Affirmation Generates Patient Referrals

The only way your patients can show their appreciation, separate and apart from paying your fee, is to refer to others. Making a referral is one of the only avenues of expression open to a satisfied patient. Here, an attempt will be made to persuade you that affirmation, an extremely potent form of interpersonal communication, is one of the more effective ways of encouraging your patients to tell others of their satisfaction with your treatment.

Most psychiatrists and psychotherapists agree that an overwhelming number of their patients suffer from low self-esteem, an anemic self-image, an impoverished ego. It behooves you, as a chiropractic physician, to enrich your patients with an uplifted sense of self. Reinforcing the importance of how patients feel about themselves is a study at Vanderbilt University which suggested that ego strength was the most powerful predictor of whether a person experienced acute illness, and for how long.¹ Despite knowing that no one factor determines why people get sick, there appears to be one overriding truth: our heads affect our health. This is why affirmation is being touted here as an indispensable therapeutic tool.

Patients brag about their doctors for a number of reasons. These reasons include being listened to attentively, not being rushed or financially gouged, and speaking in an adult and respectful manner. These very same patients also report that merely the thought of seeing their doctor provides them with a sense of relief, of reassurance and of feeling good. It is this very feeling that fuels the psychological phenomenon known as affirmation, which, in turn, induces referrals.

Doctors who are fully supportive of their patients generate something the Japanese call, amae. It emphasize a belief that the well-being of the individual depends upon the cooperation with others. Applying this precept to the therapeutic experience makes good sense. It should encourage every doctor to pay equal attention to a patient's emotional and physical needs, i.e., cooperative healing.

All sentient human beings need affirmation, that is, some form of validation that they exist and have value. Our daily newspapers and television programs groan with examples of people hungering for recognition -- some form of acknowledgment. Norman Cousins, author of Anatomy of an Illness, strongly suggested that having a positive sense of personal meaning and purpose can have a complementary effect upon the immune system. He also reasoned that if negative thoughts and emotions were capable of producing negative reactions in the body, positive thoughts and feelings could bring about positive responses. Supporting Cousins view is the literature positing that just as brain chemicals can alter thoughts, thoughts can alter chemicals. Metaphorically speaking, there appears to be a chemistry of thought.² Put another way, thoughts and perceptions push buttons (receptors) by releasing various neurochemicals that act as chemical messengers.

Practically every patient could benefit from a liberal dose of positive reinforcement. The words you speak to your patients are not fleeting abstractions, but rather electrochemical events with physiological consequences.

It is common knowledge that there is more to a patient than merely symptoms. During a consultation or examination, we are dealing with more than a collection of cells, tissues, organs, and systems. Literally, we hold in our hands an entire life; we treat people, not symptoms. Hence, because our patients often experience varying degrees of fear and trepidation sparked by the unknown, they desperately hunger for reassurance -- one important form of which is affirmation.

The question before every reader should now be: "How does one administer or communicate affirmation?" It can be accomplished verbally, vocally, or nonverbally. It mandates that doctors take special notice of such things as their patient's hobby, attire, special talents, accomplishments, family life, pets, and occupational pursuits. Any one or a combination of these human properties and pursuits should be factored into the healing process. For instance, attention should be paid and inquiries made into the health status of a patient's sick pet or an unemployed spouse. By asking, "And how is your lovely cat, Oliver, feeling today?" or "Has your husband succeeded in getting a job yet?" Questions like these qualify as genuine forms of emotional support; they communicate to your patients that you care, that you are interested in more than their fifth lumbar or third cervical.

Vocal affirmation, likewise, can be delivered in the form of a calm and reassuring voice or one that is abrupt and disconcerting. How would you describe the sound of your voice? Does it instill confidence or uneasiness? Such vocal qualities as volume, speech-speed, pitch, and emphasis each has the capacity to influence how a patient will respond to treatment.

Psychologist Albert Mehrabian tells us that the impact of ordinary conversation breaks down as follows: seven percent from what you say, 38 percent from how you say it, and 55 percent from how you look when you say it. Consider the positive impact of an affable smile on a doctor's face, or receiving a compassionate pat on the back. Both of these very simplistic forms of nonverbal affirmation have been known to have remarkable healing properties. One related study has suggested that if we assume facial expressions of happiness, we can increase blood flow to the brain and stimulate release of favorable neurotransmitters.³ What messages do your facial expressions send to your patients, doctor?

Most effective, of course, are the kind of considerate words you speak. As I have said in the past, words have consequences. The words spoken by some doctors are clearly uplifting, whereas those coming from the mouths of other doctors can either be depressing or, in some instances, downright frightening.

For years, doctors and nurses in hospitals referred to procedures and pathologies, rather than people, e.g., the cholecystectomy in room 704 or the spina bifida in room 511. For much too long, this depersonalization has been endemic to a great many hospital personnel. Fortunately, times have changed and an encouraging degree of humanism has begun to infiltrate the health care field.

Cognitive behavioral psychologists give people a systematic list of positive statements to say to themselves as they confront pain or whatever distress they have.⁴ Could not these very same positive statements be delivered to our patients with comparable effectiveness? Could not a patient's faith and confidence in a doctor, by itself, impact constructively on the immune system? When a doctor tells a patient that he/she looks good, a certain positive self-image is registered in the brain. Such simple imagery can, according to investigators at Michigan State University, alter at patient's neutrophil count.⁵

In closing, let me re-emphasize the importance of what we say to a patient, how we say it, and how we look when we say it. Patients who feel good about themselves, consciously or unconsciously, connect such a feeling with those who nurture it. Let that nurturer be you, the doctor. Be generous with your compliments. Deliberately search out qualities in your patients that warrant your affirmation. The end result will be, as the title of this column suggests, an increase in patient referral.

References

1. Blotcky AD, Tittler BI. Psychosocial predictors of physical illness: Toward a holistic model of health. Preventive Medicine, 11, 602-611, 1982.

    

2. Justice, Blair. Who Gets Sick. Houston: Peak Press, p.15, 1988.

    

3. Zajonic RB. Emotion and facial efference: A theory reclaimed. Science, 228 (4695), 15-21.

    

4. Mechanism D and Jerembko ME (eds.). Stress Reduction and Prevention. New York: Plenum.

    

5. Achterberg J. Imagery in Healing: Shamanism and Modern Medicine. Boston, New Science Library, 1985.

Editor's note: As a professor of communication, Dr. Eisenberg is frequently asked to speak at conventions and regional meetings. For further information regarding speaking engagements, you may call (914) 271-4441, or write to Two Wells Avenue, Croton-on-Hudson, New York 10520.