Show Don't Tell 4 Maximise their Dopamine!
A short instructional talk by clinician Chris Chippendale advising practitioners (likely chiropractors) to use a test–treat–retest workflow: after assessing and treating an identified joint/area, immediately sit the patient up and recheck motion (motion palpation) after each individual adjustment. The speaker argues this proves progress to patients (multiple immediate "hits of dopamine"), reduces reliance on the audible "pop," allows in-session correction if an adjustment didn’t work, increases patient trust and motivation, and makes care more engaging for the clinician. The excerpt ends with a promise of a follow-up video about a common mistake at the next visit.
Chapters
Okay, show don't tell, part four. Now we're going to talk about how we actually prove the value of what we just did in our care. So up until this point, we've had a patient who's come in, we've linked their felt symptoms with cognitive information. You know, a bit of a visual and some verbal explanation what's going on. So verbal, visual, auditory and kinesthetic learning is happening there. Then we've predicted what we think we're going to find. We've sat them on the bench, we found something. We've said, do you feel that? And how does it feel to get them to tell us that? Yeah, this area isn't right. It's stiff, it's uncomfortable. It just doesn't feel. Feel good. So at this point, they're going, right, you found the issue. It makes sense to me. And we can both agree that there's something that we need to do about it. Now what we're going to do is show them how our adjusting actually improves that. Because up until this point, they have confidence that you know what the issue is. They don't know if you can help them. They likely will think you do. But we want to prove that, and I'm going to show them rather than tell them. So after the report of items would explain what we're going to do. You know, you can get the model out. I've shown them again, this area doesn't move. It doesn't wiggle, it's really stiff. We want to get that freed up so it can move normally again. And that's what I want to do. And I tell them, you know, when we talk about the popping noise, I say, what I'm interested in is that area that felt tight. I want to feel that moving better. If we did, we know it worked. You may get a pop, you may not. But what I'm looking for is whether it worked or not. And this is important because that actually helps get them out of the idea that I need the pop to feel better. And we'll talk about that in a moment. And the way that most practitioners accidentally set themselves up to rely on the pop, even though they're telling patients, they don't. If you get sick of telling, telling patients the pop doesn't matter and they still don't buy it, this video is going to be doubly helpful for you anyway. How do we prove this? So we found the issue there, we've explained what we're going to do, we've laid them down and we've done the adjustment. Then what we're going to do is immediately after that one adjustment, sit them back up and recheck it. And I'm going through the same thing, and then I'm going to go, right, that's moving better. You know, do you feel how that's better? I want them to tell me. So hopefully, most of the time I've done the adjustments, it is now moving better, but they're feeling it, they feel the improvement and they do it right away. This is something that I never used to do. I made this mistake that a lot of practitioners make. And what it led to was basically I would treat the pain, I'd assess the patient. I go, right, I've worked out these areas I need to treat. I would then lay them down, I'd do my treatment. I give them whatever active care we're giving them that day, okay, I'll see you next week. And essentially, I was hoping that they felt better next time. Len Faye has this line I really like where he says, why are you waiting a week to find out if the treatment you did actually worked? And test, treat, retest is a much more powerful way of doing this. So I then did what most practitioners do is I then set them back up at the end of the treatment and rechecked it, hopefully to show them that, look, these areas are moving better. There's two problems with that. Number one is, what if it doesn't work? You spent the whole treatment, you're out of time. What if you've done the whole assessment and it hasn't got the changes you want, or they go, oh, it still hurts there. Now you're up against it. Now you either have to, you know, run late, which nobody likes to do, or. Or you have to fob them off, which nobody likes to do either. So instead, by setting them back up immediately afterwards, if it hasn't done what I expected, or they're going, it still feels tight. We have time to work with that. It may be it just needs to feel tight, that's fine, but we have time to do it rather than at the end of the session. If a patient feels a bit unhappy and it's the end of the session and they feel you're either rushing and you're a bit stressed, or they hear you say, oh, yeah, it'll be fine next time, they're going to have some doubts, so immediately recheck afterwards. The other reason is that even if it works well, I'm actually giving them extra hits of dopamine. What you really want with patients, if you want to really feel the value in your care is they want to associate your treatment with a sense of progress. They want to feel like when they see you, things are getting better. And if you sit them up at the end and things feel better, good, you've given them a hit of dopamine. But wouldn't it be great if you could give them multiple ones? So it's a bit of a quirk of human psychology. If I assess somebody and I find, okay, their upper cervicals, their CT and their TL junction are all jammed up. So there's three areas I want to adjust. One assessment, lay them down, do all the adjustments, sit them back up and reassess, and everything feels better. They're going to go, oh, great, it all feels better. But that's one hit of dopamine. That is one experience of progress. Instead, if I adjust the tl, sit them back up, oh, that feels better. Lay them back down, adjust the ct, sit them back up, oh, that feels better. Do it again for the upper cervical, now with the same amount of work, those are three hits of dopamine. The patient gets a much more of a feeling of progress because I'm showing them along the way rather than at the end of the session. And that sense of progress is really important because it gives them hope, it builds trust in you, and it gives them hope they're going to get better and that will even improve things. Like, they're more likely to do the things you advise them to do because you've proved how good you are. They can really trust your advice and they feel like it's working. So they're more motivated. If they're not sure it's working, they're going to be less likely to do things to help it. It's annoying, but that's human psychology. So test, treat, retest again. You don't have to use motion palpation, but I really recommend it do that after every adjustment. They're going to get multiple experiences in one session of it actually feeling better. And you don't have this kind of chasing the click thing there, because I tell them, I go, good, that's moving better. That's what I want to feel. If they hear a click or not, it doesn't matter. And I have multiple times to show them the difference rather than just telling them, I know you think you need a click. It turns out you don't. So that test, treat, retest, I do this in every single visit. It is much, much more powerful because now they have multiple feelings of progress and I have time to reassess and change. The other thing is, it's so much more fun because I'm using my brain constantly. I'm problem solving, I'm playing a detective and we're working through the progress. When patients can see you doing that, they can see you thinking on your feet and actually being that detective. And it's not massively hot like I'm using my brain. But it's not impossible to do if you're a chiropractor, if you've never done this before, it's not that hard. But they actually really like that. And I find the time goes quicker, my days fly by. I have way more fun because I'm doing something that's cognitively engaging rather than, in all honesty, if I find some problems and I go, right, I'm going to spend the next 10 minutes just treating them. That's not engaging my brain. That's where things start to feel a bit rote, they start to feel a bit routine. I'm kind of going through the motions. I've had that experience before. So not only does this get better results for your patients, it gets them more engaged. And you don't have to spend as much time verbally educating them because they're feeling it. They're going, yeah. They may not totally understand the nuances of the physiology of what we're doing, but they are understanding that I feel better when I see you and I do this at every visit. Much more fun. So if you don't do that and you don't recheck after each adjustment or after each treatment, do it, recheck it immediately. You're going to get more confidence from your patient, you're going to give them more hope, they're going to get more hits of dopamine. It's going to be more fun for you. So give that a try. The next video. What I'm going to talk about is the most common way that most practitioners, especially in the evidence based world, completely undermine this approach. You can do all of this, but the way you start the next visit could completely ruin it. I'll talk about a very, very common mistake that people don't realize they're making and how to completely avoid it and build even more trust. So stick around, there'll be another video coming next in the next day or two.
