It’s common to think that the people presenting at your practice want an immediate outcome to their presenting condition and nothing more. The thought is that people want a treatment for their given malady and they want the care to be effective, short term and affordable.
There is a tendency for chiropractors and practice members to focus on the ‘content’ of the signs and symptoms rather than the ‘context’ around the journey of life and the actions we employ to facilitate that journey. The chiropractic context could be seen as a methodology of reducing interference to life expression regardless of symptoms or no symptoms.
Based on that lack of distinction between content and context in healthcare we, as chiropractors focus much of our time and attention on mastering our technical skills, we serve people with the best techniques and most appropriate and effective clinical care that we can muster.
We spend much of our time, money and energy gaining and perfecting our ‘hard’ science and skills. We ensure that our chiropractic colleges teach as much diagnostic and therapeutic skill as possible and we structure our continuing education credits to reward attendance at post-graduate seminars that are similarly structured.
Wherever possible we downplay and minimize the ‘soft’ side of our professional activities. Communication, philosophy and the fine art of human interaction are seen as a lesser priority and rightly so if our clinical intent is driven by the focus on clinical content rather than a contextual consideration.
If we see the doctor/patient interaction as being a short-term phenomenon that has as it’s goal the resolution of the presenting symptoms in the shortest time possible we will see little need to explore other, more complex and less important components of the clinical relationship.
So, having attained our therapeutic goals we will proudly sit back and consider to have provided the person with optimum health care consistent with best practice. We will, if driven by such things write up these case studies, support research into such content driven phenomena and drive the profession towards this as the noblest of endeavors.
Unfortunately this is only a part of people’s needs in a health-care interaction and we pursue this lopsided perception to our detriment. With the rising incidence of litigation it would behoove us to be aware of what people really want in their health care experience.
Research published several years ago by a group called ‘American Health Consultants’, indicated that 70% of malpractice cases are not necessarily brought about because of a bad outcomes, but because of poor communication. According to a representative of the Picker Institute of Boston, USA. “technical care is essential, but that isn’t all that’s necessary for healing and health. Patients place a big emphasis on personal and interpersonal experiences during the treatment process.”
Medico-legal considerations are obviously one reason to consider the context over the content or the person over the condition but the bigger one is about people’s desires for their life’s journey. People are social beings and they want to associate with a person who cares and shows it. This awareness is not new. We can go back many decades in the literature and read numerous studies such as the one conducted at the University of Southampton, Aldermoor Health Centre, Southampton, UK and published in the BMJ 2001;322:468. ‘Patients prefer communication with doctors, rather than prescriptions’. A total of 824 patients completed a pre-consultation questionnaire about what they wanted the doctor to do in their consultation.
The overriding opinion was that they would prefer a “patient centered approach” to their consultation including good communication, partnership with their doctor and health promotion information – rather than an examination or a prescription.
Every day you have a choice. You could succumb to the pressure of the ‘health care system’ to be detached and professional and deliver ‘appropriate, evidence based care’. This model is focused on the content of a specific clinical issue in which you are expected to apply the intervention that the average person in a research environment found efficacious and apply it to your individual patient as though he/she was ‘average’. At the completion of this intervention you are expected to dismiss the patient until another ‘content’ presentation is made. The result is a mechanical, therapeutically driven series of random interventions for a lifetime.
The other option is to join the person in the ‘context’ of their life. Based on their values, goals and individual situation you collaboratively map out a process of chiropractic and other resource allocation that has the highest good of the person in mind. This is a lifetime journey that is generatively focused to optimize the person’s experience. This approach is ethically and morally right when one adopts the contextual framework but is considered unethical and morally wrong when viewed from the content driven position.
When it comes down to it you must ask yourself what is the most appropriate care style for you to invest your life spirit into.
Mark Postles D.C.
