The Patient Nodded – But Did Your Message Stick?

A patient sits through a careful report of findings. You explain what you think is happening, what you can and cannot do, and what the next several weeks may look like. The patient nods. They say they understand. Then they leave with a completely different interpretation of the conversation.

Every practicing chiropractor has experienced some version of this. Healthcare information is easy to hear and much harder to absorb, especially when someone is in pain, worried about a diagnosis or trying to process several unfamiliar ideas at once.

That distinction matters because chiropractic has long placed a premium on patient education. But modern evidence suggests the real objective should be larger than simply delivering information. The goal is understanding, trust and meaningful participation in care.

A 2024 review of 43 studies on patient experience and satisfaction with chiropractic care found consistently high satisfaction, with positive experiences shaped not only by clinical outcomes but also by communication, being listened to, trust, caring and the patient-practitioner relationship.¹ What happens between doctor and patient is not merely the packaging around care. It is part of the experience of care itself.

The First Conversation: “What’s Going on With Me?”

Patients generally want an explanation. But more explanation is not always better explanation. A long discussion of anatomy, biomechanics, and pathology can be clinically accurate and still fail to answer the question the patient is actually asking.

That is where chiropractors can improve the translation between professional knowledge and patient understanding. Start with the patient's concern, then connect the explanation to the problem that brought the patient into the office. Technical detail can be added when it genuinely helps the patient make sense of the situation.

This is especially important when uncertainty is unavoidable. A confident explanation of something medicine cannot actually know may sound reassuring in the moment but can damage trust later. A better conversation distinguishes between what is reasonably clear, what is less certain and what the clinician will monitor over time. The patient does not need a lecture. The patient needs a workable mental model.

The Second Conversation: “What Can You Do About It?”

This is where patient education can quietly become promotion. You may be enthusiastic about chiropractic care and still communicate in a way that leaves little room for realistic expectations, patient preferences or uncertainty. The better approach is neither pessimism nor salesmanship. It is clarity.

What is the reasonable goal of care? What might improve first? What may take longer? What should prompt a reassessment of the plan? What role does the patient play? These questions move the discussion from “Here is what I am going to do to you” toward “Here is what we are trying to accomplish together.”

Communication research also suggests how benefits and harms are presented matters, particularly for people with limited health literacy. A 2023 review concluded that verbal communication alone should generally not be relied upon when communicating risk and that visual approaches can be useful, while emphasizing the need to tailor communication to the patient.⁴

For chiropractors, the practical lesson is simple: A diagram, a simple written plan or a brief visual explanation may sometimes accomplish more than another five minutes of talking.

The Third Conversation: “What Do I Need to Do?”

Many treatment plans fail at home. The patient may leave with advice about activity, exercise, posture, sleep, work modifications, or self-management … and then discover that the instructions do not fit real life.

This is where communication becomes collaboration. Rather than asking only whether the patient agrees with the recommendation, ask whether the recommendation is workable.

“When could you realistically do this exercise?” is a different question from “Will you do these exercises?” “What might get in the way?” is often more useful than “Do you have any questions?”

Research on therapeutic alliance in physical rehabilitation and chronic musculoskeletal pain has found that the clinician-patient relationship can influence outcomes, with trust, collaboration, and communication among the elements associated with a stronger alliance.^5-6

Patient Education Is Not a Performance

There is a temptation, particularly for experienced doctors, to judge a good explanation by how completely it was delivered. But completeness and usefulness are not the same thing. The most effective conversation may actually contain less information. It may focus on the few things the patient needs to understand now, with additional information introduced as the clinical situation evolves.

That does not mean withholding information. It means organizing it around relevance. Good communication is therefore not a script. It is a clinical skill.

Practical Takeaway: Explain Less, Understand More

Before adding another explanation, consider asking another question. The information you provide matters, but the information you receive from the patient may be what allows you to make that explanation useful..

The question is no longer simply whether chiropractors educate patients. It is whether the conversation creates understanding. Patients remember experiences. They remember whether they felt heard. They remember whether the doctor seemed to understand their concern. They remember whether the plan made sense.

And as the chiropractic literature increasingly confirms, those experiences are not peripheral to patient satisfaction. They are central to it.¹

The next time a patient nods at the end of an explanation, resist the temptation to assume the conversation is finished. That may be the moment when the most important questions are still waiting to be asked.

References

1. Newell D, Holmes MM. Patient experience and satisfaction with chiropractic care: a systematic review. J Patient Exp, 2024;11:23743735241302992.
2. Talevski J, Wong Shee A, Rasmussen B, et al. Teach-back: a systematic review of implementation and impacts. PLoS One, 2020;15(4):e0231350.
3. Shersher V, Haines TP, Sturgiss L, et al. Definitions and use of the teach-back method in healthcare consultations with patients: a systematic review and thematic synthesis. Patient Educ Couns, 2021;104(1):118-129.
4. Richter R, Jansen J, Bongaerts I, et al. Communication of benefits and harms in shared decision making with patients with limited health literacy: a systematic review of risk communication strategies. Patient Educ Couns, 2023;116:107944.
5. Hall AM, Ferreira PH, Maher CG, et al. The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: a systematic review. Phys Ther, 2010;90(8):1099-1110.
6. Babatunde F, MacDermid J, MacIntyre N. The impact of therapeutic alliance in physical therapy for chronic musculoskeletal pain: a systematic review of the literature. Physiother Theory Pract, 2017;33(10):765-778.