Monday Morning Motivation | Letting Patients...

Posted by Bill Esteb on Mar 6th 2021

Monday Morning Motivation Masthead

"So, I just let patients do whatever they want?"

Frequently in my telephone consultations a chiropractor will use the word "let" in this context. As in "to permit to enter, pass or leave."

Thinking you're letting patients discontinue care, miss a visit, choose relief care over corrective care or anything else suggests that you have control over such matters. You don't. Patients are volitional.

Granted, you can tell them to seek care elsewhere.

But imagining you're letting them do anything is absurd. Parental. It reveals two unhelpful emotionally draining aberrations:

1. Mistrust – What might cause you to fear a patient making a "wrong" choice. Because they don't value their health? They'll delay their results and that will somehow reflect poorly on you? What?

2. Control – What might cause you to be so deeply invested in patients following your recommendations? Last time I checked the role of God is already taken.

Does that mean you shouldn't care? Does that mean you shouldn't follow up on missed appointments? Does that mean you let patients run the practice?

Of course not. This is about having boundaries. Precise boundaries.

Interestingly, the busiest practices don't have the inclination to squander their time or attention on such matters that offer such a low return on investment. With clear boundaries, knowing what their job is and what remains the patients' job, there's little need to helicopter over patients. Or slap Diet Cokes out of their hand. Or remind them to stop smoking, lose weight or other shortcomings that remind them of their apparent powerlessness.

Seeing patients as adults to lead, rather than children to manage, is one of the prerequisites for helping more people.

This micromanaging of patients and wanting it more than they do, produces several all-too-common effects:

1. Patients never officially end their care. They simply stop showing up, never saying thank you or goodbye. It's the easiest way to avoid being scolded for giving up on the possibilities of continued care.

2. Inactives think you're angry with them. And maybe you are. If so, it's at the expense of reducing subsequent reactivations and referrals. Or maybe you think you've permanently fixed them?

Being "right" produces a much smaller payoff than many think.

Part of appropriate anger management would be to make sure it's properly directed. Being angry with a patient's behavior, which is merely a signal of their values and beliefs, is classic symptom treating. You're addressing the behavior while ignoring the underlying cause.

It's not your fault. You weren't told that practicing chiropractic and presenting it as a long-term lifestyle adjunct, rather than a short-term diet for pain relief, puts you in the belief changing business. Not the health business, pain relief business, curve restoration business or even the subluxation reduction business.

And the number of college classes devoted to teaching strategies for changing a patient's belief or showing you how to be more persuasive? Exactly none.

So, after marching across the stage, getting your diploma and passing the board exams you found yourself in the belief changing business. Yet, equipped to deliver a medicalized version of chiropractic—usually allopractic or orthopractic.

Of course, you can always practice physical medicine—drug-free symptom relief. Patients will self-direct their care so the burden of "patient education" is practically eliminated. You don't even have to give a formal report of findings. Just let them know you can help and get busy. You can help a lot of people that way. And patients will appreciate that they have little to do other than show up. They can keep their germ-fearing, drug-taking and symptom-treating model of health care intact.

Granted, you'll have a constant need for new patients. But toeing the line, congruent with the prevailing medical model, seems to be what patients want.

I think it was Napoleon Hill who observed that "The path of least resistance makes all rivers, and some men, crooked."

Ultimately, this reveals the value each of us places on our health. We have the free will agency to attend to our health as we see fit. It's among the most personal of decisions. As a result, it can range from unhealthy idolatry to complete neglect— and everything in between.

And while it's tempting to project our values onto others, it's rarely effective, usually counterproductive, unappreciated and largely unsustainable.

Keep the judgment at bay and love them anyway. As in...

People are often unreasonable, irrational, and self-centered. Forgive them anyway.

If you are kind, people may accuse you of selfish, ulterior motives. Be kind anyway.

If you are successful, you will win some unfaithful friends and some genuine enemies. Succeed anyway.

If you are honest and sincere people may deceive you. Be honest and sincere anyway.

What you spend years creating, others could destroy overnight. Create anyway.

If you find serenity and happiness, some may be jealous. Be happy anyway.

The good you do today, will often be forgotten. Do good anyway.

Give the best you have, and it will never be enough. Give your best anyway.

In the final analysis, it is between you and God. It was never between you and them anyway.

Attributed to Kent M. Keith and revised by Mother Teresa and said to have been inscribed on the wall in the home for children in Calcutta, India.


Bill Esteb Headshot Photo

Bill Esteb has been a chiropractic patient and advocate since 1981. 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. He is the author of 12 books that 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. His Monday Morning Motivation is emailed to over 10,000 subscribers each week.