By Freddie Ulan, DC, CCN
The single most important point I discovered on the subject of patient compliance is leading by example. It is absolutely the key. Not one of the keys, it is the key. If that one thing is not there, it does not matter what procedures you use.
If you do not lead by example, you will fail in the nutritional aspect of your practice. You can get away with not being an example in medicine, you can get away with not being an example in chiropractic. You cannot get away with not being an example in nutrition. And this plays out in many different ways.
We are talking about patients coming in when they’re supposed to. And even more important, the most important aspect of compliance, is your patients doing what you tell them to do in between visits! Now I don’t know about how you run your nutritional practice, but when my patients come in to see me the first thing I do is pull out their nutritional and supplement schedule and say, “This is the program you’re on, right?”
“Good. So, you take these in the morning, with lunch, and at dinner, every day?”
“And you’re doing that every day?”
And I’m watching, because you’ll get this, “Well, you know, most of the time.”
Now, if you are also a “most of the time” kind of guy, you’ll go, “Okay.” Because here’s the axiom that actually follows from this: You will never have a patient that is more compliant than you are! This is horrible, painful truth. You will never have a patient that is more compliant than you are.
Before I started teaching in a more formal manner I was working with guys who would call me and say, “Freddie, can you please help me with my practice? Can you please help me, I’ve got patients that I just can’t get them – I just can’t figure out their program, and even when I figure out their program, I can’t get them to do the program.” I would go into their offices, watch the way they’re working with a patient and correct their technique. I would try to do all these corrections, you know, where their education was missing on these little parts. And you know what? It never fixed the practice.
The doctor calls me up says, “Doctor Ulan, can you help me? I’m having compliance problems with my patients. You always talk about compliance being the most important thing for getting the patients well. The problem is, I just can’t get compliance. I just don’t know. Maybe it’s a personality defect. Maybe I have a genetic disorder or something.” You know, can you imagine a child is born, and the doctor says to the mother, “You’re child was born with a deficiency of his compliance gene.” I’m sorry, there is no compliance gene.
One day I had one of these burning realizations. It was one of those pure “Eurekas.” I said to myself, “I wonder what kind of patient this guy is.”
So, I said to one of these guys, “So, what’s your program? What’s your nutritional program? Do you have a nutritional program? What is it?”
He says, “Just whatever I’ve eaten that day. Lattes in the morning. I get a latte every day.”
Now, this guy looks like, “Mr. Health.” Young, vibrant, he looks like a very healthy guy. But I find these practitioners who are not on their nutritional programs and they will have the most difficult time getting compliance.
To give you an example: a patient says, “Well, I do it most of the time.”
You say, “Well, what do you mean, ‘most of the time’?”
“Well, I kind of miss lunch every once in a while.”
“You miss lunch every once in a while? Like, how often?”
“You know, sometimes.”
“No, no, how often is sometimes?” (You actually have to pull it out of them.)
“Well, most of the time.”
“Well, how often is most of the time.”
“Well, like every day!”
Here’s the problem: if you also miss lunch most of the time, you’ll say, “I understand that, happens to me all the time. Alright, next subject.”
Huh? Hold it. The guy needed 6 Thytrophin a day, and he’s only getting 4 Thytrophin a day, he’s not going to get well. If he does, it’s going to take him much longer. He’s doing more to undo the good that you’re doing than the good that you’re doing.
You have to be able to be the best patient. Well, it’s not that you have to be, it’s a law. You are the best patient in your practice. And if you are a lousy patient, guess what? You can expect plenty of patients who are lousier than you!
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