538- The Role of Patient Centered Communication in Chiropractic Practice

Welcome to The Evidence-Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langmaid.

Hello and welcome to The Evidence-Based Chiropractor. I am your host, Dr. Jeff Langmaid. On today's episode, we are talking all about one of my favorite topics, which is patient communication. Not only that, we're going to talk about some research that just came out that actually highlights patient-centered communication in chiropractic. A lot of take-home facts, a lot of clinical pearls, and I'm also going to throw some commentary on there and hopefully some tips and strategies for you to be able to improve your patient communication in your practice literally after you listen to this podcast. So of course, I will drop the study down in the show notes. But before we get started, shout out to a couple partners of ours. Leander Tables, $1,000 off that Series 950. Use the code EBC2026 or connect with their team. I'll drop a link down below as well as Shockwave Centers of America, $500 off and a free cart. So if you are looking for a new table or you're looking for a shockwave unit, two great partners of this podcast hooking you up with a combined $1,500 off when you connect with them. Please let them know you heard about them on this podcast so they can hook you up with the savings. As I said at the top of today's episode, the study we're gonna highlight is titled Frequency of Patient-Centered Communication-Related Terminology in United States chiropractic curricula, chiropractic accreditation standards, and the Chiropractic National Board content. So a couple caveats, I am a massive, massive fan of exploring, talking about, and studying communication. Normally, I'm not too crazy about the research because it seems, you know, this is a soft science. However, there's some really cool parts of this study that I think are worth bringing to the table and highlighting. So, and it starts with a kind of a simple question. What's the most powerful tool you have in your practice? For many docs, they might say, it's my ability to adjust a patient. It's my diagnostic ability. Maybe it's my ability to do this technique, this specific modality. But what if it's how you communicate? It might not sound obvious at first, but I truly believe that to be the case. One of, if not the most powerful thing that you can bring to the table. And this is no detriment to providing the hands-on care that you do at all. But if you can't communicate that effectively, number one, you hurt the results of that care. And number two, you're not going to impact as many people as you could or should. So leveling up communication so that it is clear, so that it is obvious so that you are actually, I'm gonna say also, giving the right treatment. There's a lot of docs that underprescribe care on a visit-by-visit basis, if I'm blunt, because they can't accurately talk about the value of their care. So instead of confronting that quote unquote difficult conversation, it's not when done correctly, they avoid it by going shorter term care and then saying, well, that's how you do it if you're ethical. That's not true, in my opinion. Time and gravity are undefeated. People are coming in with problems. It doesn't mean you swing the pendulum the other way and need to prescribe care that you know is not necessary. But man, there's a middle ground. And there's so many docs out there that are not changing habits. They're not giving the body enough time. The patient just feels better and they're out the practice. And I think there's a better way. And hopefully if you're listening, you do as well. Communication might not sound like this obvious, most important thing, but this study looked at, again, chiropractic education programs across the United States to see how often patient-centered communication is actually taught in the schools. And the results may or may not surprise you, 'cause even though chiropractors, many of us pride ourselves in our whole-person approach to care, this study found that patient-centered communication shows up in less than 10%, less than 10%, of most chiropractic curricula. That means one of the most powerful drivers of trust, patient adherence, and outcomes may be something that you and all chiropractors are largely learning on their own or not at all after you enter practice. And we've all had this experience as well. I think it's very common. You come out of school, you're ready to take on the world, you get into a practice. I know there's gonna be some docs nodding their heads as they hear the story, And you go to a doc that you know is successful. You're like, I can't believe I got this position. This is great. And then you hear how they're communicating. You're like, oh, I didn't know it was really like that. I would never say it that way. I feel like that's uncomfortable. They might be selling too hard. And then you end up with a fractured associate relationship pretty quickly. And that's super, super common. And I think a lot of that is just coming out, not understanding anything about communication strategies, about ensuring you're building trust. And again, I mean this in the most ethical way possible, not the other way. So today we're gonna break down what this research actually found, why communication matters so much, and most importantly, how you can use this to improve your own patient outcomes and strengthen the practice that you have immediately. 'Cause in my opinion, great chiropractors don't just deliver great care, they actually deliver great conversations. So this study came out in the Journal of Chiropractic Education, again, looking at patient-centered communication often shortened to PCC. And before we get into the details, let's define that. Patient-centered communication, what does that mean? It means actively listening to the patient, showing empathy, respecting the patient's values and concerns, and encouraging shared decision-making. It's about making all of your patients feel heard, feel understood, and also involved in their care. So this isn't about just telling them what they need to know. This is about every bullet point we just mentioned. It's not just a nice idea. This is kind of the standard of care in modern healthcare. Often falls short in many places, but I hope it won't in your practice. So research across healthcare consistently shows that patient-centered communication can do a few things, all of which I think you're gonna like. 1, improve patient satisfaction. Who doesn't want that? Improve adherence to treatment plans, 'cause they actually understand what's going on and why. Important. Improve outcomes. Who doesn't want that? And reduce healthcare conflicts, which nobody wants that either. So the researchers in this study specifically, they asked a very simple question: how much emphasis is placed on patient-centered communication in chiropractic education? They looked at 3 big areas: the school curricula in chiropractic course, the accreditation board standards from the CCE— whether you like it or not, that's what they looked at— and the National Board of Chiropractic Examiners testing content. They reviewed 16 chiropractic program course catalogs, accreditation standards, and national board testing plans. They also searched for documents, you know, studies related to terms in communication like empathy, cultural competence, collaboration, motivational interviewing, emotional awareness. Essentially, they looked at all the terminology connected to patient-centered communication skills. And what they found was, again, I'll say, in some cases gonna be surprising, in some cases not at all. What was the big takeaway? Well, across US-based chiropractic programs, patient-centered communication terminology appeared in only 2% to 17% of the coursework. It's a pretty wide range, but the more striking statistic is 87% of chiropractic programs included these concepts in 10% or less of their curriculum. And nearly half the programs included patient-centered communication terminology in less than 5% of their courses. Think about that. Communication, arguably the most important. First chiropractor I ever worked for coming out, he said, what business are you in? I'm in healthcare. No, you're not. You're in the people business. And that is a, that is a truth. So communication, arguably one of the most important aspects of patient care, is represented in less than 1 out of every 20 courses in many chiropractic programs. Now let's look at the accreditation level. And I'm not dogging the schools or dogging any of these institutions, but I do think it's something that they should be looking at. So let's take a look at the accreditation level. The Council of Chiropractic Education lists 8 meta-competencies that chiropractic programs must address. Out of those 8 competencies, 4 include patient-centered communication terminology. So communication is acknowledged as important at an accreditation level. And then we get to the National Board of Examiners, the NBCE. Across all 4 NBCE bands, board exams, excuse me, there were zero patient-centered communication terms in the primary test categories. Zero. And only two mentions overall in secondary categories, both related to counseling patients about lifestyle or wellness. So while communication is arguably the most critical factor in your practice success, and I mean that in terms of patient volume, I mean that in terms of income, and I mean that in terms of outcomes, it's barely at all represented in any of the testing, which leads to the question, if something isn't heavily tested, how much emphasis is there really in the education? So if we zoom out, 'cause this study's not trying to criticize chiropractic education, nor am I. It's trying to understand how communication skills are currently represented, and there's a really interesting context. Chiropractic has historically promoted a really holistic, and at times vitalistic, view of patient care, meaning chiropractors, we, Consider things, physical health, emotional well-being, lifestyle factors, psychosocial. So in theory, our core philosophy that aligns very well with patient-centered communication has since the beginning. But the research suggests that this concept may not be consistently emphasized across modern training. So another interesting comparison from this paper looked at terminology, other terminology. So for example, The term subluxation appears in roughly 20% of chiropractic curriculum language. Psychosocial terminology, 3 to 14%. So communication terminology, it falls below or to similar levels depending upon the program. And here's the interesting point, and the authors were very clear, just because a term doesn't appear frequently in a course catalog doesn't mean it's not being taught. So it's important to keep that in mind. Course catalogs only show the descriptions. They don't show what actually happens in the classroom and they definitely don't show what happens in clinical training environments. So that's often where communication skills are really gonna be learned. So the study doesn't say chiropractors lack communication skills, it just highlights that communication may be underrepresented in the formal structure of education. And here's the good news, that opens the door for improvement. And it also means if you're struggling to get new patients in your door, if you're struggling to communicate who you are and what you do, if you're struggling during your report of findings and getting patients to start care, if you're struggling to get patients to stick around your practice and they're leaving far too early and breaking care plans, it means that you might just not have the training yet. You might not have built that skill. You might not have put in the time necessary to get the result that you want. So that's great because it doesn't mean it always has to be that way. It means it's a soft skill that you can continue to work on. And we know that clinical outcomes are influenced more by more than just the adjustment that you give. It's by your therapeutic alliance, you know, the relationship between you as the doctor and the patient. In research across healthcare, it consistently shows that strong doctor-patient communication can lead to higher trust, again, greater adherence to care plans, better outcomes, lower dropout rates. And in chiropractic, communication is really important because often our plans involve multiple visits. They involve lifestyle changes, rehab exercises, long-term health strategies. It's not just one and done. This is a care journey. It's why we talk about the patient journey within The Smart Chiropractor so much. It's a journey. You're the guide. And communication is what keeps patients engaged in that journey. Now, another interesting statistic reference in the paper, it comes from a survey of nearly 4,000 docs, a pretty good size. It found that 45% of chiropractors report using scientific resources daily, to support communication. So that's pretty encouraging. It shows that many chiropractors out there, almost half, are actively using research to educate patients. Now, as you've heard me talk about in this podcast, you know, you gotta communicate the right way, you know, so because research itself is usually pretty dry, pretty boring, and pretty hard to understand. So hopefully some of what you're getting, if you're a listener of this podcast for a while, is the understanding on how to communicate research in a simple fashion. What are the key aspects? And how can you apply it to the communication that you have in your practice. It's about delivering the information in a way that resonates, not just speaking at somebody. And that's where patient-centered communication really comes in. So highlighting this in all of the usual suspects, in your report of findings, asking questions, what concerns you the most about what's going on? What are you hoping to get back doing? That's a patient-centered way to approach things. During your care plan discussions. Letting people know your care plan is determined by two things. Dr. Steven Frantz in Rockville practice, I love the way he puts this. Your care plan is determined by two things, your health goals and our examination findings. That frames where they're going and why you're recommending it. It's not just that you want to do these visits. It's not just that they want to do this. It's not just that you found this. It's both, it's all, it's the last two. It is their health goals. What are they trying to do? That should impact your care plan. Are they looking to just get out of pain? Are they looking for performance? Are they looking for optimal health over time? Those are their goals. They have to tell you that. And then what are your findings? What's realistic? Are they in a state of advanced degenerative changes with abject pain, with comorbidities? That's gonna be a challenge. And are they a fear avoidance behavior or Are they actually in really good shape and they just had an acute injury? This is gonna dramatically alter the care plan that you give, but you have to let people know why you are recommending what you're recommending. Of course, in your marketing, letting people know that you take the time to understand their health goals before building their care plan. There are many people that go in and get one-size-fits-all care from doctors of all types. Highlighting that that's not how you do things is a competitive advantage, especially if you actually implement it in your practice. And of course, in your reactivation campaigns, leading with empathy. Instead of, you know, you're overdue, you missed an appointment, just letting people know, hey, we know life gets busy. If something comes up or is bothering you, you'd like to check out progress as far as where you're at and improve, we're here to help you. Just letting people know in very plain, simple language that you are there to help them. So again, this study showed that patient-centered communication appears in less than 10% of most chiropractic curricula, but that doesn't mean communication skills are not important. It might be one of the most important important things you can have in your practice, but it is something that you're gonna have to learn. Communication is a skill for almost all of us. So one, understanding how do you want to show up? Who is your ideal patient? What are they struggling with? How do you wanna show up? How do you want to be for your patients? And then framing out your communication, not scripting every word and being cheesy, But just framing out, here's how I like to do things. And so you have the understanding I mean this. Just literally, that first visit, what should that look like? What should that feel like? It shouldn't just be a free-for-all every single time. Your report of findings, what should that look like? What should that feel like? What are the key questions? What are you listening for? And what are you ensuring that every patient hears? So it's a system and there's latitude within that system for you to be the doctor doctor. And ensure that that patient is really understanding what's going on. So great study. Uh, I think it highlights some opportunities for us to continue to improve while also putting some very real numbers on what that looks like. Now, before we wrap up today, big shout out to Diabetes Reversal Group, a partner of this podcast. I'm going to drop a link down below where you can watch a video and learn if you want to bring diabetes type 2 care into your practice. They make it easy. You don't have to buy anything. You don't have to do anything. You refer your patients over to them. They have a money-back guarantee. It's, it's a patented program developed by a chiropractor that has been around for a long time. It's nice, check it out. As well as NovoPulse and their OA Recovery Program. Patients are walking into your practice each and every day with osteoarthritis, and if you are not having a specific solution for that, you might be leaving some opportunity to help them on the table and certainly some opportunity for revenue in your practice. So the NovoPulse OA Recovery Program might be a great opportunity. I'll drop that link down below. Below as well. So thank you for tuning in, whether this is your first episode or 500th episode, thank you for tuning in. Thank you for being a chiropractor. Have a fantastic week in practice and I will talk to you soon.

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