Patient Compliance Relies on Communication and Education

By: William D. Esteb

“Not Invented Here”

Personality, tableside manner, a sense of humor and millions of other subtle details affect patient compliance. In the midst of this complex equation is the importance of patient education. Making sure patients appreciate the value of their orthotics is more than a marketing overture. It is an essential part of enlisting patients in the vision you have for their health. Chiropractors who are effective, benefit from better rapport, less stress and better results. Compliance is a communication challenge, not a clinical obstacle.

This distinction is important. Resorting to rational explanations peppered with vectors, angles and millimeters do little to produce patients eager to embrace Chiropractic or welcome a hidden addition to their shoes. Best results are achieved when patients are emotionally invested in their care. Continually refining the communication and patient leadership necessary to produce this patient commitment is one of the hallmarks of busy practices.

Like riding a bicycle, improving patient communications isn’t something you learn by reading a magazine article! You practice. You try it. You fail. You try again. In fact, the old Chinese proverb comes to mind: “Fall down seven, get up eight.” And like so many success skills, persistence pays off. Far too many Chiropractors stop short of success, giving up after a few tries and then retreating to their familiar, yet ineffectual communication strategies.

An intellectual immune system

Introducing Chiropractic to a patient is not unlike a common phenomenon seen in corporate cultures; even Chiropractic circles. If the technology, idea or process comes from outside the organization, it’s suspect.

It’s what happens to patients when you “educate” them about Chiropractic. Like a drug injected into the passive patient, a well-rehearsed script is supposed to work its magic and change a patient’s behaviors. Since your new health and healing paradigm was “not invented here,” that is, by the patient, like the immune system, the patient’s bias for the status quo kicks in, rejecting your new, Chiropractic model. All this, while the patient seemingly nods at the right times and even acts interested in your passionate presentation at the view box!

This creates a serious problem for those accustomed to telling patients what to do and expecting their social authority alone to cause patients to follow obediently.

Don’t tell ‘em. Ask ‘em.

Remember the first time you heard the Chiropractic story? Remember the beauty, majesty and simplicity of the notion that the body is self-healing, self-regulating, with its every function controlled and monitored by the nervous system, and that any interference (subluxation) to this “master system” reduces the person’s health potential? Remember how refreshing that sounded? Remember that “ah-ha?” I hope you’re creating opportunities for that same discovery to be recreated for each of your patients. After all. Look what it did for you!

But how?

Clearly, in light of the “not invented here” phenomena, your approach will need to be different from the outside-in, yakking at patients that currently passes for patient education. Instead, think Socrates: ask better questions.

“How do you explain that it hurts up here, but your examination shows your problem is actually down here?” you pose to your new patient at your report.

“What do you suppose would happen if we adjust your spine up here, but the foundation of your spine isn’t level?” you observe at your view box.

“Ever sit at a wobbly restaurant table?” you ask. “How did you stop the wobble?”

Naturally, you know the answers to these questions and you could save yourself precious seconds by simply sharing your experience and insights. Do, and you deny your patients the opportunity to become fully invested in what you’re proposing. By short-circuiting the introspection required of the patient, you “win the battle” by controlling the report, but you “lose the war” for the patient’s mind. The not-invented-here subroutine kicks in and the patient nods, all the while rejecting your premise.

Ask these and other Socratic questions and the patient responds, “I don’t know.”

This patient response puts countless well-intentioned Chiropractors on the ropes. Shut down by three little words, they return to the more predictable and ineffective approach of minting a torrent of words describing compensatory reactions and primary subluxations versus secondary subluxations.

Our culture is so wrapped up in being “right” and looking good, many patients are naturally reluctant to answer your probing questions for fear of being wrong. In this case, an old Anthony Robbins technique may come in handy:

“Well, if you did know…” (and restate your question.)

This can serve to give the patient “permission” to fail or be incorrect.

Another possibility that might prompt patients to respond with an “I don’t know” is that they have a Driver or Commander personality profile. They resent having to play your question and answer game. In fact, their mentality is one of, “why-should-I-tell-you-after-all-I’m-paying-you-to-tell-me?” Decide if it’s worth pushing harder to get them to participate. Often these efforts are counterproductive. Just take it as a sign of what will likely be a “fix me” mentality to their care.

Motivating patients

Trained by a lifetime of consulting medical practitioners, many patients show up in your office with a passive model of health restoration. With little more effort than showing up for a haircut, many patients assume an emotional distance, thinking that what you do to them is all it’ll take for the recovery they seek.

Encouraging, inspiring and motivating patients has become the modern day equivalent of the search for the Holy Grail. “If I can just find the right words to say at the right time, the patient will get it,” hallucinates the Chiropractor. But motivation, like health, is an inside-out process. Patients motivate themselves in the same way Chiropractors motivate themselves. Where does it come from? It’s already there!

Ever attend a seminar and leave feeling motivated and inspired? All the speaker did was remind you of the truth already in you. He or she simply helped you see what you had overlooked, ignored or set aside as something impossible or unreachable. The speaker simply caused you to turn your modest “pilot light” dream, into a raging front burner possibility. You did it to yourself!

You have the same opportunity with patients. You can help remind them of the importance of their health, that they’re the ones that do the healing, not you and that what they do outside your office is just as, or more important as what you do during their visits. And you can do it without lecturing, without making them feel small and without learning a script. You do it by asking questions and listening.

Help patients attach the same meaning to Chiropractic care as you do by presenting them with the evidence (examination findings) and asking them to draw some conclusions. The result? A motivated patient. An involved patient, And ultimately, an appreciative patient.

About the Author

William Esteb is the creative director of Patient Media, Inc., a resource for patient-centered patient communication materials for the Chiropractic professional.