There is a saying in the coaching field that "if you're working harder than the client, something is wrong." This axiom can easily translate to the profession of chiropractic. You've no doubt worked with patients in situations in which you felt like you were more interested in improving their health, function, and well-being than they were. I detect a deep level of frustration from clients when they recognize that their practice success depends, in part, on good clinical outcomes, but have too many patients who don't hold up their end of the bargain to achieve better health.
Is it possible for be more effective in motivating patients to stick with care plans, to follow through, and to take more active roles in improving their own health? Yes, it is.
Advising vs. Coaching
If you want to become more effective in motivating patients, it's important to understand how advising differs from coaching. Chiropractors can and should give advice. That's a big part of why patients come to see you - because you have knowledge that they don't have. But offering even your best advice only goes so far, as you've surely discovered in daily practice.
Let's say you're treating a patient in her mid-50s with chronic low back pain, who is also overweight, sedentary, and taking cholesterol lowering medication. Wearing your advising hat, you might explain why the patient should do back-strengthening exercises at home in addition to receiving regular chiropractic treatments.
Broaching the subject of weight reduction and physical activity, however, is delicate and potentially risky, but necessary if you are committed to helping the patient not only have a stronger back, but also enjoy optimal health. This is where coaching comes in, and this level of conversation is all about empowering the patient to take action based on their own motivation, not what you want them to be motivated to do.
Your Unique Role
Today's patients, and in particular baby boomers, have come to believe that if they take good enough care of themselves, they should be able to circumvent many of the aches and pains associated with aging. These patients are often eager to be active participants in wellness activities and appreciate a doctor who is willing to spend time coaching them.
Coaching in the situation described above, with a baby boomer who wants to stave off "seniorhood," might involve inquiries like these:
So, are you thinking, "Who has that kind of time to spend with patients?" Ask yourself how much time you spend trying to attract new patients because you are not as successful as you'd like to be in retaining the ones you already have. I'd argue that chiropractors can't afford not to spend adequate time with each patient to more fully understand where the person has been, where they are and where they want to be with their health.
The Benefits
For the practitioner, one of the most important benefits of taking the time to engage in coaching conversations is that you gain insight into how ready a patient is to make lifestyle changes. Until a patient is emotionally ready to change, all of the coaching in the world won't matter. But when you determine through a coaching conversation that a patient is indeed ready, you can make a real difference.
A secondary (but also important) benefit to you is that when patients appreciate that you genuinely care about their well-being and they begin to have positive health outcomes, they become extraordinarily loyal. These kinds of raving fans cannot be valued too highly.
The benefit to patients derived from engaging in coaching conversations is that it helps them get clear on what's important to them and what they are willing to do to feel better.
[pb]One of the foundational principles of coaching is that an individual will almost always follow through on their own ideas more consistently and with greater success than they will follow through on the recommendations of other people. Your role as coach is to "lead from behind" and help patients become clear on their personal health values, vision and goals.
Dealing With Ambivalence
When we speak of coaching and motivating patients, we must acknowledge the power of ambivalence. Whether they realize it or not, most people have some degree of ambivalence about making health and lifestyle changes because they have competing goals. Yes, they want to be able to easily walk up three flights of stairs, but they don't want to spend time building up their stamina.
You can identify ambi-valence during coaching conversations by listening for the "but" in the middle of sentences. For example, if a patient says, "I really do want to exercise, but I don't have time," the "but" cancels out whatever came before it, and so nothing changes. Here are some coaching questions you can use in that situation:
Working with ambivalence is a part of the coaching process. Try not to get frustrated and know that oftentimes, it's two steps forward, one step back for patients who are changing old habits.
Avoid Potential Landmines
There are a few caveats related to using coaching with patients. First, be sure to have a patient's permission before delving into conversations that go beyond the reason they are in your office. Going down a road with a patient who is not ready to discuss a particular issue will come across as judgmental and compromise the process.
Second, it's important to phrase questions so you don't come across as judgmental. When a patient confides that they routinely have three or four alcoholic drinks daily, there's a big difference between asking, "Why do you think you drink too much?" vs. "What do you feel would be a reasonable goal in terms of alcohol consumption?"
Other landmines associated with coaching involve putting your own agenda ahead of the patient's, asking leading questions, and giving advice when you should be letting the patient come up with their own ideas. Be aware of these missteps as you venture into coaching conversations.
You're Part of the Solution
Are you ready to help close the gap for people who say they want to be well, but live with the consequences of modern life and a medical model of "fix what's broken"? If you are committed to being a leader in the current trend toward chiropractors being seen as the "go-to" practitioners for wellness, the time and energy you invest to become proficient in coaching will be worth the effort.
Continuing to impress the advertising and marketing world, The Foundation for Chiropractic Progress (F4CP) has again been recognized by industry organizations for its excellence in educating consumers on the benefits of chiropractic, this time through social media, newsletters, and demonstrating thought leadership by promoting holistic well-being.
Dr. Louis Sportelli received the Lee-Homewood Chiropractic Heritage Award during the annual conference of the Association for the History of Chiropractic (AHC). During his nearly 60-year career, Dr. Sportelli has embodied the spirit of the award, given to “living individuals who have made outstanding contributions to the chiropractic profession.”
Presently there is no consensus on the best treatment for Achilles tendon rupture; and its management is still controversial. The treatment options are conservative treatment and surgical repair. With either treatment, be it conservative or surgical, Achilles tendon tears necessitate prolonged recovery and rehabilitative management.
| Digital Exclusive