Please - Shut Up!

I love chiropractic and most chiropractors. I am, I admit, your self-appointed scourge. If I don't scold you in a forum like this, who's going to? Remember the story of "The Emperors New Clothes" and the little kid who spoke up, while everyone else was afraid to point out the obvious? That would be me! Last year, in response to your calls, letters and e-mails, I devoted most of my columns to patient management/money issues. Most of those who contacted me thanked me for the "wake up" and pledged to do better, especially with new patients. One DC told me he appreciated my "kick-ass attitude toward all the wimpy attitudes in the profession!"

If you're trying to improve your practice let me make another suggestion. Shut up! Now before you get all upset, let me explain. One of the most common complaints I hear about doctors from their staff is that they talk too much. They're not complaining that your report of findings is too long or your progress reports are too detailed. They aren't upset that you're giving the patient too much information about what's wrong with them. They are complaining that you spend too much time talking about your golf game, your boat, or what you did last week end!

Here's the picture. It's your busiest time of day. You are about 20 minutes behind schedule. You take care of a long-term patient and exchange a few pleasantries. In response to some interest on their part, you launch into a discussion of your "secrets for catching the big ones" at your favorite fishing spot. You discuss the factors behind the high price of gas at the marina and exchange a few tips on the best weight line to catch whatever's "biting."

Moving on to the next patient, you are now running 30 minutes behind. A few more encounters like this and you end the evening running an hour late.

After days, weeks and months (I don't want to think about years) of this, here's what you've accomplished. Your staff is entirely frustrated at trying to keep any semblance of appointments. Patients realize that you are rarely on schedule so they, too, aren't on time. In fact, if they are really in a time pinch they'll skip the appointment. They simply don't have time for one of your 10-minute chats, especially if you are running 30 minutes late as usual! "Drop-ins" pull into your parking lot, take one look at the cars and drive off. When you complain about missed appointments and your staff tries to explain, you don't believe them.

Finally, the day arrives when right in the middle of a nice chat on your favorite topic, your patient announces: "Doc, I'm sorry to interrupt, but I've got to get going. Could you adjust me so that I could get going?" You feel hurt, maybe a little insulted and puzzled. After all, you were just trying to keep the doctor/patient relationship going. After a few more incidents, you finally decide it's time to do something, but what?

Of course, you talk with new patients to explain, educate and inform. You are on your best behavior with new patients. I believe the talking problem starts after the doctor runs out of things that have to be said. I've often wondered how it feels to be a new patient. We show them videos, we hand them pamphlets and work hard to educate them about chiropractic. Part of our motivation is the knowledge that enthusiastic new patients, if they are going to refer, tend to refer early on in their care. They get lots of attention, and with good reason, but then time passes and the trouble begins. We have run out of things to talk about. We feel a strong need to "make nice." After all, it would be rude to not visit with the patient, right?

I once heard someone talking about developing an ideal patient encounter. We already understand the concept as it applies to a new patient. The idea was to come up with everything that you needed to do with (and for) an established patient on a routine visit. For instance: greet the patient; inquire about any health changes; run your pre-adjustment exam; adjust the patient; "words of wisdom" for the day, etc. The objective was to give the optimum service possible on every visit: nothing more, nothing less. I thought it was a profound concept!

A friend of mine, Dr. Les Whitehead, practices in Palmerston North, New Zealand. I recall him discussing what he thought patients need to know about their care. He said we need to educate the patient without wasting a lot of time. He described a conversation where he explained the adjustment as a combination of "microsurgery, physical therapy," and other procedures I can't remember. (Les, I apologize for not remembering every one of your brilliant words!) The idea he got across, in just a few words, was incredible. To this day, it is one of the best descriptions of an adjustment I've heard. If we could all talk with patients in words like those, what would happen to your patients and your practice?

If you could spend less time talking about things that don't matter and more about things that do matter to the patient, what would happen? Nosiness might make them listen to your "lifestyles of the other half," but they are really, like all of us, are more interested in themselves. Why not start thinking aloud when you examine a patient? Tell them what seems different or better since last time. Why not talk about what general areas of the body are supplied by the vertebrae you adjust? Explain to them how chiropractic can help various problems: even ones they don't have.

Become the voice over of the adjusting room. I can see you giving a running commentary on each adjustment. Like a great golf commentator, you explain the "shot": the difficulty of the lie; the direction of the drive; the right club to make the shot. A hush settles over the adjusting room. Doctor Soandso sets up on C-5. He hesitates for a moment and adjusts his stance. He talks to the vertebra. He delivers a thrust and clunk, he's done it again! The gallery goes wild! Another perfect adjustment.

Okay, maybe I'm a little carried away on the topic, but I hope you get the idea. There are so many worthwhile things to talk about with and to the patient. There's no excuse for wasting your time and the patient's. There's time to inquire about major events in the patient's life. Weddings, anniversaries and special occasions can and should be recognized, but there's no need to help them choose a caterer or plan their vacation. You can share their enjoyment of the results of a big game, but not a play-by-play recap.

Finally, the best reason I can give you to shut up is this. Any time you can't give a patient what they are accustomed to receiving, is an opportunity for the patient to feel that you didn't care. By routinely talking too much, you aren't able to show the patient you care on a consistent basis. If you start with your new patients and develop your own ideal patient encounter, it won't be long before you are on schedule. Your staff will be less frustrated, and you won't feel as thought you have to "butter up" the patients to make them happy. Try it and let me know how you do!