EPISODE 439: The Patient Experience: The Chiropractor's Communication with Chris Chippendale DC

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry. 

Dr. Kevin Christie: All right. Excited to have Dr. Chris Chippendale on the podcast again, not, not your first time. Is it? Maybe your, your third time. Um, I was thinking this earlier. Yeah. Third or fourth maybe. Yeah, it is. [00:03:00] And so, uh, before we dive into some aspects of the patient experience today, uh, what's new in your world?

Chris Chippendale, DC: Yeah, so, um, I've been doing a lot of work with our team at the moment. We've expanded a little bit and, um, doing quite a bit of work with a couple of new graduates we're onboarding, so that's been really good fun getting them up to speed. Um, and also just increasing our network in our community. We've got a few other practitioners in the area.

Um, we're looking at actually doing some collaborative work with a couple of osteopaths and physiotherapists as well. So that's had quite a bit of my focus lately at the moment as well. In terms of my coaching, I've just wrapped up the, the cohort for this year for my certification program. Mm-hmm. Um, and then yeah, looking to enjoy a bit of time off in the summer and then dive back into September.

Dr. Kevin Christie: Yeah. There's, uh, I, September always seems like the beginning of the year for people. I was listening to that a couple years ago on a podcast. See, obviously everybody thinks January 1st is the beginning of the year, which on a calendar it is, but September really seems like the beginning, right?

Chris Chippendale, DC: Yeah. Yeah.

I think we've had the nice break and we're ready to, [00:04:00] to get back into it.

Dr. Kevin Christie: Yeah, absolutely. So it's, uh, I'm ready to hit that hard. We get, we're always slower in South Florida in the summer 'cause everybody's vacationing or snowbirds are gone. And so it's time for us to unwind a little bit and, and plan for the, the rush of the, of the season for us.

So it's exciting. But um, the other thing that you and I, uh, I want to make mention, you, you did. So for our mastermind group, we, we try to supplement our in-person meetings our four per year with three webinars, uh, from outside experts. And, uh, you know, last year we did it all on finances. That was in 2024 and this year we wanted to do it on, on leadership and you were kind enough to do part one of that for us and we was very well received.

So I want to thank you for that.

Chris Chippendale, DC: Oh my pleasure. It was good fun. It was a really good crowd of the Mastermind. It was, it was lovely to present them and get something we sort of chatted about online. It was nice to put a face to a name.

Dr. Kevin Christie: Yeah, it was great. And then, um, it kind of worked out because something that my, my wife and I had been planning for since [00:05:00] 2019 was that, and this was before we, uh, we were married, but before we had kids and we're like, you know, uh, we, we wanted to have a family.

I mean, we do now we got two young boys. Like when they're six and four. Um, so, which that'll be next year, there'll be six and four. We want to start doing summer trips where we actually immerse do immersion into a particular area or city. Mostly probably be in different places in Europe throughout the years, but it'll be also be in, in the states and, and such.

We, we probably won't do any, any places that are, uh, uh, really, uh, I, I like, like I've been to Cambodia, I've been to some places that are. Definitely a little bit outside of your comfort zone, right?

Chris Chippendale, DC: Yeah, yeah. Easier without kids.

Dr. Kevin Christie: Yeah. Easy without kids and by myself, with, with friends. So, uh, but it'll probably be places.

And we decided, uh, my wife got the first pick of the year and she, she picked the cots walls, which isn't too far from your area. Right. Chris?

Chris Chippendale, DC: Yeah. Yeah. It's literally just the [00:06:00] other side of London, so

Dr. Kevin Christie: I'm not

Chris Chippendale, DC: too far

Dr. Kevin Christie: at

Chris Chippendale, DC: all.

Dr. Kevin Christie: Yeah. So we decided to do that and when I said that, and then it was like, right, right after that we had the webinar that you did for us and I was like, well, we, maybe we'll just piggyback a kind of a masterclass each summer when I'm, when I'm over in Europe, and why not do it with you in the London area?

So we're gonna do that. Uh, June 20th, all around the patient experience you and I'll kind of co tackle that together and, and, and, uh, try to educate and have, have fun as well and limit that to about 25 to 30. So I'm excited to collaborate with you on that.

Chris Chippendale, DC: Yeah, definitely. I know we sort of chatted about stuff over the years is, hey, we should do something at some point.

And this, everything seemed to align and it should be really good fun. I'm really excited for it.

Dr. Kevin Christie: Yeah, it'll be great. And then we're gonna dive into a, a little bit of a surface level of that information today, but essentially the way we. You and I kind of talk about looking at the patient experiences, you know, you're gonna have clinical outcomes, right?

That's gonna be the, the table stakes of the whole thing. And you gotta get good clinical outcomes. Uh, and then there's gonna be [00:07:00] doctor communication. Uh, and that's not just communicating to the patient, but communicating to the team. And, and obviously the team communicating well also. Uh, and then the, and then there's the kind of the third and fourth bucket, which is service and hospitality.

And they're, they're different. And, uh, you know, you read certain books like, um, never Lose a Customer Again by Joey Coleman. That's gonna be on the hospitality side. Never. Uh, or the other one is set Setting the table. Uh, that was a, I think a book written 20 years ago. That's kind of on the hospitality side.

Uh, but then there's the service side and, um. You know, and we, we recently did a podcast and a, a coaching call on the friction free patient experience. And it's just, you know, like, are you verifying the insurance appropriately? Are you, uh, scheduling, you know, calling back patients when they call it just like the service.

It's not hospitality, but it's where it can also, uh, go wrong. And so we're gonna really dive into all aspects, aspects of that at our, at our masterclass next year. And, uh, but today I want to, I really want to dive into [00:08:00] that doctor. Uh, communication side of it and, and, and go from there. Does that sound good?

Yeah, definitely. Um, what, you know, like, let's, let's kind of look, set the context for the listener. I feel like the doctor communication, if it's really good and you'll, you'll explain what good is to us. Um, I think that's actually going to. Uh, be good for the clinical outcomes, right? Like inherently it's gonna have a, a doctor that communicates well, even if you took the same treatment.

Everything else is the same, but the communication was poor by one doctor and really good on the other. The clinical outcomes in my mind are gonna be different. So there's that part of the. The doc communication and there's just like the, the essentials, right? It's like, okay, what, what's the diagnosis?

What's the, um, treatment plan? What's the expectations? Why did the injury happen? And then obviously there's the communicating with the team and stuff. And so, um, you start where you want to start, but I want to kind of keep, [00:09:00] keep it within the guardrails of, of that.

Chris Chippendale, DC: Yeah, absolutely. So, I mean, you're completely right.

The, the communication will make or break it even if you can get great clinical outcomes, you've got great diagnostic skills, you know, you are really good at treating, you're really good with your hands, really good at creating an effective treatment plan. Uh, if you can't communicate that plan well to the patient, they don't know what they're getting into, they're already gonna feel a bit unsure and uncertain, and we know that that kills retention.

If they don't feel really confident in what you are doing and what's coming up, as soon as they're a little bit unsure, they'll have a tendency to. Stop back and go, ah, maybe, maybe I'll try something else. So obviously they don't get the benefit of all your great clinical skills if that communication isn't there and the communication isn't just you explaining well.

Yeah, most. In fact, pretty much all the questions I get from chiropractors when they reach out asking for advice, it's around the talking part. It's, how do I say this? How do I get them to understand that? And we forget that we have to do a really good job understanding the patient if we're actually gonna be able to explain it in a way that makes sense to [00:10:00] them, that taps into their particular goals and their desires.

You know, really understanding who we're talking to and how we need to adapt to our communication to that. But the other side is that if we're doing a good job with that communication, especially the understanding, patients will trust us so much more. And we know that trust as an independent variable has a big impact on outcomes.

Partly because they're more likely to follow your advice if they trust you. But also if they're coming in and they're working with someone who they trust, they feel this chiropractor's got their back, they're safer, they're gonna be more relaxed. In the treatment room, they're gonna have more hope.

They're not gonna feel alone. And many, especially chronic pain sufferers, they can end up feeling alone that, oh, this person couldn't help that person, you know, promised me they'd fix it and they didn't. Mm-hmm. And when you feel alone, even if it's metaphorically, the brain starts to act as if you are alone.

And from a human primate perspective, that means that you're in danger. So it's gonna kick off all the sympathetic risk responses, all the fight or flight stuff as well. So it's not just about, you know, being a good educator and being [00:11:00] nice and warm and welcoming. This will have physiological impacts on the patient as well.

So you are actually gonna create, uh, an environment internally for that patient that is far better set up for healing recovery mm-hmm. Than somebody who's a little bit unsure. And, you know, most patients come into us nervous, especially if they haven't seen a chiropractor before. They, they've seen the YouTube videos and the TikTok reels.

They don't quite know what we're gonna do. Or they have seen someone that really helped them, but now they're seeing someone new and you know, just because they know chiropractic works, that doesn't mean they feel totally relaxed seeing you as a new practitioner as well. So being able to build that trust.

Yes, the education part is really important and yes, getting patients empowered to act on our advice matters, but it's also just really good for. That healing environment for calming down the nervous system, for calming down muscle tension and meaning that they're actually in a better state to heal and independently, regardless of what you do, that will help create a better outcome.

So we, we separate these in the research and we separate them. We teach and talk about them, but in reality they, they're kind of, you know, they're not really [00:12:00] that individual. They all affect each other.

Dr. Kevin Christie: They do. They do. And a couple things you mentioned is, um. Retention kills outcomes. Right. And I know at least in the states, a lot of chiropractors on the evidence-based side have this kind of uneasy relationship with the word retention, uh, or whatever, you know, and it's because I think obviously they think it's like, oh, well you're gonna force 'em to come for a year straight.

Uh, and that's not the case. Right. I would say the evidence-based aspect of retention is them following their. Uh, their treatment plan that is based on, on evidence. And, uh, too many people, uh, do not follow it. Um, or maybe they, you know, they, they come in and they're seven outta 10 pain and they get down to like two outta 10 pain and they stop.

But you didn't really fix the function part of it. It comes right back. So that's a, that's a big issue there, and that's why the communication is gonna be. Um, so important. And so I think one of the things we always have to try to reframe with our evidence-based chiropractors is retention, or adherence is a [00:13:00] very, very, very important thing.

Um, because as a evidence-based chiropractor, you're, you're giving, you know, good treatment plans, you're giving evidence-based treatment plans. You're not, we're not talking about retaining them, uh, for something that is, uh, unreasonable.

Chris Chippendale, DC: Yeah, absolutely. I know that that word retention does come with baggage for, I mean, it's a little bit like maintenance care.

Some of us will attach some baggage for that, but adherence is a really good word. It's okay. You've given them a plan. You obviously believe this plan is the best that you know, chance they have to get the improvement there. Why wouldn't you want to help 'em Stick with the plan. Now, I think part of where that comes from is many of us, we, we see it as our job to persuade the patient.

You know, we feel like we have to kind of educate, but sort of with an agenda to persuade them to stick with the plan. And, you know, we're not trying to manipulate patients or do anything unethical or, you know. Sleazy sales tactics or anything like that. But we think that our, particularly our reported findings, but our pe patient education, the idea of it is to make sure the patient does what we think is best for them.

And when you're in that state of trying to persuade or [00:14:00] convince patients, there's always that little agenda there. They, they will pick up on that. They can sense that, oh, you are asking this question for this reason. You know, you are, you're saying it this way. I, I feel like you want something for me that I maybe don't want.

Yeah. Um, I literally had an email yesterday morning, come from a, a student who someone had passed on some of my material on, um, on particular communication strategies from motivational interviewing, and he said, look, this stuff's great, and I can see how it could really help. But I was on a sales call with a practice building company recently and he was using this stuff and it just laid me feeling icky.

He's like, how do you do it without it feeling icky? And I just said, well, it's, you knew he had an agenda. You could tell he was trying to do it to convince you of something. When I do it with a patient, I'm not trying to persuade anyone of anything. I never try to convince a patient what to do anymore. My job is to find out more about them, get curious and explore.

And when I understand what it is they really want and I understand enough clinically about what's going on and what we need to do, then I'm just gonna, I'm offer solutions, but offer them in a way that's inspiring to a [00:15:00] patient where they feel empowered, not, oh, I've been persuaded. I guess logically it makes sense to do that.

And the nice thing with that, I find it so much more effective than trying to educate a patient to do a specific thing. Mm-hmm. Um, patients much prefer, and I much prefer it as a practitioner as well, it's so much less pressure on me. Um, and I think that's where that, you know, that kind of idea of retention and that sort of thing, we, we trip over our own.

You know, trip over own feet a little bit because we think we're trying to make a patient do something or convince 'em to, whereas to me, you know, good retention comes from the fact that I'm offering advice that makes sense to them, that they understand that it's clearly gonna help 'em get where they want to be.

And I'm doing it in a way where I'm, I don't have an agenda, you know, they're free to turn around and go, thanks Chris. I've heard that it's actually not for me. They know I'm not gonna go chase them out the door and go, wait, wait, come back. Let me explain again. Um, and it's, it's a much better place for everybody and more effective.

Dr. Kevin Christie: Yeah, absolutely. And I think it's, you know, trying to be compelling versus convincing is, is, is a key, uh, aspect of this whole thing with your communication. And I know like a lot [00:16:00] of younger docs, I wanna actually speak to the younger docs a little bit right now. Give them some, um, give them some future excitement or just the confidence that they'll get better.

Uh, you know, the younger docs, they overexplain, I mean, even some seasoned docs will, but you know, they're over. Explaining and over, uh, jargony and scientific, that's, that's a problem. Um, I do think. You know, you mentioned patients having confidence in the provider and the doctor. Uh, yeah. Sometimes when you're, you know, on the younger side, that inherently is going, kind of ding you a little bit on that.

Um, but you know, I feel like that's why doctors tend to do well. A little bit later, like it's shifted a bit versus if you're like a tech entrepreneur, you could be 26 and everybody's like, yeah, he is probably just some tech savant, right? But with a doctor, they're kind of thinking like, yeah, there's like a sweet spot of wisdom and uh, it so it gets better and your communication gets better and your [00:17:00] confident gets better.

You just, um, you gotta understand, I think the big thing, you gotta understand. Is, you can get better at this, right? Mm-hmm. It's not a, it's not a fact that you are either born, you know, born with the charisma to do it, and if you weren't, you don't have it and you never can get better. Is there gonna be some people that are better than others?

Yeah, sure. But if you can provide real, like really good clinical. Um, outcomes, trustworthiness, and, and then keep on getting better at the communication, uh, it you will improve. Right. So what are some of your thoughts on, just from the younger providers version that you see? Yeah, absolutely.

Chris Chippendale, DC: I mean, first I completely agree.

It is, it is definitely something no matter where you're at, you can improve. I mean, one of our associates, um, years ago was patients loved him and had real confidence in him. And, you know, he, he had a very young face. He came straight from school, straight from university. He was in his early twenties. He looked a fair bit younger.

Um, you know, and, and that was something that, you know, the old patient might comment on it like, you know, he looks really young, [00:18:00] but he really knows what he's doing. And he had, he had a good element of natural ability, but also we did a lot of work coaching on that even before he joined the practice. I spent a few months going through a lot of this content with him and this material.

And it meant that when he came out, yeah, he was aware. Patients would look at him and go, oh. How long have you been doing this? And he would get that question, but he knew how to respond and he knew how to communicate and connect. That left them feeling really confident in him. Um, so even in his first few months when he was still finding his feet, he was getting really good results with patients.

And a lot of patients, you know, we'd get that feedback of, oh, he looks young, but they would always follow up with, but yeah, I really trust him. He really knows what he's doing. So you can definitely improve that. And the metaphor I often use with it is, it's a bit like singing. My wife is an amazing singer.

She only started having lessons in the last couple of years, but she, she can fill a karaoke for like that. Like everyone gets up and it's churning when she goes. I would clear the floor instantly if I tried. I'm the complete opposite end of the spectrum now. We could both get better, you know, I could certainly get to a point where I'd be okay, [00:19:00] feeling like I could do, I'm never gonna be professional, but I could get to a point good enough where I wouldn't put people off and, you know.

I could actually do an all right job with that practice. She's just started taking lessons in the last couple of years to take her up the next level. So no matter where you are, you can always improve. Um. And it does. You'll improve with experience, but the experience only gets you better if it's deliberate practice.

This idea that you just get better over time. If I'm being totally honest, there's a lot of more experienced practitioners out there who are kind of coasting on the fact that no, they've got a couple of gray hairs and they don't look so young, and they've been doing it so long. They've been able to build up a practice for themselves and they think, oh, that means I'm a good communicator.

And then when you actually chat to them and they actually go, and if you get 'em to look at the stats and they often don't want to because they're worried, what they'll find, you realize that actually they're doing a good enough job. It's built over time, but there's a lot of things that they could still do to improve.

There's a lot of other things that maybe they just kind of started to coast on. I'm good enough now to feel okay with it. So yes, it's [00:20:00] something that I think new practitioners, you know, they've got a bit more work to do and there's a bit more to do that and it will get better over time. But you really fast track that if you do deliberate.

Practice. You have to act, actually put in specific skills, practice them, and then pay attention to the feedback. You know, the people who can coast, there's this kind of myth that, oh, if you take care of your patients, you know, they'll take care of you and just do a good job and it'll be all right. That's generally promoted by practitioners who are naturally pretty good communicators anyway.

Mm-hmm. So they got away with not having to practice, but you give that advice to somebody who needs a bit of work and they can end up trapped in a, you know, in a practice that is always frustrating, but it's, it's never painful enough that they quit. And you, I'm sure you've had communication with a lot practitioners like this as well, where they're just kind of tolerating their practice.

It's like it's, uh, they're unhappy but not so unhappy that they make a drastic change, and then they just kind of coast on that level as well. So, you know, I, I wouldn't say experience on its own is gonna necessarily happen. It's, it's one part of it and it definitely helps, but it is not the be all and end all.[00:21:00]

Dr. Kevin Christie: Yeah, a lot of practices become aimless. And I think something that happens that I've fallen into this with, um, you know, having experience and communicating is you get lazy with it sometimes. And, and it's that, um, it's kinda that curse of knowledge, uh, where you just, you know, you kind of just figure they get, they understand or know, or, you know, sometimes you.

You feel like you've said the same thing over and over again for 20 years, and you gotta realize, like that person you're saying it to that day is the first time they're hearing it. And so, uh, you can't just poo poo it for sure. Um, but yeah, I think as a, as you get experienced, you gotta be careful with being lazy in your communication.

Chris Chippendale, DC: Yeah, definitely. And it's, and I've had that, like I've, I've had lazy stages in the past. I can definitely think of times where I felt like. I was kind of going through the motions and yeah, we're saying the same thing, particularly when I felt that it was my job to persuade a patient and I'd go, well. I've got more reporter findings.

I know how to say it. They'll either do it or they won't. And I was like, ah, we'll see some of them. Do enough of them do that? I'm busy. That's fine. Um, when I started getting more curious and look at a [00:22:00] much more patient centered approach, though, that curiosity made it a lot more fun because I now I see a new patient and I go.

Ooh, let's see what's gonna happen. Like, I dunno what I'm gonna find. We might have a really interesting conversation. It might go in a really different place. You know, it's more than just, ah, I reckon I can find the pain generator. I have no idea what kind of person's gonna bring that, that tissue and that spine into me as well.

So yeah, I think certainly that curiosity and that ability to really connect to that deeper level. Like I enjoy practice more now than I ever have. In the rest of my career, it's, it brings a lot more fulfillment to me. 'cause every day is different. Um, and yeah, you can definitely get through that, that point where it feels a bit routine, but if you can break through the other side, it actually gets even more fun.

Dr. Kevin Christie: Yeah, no, it makes sense for sure. Now, what would be, uh, just, you know, some of your tips for the doctor communicating to the patient, then we'll go doctor to the team.

Chris Chippendale, DC: So doctor, patient and I kind of touched on a little earlier, the number one thing is you've gotta be a really good listener, and that is something that you can choose to do.

That is [00:23:00] something that you can, you know, set your attention to. And the key thing for me is listening to understand, not listening to respond. Um mm-hmm. We've all had experiences where other people have clearly been listening to respond. Like, you're at a dinner party, you're at a night out, and there's that person who's the classic story topper.

It doesn't matter what anyone says, they just can't wait to jump in with their story. Yeah, it's like your story, but it's better for them 'cause they're in it and you know, that kind of, I'm not really listing, I don't care what you're saying. I'm just waiting until you say something that allows me to jump in.

You know, that's the kind of extreme version. But I think a lot of us as practitioners, we get trained to do this 'cause we, we look at our O-P-Q-R-S-T or socr, you know, whatever. Clinical history form you use, and we are listening to the patient tell us their story, tell us what's brought them there. And we are doing it with this agenda of, I've gotta fill in these boxes and get this specific info.

Mm-hmm. So we're really listening to get some answers and kind of respond with, okay. Tell me about what makes it worse. Tell me about what makes it better. What else have you tried? And we need that info. I'm not against those questions, but if we go into it with that [00:24:00] intention there, it can start to feel routine to the patient and they feel that, you know, we're not really listening in the same level.

If you are listening to understand and really just find out, first of all, like. What journey has this person been through? You know what? What's going on with them? How do they feel about what's going on? What are they really worried about? What are they struggling with? What are some of the things they've tried that have left them feeling frustrated or anxious?

Mm-hmm. If I can show that I've understood that, and just briefly and a very brief summary, you can do this. You just reflect back what you've heard. Then straight away they're going, wow, this doctor really listens, and that is the number one thing that patients look for. You survey members of the public and say, what do you want in a doctor?

A doctor who listens is always, every survey I've seen the number one thing. So we need to do that in a way that shows we listen to them, not just let me put on my chiro processor brain and, and analyze where I think the pain generator is. So being able to do that before you actually try and communicate back, I think is really, really key there.

Dr. Kevin Christie: And in, um. Motivational interviewing, if you had to just describe it briefly, what is [00:25:00] that? Uh, and then what does it do in that regard?

Chris Chippendale, DC: So motivational interviewing is, it's an approach that actually came out of, um, came outta psychotherapy working with, um, alcoholics originally. But they've adapted it and expanded it, and it's a very big part of healthcare now as well.

It's just as relevant for chiropractors, really. It's about helping to empower patients to make changes in their behavior. So from a healthcare point of view, that could be. Just getting them to stretch occasionally. It could be getting them to maybe move a little bit more, maybe, you know, take on some exercise, maybe work on their diet, whatever it might be.

You know, we all have patients who come to us and we can go, well, I can see the problem, you know, I can fix this thing and I can adjust that, and I can loosen that. But the real problem is their behavior is leading them back into the same situation. Mm-hmm. And you know, we've all had countless frustrating experiences where you can tell the patient what to do, doesn't mean they're going to do it.

So motivational interviewing is about really understanding what's going on with this person. So working out what stage of change are they in? Because you look at the research, there's [00:26:00] actually five different stages of change and we often try to assume that they're actually towards the end and try to push them along and done badly.

That can actually reinforce reasons to stay the same. Um, and I can look back to my earlier career and the way I interacted with patients. I definitely pushed some patients in the opposite direction without meaning to, you know, giving advice, but giving it at the wrong time. Um, we're trying to use logic without actually checking if that's what they needed.

So you can actually make it harder for patients to get better if you don't do that. And motivational interviewing is the, what, it's the best tool I've found for helping to empower patients and, and just nudge them along that process. And sometimes that means being patient. Sometimes it means you can't get 'em to change everything, you know, in the next few.

I mean, you think about. Well, you listeners might have had this before where they've gone, you know what? I just need to overhaul my health and I'm just gonna, I'm gonna get back to the gym. I'm gonna eat properly. I'm gonna cut out the alcohol, I'm gonna cut that. You know, all these sorts of things. People maybe do that two or three times in their life.

Dr. Kevin Christie: Mm-hmm.

Chris Chippendale, DC: Like where they go, I'm really gonna overhaul everything. Yeah. As chiropractors, we sometimes try to encourage our patients to do that now, [00:27:00] and if not, they're not at that point in time when they're ready for that. And odds C are, they usually aren't, you can end up making it harder for them to do anything.

Mm-hmm. So it's really about doing that and helping patients to understand their own reasons to change, and also their own reasons why they maybe don't wanna change. They're, they're usually in two minds about it. If they're not in two minds about it, they're already doing it. Mm-hmm. So, helping to see what's on either side of these kind of scales and helping to, you know, reinforce the reasons to change and help the reasons to stay the same, become a little bit less powerful.

Dr. Kevin Christie: I love it. And then, um, you could punt this if you, if you want, but because I'm not too familiar with it either. But have you heard of. NLP or neurolinguistic programming? Yeah,

Chris Chippendale, DC: so I'm, I'm familiar with it. I'm familiar with the overall concepts. I haven't really studied it that much. Um, the reason being, it's it's often used in, in the context of a little bit more persuasion.

Correct. So it's kind of, it's sort of like the art of persuasion, that sort of thing, which to me. Usually means I'm coming to the patient interaction with that agenda. Yeah. And it's, you know, it'd be a well-meaning agenda. I, I want the best for [00:28:00] the patient, but I'm trying to use my language to nudge them a certain way that I've already decided is right for them.

Motivational interviewing is much more patient centered to me. Mm-hmm. The underlying ethos is work out. Where do they want to go and help them see what they need to do to get there. Now, I'm not saying anyone who uses NLP isn't patient centered and it's automatically unethical. Um, you can certainly use it in service of that, but the, the kind of foundations of it and the background and context didn't gel with me quite the same ways.

Motivations for you, I'm, I'm sure there are overlap. So I know people who've done NLP courses who've come and done my courses and said, oh yeah, there's, there's a thing a bit like this in LLP where they talk about that and a lot of the skills about kind of rebuilt building rapport, which MI does a really good job with, come into NLP as well.

So there'll definitely be some overlap there as well. Just to me, motivation interviewing, it felt that there was more kind of respect for the patient's autonomy and it's more about supporting and guiding them versus trying to persuade and push them a certain way.

Dr. Kevin Christie: Yeah, and that's why I brought it up.

'cause you know, it can get a bad rep, the NLP stuff [00:29:00] and, uh, and I, I don't have a lot of experience in it. I remember. I remember being on the other end of someone that was NL ping me, uh, and it didn't feel great. And so, yeah, I, I've

Chris Chippendale, DC: had both, I've had people motivationally interviewing me and it's never bothered me.

Yeah. Like, well, even if I can see what they're doing, I'm like, oh, you're doing that thing well, you're trying to help me work something out. Yeah. Like, I can straight away spot, you're trying to help me. Whereas Yeah, the NLP. Hmm. Like, you know, the kind of sales calls you might get, stuff like that where it's sometimes use, I'm like, uh, I see what you're doing.

And I, you just, you feel there's a disconnect between the words you're saying and the way you're saying it. And I feel like there's, there's some difference between what you're trying to present to me and what's going on in your brain. Whereas with mi it's nice. I can get rid of that mask totally. And just be myself and not have to worry about how I'm seen and that sort of thing.

I'm not totally anti It could, it's how you use it.

Dr. Kevin Christie: Definitely. Oh, of course, for sure. That was one thing I got outta your webinar you did for us was. That differentiation of it. And, um, and I, and I appreciated that. Um, I wanted to go, I'm gonna throw [00:30:00] something out there. Uh, I recently released a podcast, just the audio of a lesson that Bobby maybe did for our chiropractic Success Academy, and it's fascinating his.

Take on. Um, you know, as doctors, we, we, we know we have difficult patients, right? Uh, and challenging patients and sometimes they're, you know, I've heard it called the 10 percenters or like 10% of your patient base just gonna be challenging. But he actually came at it from the angle of how much. How much are the chiropractors actually expecting their patients to be like them or to be, you know, perfectly emotionally intelligent and friendly, and the type of person you'd like to have a beer with?

Right? It's almost like, uh, too many doctors are expecting their patients to be. Have a pint worthy i'll, I'll give you the UK version of having a beer worthy when that's just [00:31:00] not gonna be the case. And you're gonna have a potpourri of types of people and they're not necessarily. Bad people, challenging people, difficult people, they're just different.

Or you know, or maybe you have a, a, a narrow margin of what you like in people. Uh, what, what are some of your thoughts on that? I found it just very fascinating what Bobby was talking about. I know you haven't listened to it yet. Because it hasn't come out. No, I

Chris Chippendale, DC: think Bobby and I have had conversations on this theme before as well, so yeah, definitely.

I think this is, I kind of differentiate between what I call genuine patient-centered care with patient-centered light, and in my experience, most practitioners who describe themselves as patient-centered are patient-centered light. They think that, okay, well, you know, being patient centered, it's about not being money centered, not being doctor centered, not selling big plans, not doing the, they're like, well, I'm, I don't do the bad stuff and that makes me good.

It's like, no, if you don't do the bad stuff, that makes you not bad. Yeah. But it, this is, it's not a binary thing. It's, it's a spectrum. [00:32:00] And going to that genuinely patient centered place, it, it does require you to understand that yeah, people are different to you. They will have different priorities. They will have different values.

You know, we had a coaching morning with all our, all our dcs this morning in the clinic. And you know, this topic came up of a patient who, you know, he wanted to get his neck sorted 'cause he was aware that his lifestyle wasn't great. And when he would go out and drink all weekend, his neck would get bad.

And he said, well I just, I really wanna get his neck sorted so I can go out and drink on the weekend and not worry about my neck on Monday. And you know, this newer chiropractor saying like, yeah, but like, it's tough 'cause it's like. You know, he should like, that's just gonna flare things up. And we were chatting about it.

I said, look, if his value, if he genuinely, that's what, that's what he's after. I said, as long as you've given him the advice and you let him know what to expect, and he knows that, you know what, if you do go back and you start drinking 15 pints in the weekend again. Mm-hmm. It's a good chance this is gonna come back like you've done your job.

And it's, it's a struggle, I think, not just for new chiropractors, experienced ones as well, because we assume that what we feel is best for the patient is what they feel is best. Mm-hmm. [00:33:00] And if they don't agree, if they have different values or different priorities, we start to label them as difficult patients.

Dr. Kevin Christie: Yeah.

Chris Chippendale, DC: And then the problem is we start to respond to them like they're difficult. Mm-hmm. As soon as you say, ah, this is a difficult patient, yeah. You will not engage with 'em in the same way. You, you'll start to try to create an agenda in your head. 'cause you'll try to go, I need to get 'em to see this thing.

Or you'll do the opposite. You'll pull back and disengage and go, well, you know, I'll do what I can, but they don't really want to help themself. And as soon as you're saying that to me, you, you can't be patient centered and do that. And, and I get it. And I, I don't judge any practitioners for that. I, I, there's a couple of patients I can think of right now who challenge me in this regard where I see 'em come up and it's like, okay, I need to.

Just remember to, you know, check in with them and see if they're happy with care and, and not try to persuade them. 'cause they're doing a couple of things that are making me think, you know, I really want to just get you to understand X, Y, Z. So it's not about being a saint and being perfect all the time, but it's, it's recognizing that and recognizing that different people want different things.

Mm-hmm. And that's okay. [00:34:00] Because if you, if you can't accept that, I would argue you can't be truly patient centered. 'cause you can't put their goals first. You can't really engage in shared decision making. 'cause you'd always take on a slightly paternalistic, slightly patronizing, I know what's best role.

Um, and then you get frustrated with those 10 percenters who don't do it. You know, I heard a sta, I heard someone recently talk about, you know, marriages don't break down because there aren't enough good times they break down. 'cause the bad times are so bad people go, it's not worth it. And I think a lot of chiropractors break down because those 10 percenters frustrate them and stress them so much.

They fall out of love no matter what the 90% who get better results to. And I think most of us think about how do we help the good ones do better. But if you can change that perspective and you can look at it as, you know, difficult situations. Sure. I have difficult conversations with patients, but if I can avoid that labeling that I find, they just don't drag me down the same way.

I can stay more present, I can stay more patient centered, and I might get out and go, okay, good. Like, you know, Bob, my maintenance patient always comes in and we have a laugh. He's a neck, [00:35:00] a bit of a palate cleanser. Like, that's fine. Um, but it's just about, yeah, trying not to fall into that trap of feeling like you need to change them because again, that once that labeling kicks in, it's really hard not to do anymore.

Dr. Kevin Christie: Love it. Great, great answer. And I think gr you know, sage advice for sure. So let's, uh, segue to our, our last part of this, um, doctor communication and that is with the team. What are some of your insights, uh, with the doctor communi communicating with the team effectively? It's always, it's always bad when you stutter on the word communicating

Chris Chippendale, DC: until you pointed out I hadn't noticed.

So yeah, you got away with that one. Um, yeah, so there's two main ways I think about this. You've got the internal communication, which is, you know, the way that you might communicate with your team behind the scenes. Mm-hmm. And that can be things like training, for example, a really big thing, making sure that.

You have expectations for them and they know what they are, and they feel like they know how to achieve them. Not just like a drive by here, do this better, but actually finding out what they might need help with and [00:36:00] being there for them to help them improve. Um, but that can also be just things like, you know, if you say you're gonna send so-and-so some stretches, or you say you're gonna send an email to this practitioner, making sure that's done.

You know, I, I don't. Send emails out to gps myself, but I will draft it and I'll send it to my team. They will letterhead it and check through it and spell check it 'cause Lord knows I need spell checking. They'll make sure it looks professional and they'll send it out. But if, if that doesn't happen that well, suddenly patients call up going, ah.

GP didn't get the letter and Oh, was that me or was that the front desk? You know, so you've gotta have that clear communication there. But also, you know, making sure the front desk knows how to communicate in the way that you want them to as well. That matches your own practice. I've heard from many, many practitioners, you know, who tell me that, oh, things are going great, but.

They're working on their communication and they're doing a really good job, but the patients don't seem to follow through. And then, you know, if I come into their practice or I chat to 'em about their team, I realize that their team are undermining them. They're sabotaging them, not deliberately, but they just haven't been trained in, [00:37:00] in how to actually encourage patients to follow.

So like a really obvious example I recommend to practitioners that. They encourage patients to book a few visits ahead of the start, if you know they're gonna need to come in this many times a week for this many weeks at the start. You know, if they pre-book those, the patient comes in, they know there's a plan, the plan's in place, they're not having to recommit to care every time they come in.

But many practitioners will do that and they'll recommend it, and they go, well, patients don't do it. And then you go, well, how are your front? How are your front desk addressing that? And if the front desk don't know, that's what you expect. And they don't know how to do that. I've heard from practitioners who found out it's because the CA was going, ah, yeah.

Well just let's put you in for next week. We can do the recs next time. Yep. And straight away the patient's not gonna push on that. They're gonna, oh, that's how we do things here. So making sure they know how to, how to do that in that way. And again, making sure that they're trained. 'cause about the research shows between about 50 and 60% of patients rate their interactions with the surrounding team as a really important part of their experience.

And I know what my first practice when [00:38:00] I started out. Um, I know for a fact we lost patients because of the front desk. There was a particular person on the front desk. Um, one person came, they came in a few years later and they said, oh, I've wanted to come back. But I couldn't while that dragon lady was there.

That's literally the like, and I knew what they meant, you know, very good, great administrative skills, but could not take criticism and could not be wrong. And if something, if there's a miscommunication with a patient, they left to explaining why it wasn't their fault. And, and that can, you know, we lost patients because of that.

Yeah, so it's what I'm very picky with who I hire, not just for our associates, but on the front desk as well. Mm-hmm. And we make sure they have that training because you can completely, you can do the best job, but it can be completely blown by one, you know, maybe not even negative, but just unfortunate or unhelpful interaction with the front desk as well.

Um, so that's, to me, that's a key thing. And I've started doing more training for CAS on this as well because a lot of them I find as well, they really love it. Mm-hmm. When someone actually shows them, here's how to really connect with patients and here's a way that's gonna help your practitioner [00:39:00] to actually, you know, get a better result with 'em.

That. The vast majority are like great. They're really eager, they're really keen. Um, and I think a lot of clinic owners don't necessarily think about this or don't think about it's worth investing in. And when they do, they often see that it can really, you know, light a light a spark in the cas as well.

You know, most of them really love and if, if they really don't and they really push back against it, that suggests you may have a hiring issue. But I find the vast majority of 'em, they can be fixed with just a little bit of training and a bit of encouragement, enthusiasm.

Dr. Kevin Christie: Yeah, obviously I think not enough chiropractors are training their, their staff and having meetings and trainings and, and expectations of that.

Uh, they, you know, the, the team has to be an advocate for the patient and for the doctor and what they're recommending. And so, uh, and we don't

Chris Chippendale, DC: see it as well, we're so focused on what happens in the room. We are often not there when these, you know, I've had times where I've realized, oh, so when you do that, you say it that way.

They're like, yeah. I was like, oh, that's been going on for a while. No, no, we need, we need to fix that. But I wasn't there to observe it. That doesn't mean you have to sit on the front desk all the time, but finding some way of, you know, [00:40:00] just getting that feedback, how it's going. I think it's really, really key.

'cause I went to a lot of chiropractors who, when they found this out, went, oh man, I should have fixed that a long time ago. They were frankly, a little horrified about what might have been going on when they weren't there.

Dr. Kevin Christie: Yeah. You know, I wrote a, an article about the patient. Uh, adherence triangle, communication triangle.

And it was basically, you know, you gotta have doctor to patient communication. You gotta have doctor to front desk or team communication, and then team to patient communication. And oftentimes there's a, a, a side of that triangle that is broken and, and it really needs to be fixed. And, uh, and yeah, sometimes it's subconscious.

Like even, um, the Scheduling Institute talks about new patients, like they're big on bonusing the front desk in a particular way. Based on new patient numbers because, uh, various reasons, but one of the things they talked about, they came and spoke to our mastermind, uh, back in 2023, I believe it was. And, um, they said like, you'd be shocked, but front desk patients don't necessarily [00:41:00] like to deal with, uh, new patients.

Uh, because it's added work and if there's, you know, there's more intake and there's verifying insurance and there's like, there's all this work to new patients that a regular patient doesn't have. And so subconsciously they may thwart it a little bit, uh, versus if you bonus them on front desk. I'm not gonna dive into the bonus situation today.

Um, but if they get some kind of bonus on new patients, they will do everything under the sun to try to get the new patient to, to get in. So

Chris Chippendale, DC: yeah, definitely. We, we started working with, um, a remote reception team, uh, recently balanced VA, who we have in-house reception, but they do out of hours and they do, if, like, if the phone isn't picked up quick enough, it'll divert to them.

Um, and I was chatting to the owner and, uh, he said, look, you know. He worked out quite quickly. I have to, I have to bonus my team. Every time they book in a new patient, they earn an extra bonus 'cause it is, it's extra work and it's extra steps and you know, by doing that they're then great and they really look forward to doing a good job.

[00:42:00] So, you know, I dunno if ev, we don't do that in the clinical cells, but whether it's some, whether it's a financial bonus or it's more training, I think that's something to watch out for. Definitely. 'cause yeah, if someone calls up as a new patient, I'm sure quite a few on the front desk I go. Okay, well here goes the next 10 minutes and there's gonna be a bunch of questions and maybe there's other patients waiting in reception and you they, they're feeling time pressured as well.

So I think it's a good idea to find out if that's going on and find out what you can do to help with it as well.

Dr. Kevin Christie: Awesome. Chris, this was great. Um, I'm excited about next year, June 20th. Uh, just save the date now if you're listening. Uh, but we actually will have a re registration page up there. You can, you can sign up.

We are gonna limit it, so make sure you do, uh, save that spot. But, uh, how else can they find what you're doing, Chris?

Chris Chippendale, DC: Uh, so best ways to find me, uh, my website, patient centered.co uk or.co.uk for American audience there, um, I, as far as I'm aware, I'm the only Chris Chippendale and Chiropractic. If you're on Facebook, I'm, I'm generally around on there, you can message me, um, or my email [00:43:00] address is just.

chris@patientcentered.co uk. Um, well probably worth putting that in the show notes 'cause we spell it differently here, which if I'd known at the time when I set up my website, I probably would've picked a different name. But there we, um, but yeah, just email or find me on Facebook or find me on my website.

Always happy to chat and if, you know, people want a bit of advice or some signposting where to go, more than happy to help. Awesome. Sounds good. Thank you.