Healing Hands, Caring Hearts

Chiropractors are famous for delivering a high level of patient satisfaction. Patients know this overwhelmingly, and researchers confirm it. Of the millions of patients who receive chiropractic treatment every year, most are either satisfied or very satisfied.

Chiropractic patients with lumbar radiculopathy were very satisfied (80-90%) when asked about the examination, information, and overall management.⁵ Garner found that nearly all patients (97.7%) were either very satisfied or satisfied with the chiropractic care they received.³

Patients are not the only ones who are satisfied with our services; 80% of referring medical doctors express satisfaction with their chiropractic patient referrals.²

DCs vs. MDs: No Comparison

The research becomes more revealing when we use medical doctors as a comparative group. Leininger, et al., conducted an analysis of patient satisfaction with the care provided by chiropractors and medical doctors for acute or subacute neck pain.⁶ The study revealed a 92% satisfaction rate for chiropractors and a 67% satisfaction rate for medical doctors. Furthermore, medical doctors had an 11% dissatisfaction rate, whereas chiropractors had none.

Another study measured an equal number of patients with back pain – half seen by chiropractors and half seen by medical doctors. Over 90% of the patients treated by chiropractors were satisfied, whereas only 38% of patients were satisfied with their medical care.¹

Patient Satisfaction and Outcomes

But satisfaction is not just about a positive clinical experience; it actually enhances the patient’s outcome, with caring and compassion being the fundamental drivers of satisfaction.

A recent study measured the association of physician empathy with pain and function among patients with chronic low back pain.⁷ Patients of the very empathic physician reported noticeably lower pain intensity and less back-related disability compared to patients of the slightly empathic physician. Physician empathy was associated with more favorable patient outcomes.

Note: Chiropractic physicians should be aware that researchers do not pay attention to the empathy training of their therapists who provide treatments within the clinical trial, so it is not unreasonable to conceive that chiropractic practitioners who focus on empathy will notice even better results than the clinical trials demonstrate.

Researchers assessed whether a doctor’s demeanor affects patients differently using the same words. Patients received a histamine skin prick and met a provider acting in one of two ways: warm and competent or cold and incompetent.⁴ The warm provider was engaging and professional, while the cold provider was disengaged and unsure.

Both patient groups received a placebo cream, which was presented as an antihistamine. The placebo only reduced allergic reactions when given by a warm, competent provider. A doctor’s warmth and competence enhanced the effectiveness of treatments. It’s not just what you say, but also how you say it.

We often think the only parts of health care that really matter are the “active” ingredients of chiropractic, like manipulation and rehab. But focusing only on those ingredients leaves important components of care underappreciated and underutilized. To truly help patients thrive, we should include caring.

Practice Recommendations

Practices grounded in scientific evidence have the potential to improve the experience of patients. Zulman, et al., conducted a systematic review to identify evidence and practices that promote clinician presence, a state of awareness, focus, and attention with the intent to understand patients.⁸ Evidence synthesis demonstrated five recommendations:

1. Prepare with intention (take a moment to prepare and focus before greeting a patient)
2. Listen intently and completely (sit down, lean forward.
3. Agree on what matters most (find out what the patient cares about and incorporate these priorities into the visit agenda.
4. Connect with the patient’s story (consider life circumstances that influence the patient’s health; acknowledge positive efforts; celebrate successes.
5. Explore emotional cues (notice, name, and validate the patient’s emotions).

We, as health care providers, cannot take our past successes for granted. We must continue to focus on improving.

References

1. Bezdjian S, Whedon JM, Goehl JM, Kazal LA Jr. Experiences and attitudes about chiropractic care and prescription drug therapy among patients with back pain: a cross-sectional survey. J Chiropr Med, 2021;20:1-8.
2. Boudreau LA, Busse JW, McBride G. Chiropractic services in the Canadian Armed Forces: a pilot project. Mil Med, 2006;171:572-6.
3. Garner MJ, Aker P, Balon J, et al. Chiropractic care of musculoskeletal disorders in a unique population within Canadian community health centers. J Manipulative Physiol Ther, 2007;30:165-170.
4. Howe LC, Goyer JP, Crum AJ. Harnessing the placebo effect: exploring the influence of physician characteristics on placebo response. Health Psychol, 2017;36:1074-1082.
5. Jensen RK, Lillesø S, Jensen JS, et al. Patient expectations and levels of satisfaction in chiropractic treatment for lumbar radiculopathy. A mixed methods study. Chiropr Man Therap, 2023;31:13.
6. Leininger BD, Evans R, Bronfort G. Exploring patient satisfaction: a secondary analysis of a randomized clinical trial of spinal manipulation, home exercise, and medication for acute and subacute neck pain. J Manipulative Physiol Ther, 2014;37:593-601.
7. Licciardone JC, Tran Y, Ngo K, et al. Physician empathy and chronic pain outcomes. JAMA Netw Open, 2024;7:e246026.
8. Zulman DM, Haverfield MC, Shaw JG, et al. Practices to foster physician presence and connection with patients in the clinical encounter. JAMA, 2020;323:70-81.