Why is it important to trust your chiropractor

A week ago, a referral from a friend reached out to be about a case. It doesn’t sound too complex. It sounds like a chronic musculoskeletal injury (e.g., joint sprain, muscle strain) that was recently re-injured again. The person was in a lot of pain, already sought care from other practitioners and wanted some help.

I spent the night texting them, from 11:30pm to 1am, that is 2.5 hours. After trying to get a deeper understanding of what’s going on. I spent a lot of time trying to tease through what is important, and what is not. As well as to provide reassurance that it is okay (for now). I gave them some advice regarding medication, which they were already prescribed. Finally, I advised them to check in for an assessment after a few days, even if they were feeling better. I did emphasise this. It was very clear they needed help.

I did follow up with them a few days later. They took my recommendations and were feeling better. I followed up on the assessment and they mentioned that they will try to schedule a session. I left it at that. They did not schedule a session.

Learn to trust your chiropractor

Last evening, they checked in again. The problem was back. It has gotten worse after they went for some dry needling treatment with another practitioner. They also consulted with a doctor who advised no further investigation is required at this stage. They WhatsApp me to want my opinion on this matter.

I personally find the situation curious. If you needed help and help was provided to you, you felt better but decided to go see another practitioner. Why would you return to me for advice?

My business owner friend, whom I shared this experience with, highlighted that it is a trust issue. I think that makes a lot of sense. If you are going to see someone else because you don’t trust me enough with your care, then why are you circling back to someone whom you didn’t trust in the first place?

Too many cooks spoil the broth

Remember that in this case, they already saw at least two practitioners prior to reaching out to me. They were not feeling better and therefore they wanted my help. I did provide the help, in the middle of the night, at no cost. They also did feel better.

I am at least the third person they reached out to. There was another practitioner who provided the dry needling. There was also a medical doctor whom they saw, but could potentially be the same doctor as the one the saw before reaching out to me.

How many chiropractors does it take to fix a lightbulb?

There are at least four practitioners here! I think if anyone needs to rotate between four practitioners, there must be a trust issue. The practitioner they saw did advise significant pain after dry needling is normal. The medical doctor advised that they did not need further investigation (i.e., everything is fine, barring the initial injury, for now).

I am guessing if they are circling back to me, that means they don’t trust the advice provided right? But they also didn’t trust my recommendation or didn’t trust me enough to continue care with me either! Why would you trust anything I were to say now?

It is a curious and mind boggling situation, at least to me.

What is my responsibility as a chiropractor?

I do think that I have responsibilities as a chiropractor. This largely is towards my clients and cases I do take on. I also feel a responsibility towards educating people and providing what I would consider helpful information on my website. I get that I am in a helping profession but I don’t see that the onus for me to help everyone.

Over the years, I also have learnt that if you want to provide help, you must expect nothing in return. This is also the case here. I did provide advice and recommendation, in a very timely manner, without expecting that they would actually check in for an assessment (i.e., I get paid).

Interesting, if you ask people who are business owners and in sales, they would probably find what I did incredibly foolish. The smart thing to do is to arrange for them to come in for an assessment the next day, then take it from there.

Pain is context dependent

Sentiments of withholding care until being paid are coming from people who do not work with people in actual pain. The person in concern was waking up in the middle of the night, think 3am in the morning, with excruciating pain. While I totally do agree that I deserve to get paid for both my time and expertise, I am also empathetic to that it’s a difficult situation. Not only for the person in pain but also for those around them.

Sometimes all we need is good advice and someone to take the time to provide clarity. I would like to think I succeeded at that cos I managed to change their mind on certain matters. They also did take my advice on medication. Most importantly, they felt better.

Plain old reassurance can provide peace of mind. That alone can help to improve the overall pain experience. Imagine yourself being stabbed by random person with a needle versus getting a routine vaccination at the clinic. How do you think the experience will differ?

Understanding pain science can make recovery a lot better

Freaking out over very severe pain feels worse because you don’t know what is going on. Simple assurance and having a plan of what you can do (e.g., medication, next steps) can give a sense of control, which is often enough to help. This was why I didn’t want to wait.

Let’s look at the images above, which do you think hurt more? Both were real life cases!

The nail in the boot hurt more. The builder was dying of pain but when they opened the boot up in the hospital, the nail went between the toes. There was ZERO injury. The nail that gone through the roof the mouth barely hurt. The constructor walker went on with life as is and only realised after he saw a dentist a few days later for what he thought was a toothache.

Pain is time sensitive

The other reason why I didn’t want to wait is because pain is time sensitive. Especially when it comes to medication, the earlier you take your medication “correctly”, the more relief you will feel. The earlier you feel relief, the easier the condition is to treat. Especially for acute cases.

A lot of times people avoid prescribed pain medication or take lower doses because they do not want to be dependent on it. However, taking medication inappropriately can lead to poor pain relief, consequently increased sensitisation, and more pain! The end result is taking even more medication in the longer term.

Sometimes by trying to help ourselves, we don’t end up helping ourselves. This was the case here. The person was skipping on medication and was not getting the pain relief that was intended. This is a lose-lose situation. You take the medication, which does indeed comes with some small risks but don’t get any benefits. Um, that doesn’t make sense right?

This was one of the issues I spent 2.5 hours trying to address on WhatsApp. Yes, I could have just told them what to do but people already know what to do! Most of the time what is needed is someone to explain why that works better. And that, my dear readers, takes a lot of time.

Providing best care is not always in the best interest of your chiropractor

Being in a helping profession, there is always an inherent conflict between best care versus rewards. I say best care because I could have made them wait the next day to come in for an assessment, then provide the advice and recommendation then. This is still very good care. But not necessarily the best.

When I look at best care, I don’t just consider what is the best thing I can do for a client or person as a clinician. I also consider what is the best I can do as an individual with the resources I have.

Unfortunately, being the best version of myself runs the risk of not being rewarded! I tell everyone that the better job I do as a chiropractor, the less money I make. People find it incredibly hard to believe.

The assumption is that if you do a good job and/or provide value, you will get referrals and you will get clients. In this specific instance, I did the best I possibly could, I provided (tangible) value, the value was acknowledged.

But did they choose me as their practitioner? No.

Is this an outlier case? Also, no.

Moving into a small home practice is a deliberate choice

I think people always find it strange that I wanted to move into a home practice. I guess it’s more common to envision success as a chiropractor as a big clinic with multiple locations or at least multiple practitioners. Unfortunately, that’s not really what I subscribed to.

The main motivation to moving to home practice is because of the uncertainty of commercial rent. There is no winning. If you are paying a lot, you worry about being able to make rent. You have to spend more money on marketing just to make rent. Money becomes the number one priority.

When rent is cheaper, you start to worry about what happens when your lease ends. If you are on a rolling lease (i.e., periodic or month-to-month lease), you start to worry about when you will get kicked out. And if so, where do you go to next.

All these considerations take up bandwidth. And does distract me from being the best chiropractor I can be.

Conflict between being the best chiropractor and financial reward

I do think there is an inherent conflict between being in a helping profession and being financially rewarded. I do think that the better job you do, the less money you make.

Yes, I do agree that if you do a good job you should get more referrals. But I don’t think that is entirely true. In fact, I am more inclined to that people who are most charismatic and good-with-people get the most referrals. Even if they don’t do a very good job.

Have a think about that.