Doctor–Patient Relationship: An Interesting Tango

By: William D. Esteb

Your relationship with patients is an interesting tango. Like any dance, when both partners attempt to lead, expect a few toes to get stepped on! Who leads in your patient relationships? Conventional wisdom and the social position given to doctors suggest that the doctor is to lead. After all, it is the doctor who knows more, is more resourceful, and is the one most commonly expected to offer solutions to the patient’s problem. Some might suggest that it is so obvious that the doctor should lead, direct, or control patient relationships that they might wonder what more could be said about the topic!

Hold onto your self-esteem. Here we go with a couple of painful realities about patients that you may have overlooked:

The Patient

Patients control the relationship. Patients are the ones who decide whether to consult your office, some other Chiropractor, or get numbed by drugs prescribed by their medical doctors. This is so fundamental that it’s rarely given much thought. Fortunately, in the U.S. we still have this freedom. While some doctors attempt to enhance the likelihood of being chosen by “getting on lists” and accepting ten cents on the dollar by becoming a “provider” to some healthcare rationing organization, ultimately, patients make the choice. The only real control you have is whether or not you’re going to accept patients and offer them care.

Patients consider discontinuing care prior to every visit. Regardless of the recommendations you’ve made at your report, and regardless of whether their names are in your appointment book, patients decide whether to show up just prior to every office visit. Think of it. Every patient who actually makes it into your reception area has just made this important decision. They’ve weighed the pros and cons of doing what you recommended. They’ve wrestled with all the other demands on their time and money (and there are lots of them), and you came out on top. At least for now.

Patients are volitional creatures. When patients are lessened by throbbing headaches or tamed by intense back pain, they are relatively easy to control. These docile creatures will submit to painful examinations, diagnostic radiation—even long, unexplained waits in the reception room. Once they feel better they discard you and any heavy-handed, guilt-tripping “management” techniques you use like yesterday’s garbage. Worse, they tell their friends of your disrespectful behaviors.

You think you control patients? Try ordering them to do exercises. Try forcing them to consistently show up on time. Demand that they refer others. Stop smoking. Lose weight. Or a dozen other activities that would enhance their health or help speed the healing process.

The fact is, you can’t control patients. Many of the behaviors that look like patient compliance are merely the result of patient satisfaction with the symptomatic relief they’re experiencing. It’s tempting to associate patient compliance with your office policy, brilliant report, multiple appointment procedures, or other “management” techniques. But most patient follow-through is merely the result of enjoying an adequate return on their investment of time and money.

While you can’t really control patients, you certainly can influence them. Some doctors are masters at this. They realize they can’t control patients, but they can control themselves. Their words. Their actions. Their attitudes. Their intentions. Their office environment. And the depth, quality, and purpose of their patient relationships.

Since patients hire you, fire you, and largely control the relationship, why not find out what kind of influence they want from you? Ask your new patients, “What kind of doctor are you looking for?”

Be ready for a blank stare! They didn’t know there were different types of doctors.

The Doctor/Patient Relationship

The way I see it, there are three basic types of doctor/patient relationships that accommodate the points raised above. Patients may unknowingly be seeking one type, while you’re more comfortable or willing to be a different type of doctor. The resulting dissonance stunts the relationship, interferes with the healing process, sabotages referrals, and generally makes practice more work than it should be.

Please, I’m not suggesting that you become some kind of chameleon! Nor am I suggesting that you sell out your ethics, values, or practice purpose. Quite the contrary. I’m suggesting that you find out how to set the best tone for your patient relationships based on what role patients want you to play in their lives.

The Doctor as Parent

We’ll start here because so many doctors are familiar with it. This is the old, all-knowing, doctor-on-a-pedestal model. My way or the highway. Doctor’s orders. Do what I say and I’ll get you better.

This dictatorial role gives the doctor the illusion of actually being in control. Patients in their late 50s and 60s are the most responsive to this type of relationship. They often feel like victims to their bodies, their condition, or their lack of choices. They rarely want to take responsibility for their health and are delighted by a doctor willing to assume it for them. Many patients respond positively to a doctor who is decisive, confident, and in control. This bolsters a patient’s confidence and increases his/her optimism, actually enhancing the healing process!

So, why not adopt this model for all patient relationships? Some doctors do. Unfortunately, a growing number of patients don’t want this type of doctor anymore—especially those who come to Chiropractic after an unsatisfactory brush with a medical doctor or two who know no other model.

The Doctor as Coach

Some patients would rather see their doctor as a partner or a coach. They don’t want to be dependent on Chiropractic! They just want a little help to get them feeling better. Many Chiropractors prefer this role, particularly doctors who are themselves members of the Baby Boom generation. But remember, you have to have the patients’ permission before you can get away with nagging them about the “fundamentals” or yelling at them in the locker room at halftime!

The coach offers suggestions and encouragement, ostensibly to help the patient’s performance or achieve a personal goal of just feeling better. The relationship tends to be somewhat shallow, focusing on posture, biomechanics, or getting out of pain or back to work. This can reduce the doctor’s role to that of a compassionate technician.

While many patients will be delighted with the attention and mentorship of this style of relationship, it is merely an updated medical model, ignoring that it’s the patient who does the doctoring, not the doctor. Ironically, assume the role of a coach with a patient who expects/wants/needs a traditional doctor to take charge, and the patient perceives you as a wimp. Indecisive. Wishy-washy.

The Doctor as Wizard

I’ll call this third type of doctor the “wizard” role. I’ve met a few of them over the years, and being with them is an incredible pleasure. Before you discount the name, let me describe the Chiropractic wizards that I know.

First, wizards know themselves so well, a patient’s rejection, lack of compliance, or the other usual irritants of practice are no longer a threat. Because wizards don’t seek approval, patients find them interesting, if not a bit odd. Wizards see themselves as facilitators, change agents, or catalysts. Their emotional detachment allows them to rise above the patient’s problem and be more resourceful. Don’t confuse their detachment with aloofness or distance. They’re excellent at building rapport and have the ability to connect with patients in deep and meaningful ways.

Wizards acknowledge that the real doctor is in the patient. They’re passionate. Centered. And above all, naturally curious. They see themselves as a servant tool that unleashes not only the patient’s inborn healing ability, but the patient’s self-awareness. In fact, they see the patient’s health problem as merely the vehicle that brings a total stranger into their sphere of influence for the important work of helping patients discover themselves.

So, when you ask your patients, “What kind of doctor are you looking for?” you may need to give them some hints. “Are you looking for someone who will take responsibility for your health, or are you looking for someone to nag you to do what’s best for you, or are you looking for someone to help you discover how to be and perform at your very best?”

“Gee, I don’t know, I just thought a Chiropractor might be able to help me with my headaches.”

No problem. Being the wizard that you are, you’ll know exactly what to do!