Why Patient Education Doesn't Work
Posted by Bill Esteb on Mar 19th 2016
My introduction to chiropractic back in 1981 was through the lens of patient education. Does it seem odd for me now to claim that patient education doesn’t work?
If so, then read on, because I’m going to demonstrate that what most chiropractors call patient education is not, in fact, education—and a simple solution could dramatically enrich your practice. But first, why even bother educating patients? Is it worth the trouble?
The Effect of Mass Hypnosis
Granted, you don’t have to educate patients. Many chiropractors don’t. Practices that lack a formal patient education process often share many of the following characteristics:
- Patients discontinue care after getting relief
- The practice relies heavily on third party reimbursements
- Patient retention is in the single visit range
- The practice has a constant need for more new patients
- The practice spends large amounts of money on marketing
- Children and families are rarely seen in the practice
- You find it challenging to take extended vacations
Make no mistake—you can help a lot of people by offering them self-directed pain relief without drugs or surgery. And if providing little more than palliative care for neck and back pain is your vision of chiropractic, then patient education is probably a needless distraction.
Ironically, while pain relief may be what prompts most patients to initially seek chiropractic care, it’s not the way most chiropractors use chiropractic. Many in the profession rely on regular chiropractic care as a long-term lifestyle adjunct, regardless of the presence of obvious aches or pains.
Those of us who make this investment have different beliefs than most of the people in our allopathic culture of shortcuts, instant gratification and general mistrust of the wisdom of the body.
It’s not what we know. It’s what we believe.
Wrongheaded Ideas Cost You
Chiropractic care is different from medical treatment. This difference has allowed the profession to co-exist beside medicine as a separate and distinct profession with its own language, intentions, procedures and outcomes.
That’s why effective patient education is critical. Because without it, patients bring their medical mindset (and expectations) to your adjusting table.
You’re the doctor – You have the title, but you’re totally dependent upon arousing the doctor within the patient by locating and reducing nerve interference.
The patient is a victim – The patient’s mistrust of the body and its self-healing capacity is unhelpful if you’re going to create a partnership that will endure the expectation of fast, fast relief.
You’re the hero – Many television dramas rely on this superhuman myth, but the real hero is the capacity of the patient’s body to self-heal, not your diagnosis, golden hands, “clicker thing” or hi-lo adjusting table.
You’re treating pain – Because pain is what prompts many patients to begin care, they think your adjustments are treating their pain. Returning normalcy to their spinal biomechanics and nervous system is no match for opiates or even NSAIDs.
You control their recovery – Most patients assume your “prescription” of three “dosages” of adjustments each week will automatically produce relief in a reasonable time frame. Few patients understand that the pace of their recovery reveals more about them, than it does about you.
Spinal problems are permanently fixed – Other health issues, like the flu or an infection, have a beginning, middle and end and ultimately resolve. To patients, the notion of ongoing support of their spine seems questionable, fueling the “if-it’s-not-broken-why-fix-it?” belief.
Without effective education, patients are left to create their own meaning from their encounters with you. This reduces reactivations (“I already tried chiropractic”) decreases referrals (“If you have back pain like I did, she might be able to help you”) and virtually eliminates cash-paying once-a-monthers (“Why fix it if it’s not broken?”).
Talk Is Cheap. And Ineffective.
Effective patient education helps set appropriate expectations, encourage better patient follow through, inspire healthier choices, increase patient respect, stimulate better referrals and, ultimately, produce greater patient satisfaction.
So why are most patient education efforts ineffective, and why do they fail to deliver these benefits?
Because most so-called chiropractic patient education is…
- A series of claims, declarations or assertions
- Easily ignored or considered irrelevant
- Rarely about how chiropractic differs from medicine
- Passive, unilateral and not interactive
- Often perceived as a sales overture
- Confronting to patients and makes them wrong
- Too much work and largely thankless
No wonder so few chiropractors take their role as a belief changer seriously. No wonder so many chiropractors limit their patient “education” to the report of findings. No wonder chiropractors, even after decades in practice, continue to have a voracious appetite for new patients.
That’s because what is called patient education is merely patient teaching.
Simply put, if you’re talking, you’re teaching. Teaching falls on deaf ears. Patients can easily feign interest. Whatever you say goes in one ear and out the other. Teaching has little hope of changing a patient’s beliefs about their spine, their nervous system, their body or their health.
In fact, this kind of teaching does far more to reinforce your beliefs than to change theirs!
Ask and You Shall Receive
You were probably “taught” organic chemistry or a new adjusting protocol. Using the teaching techniques you encountered in the classroom to inspire patients in your practice simply doesn’t work. And won’t.
Long ago, Socrates discovered that real power is found in asking questions. Chances are, you don’t ask patients enough questions. Oh, you do during your examination, but that’s merely to uncover or confirm your clinical impressions. Later, the questions you ask patients should be designed to better understand their beliefs and worldview.
In the same way that software controls hardware, beliefs produce behaviors. Asking questions is a way you show interest in the patient’s “operating system.”
What is the purpose of pain?
How does the medication find the headache?
What do you think is the greatest stress on your body?
What’s your theory about what causes cancer?
What’s the difference between a good drug and a bad drug?
Why isn’t everyone allergic to the same thing?
How do you “catch” a cold?
The purpose here isn’t to make patients wrong, but to cultivate a dialogue. You can’t change a patient’s beliefs—only they can do that. The key is to create the environment, the trust and the emotional safety that allows interested patients to become aware of their beliefs and then elect to abandon them after some (rare) critical thinking.
True patient education means showing up authentically curious and asking questions in an effort to understand how patients see their bodies, their health and the value they place on it. Don’t be surprised if patients show little interest in your model of health and healing if you’re unwilling to first show interest in theirs.