44 Total Immersion: Speaking a Language Your Patients Can Understand
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Dynamic Chiropractic – February 1, 2013, Vol. 31, Issue 03

Total Immersion: Speaking a Language Your Patients Can Understand

By K. Jeffrey Miller, DC, MBA

In recent years, software systems have emerged with a fresh twist on learning new languages. The twist is referred to as "total immersion," and it places emphasis on hearing and speaking a language.

This is aided by viewing pictures representative of the items and activities the words describe. Reading and writing the language are often included, but they are secondary. This is contrary to the methods American public schools have used for years, where reading and writing a language is the primary method of instruction.

Hearing, seeing and speaking are said to be the most important components in language development. The programs emphasize these components and cite the development of language in children as proof of their methods. Small children learn to speak their native tongue by hearing, seeing and speaking long before they can read or write.

From using one of the programs recently, I can attest that total immersion is effective. I am learning to speak another language much quicker than I thought possible. And interestingly, the process reminds me of my initial months at chiropractic college. Students must learn a new language when they enter chiropractic college. They are immediately inundated with terms related to human science, medicine and chiropractic. Thankfully, the learning curve isn't too sharp and everyone is out of it quickly.

The reason the curve ends quickly is the same reason the new language programs are effective: "total immersion." Once you enter chiropractic college, everything you hear, see, read, write and talk about is related to human science, medicine and chiropractic. Students quickly become multilingual, so to speak. Being multilingual is fine as long as the people you need to communicate with speak the same languages you do. If they don't, it can be a problem.

Case in point: Upon graduation the new chiropractor leaves the world of total immersion in health and chiropractic language (doctor talk) and enters a world (practice) where the majority of people (patients) don't understand their language. Communication becomes an immediate problem.

Like my recent experience with language software, I can attest to the communication problem encountered by new doctors. My initial communication skills in practice were poor because I spoke to my patients in "doctor." My patients did not understand me, which was evident in the blank stares I received during our conversations.

I knew I was not communicating well, but once you are on your own, there isn't a professor or experienced clinician down the hall to help. Those of you with practice experience know that the chiropractor down the street isn't there to help, either.

This problem took some time to resolve and the resolution occurred primarily by accident. A middle-aged woman with a lower back problem entered my office one day for care. After her examination and report of findings, she accepted care. However, she told me up front she might have to stop care the minute her funds were exhausted. She did not have insurance coverage and her financial situation was not good.

A few visits into her plan of care, I entered the treatment room and noticed she was holding a large, hardback book. The book was a self-help book for people with lower back problems, written by an exercise guru who had several exercise books on the market at that time. She showed the book to me and related that she had bought it in a drug store over the weekend, hoping it could help her. She thought it might eliminate the need to receive some of the care I'd recommended. This led to a request from her that I read the book and tell her which parts of it to follow.

My initial thought was, Great! This was followed by, What could this book tell me I don't already know? I'm a doctor. That's much better than an exercise guru with no real credentials. I'll just be wasting my time; and if she thinks there is the slightest chance the book will help her, she will never follow her treatment plan.

She was really a sweet lady, so I sat down, took a quick look at the book and said, "Sure. I'll read through it and see if there is something that will help you." It was hard to say, but it was the right thing to say. This wasn't about me. It was about her and I was her doctor. I had promised to help when I accepted her as a patient.

I took the book home that night and, despite being annoyed, read it. It was one of the best things I ever did. Several sections of the book backed up recommendations I had made for the patient; and they were written in a much clearer manner than I had explained them. I actually learned something.

During the patient's next visit, I went over the sections I thought would help. I marked and emphasized the points that backed up her treatment plan. She was very pleased. She appreciated me taking the time to read the book and felt she had made a good investment in the book. Ultimately it fostered a better understanding of her treatment plan.

The patient's understanding of their treatment plan is very important. The doctor's ability to obtain informed consent from the patient for treatment is directly related to their ability to communicate the treatment plan clearly. This is a key issue in today's environment of excessive litigation. A doctor is less likely to be sued if they are a good communicator and their patients have a clear picture of their diagnosis, treatment and prognosis.

I was happy my patient was pleased and that I had not let my initial arrogance ruin our doctor-patient relationship. This started a trend for me. I began to buy self-help books on back pain, headaches, etc. They helped a great deal with translating complex health care language to a language patients understood. My reports of findings improved, as did my public speaking skills. I purchased self-help books written by medical doctors, physical therapists, osteopaths, massage therapists, chiropractors, patients, other exercise gurus and consumer organizations.

I read them all and my efforts were rewarded. Not only did my patient communications improve, but the books also helped with the most successful project of my practice. I had been trying to work my way into local factories as a company doctor. It was proving difficult and I had been shut down at every angle. I kept trying and eventually developed an opportunity to teach a back-safety class for a large manufacturer of saw blades. The books helped me organize my information for the classes. They helped me explain important information I needed to convey, and to defend pointed questions and skepticism.

Many of the books written by non-chiropractic authors contained multiple criticisms of chiropractic. As I read the criticisms, I thought about what I would say if faced with these slights personally. I worked through answers for questions / statements such as, "Why do chiropractors keep you coming back forever?" and "Chiropractors aren't real doctors." I practiced responding and was able to address the issues whenever they arose. I became one of the company's doctors.

This lesson was also valuable when I began developing a relationship with a second company. The company's safety officer was married to a medical doctor who did not like chiropractors. Because of this, he argued against hiring me. I was hired despite his efforts and he became determined to make me look bad and get rid of me.

For months I encountered criticisms and slanders that originated with the safety officer's wife. Being a pathologist for the Red Cross, she was obviously an expert on occupational safety, ergonomics and most especially, the ills of chiropractic. Fortunately, I had heard (read) it all and was more than prepared. The safety officer left the company long before I did.

The events described here all occurred early in my practice, more than 20 years ago now. Still, I think stumbling upon the self-help books through my patient was one of the great lessons I learned in practice. It helped make my practice a success. Young or old, I think every doctor can learn something from these texts. They make it easy for any doctor to add "patient" as a spoken language.

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