This exact situation tends to impact us as chiropractors on so many levels. For many of us it’s like an arrow to the heart and brings up all sorts of issues around value and self worth.
After speaking with 1000’s of doctors around the globe I have realized that depending on their behavioral style they tend to respond to this situation in very different ways.
Classically “High D’s” or “Drivers” or “Assertive’s” respond by getting snippy or angry with their patients trying to scare or manipulate their patients into care. Letting them know if they don’t follow the doctor’s recommendations all of the terrible things that are going to happen with them. And as always with all “scare tactics” it’s all tied up in a beautiful pink ribbon of “It’s in their patient’s best interests”.
Classically “Non-assertive’s” join what we call the “O.K corral” and just say, “okay” and let the patient leave.
The “Assertive” gets to feel good knowing that they said what they wanted to say. They get to tell their friends at chiropractic seminars how they really laid into their patient.
The “Non-assertive’s” feel very frustrated because they didn’t say what they really wanted to say.
But regardless, the vast majority of the time if we deal with this problem in either of these manners our patients don’t continue care, they don’t get the results that they really came in for, and we end up frustrated!
I want you to imagine your patient has mustered up enough courage to finally say to you that they feel that they need to stop care because they don’t have enough money. I want you to recognize the stress that they are most likely under by the time they finally say this to you.
Now I want you to imagine you say to them “Mary, if you stop care now you will never get the results that you’re looking for and you will have serious problems in the future.”
Although you may manipulate her into continuing care in the moment the odds are she will very soon quit care for good and never return.
What we find rarely ever works is TELLING people what they “HAVE TO” do. Regardless if they are patients, spouses, children or bank tellers, telling people what they have to do rarely works!
Instead we need to ask Socratic questions to help us clarify what the problem truly is so we can come up with a reasonable and logical solution.
In our L.A.A.S.R. process which stands for Listen, Acknowledge, Ask, Solution and Resolution we always make sure that we actively listen to our patients. Then we must acknowledge them. In this case I might say, “Mary I am so sorry you’re going to have to stop care. I absolutely love working with you and you’ve been gaining such ground and doing so great.”
Do you see how this de-escalates the situation? Remember she is stressed about having to quit, or disappoint you, or has possibly come in ready for a fight! By Acknowledging their concerns and the situation this way we can take the wind out of the sail and de-escalate the situation. Now we can begin to have a conversation. But I am NOT going to TELL her what she HAS TO DO!
Instead we want to ask appropriate questions – i.e., “Mary let me ask you a question, if finances were not an issue, and I know that they are, but if they really were not an issue would you want to continue care? Or are you just (feeling good/unhappy with care/feeling stuck in care etc.) And would rather not continue at this time?”
If Mary says that she would do anything to continue care but she simply cannot afford it. She just lost her job, her mother got sick, her dog got hit by a car and she was living out a country song then I personally would buy it. And I would try to figure a way for her to be able to get some of the care that she needs. The odds are some care will be better than no care. (Of course you have to do what you feel is clinically best for your patients.)
But it if she were to say, “Yes the truth of the matter is I am really feeling pretty good and I think I will just stop at this time” then you have clarified the real problem that you can now address.
My experience is, if you will really focus and clarify the problem the solution will become self-evident. Then if you will use the L.A.A.S.R. process you can help people find solutions and resolution versus pissing them off or joining the okay corral.
I’d love to know your thoughts and hear what’s worked for you.
Much love and aloha,
Russ Rosen – A dynamic and passionate chiropractor, author, international coach, educator and speaker, Russ ran one of the most successful wellness practices in Maui Hawaii for 14 years. Dr. Rosen is best known for his “Patient Care” vs. “Patient Scare” Wellness Communication systems.
He served as Lead Author and Director of Dr. Patrick Gentempo’s Creating Wellness Management System. Dr. Rosen is the proud recipient of CLA/CWA’s 2007 “Lifetime Achievement” award. Since 2001 Russ has helped hundreds of doctors thrive in a True Optimal-Health model and is CEO of The Optimal Health Chiropractic System.