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Patient Scare vs. Patient Care

Patient Scare vs. Patient Care

From my perspective there are two different and distinct models of practicing and communicating with our patients. Doctors often ask me if you can just use a little from both, and my answer is NO. Truly, these two models are mutually exclusive. Both models "work" the question is how do you define "work" and what are you trying to accomplish?

One of the models I call patient scare, and the other I call patient care.

Patient scare comes from the place of inequality. It is based on a model of control. It is the parent speaking to the child; the aggressor speaking to the victim (in a passive aggressive model.) In this model there is some form of fear and manipulation or coercion.

In the management world there are shades of gray within this model. Some of the management companies are overt and extreme in their controlling patient scare tactics. They pride themselves on making people cry when they are finally told that they do in fact, have subluxations. They want it to feel as if they told the patient they had cancer!

The interesting thing for me is, is that how we want to open a relationship of healing with another human being? I remember reading Bernie Siegal, M.D.'s book, Love, Medicine, and Miracles. He was discussing the importance of not scaring the hell out of his patients! He said when he told a patient that they had cancer he would tell them in the same breath something like, You have cancer and I want to introduce you to several people today who had what you have and have survived! Doesn't that sound more honoring to our patients?

Of course these scare tactics are all wrapped up in a nice package of "It is in the patient's best interest and the end justifies the means." But, I can tell you that many doctors using these coercive controlling techniques, deep down, do not feel good about what they are doing. When I consult with one of these docs, I always ask them if they use the same "scripts and tones" with a friend or family member as they do with a new patient. Inevitably the answer is, No... We then go into the question of why not and Pandora's Box has been opened.

Other management companies are more subtle with their patient scare tactics. But the fact is any time we are manipulating others to do what we want them, to do what is in our best interest, even if it is also in their best interest, anytime we are using some form of fear; we are using control.

Of course control "works." The question is how we define "works." Most people feel if we get our patients to comply then it works.

So what is the problem with getting people to comply, and using control? That's right, control always leads to rebellion. Think about it, think about every time someone has ever tried to control you, what did you eventually do... that's right, rebel.

You may get them to follow through with their year plan, but they are not coming back after the year is up and they are not referring in their friends and family willingly. Again, you can shame and guilt them into referring, but it is what I call a coercion practice vs. an attraction practice. There is no question we can get people to comply by using these techniques, but at what cost? Also, if we want an internal referral based practice full of happy lifetime patients, in the long run it just doesn't work.

From my perspective there is another way. This is what I call an attraction practice; this is where we use patient care not patient scare. To me what that means is we treat people as the bright, intelligent and loving people that they are. We treat them with love and respect. What I mean by treating them with love is we love them enough to appreciate them for who they are and where they are. (If you have read Dr. Donald Epstein's The Twelve Stages of Healing, you recognize that our patients all come in at different stages along the healing path. Some come in suffering and they want to be fixed, while others understand the difference between the symptom model and the wellness model and they are offended when we try to fix them.)

The point is you can't get there from here... What I mean is, you cannot start a relationship with people in the control patient scare model and expect to transition them to wellness care. It just doesn't work. To help people to the wellness model we must start the relationship off from a place of love and respect. We must come from a place of equality vs. inequality. We must respect them enough to allow them to make their own decisions that are in their best interest. We must love and appreciate them equally, whether they choose to follow our recommendations or not. That's right, we must not be charged if they don't choose to follow our recommendations. (There are several headspace issues that need to be resolved around this one.) I realize that many of the management companies out there tell doctors to "break up" with their patients if the patient does not choose to follow through with the doctor's recommendations. They want the doctor to make the patient feel bad and wrong as they walk out the door. This is the "only chance" the doctor has of the patient coming to their senses and come back in for care.

Obviously from the patient scare model this makes perfect sense. But from the patient care model it is simply ludicrous! I have had dozens of patients over the years choose not to follow my recommendations that either came in for care at another time or referred in friends and family because they liked how they were treated. Although they did not feel that it was the best thing for them at the time, or they could not afford the care, they saw the value and felt valued as a person while they were at my office.

In the patient scare model we are told that patients must respect us as the doctor. And as we discover their meaning of the word respect, there is always some hint of fear involved. I wrestled with this concept for most of my life. When I was a very young boy, my grandfather who was quite a barroom brawler would always tell me that, "Might is right and you must get people to fear you so they will have a healthy respect for you."

It was through my trials and tribulations as a chiropractor that I finally got my arms around this concept. I do agree with my grandfather, if we are to come from the patient scare model, then by all means our patients must have a healthy respect which includes a little bit of fear for their doctor. If on the other hand you are going to use the patient care model, then I don't feel there is any room for fear. To me, in the patient care model, I believe respect means that the patients honor us, that they hold us in high regard. I believe it means that our patients feel better about themselves just by being in our presence. And of course, we the doctors have the same respect for our patients, staff, family and all human beings.

In the patient care model we treat our patients with love and respect and we offer them real choices. In the patient scare model we offer them one real choice and one choice that only an imbecile would choose, like "corrective care vs. patch it up care." Again, although they may be successfully manipulated by such a ploy, eventually they feel duped and they rebel. Think about it, the first time you were asked or told to use these types of scripts with such manipulative ploys, didn't it feel wrong? Weren't you somewhat embarrassed to actually do it the first few times? I know I was.

I believe if we can offer our patients love and choices then all we have to do is tell them our truth and consequencesof their actions. Notice I said our truth and consequences not The Truth and consequences. What I mean is we do not come from the angry parent; we let them know from our best understanding of what is going on with them right now, this is what I believe you can expect to happen from the choices you are making. Does that mean that we don't tell them about spinal degeneration and the long term affects of subluxations? No, it just means that our intent is not to scare the hell out of them. We are clean in our interaction, we tell them our truth, which we must realize is our truth in the present moment, and if you have been practicing for any period of time you recognize that as you grow and evolve and learn, your "truth" continues to grow and evolve and change also.

If we tell them our truth and the consequences of their actions we become an authority that they hold in high regard. From my perspective business is real simple. They have a problem, you have a solution. If they get that your solution will help their problem, you are in business. In the patient care model we don't become the authority that they fear. We, on the other hand become an authority that they hold in high regard. The problem with becoming the authority that they fear is they are no longer responsible for their health; we are, and that is a lot of responsibility for one person to carry on their shoulders all day long!

I was speaking with Patrick Gentempo, D.C. and we were discussing this concept. He made a profound statement. He said that he agreed that we did not want to scare the hell out of people, but the fact is, sometimes the truth can be pretty darn scary! I would have to agree with him. Sometimes the truth is pretty darn scary and our patients are paying us to tell them the truth. The big difference is the energy behind the form; it is our intent and where we are coming from. There is absolutely no question that our patients can sense this. And, if we want to build long term lasting relationships and fill our practices full of patients who love what we do, take responsibility for their health and refer in their family and friends; then we may want to consider coming from a patient care model or attraction practice vs. a patient scare model or coercion/control practice.

The morning I was finishing up this article, I went to a lab for some blood work. While I was waiting in the waiting room I picked up a magazine called "Cure: Cancer updates, Research & Education." I read an article by Edward T. Creagan, M.D. entitled, "Doctor, what are you trying to tell me?"

In this article the doctor goes on about what questions the cancer patient should be asking the doctor. In the section called, "10 ways to talk frankly with your doctor," he starts by writing, "As a patient, you must become the most empowered and the most knowledgeable person about your disease..." He then goes on to write, "If you feel a sense of paternalism or of being talked down to, it might be the time to seek a second opinion." "Bottom line: A partnership, which is a participatory relationship with your physician, provides the best results long term. This should be viewed as an alliance..."

The M.D.'s who were notorious for treating patients with the ultimate patient scare tactics are making the change towards patient care. It is ironic that we chiropractors who always had the patients on our side, who always had patients love our "humanness and caring approach" are now jumping onto the sinking ship of the old medical model of patient scare.

Russ Rosen, D.C. - Jun 08, 2003