Dynamic Chiropractic - September 10, 1993, Volume 11, Issue 19

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No Brakes

William Esteb is the author of A Patient's Point of View and My Report of Findings.

Ever remember starting your car and driving off, thinking the car was underpowered? You felt silly later when you discovered the parking brake was still on! When you release the brake, the car glided through traffic effortlessly. Many practices are inadvertently being operated with the brakes on, preventing the normal growth and fulfillment deserved by the doctor and staff.

If there was a big lever in the x-ray room or a handle on a control panel in the hallway closet, detecting and correcting an improper use of the office brakes would be easy and instantly obvious to anyone. Since these brake levers are hidden, meeting room facilities, seminar speakers, motivational cassette manufacturers, and self-help book publishers have a rosy future.

After consulting, touring offices, and listening to doctors on the telephone, I have discovered some common lever locations in chiropractic offices. If your practice seems to be cruising with an unseen force holding it back, you might check the following locations.

Chiropractic Philosophy

Chiropractic is poised to tap into the natural demand of wellness care. More and more doctors are recognizing that the disease processes that threaten us most are lifestyle influenced. An interest in diet, exercise, and mental attitude have captured the attention of late night televised "infomercials" that offer everything from permanent weight loss to the health secrets of dried foods. Chiropractors who have confined their chiropractic influence to the narrow domain of relief of low back pain or the easiest personal injury cases, will find their practices shrinking. Frustrated medics who think that symptomatic relief is the only worthy dimension of chiropractic are finding their practices implode upon them. Wellness is the growth market. Pain relief only puts the brakes on.

Physical Conditioning

There may be nothing more pathetic than doctors who want to rise above their current patient volume but don't have the energy. Funny how many prefer gimmicks or new get-rich-quick patient schemes to the more effective process of working on themselves. Until you have the mental discipline to accomplish the appropriate self-improvement, don't expect patients to respect you, comply with your recommendations, or refer others. Lose the extra 10 pounds; get in shape. If the era of low deductibles made you lazy or a "I'm-a-doctor-I-deserve-it" attitude, welcome to the '90s. Check the mirror for a brake lever.

Willingness to Risk Rejection

The fear of rejection is one of the most prevalent fears we face. It's what stops perfectly capable doctors from doing lectures, confronting patients to pay their bills, calling new patients after the first adjustment, asking for referrals, and the other countless proven techniques for growing a practice. "That's not me," they say, "I just can't see myself doing that," doctors observe at a seminar. "Give me something else I can do to build my practice." It is so easy to take a stranger's "No" or a patient's blank stare personally. It's the doctor who can see beyond the possible rejections that enjoys a brake-free practice.


After frequent seminars and rah-rahs in the hotel ballrooms, it's easy to forget that the world doesn't care. The world doesn't care about your practice or chiropractic. The world doesn't owe you a living. The only way chiropractic matters is when you make it matter to those you encounter. If you're not excited about chiropractic, don't expect your staff or anyone else you meet to be excited. Your ability to focus your energy and mental abilities to remind others of the power and success of chiropractic, is in direct proportion to the success you'll enjoy. Excitement and confidence, even when it's difficult to produce, are essential characteristics of the practitioner who has released the brakes.

Office Layout

Funny how we're more willing to update the car we drive on a regular basis than to make improvements to the office environment. New car purchases may be easy to justify: new safety features, the CD music entertainment center; better gas mileage, etc. Needed changes to your office environment are rarely so obvious. Make some changes.

Question your current notions about doors on rooms, privacy, open offices, gowning patients, time spent with the patient, and all the other dogma. Keep in mind countless patients are getting perfectly good results (and loving it) at the hands of doctors using the exact opposite procedures, techniques, or office layout you believe in.

Patient Communication

Patient education is an important topic and yet it prompts many doctors to say, "Yeah, but what else do you have?" Those with brake-free practices recognize that the real day-to-day joy isn't how many new patients you get or how much money you make, it's enjoying process of cracking the safe of each patient's cerebral cortex. Every patient has a different combination. Without access to the safe, there is poor rapport, poor compliance, and few referrals. Find the combination, and the dance you dance with each patient becomes a lot more interesting and fulfilling. Until you enjoy the process of finding the combination, you'll never achieve passing-lane speed. Get out the sandpaper and roughen up those fingertips. Listen for the tumblers to fall. Pay attention to what it will take to help each patient get it.

None of these suggestions are dependent upon the cooperation of the weather report, the size of your town, hospital privileges, or changes in the trend towards managed care. You are in charge. It's your responsibility to find the brake lever in your office and release it.

I live in Colorado Springs at the foot of Pikes Peak. Tourists from around the world come to Colorado Springs to drive to its 14,000 foot summit. Car rental companies at the airport regularly remind flatlanders how to drive in the mountains, particularly how to properly handle the descent of Pikes Peak. Seems a favorite summer afternoon pastime among those who live at the foot of the Pikes Peak Highway, is to count the number cars with their back tires on fire from using the brakes for the 12-mile descent, instead of shifting into a lower gear.

Is your practice on fire, or is that just your brakes I smell?

William Esteb
Colorado Springs, Colorado