Dear Bill | Fumbling the Socratic Method

Posted by Bill Esteb on Sep 15th 2020

Dear Bill,

I have used Patient Media in my practice for years, its great stuff!

Listening to your tapes and reading your books, you have repeated many times to ask questions to get patients to think.

So, here's my question. Patient Bob comes in and says he's sore here and here. And I respond with the universal question, "Why do you think that is?" expecting to hear an answer suggesting he is taking ownership of his situation. But 99% of the time I get an "I don't know."

I'm stuck for a reply. What should I say?

I don't know.

Just kidding.

A patients' "I don't know" can have many meanings:

1. I'm not sure and I don't want to be wrong.
2. I'm not sure and I don't want to appear stupid.
3. I'm afraid if I answer it'll set me up for something I don't want.
4. I truly don't know.
5. I'm tired and I don't want to play.

I'm sure there are others.

Let's first remind ourselves why you would even try to engage a patient in this type of Socratic interchange. Because simply supplying some type of reassuring "I got this" answer and motioning to the adjusting table is what most patients are hoping for.

Yet if you have any hope of being anything but a self-directed pain clinic, you have an obligation to adjust both below and above the occiput. Granted, you can help a lot of grateful people by providing drug-free pain relief. However, if you have an interest in getting patients to appreciate the nervous system focus, whole body, non-allopathic, preventative and pediatric aspects of chiropractic care, you'll want to engage their cerebral cortex.

Typically (and least effectively) this is done by taking a deep breath and spewing facts, assertions and chiropractic principles.

Patients will dutifully nod. Which is often interpreted as agreement--even understanding.

It's not. 

It's often a patient strategy designed to try to reduce the length of your rants!

A far more productive approach is to engage interested patients in some critical thinking. Granted, that's often too much to ask for today's digital-screened consumer, but persevere and you're likely to find a handful of patients willing to play.

Socratic desktop easel

Here are 52 questions you can ask patients to get you started.

1. Avoid ambushing patients. Instead of springing the question-of-the-day onto patients, alert them in the reception room. Reveal the question you'll be asking. If I were in practice, I'd either use a dry erasable white board for this purpose, or a little desktop plexiglass stand to get patients thinking. That way I wouldn't be so likely to catch them off guard in the adjusting room. You'll have a much more productive adjusting room conversation than the traditional "table talk."

2. Use the Tony Robbins strategy. Tony is a master at asking questions. When he asks questions of individuals who are stuck for an answer and reply with an "I don't know," he will often respond with, "Pretend for a moment that you did know..." Many of us are so stuck on being right, we fail to explore our options. This type of follow up gives the person permission to be wrong.

3. Break up their question into smaller questions. In the example above in which the patient mentions they are "sore here and here," deconstruct their observation by digging deeper. What do you mean by sore? What might be some of the causes of soreness? What would be the body's purpose in exhibiting the symptom soreness? Don't simply blurt out the answer to demonstrate that you know the answer. If you can, bring patients along for the ride.

4. Do you have a theory? Create an emotionally safe environment, in other words, non-judgmental, and encourage patients to reveal their theoretical answer to your question. If the patient attributes their problem to little green men from Mars or the radiation from the new 5G tower in their neighborhood, you'd want to know!

5. Withhold your answer. It's not my go to response, but it's an option. The example I used on Million Dollar Questions is asking a patient what they think causes cancer. Which, by the way, is NOT merely a clever way to divulge your theory of what causes cancer! If patients don't have a theory about what causes cancer, urge them to think about it and discuss on their next visit. Weeks later, from out of the blue, patients may ask, "Hey doc, what's your theory about what causes cancer?" Now that they're ready, answer their question. You're much more likely to have a fascinating conversation.

If you want to utilize the Socratic method, be sure there's privacy. Project a tone of relaxed, nonjudgmental confidence.

Remember, even though when we were in school we were told that "there's no such thing as a stupid question," we came to learn that there could be, especially when the whole class laughed at us!

Patients aren't accustomed to being asked questions from their doctor. This is a new thing for them.

You may even want to ask them why they think you ask so many questions!

Thanks for the question!

Email Bill with your question.

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