seek. Instead, make sure they know that ultimately, they're the doctor.

5. Remind you of your mission. Telling the chiropractic story is sure to reenergize you and remind you why you chose the path less traveled.

When taken together these may increase the likelihood of patients embracing chiropractic to support and advance their health and well-being. And if not, at least your enthusiasm can be renewed.

Create a Relevant Curriculum

If you're serious about patient education, you'd want a clearly defined syllabus, outlining the essential topics of your patient education curriculum.

Here's mine. It's short:

Chiropractic care is different from medicine. Make sure every patient understands that the intention and outcome between the two are different. No need to put down medicine. Medicine has its place. Especially if heroic lifesaving measures are needed.

Chiropractic doesn't treat anything. Related to the issue above, every patient needs to know that you won't be treating their symptoms. Explain that as nervous system interference is reduced their body won't need to express the symptoms that brought them to your practice.

Vertebral subluxation is the result of stress. Yes, I'm suggesting that you use the term subluxation. Every discipline has its own language and nomenclature. Chiropractic is no exception. Be sure to explain the three types of stress and how it can affect their spine and nervous system.

A series of consistent visits will be needed. Like a regime of antibiotics, repeated adjustments will be needed to create the momentum necessary to make spinal changes. Since each visit builds on the ones before, missing visits can interfere with the healing process.

You control the speed of your recovery. This is a biggie. The speed of their recovery is outside your control. Instead, it's the result of a combination of factors. Foremost among them: their age, how long they've had their problem and what they're willing to do between visits to support their care.

How long you benefit is up to you. Countless patients still think that "once you see a chiropractor you have to go for the rest of your life." In fact, this myth prevents many patients from even beginning care! Make sure every new patient understands there are five ways to use chiropractic: relief, correction, maintenance, prevention and wellness.

Use Appropriate Media and Methods

If you accept that your primary mission is to "adjust" the portion of their nervous system above the atlas, then you're in the belief-changing business. Without a change in belief, patients will predictably discontinue their care when their symptoms subside. And while you can't change their beliefs, you can foster an environment which might provoke the necessary critical thinking.

Are you using every means within your practice to do so?

Precare interview. Before you accept a new patient make sure they understand the basics. (It's why we created the How Our Practice Works poster and patient handout.)

Report of findings. Make sure you give a report of findings. If you don't take their case seriously enough to give a formal report of findings, rest assured patients won't either.

Lectures and seminars. Yes, even in the era of Covid-19 patients will attend your lecture. I know, because I masked up to join seven others last Wednesday evening when my wife began care with her new chiropractor. You want care? You'll need to attend our new patient seminar.

Orientation videos. Videos still have a place in your patient communication program. "But patients complain." And? This is how we roll around here. Want what we have? Then watch the video. Leadership isn't a popularity contest. (See below.)

Office walls. Many practices that grouse about patient drop out have filled their practice with artistic wall art, or worse, wall graphics that are never used or referenced. Again, if you don't take it seriously, neither will patients.

Brochures. Chiropractic brochures have their place, but in the post-Internet era, they're not for patients. Instead, they're for the people your patients know. Use them to stimulate referrals and not so much for patient education. Here's how to use a brochure for just such a purpose.

Table talk. On each visit you could hope to enlarge their understanding. But rather than ear-raping them with the topic of the day, stimulate a conversation. Ask a question and trust the process. Here are some patient questions to get you going.

External to your practice, make sure your message is similarly congruent:

Website. Most chiropractic practice websites lack authenticity. They may appeal to the chiropractor paying for it, but rarely to the patients they're trying to attract! Your website should resonate with your ideal patient and repel those who would be better served elsewhere. Instead, most websites try to pander to anyone warmer than room temperature with a spine. That usually means going beige.

Emails. Some practices wear out their welcome and create email fatigue by bombarding their patient list too frequently or with irrelevant offers. Most do the reverse, ignoring this channel all together. When done thoughtfully, email can educate, lead and inspire patients.

Social media. Cultivate your tribe. Share your personality. Be generous. Provoke critical thinking. Stand for something. Make a ruckus.

Newsletters. Granted, a snail mailed newsletter is old school. But it's a way to 1) reach an entire household, 2) keep your mailing list of inactives up to date, and 3) position you and your practice as the natural health authority. It's a professional point of contact that can keep patients engaged.

Make Sure the Entire Team is On Board

You either think patient education is important or you don't. That it improves patient outcomes, or it doesn't. That it equips patients to be better stewards of their health, or it doesn't. If so, then you have a moral obligation to deliver it. If you don't, then don't waste your time or that of patients.

Be resolute about this. And make sure everyone on your team is equally committed. If a patient's compliance with your educational protocol is seen as doing you a favor or is introduced with an apologetic tone ("I know this is an imposition but…") then don't bother.

I'm reminded of the comment I've heard in virtually every patient focus group that I've conducted in practices that do patient lectures. Almost without exception patients observe, "I didn't want to go, but afterwards I was glad I did."

You have the greatest authority at the beginning of the relationship. As their care progresses and they experience the relief they sought, your influence diminishes. So, if patient education is important, then deliver most of your curriculum during the first week or so when they are most available. And if watching a first-visit 4-minute orientation video is a deal breaker, then you may want to refer them to another chiropractor. Because their lack of cooperation is merely a warning that they're likely to balk at X-rays, declare their neck off limits to your adjustments and that three times a week is too inconvenient.

Granted, this level of bloody-mindedness may require an Academy Award-winning performance if you're feeling the financial pinch of fewer patient visits these days. However, rest assured that the best patients will find your confidence and certainty reassuring, even inspiring.

Covid-19 and Chiropractic Patient Education

To avoid this becoming a screed about fearmongering by the media, germaphobia, statistical sleight of hand and the governmental power grab we're witnessing from this plandemic, let me leave it at this: germs trump subluxations. In other words, most patients are more concerned about microbes than subluxations.

So, with Covid-19 you couldn't have asked for a better teaching opportunity!

Germ theory. Many of your patients think germs automatically cause disease. At least that's how the media portrays it. However, germs don't cause disease any more than baseball bats cause home runs. Is there a relationship? Sure. But there's more to it than the simplistic cause-effect relationship many believe. The germ theory is just a theory.

Hospitable host. Germs are like seeds. They only germinate when circumstances are just right. Nutrient rich soil. The right amount of light. The correct temperature. Enough moisture. All, in the right combination. For germs to be a threat, our bodies must be cordial hosts, similarly offering the necessary combination of circumstances for a germ to manifest as disease. That's true of the coronavirus and any other microscopic bug.

Nervous system and immune system link. I'll leave it to you to decide whether chiropractic care directly or indirectly influences the immune system. While there may not be sufficient evidence published in peer-reviewed journals of such a nexus, there is certainly ample anecdotal evidence. How many times have patients observed that "since beginning chiropractic care my kids seem healthier than other children" or "I don't seem to get the bugs that are going around."

Many patients don't know that Louis Pasteur, the father of the germ theory, retracted his claim on his deathbed observing, "The microbe is nothing, the terrain is everything." In other words, it's the suitability of the host, not the germ.

In summation, patient education, whether pre-Internet or post-Covid is ultimately about showing up as a leader. Respectful. Compassionate. And courageous.

Thanks for the question!

Email Bill with your question.

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