What Are You Really Saying?

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Thanks to Today's Chiropractic for permission to reproduce this article!

By Rachel Sullivan

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Actions may speak louder than words, but for the busy chiropractic office and the average patient, words may not be doing much at all. In an ideal world, a patient would seek out care, ask pertinent questions, provide all relevant information and leave feeling secure they had been heard, understood and, most importantly, treated well.

Unfortunately for far too many patients—and their chiropractic caregivers—the world is far from ideal. To this end, numerous experts agree miscommunication generally arises either during the course of chiropractors’ lay lectures or discussion of case histories.

“The single biggest problem, in my opinion, is that too many chiropractors talk too much,” says Bill Esteb, owner of Patient Media. “Most people think effective communication is about eloquent, suave answers, but behind that is the ability to listen. I’ve met a lot of chiropractors who aren’t good listeners, because they confuse listening with hearing. One is a physiological act; the other is a social skill.”

Mike Headlee, D.C., agrees. “In a nutshell, to do my job and spread the message of chiropractic care, the first thing I tell patients is it’s about them. I let them talk and when it’s my turn to explain what I can do, I will clarify what they said. This is about building a rapport and really making a connection. The object is to put them at ease and get the message across, but the main objective is to help each patient on the particular day I am seeing them.”

In this capacity, Headlee says he begins each session with his patients using an open-ended question like, “What can I do for you today?” Then, and most importantly in his opinion, he shuts up to listen. “I think it’s absolutely critical to know what experience my patients have had with chiropractic before me,” Headlee explains. “I’m not asking for the names of their former doctors, but I do want to know what worked and what didn’t. It’s important to hear what the patient has to say about their situation. It’s amazing to realize how many patients know something is wrong with them, but don’t know what.”

“To get our message across,” says Marc Schneider, D.C. and current Executive Director of Student Services at Life University, “we have to know who we’re talking to. It isn’t a question of intelligence as much as it’s a question of experience. I’d explain something to a car mechanic very differently than I would to a person with a Ph.D. in biology. It’s about using the right analogies and metaphors that the patient deals with on a daily basis. If you know your patients, you know how to communicate with them.”

While reading patients is a skill honed with experience, Schneider says to some degree it’s taught. “We teach our students to begin with open-ended questions,” Schneider adds. “Then we encourage them to narrow down to specifics. With enough experience, a good chiropractor will learn certain injuries most often come from certain actions. That way, when I ask a patient if they’ve experienced trauma—and they say no—I can clarify I don’t mean a [life-threatening] situation, but a fall down the stairs or a football injury.”

For his own part, Esteb says he first learned about chiropractic when he attended a seminar. He was so impressed with the speakers’ ability to convey their message, he became a public speaker. “I’ve traveled the world now, giving lectures on the patient’s point of view. Esteb says. “One of the things I tell chiropractors is they need to have their elevator speech ready—you know, the 60-second speech explaining what chiropractic is, not how it’s done. You also need to explain it in words all people will understand. Most people don’t know what ‘adjustment’ or ‘subluxation’ mean. You can’t use shop talk.”

In order to test his message, Headlee says he often rehearses with his kids. “Use sixth-grade education levels to practice your metaphors and models on people,” Headlee says. “But, in my opinion, the most important question is asking your patients to explain what you’ve just told them. I always ask what people got from my message and then I repeat and clarify the important bits.”

One tactic upon which all three experts agree is the use of more than just words. “Models and touchable exhibits also help the patient understand,” Headlee says. “I use metaphors I can show examples of—like lawn mower tires to show how a bad alignment can affect the tire. You can still use it, but it isn’t [working at maximum efficiency.] I also use a cell phone metaphor to explain the nervous system. You can make a call with only one or two bars of service, but it may be crackly and full of static. You get all the bars working and you can talk to someone across the world just as clearly as if they were next to you.”

Esteb agrees. “If your mission is to change the world, you want to use every opportunity to do so. Blank walls or pretty seascapes don’t benefit patients the way a poster or model will. Videos, posters, charts, touchable models, anatomical models—these will all reach more channels than a plain auditory message.” Schneider further explains there are three primary ways for chiropractors to relate their message. “Tell people so they hear you,” he says. “Give them something to touch—a model, or their spouse, if they’re in the room. Show them how they can move differently after an adjustment. Then, show them a photo or a video. Use all three all the time. I strongly recommend it.”

Of course, when it happens, the failure to communicate effectively can be more than simply frustrating. “If you aren’t hearing each other, you can be giving someone the wrong care,” Schneider says. “If you aren’t listening, you’re delivering care the patient doesn’t need. You can’t use the same approach for every patient and the only way to know is to listen to their words, meanings and body language.”

“I’d bet most malpractice claims come from cases where the patient didn’t feel like she or he was being heard,” Esteb observes. “Give your patients options and don’t force your way of thinking on them. Give a patient time to see things your way.”

Some common problems originating from a failure to communicate include the practitioner’s inability to dispel the myths a patient may already hold. In a chiropractor’s efforts to dispel these misconceptions, the importance of being forthright and honest is another area where all three experts agree. “Be up front about your expectations and learn what the patient’s expectations are,” Schneider warns. “It’s critical to set expectations reasonably and responsibly.”

Another area where Esteb says he often sees professionals failing to communicate is when they’re asked to address patients’ concerns. “You have to follow even the most bizarre comment,” Esteb says. “Turning the conversation back to the ‘safe zone’ won’t address [what effectively is] a very stark warning shot across the bow. If a patient is unhappy, the best or most aggressive adjustment won’t make them feel better—talking to them will.”

Generally, Headlee explains, he follows four steps with every patient. “First, get a history, but use your doctoring skills,” he says. “Pain in the ribs may be caused by something else, but you have to listen to what the patient thinks is wrong. Second, make sure that the patient knows we can help. Do a functional test and then show them how you can address it. Third, give enough clear plans. Do reassessments and if what you’re doing isn’t working, change your approach. Finally, tell people about the cost up front. Don’t freak out over the money, but let the patient know what to expect.”

“If you want to be a good communicator, start by being a good listener,” Esteb adds. “You can’t affect a patient’s behaviors without affecting what they believe—and to know that, you have to know your patient.”

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