Dear Bill,

"I'm guilty of not recommending the optimum care plan for fear that patients will either reject it or try negotiating a less than optimal visit schedule. I dread this part of giving a report of findings. How can I get past this?"


This relatively common issue stems from one or more of these unhelpful beliefs or conditions:

1. You've agreed to treat their symptom. Before your report, probably at your initial consultation, you agreed tacitly or explicitly to accept them as a new patient with the objective of treating their symptom. Besides practicing medicine, you've taken on an obligation over which you have little control. No wonder you feel some dread.

Remember, there are countless variables that can affect whether your intervention will produce the outcome patients are seeking. The fact that chiropractic care so often produces the relief patients want, lulls many chiropractors into thinking their adjustments are treating the symptom. When in fact, it's reducing the nervous system interference. Explain this critical distinction. Then, if, or when, this interference can be reduced, their body will no longer have a need to express their symptom.

2. You're trusting your crystal ball. If you haven't cleaned the crystal ball you got with your license, it may need some polishing. You weren't issued a crystal ball? Oops!

Right up there with agreeing to treat their symptoms is the inclination to offer up a "prescription of care" that by implication predicts the relief of their symptoms. You may be familiar with this common delusion: three visits per week for the first four weeks, followed by two visits a week for the next four weeks, followed by one visit per week…

How do you know if any of this will play out? You don't. How do you know if patients will make changes to their lifestyle that could serve to enhance or inhibit their recovery? You don't. This commonly recommended treatment plan is devoid of critical thinking and difficult to defend. It hopes to circumvent an imagined patient's complaint about the imposition of repeatedly coming to your practice—which becomes a self-fulfilling prophecy.

3. You think their problem is your problem. Before you can professionally distance yourself from the obligation of treating their symptom, you'll want to remind yourself of the meaning you're attaching to it.

Because whatever condition prompted patients to consult your practice it's merely their body communicating with its owner. Pain is a language that lacks nuance, but it often means: "a limit has been reached" or "a change is needed."

Why would you choose to get in the middle of that conversation?

Granted, relieving their symptom is heroic, producing a dopamine hit, but their symptom has nothing to do with you. Be an empathetic and compassionate partner but reject the temptation to assume ownership of a problem they will happily delegate. Don't take the bait.

4. You're seeking their approval. Pulling punches and compromising their care to avoid being disappointed is understandable, but inappropriate. Being liked is overrated, especially if you want to lead and influence others. Be likeable, but read The Courage to Be Disliked. Especially if you're a people pleaser or self-sacrificer.

5. Invested in the patient's choices. It comes down to this. Each of us has the free will agency to value our health and treat our body as we wish. This is hardwired long before you meet the patient and unlikely to change based upon your radiographic seminarette, table talk or impassioned pleas. Make sure you don't want it more than they do.

6. You're comparing yourself with other chiropractors. This is one of the pathologies created by social media. There will always be someone taller, richer, prettier, more successful, etc. than you. Comparisons are a surefire way to beat yourself up and feel less than. Not recommended. The "do-it-the-way-I-do-it" technique, seminar or online video is rarely helpful because your "doing" isn't the problem. It's who you're being—something such programs rarely address and likely fail if they did.

So, how about this?

"Since we don't know how your body will respond to chiropractic care, or what you'll be willing to do between visits to support your care, we'll sit down like this after 12 visits and compare where you were with where you are. You'll likely need more than 12 visits, but by then, you and I can better chart a realistic care plan that makes sense for you and your health goals."

Hope that helps. Thanks for the question!

Ask Bill your question.

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