Chiropractic + Naturopathic Doctor

Patient Education 101

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

Features Clinical Patient Care

“The educated differ from the uneducated as the living differ from the dead.”

“The educated differ from the uneducated as the living differ from the dead.”


For a growing number of practitioners, the gaps between appointments far outweigh the number of booked appointments. Because we all want to offer the benefits of chiropractic to as many patients as possible, while building a sustainable practice, this has to be remedied immediately. The good news is that if you are seeing any patients at all, you have the ability to influence this situation. The bad news is that many DCs have no idea what is working, much less how to do more of it more efficiently. You may be relieved to know that success is just a matter of doing the right thing consistently. This may come as a bit of a shocker, but even in our exceedingly high-tech world, when it comes to building a successful chiropractic practice, simple often still works best.


Throughout our combined 30-plus years in practice, we have found that the most enthusiastic patients, and those who become our best referral sources, are coincidentally those whom we have educated the most effectively. Conversely, patients that leave as soon as the pain is gone, often only to return in even worse condition, are the ones whom we have failed, most miserably, to enlighten.

Our research has found the lack of an effective system for patient education to be the most common contributor to practice failure. The truly successful practitioners – whether in practice two years or 52 years – affirm that it is the rapport generated one-on-one that creates the trust needed to turn “patient” into “advocate.” The big surprise is finding that the clinical results you achieve with that patient play a smaller role in the creation of an enthusiastic referrer than we have been led to believe. From a patient’s perspective, “getting them better” is a given. Educating them so that they understand what you are doing, feel involved and invested in their own care, and know how you can help them to optimize their wellness in the future, is the element that can make the difference between retaining these patients – as well as having them send you new ones – and living with an empty appointment book. 

Everyone has patients, but what we really want are advocates. Patients come for their appointments; advocates not only keep their appointments, but are eager to actively spread, with enthusiasm, the features and benefits of your service within their sphere of influence.

The sad but overarching reality is that unlike most of the other major players in health care, we have little third-party endorsement enthusiastically pushing the wonders of chiropractic care. This, combined with unjust external factors that challenge our credibility with consumers, has created skepticism regarding our efficacy, and clinical and cultural authority. Even those formerly predisposed to chiropractic care are questioning their position. This has served to statistically reduce our market share over the last decade, impacting even those previously converted.

Our experience continues to reinforce the belief that, even in these seemingly bleak times, opportunity abounds – you just have to recognize this potential, and make it work for you. It is of interest to note  that “the other guy” isn’t doing so great either. That is, public confidence in the conventional medical approach to health provision is at an all-time low, and consumers are looking for effective alternatives. Building advocates often means laying out the foundation for new attitudes through effective patient education.

As well, the emerging body of evidence supporting the overall health benefits associated with the maintenance of mobility and an active lifestyle play in well with the traditional chiropractic paradigm. As we said, opportunity abounds! The only way to craft opportunity is through creating awareness/understanding of the service you are providing. This is done via effective education.

Why spend time on this?  From a consumer’s perspective, it is very difficult to need something you don’t understand. A consumer must possess more than a basic awareness of how the features and benefits of a product or service can either satisfy a need or make an improvement to his/her life, in order to fulfil a purchase equation. For the majority of the public, there is little or no understanding of chiropractic; therefore, no apparent need for the service. Alternatively, their understanding is polluted by mistruths or innuendo that create suspicion and distrust. You must create the awareness that will help people to understand why they need your care, and then build on the knowledge that will, in turn, spur them to become advocates for the service you provide. 

To more fully understand the critical importance of patient education, let’s break it down fundamentally by examining the following two questions: What is the purpose of educating a patient? Who does patient education really benefit?

What is the purpose of educating a patient?

Although at first blush, it seems that patient education is merely “sales,” if you penetrate a little deeper, you can better appreciate the following benefits of doing it well:

1. Understanding equals ownership  – The more information we have on any item or service that we are considering purchasing, naturally the greater the level of understanding of the related features and benefits associated with it. Once the tipping point has been reached intellectually to move from a “want” to a “need” to an actual purchase, all of that accumulated information then, in turn, serves to buttress up or validate decisions for making the buy. It is like building a frame for a car – the greater the number of cross-members (reinforcing ideas), the stronger the frame. In the case of the potential patient, we are building a framework of understanding leading to the creation of a foundational belief in the validity and appropriateness of care that we are suggesting.

The key word here is “belief.” When an idea or suggestion transforms into a belief, there is a sense of ownership attached to it. We all do this. According to psychologists, once we take on a belief as our own, the tendency is to consciously and subconsciously look for positive reinforcement to support it, even when it is challenged.

For example, until Galileo came along, people believed that the world was flat, and even after it was proven otherwise, astronomers of the day fought to reinforce this failed assumption for years. Similarly, until recently, most people believed that conventional medical care alone could provide solutions to health-care problems, and thus participated in the rejection of practices outside of its realm. Notice that even with current evidence supporting natural/manual specialties, it is difficult to help the public reshape this belief.  However, the slowly emerging “idea” and “suggestion” that chiropractic is a valid health-care practice can be transformed, through proper instruction and education, into a “belief” in its benefits. This belief will result in the public’s ownership of chiropractic as an integral piece of the health-care system. 

2. Education creates enthusiasm – Depth of understanding and sense of ownership increases the likelihood of enthusiastic broadcasting within individual communities. It is our conclusive belief that it is not the satisfied patient who refers, but rather the enthusiastic one.

Results are a given. When patients pay the fee for treatment, they expects results. In other words, patients assume their needs will be satisfied. Although satisfaction in itself is not a motivator for referral, educated enthusiasm most definitely is.

The progression is simple and works every time: Educationgknowledgegunderstandinggcompliancegfulfilled expectationsgbeliefgenthusiasmgreferrals.

Who does patient education really benefit?

Education makes all our jobs easier. The greater the level of patient education, the less ongoing reinforcement is required to justify the treatment experience. This translates into patients who seamlessly become part of the clinic experience, understand the process, follow their prescribed treatment plans and achieve the best results. Logic dictates that they are happier and therefore bring a positive energy to the environment. This powerful intangible spreads to both staff and other patients.

Take a minute to reflect on the patients who come into your clinic. It is easy to pick out those who contribute to your day and, to nobody’s surprise, they are usually the ones you look forward to working with most. We will bet the farm on the fact that these are also the patients you have connected with, and educated, best.

The problem is that for many practitioners, there are too few real advocates. In the most successful of practices, advocates abound and so does the energy they bring to the clinic. You will never see a truly busy clinic where everyone is not having fun, doctors, staff and patients alike. This is a healing environment and what a practice is meant to be.

As you digest what we have presented so far, it should become clear that education really benefits both the patients and the providers. There is truly no downside here.

There is a definite “why and how” to patient education. We will explore in depth the how-to component of the equation in the second part of this article offered in the next edition of Canadian Chiropractor. We will leave you with this thought: “It all boils down to rapport.”

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 Committee.  

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.

Education of any sort has three purposes:
1 It creates a revised understanding of previously held belief. Most people who come into our clinics already have a preconceived idea as to what chiropractic is. Education serves to broaden the understanding by providing relevant information designed to reinforce the positive aspects of what we do and dispel the negative misconceptions. As you try to glean new patients’ levels of understanding, remember that the quality of the “ask” will very much determine how effective you will be at identifying their negative preconceptions and biases. Never forget that you cannot educate until you understand and break down established barriers. It just won’t work because you are going up against an already established belief system (see “Breaking It Down”). You must neutralize this first, to change the paradigm.
2  It provides new information on the broader benefits of chiropractic
that will allow that patient to understand the relevance of treatment
to his or her particular needs. As the clinical experience unfolds,
then, and the belief system is being cultivated, that person becomes
armed with the right tools to advocate in an effective and proactive
way when discussing the features and relevance of care with family and
3 It creates better questions. The science of human behaviour has proven
that the broader the education in any subject studied, the better the
person is equipped to ask more meaningful and provocative questions.
This in turn, further broadens their scope of understanding (in this
case of chiropractic) and its personal relevance to their needs and
those of family and friends. In short, the more one understands and the
more positive reinforcement one receives, the greater one’s enthusiasm
for the product/service become as well as the likelihood of that person
advocating on its behalf. Abe Lincoln once said, “Education creates
empowerment and this in turn creates the power of enthusiastic

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