Chiropractic + Naturopathic Doctor

Patient Education 101

By Douglas Pooley DC Dennis Mizel BSc DC FCCRS(c)   

Features Clinical Patient Care

Consumers come for treatment and go home. In Part 1 of this article, we
noted that, with the advocate, we have someone who not only keeps their
appointments, but is eager to actively spread the features and benefits
of your service within their sphere of influence.

Effective education is, in theory, quite simple. It distills down to communicating to a prospective patient in such a way as to provide sufficient information to bridge the credibility/trust gaps, and, with time and reinforcement, have them become a passionate advocate for you and your services. But how do you educate effectively? 
Before we begin, here are two points to keep in mind:

  1. We polled some real “hitters” about what it takes to build a powerhouse practice, and the most common response is summed up as: “You build a successful practice one patient at a time.”
  2. Creating rapport is like building a bank account. If we look at actions that contribute to a strong relationship as making a “deposit” into our rapport account, we can understand circumstances that weaken a strong relationship as making a “withdrawal” from that same account. The best of the best recognize implicitly that what you put into the account must far outweigh the withdrawals for a relationship to thrive, and that the deposits must come first. It is in exceeding expectations that we build up enough relationship equity to sustain the inevitable bumps in the road and still stay on course.

Now, from a practicality standpoint, where does this leave you?  We think it means that success is directly proportional to the strength of your communicative skills with each and every patient who walks through your door.


A quick scan of that person’s understanding of chiropractic during the course of the initial consultation is invaluable. The sooner you can dispel myths and misconceptions, the more open the patient will become to what you are offering. You must break down these barriers before you can ever hope to educate them. You want them to listen to you with an open mind, ultimately trust that you have their best interests at heart and believe that you will be competent with their treatment while remaining fair from a cost and time perspective. To do this, you must develop a rapport gently and remember there is a big difference between nudge and shove.

The trick here is in this old but sage saying: “Everyone wants to buy, but no one wants to be sold.” You complete a successful educational exchange by providing the prospective patient with sufficient information pertinent to his or her personal wants and needs to allow them to perceive compelling relevance sufficient to trigger a purchase. 

In our case, that translates into enlightening patients as to the features and benefits of chiropractic as they apply to their particular concerns and circumstances – in other words, understanding, first, the requirements of the individual and then matching your services in such a way as to best address those concerns.
That is the first half of the equation.

The second important factor involves going beyond explaining chiropractic as logical and reasonable, in the patient’s particular case, and progressing to the most important element: making it the most desirable course of action. Seeing the exchange as being both fair and valuable is important, but if you can’t stimulate patients viscerally and create a desire for the service, often it will be put aside in favour of something with deeper emotional attachment.

You must get inside that person’s world and that means asking the right questions.

During the consultation and examination, you need to be drilling down to the most compelling motivators for why that person made the choice to explore chiropractic care and determining how the service you offer is the desirable one, in light of those. It has been our experience that the most common motivators are all emotional (See sidebar on this page.) 

You must penetrate to the “emotional core” in order to best treat the patient, of course, but also to fully ascertain why they are in your office. By achieving this, and then keeping it in mind during your examination, the report of findings and treatment plan will become a direct reflection of that individual’s core needs. This will not only have obvious therapeutic benefits for the patient, but will also result in the formation of an advocate who will tell others not only how you treated their pain, but that you were able to impact other needs as well. This will make others, in turn, desire your services. 

The key to effective patient education is first a matter of understanding a person’s needs, and only then working on addressing them. You can never fill a hole you can’t see.

“To know how to suggest is the great art of teaching” – Ralph Waldo Emerson
This is where the rubber really hits the road. We have explored what education is, the benefits of patient education and who benefits from patient education, so the big question remains what do patients need to know?

There are many areas of patient education that need to be covered, but first things first. Among those surveyed on educational needs, there was agreement that from a patient’s perspective the following five questions needed to be addressed first in order to create the baseline for any true trusting compliance. (That consensus also extended to the belief that they must be effectively satisfied with the service within the first two patient visits.)

  • Are you qualified to assess and treat my concerns?
  • Do you know what my problem is?
  • Can you effectively treat my complaints?
  • How long will it take to fix?
  • How much will it cost?

Whether on a conscious or subconscious level, each of the above queries must be addressed to the patient’s satisfaction to start movement towards long-term compliance and rapport.

With the exception of “are you qualified,” responses to the other four areas in question can be amended over time depending upon individual circumstances, but must still be dealt with to the patient’s satisfaction as part of the initial exchanges.

As well as being necessary for optimal monitoring, re-exams offer the best opportunity to educate the patient and reinforce the validity of their decision to seek your care. Present all changes and improvements to the patient, and use these to either substantiate your initial care program or to demonstrate the need to restructure your approach to better suit their emergent needs.

Finally, it is a good idea to provide patients with the opportunity to attend a well-structured healthcare class as early into their program of care as possible and encourage them to bring friends and family. This is an ideal venue for providing patients with the tools to better understand how the body works, dispel myths and have their questions answered in a safe and nurturing environment.

At first blush, all of this appears to be entirely the doctor’s job. Most certainly, he/she must have direct one-on-one conversation with the patient to address any concern that may pop up in each of the above areas. But, whenever possible, this is a team effort.

When available, it is the job of the chiropractic assistant (CA) to fill in the gaps and support the patient through the intervention process. We all know that healing is often not a straight line, and there can be periods of little apparent change or even setbacks before the ultimate goals are reached. The job of the CA is to help the patients through the rocky periods by reinforcing clinical realities through relating their own personal experiences working with other patients.

It has been our experience that many chiropractors do as ineffective a job of educating their staff as they do their patients. Get your staff involved, as they have different levels of credibility and can provide invaluable positive reinforcement for patients during their term under chiropractic care.

Explore the following eight points, one point at a time, through and 11-week process as follows: explore one point per week for four weeks and then on the fifth week review your progress to date. After this, move on, weekly, to the next four points, and so forth. Revisit the process once a month for six months to ensure that your agreed upon processes for execution of each point are being followed. You cannot help but benefit from this process.

Chiropractic assistants can help out by doing the following: 

  • Remind the patient that the problem they are suffering with could have taken months or years to actually develop, and healing can often be just as protracted a journey back.
  • If the injury is acute, remind the patient of the severity of the incident and that the doctor has experience with many cases such as this.
  • With the management of chronic conditions, explain to the patient that it is usual for long-standing problems to be somewhat slower to respond and that each individual’s body takes its own amount of time to respond.
  • When the patient is discouraged with the length of time that care is taking, ask if they have been following doctor’s recommendations.
  • When the patient questions the frequency of care, remind them that each treatment schedule is customized because no two patient complaints are the same and corrections sometimes have to be made in a deliberate and planned fashion.
  • Show and tell – this is very individual and requires that your CAs have a thorough understanding of the practice. Educate your staff on information contained in wall charts and posters, and get them comfortable in handling the model of the spine and explaining it with relevance to the patient. Teach staff the three basic phases of care and role play at staff meetings, until they comfortably own the process. Use pamphlets and DVDs as the learning tools that they are. Personalize the process to dramatically improve effectiveness by reviewing, with your CA, which features to point out to the patient before the patient comes in.
  • Remember to schedule re-exams every 12 visits.
  • Assist with health-care classes.

If you were to do nothing else except take the above eight points, print them out and use them to educate your staff, we guarantee that your practice will grow, incorporate more compliant and enthusiastic patients and, along with all this, increase your personal satisfaction and the financial reward that you deserve. (Please feel free to write us for details regarding how to incorporate this CA training.) 

The “take-away” from this article is simple: education creates understanding, in both your staff and your patients, which leads to compliance on the part of your patients. This, in turn, enhances the likelihood of positive clinical outcomes that satisfy on all levels, including intellectually, the terms for fulfilling a successful purchase experience. The final result leaves the patient primed for enthusiastic advocacy.

Sounds like a win all around!


  • “It hurts, and nothing else that I have done so far has helped.” The emotions here are pain, frustration and possibly depression, which of itself can become a secondary problem.
  • “I don’t understand what is happening to me – and that scares me!”  The emotion here is fear, which over time leads to frustration and anger.
  • “I can’t do the things I used to do without making it worse,” Here we see perceived loss of self-efficacy, which can become the primary disability and can lead to a sense of loss or failure. This, in turn, can become the energy sink, especially among chronic patients.
  • “I can’t go to work,” The deeper meaning, here, is I can’t pay my bills or support my family – the emotions here are fear and frustration.
  • “I can’t take care of myself physically.” The emotion here is again fear with helplessness and associated resignation that “I will not get better without help.”
  • “I can’t participate in a treasured leisure activity.” Here, the emotions are  loss, anger and frustration.
  • “I can’t move effectively due to pain and/or restriction.” The emotion here is fear of isolation and abandonment. For the elderly, there is fear of progressive disability leading to ultimate death.
  • “I feel weak and vulnerable.” This loss of self-esteem is more common in males and relates to tying self-image to physical strength and prowess.
  • “I don’t have a lot of money.” This is a fear that costs of treatment could exceed financial ability to pay. This is a major motivator for many people in our current economic climate and should be dealt with early in the exchange.
  • “I will no longer be able to serve as caregiver to those who depend upon me.” The emotion here is fear and anxiety.

Dr. Pooley graduated from CMCC in 1978 and has since been in practice
in St. Thomas, Ont., where, 14 years ago, he created Canada’s first
true comprehensive natural health care centre.  He has served as
president of both the OCA and the CCA.  He has authored/co-authored
various informational pamphlets for public education and has sat on a
number of public relations and communications committees.  He was
elected to the CCO in 2008 and sits on the CCO Quality Assurance

Dr. Mizel graduated from CMCC in 1977 and earned his fellowship in
rehabilitation from CMCC in 1997.  He completed his training in
acupuncture in 2002. Dr. Mizel has served as OCA and CCO president and
now serves as vice president of the CCO.  Dr. Mizel maintains an active
family-based, multidisciplinary clinic in St. Catharines, Ont., and has
spoken for various Canadian and international groups on inspiration,
team building, effective communication and practice growth.

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