Patient Personality and Clinical Compliance (Pt. 1)

Inconsistent patient compliance is an ongoing issue in many practices. Many patients enter the office, ask for help, seem ready to proceed, and then become an impediment to the process.

Much of this problem is personality-based. Some patients have personality types and traits that are hard to manage; personalities that create obstacles and result in patients being their own worst enemies.

These truths are the basis for this series. Doctors must be able to recognize challenging personality types and handle the circumstances they create. Prompts for patient communications are incorporated into the discussion of each personality. I begin with detail-oriented and skeptical patients.

The Detail-Oriented Patient

Detail-oriented patients want to know every detail of their diagnosis and treatment; a degree of detail exceeding that of average patients. Average patients just want their pain to go away. Specifics of the process are usually of lesser importance.

Patients in this category ask multiple questions, with one question leading to another. They take notes and ask for literature. Internet searches are a routine activity for detail-oriented patients during their care.

The terms academic and "nerdy" are good descriptors for these patients. Their occupations are often black and white in nature. To them, there should always be a formula and a clear answer. Sample occupations are professors, engineers, computer programmers, and similar fields.

Unfortunately, patients with black-and-white mindsets have a hard time dealing with the gray world of health care. The exact causes, effects and treatments of many health care issues are not always known.

What You Can Do

When you recognize this situation, it must be addressed immediately. Otherwise, unending questions result in excessive time spent during visits, and the patient begins to wrestle you for control and coordination of their case.

You can't be swayed and must maintain control. If not, the situation will cause undue wear and tear on you. To these patients, I typically say, "After treating you for a little while now, I am beginning to think this is not going to work." This statement is usually a surprise to the patient. Their response is generally along the lines of, "What do you mean?"

"You are overthinking everything and giving yourself information overload," should be your response. "You are focusing on every little ache and twinge and what they mean. You need to relax and let your body heal. I said healing would take weeks or months, and we are just getting started. Most patients give care a little time initially to allow things to develop. We established benchmarks for care and progress when we started. Let yourself get to the first benchmark before becoming anxious and overthinking everything. Let's make a deal: don't worry until I do."

The first time I said this, it was out of frustration. It just popped out of my mouth. But the patient's husband immediately chimed in, remarking, "She does that all the time. I told her to chill out."

During the conversation, I portray the patient's detail-oriented personality as admirable, but clarify that the trait can cause a glitch in the treatment process. It works. Unfortunately, I have had to say this too often. I practice in a teaching hospital on a university campus, where many of my patients are professors. So far, I have only encountered one patient who felt insulted.

The conversation relieves my stress. If healing does not occur because the patient complicates their situation, I have predicted the occurrence. The patient must take some of the responsibility for the failure.

When you notify a patient of an obstacle that may influence their prognosis, and it occurs, you are an expert. If you do not notify the patient of the obstacle and its effect, and it occurs, it is difficult to explain to the patient in the aftermath. If results were associated with factors the patient has partial or complete control over, the the patient bears a degree of responsibility.

The Skeptical Patient

Skeptical patients are a dime a dozen in chiropractic practice. It is part of our heritage. Fear of what we do, whether inflicted upon the profession or self-generated, has created hesitancy among the public.

Skeptical patients come in for varying reasons. For many, chiropractic is the last hope. Everything else has failed, and the patient finds him/herself in desperation mode. Some skeptical patients visit us because a friend or loved one convinced them to try chiropractic. Convincing may have been through friendly means or threats. Significant others are known for the latter.

Skeptical patients may seem nervous, hesitant and sometimes belligerent or angry. In addition to fear, a general lack of confidence in chiropractic is common for skeptical patients. This lack of confidence often has a Jekyll-and-Hyde twist. Suspicious patients with an initial lack of confidence can suddenly flip to complete confidence.

Once care is recommended, skeptics will flip and declare they want to see how the first adjustment goes before committing to following through. They want to see if one adjustment does the trick. These patients go from "This probably won't work" to "It should work in one visit."

What You Can Do

For skeptical patients, I try to identify their most significant concerns. Skepticism is often a combination of fear and financial matters. If it is fear, I describe the actual safety of chiropractic. If it is financial, I have staff explain payment options to the patient.

For those patients wanting to try one adjustment, I simply say, "That's not how it works. I cannot accept you as a patient under those circumstances."

I remind them of how I explained that care and healing would take time. I follow this by stating, "Care is a process, not an event; a one-adjustment fix is very rare."

I describe post-adjustment soreness to these patients, explaining that while uncommon, injured tissues can be slightly sore after being adjusted. I explain further that if it happened, not only would they think chiropractic did not work, but they also might think it made them worse.

This result would perpetuate their skepticism, preventing them from following through with care that would have helped them. One adjustment would only cause disappointment and waste everyone's time.

Some skeptics leave, some stay and then quit as they'd originally planned, and some follow through.

Author's Note: In the second and third parts of this series [June and July issues, respectively], I will discuss other patient personalities related to clinical compliance. In Pt. 2, I will discuss deniers and worriers. In Pt. 3, I will discuss one-visit-wonder and best-buddy patients.