I really do encourage all of you to watch this video. It’s rare for a client to be willing to openly share their frustration of working with me. This may be an extreme case of choosing task over social relationship.
The thing about working with me is that there’s a good chance you’ll leave my office feeling like nothing has changed. It’s very likely that your pain scores will be the same before vs after session.
As for state-of-mind, some would feel empowered while others would feel confused. Both are reasonable responses.
For those who feel confused, you may then think of dropping out of care because you just don’t get it. You don’t see how what I am doing is going to help and you don’t feel like it’s helping.
You may also be frustrated. If that’s the case, I’ll like to encourage you to see if you can take a timeout and direct your attention towards being self-compassionate or being kind to yourself.
If it’s not too much to ask for, be patient with me.
So this blog post is really about taking a step back and to re-examine what does it mean to recover.
I’ve talked about how long-term pain solutions is not too different from sustainable weight loss in the sense that it is in the hard change.
I have also talked about how long-term pain solutions is not about how you feel in the short-term but taking a problem-solving process-over-feeling/outcomes approach to recovery. Remember, research shows feeling better after a treatment DOES NOT actually mean you are on the right track to recovery!
(This is why quick-fixes don’t work. They make you feel better but the pain always come back. It’s an illusion of recovery.)
Your relationship with your chiropractor
You may be frustrated with me now and that is genuinely okay.
When you are working with a chiropractor, there is a social relationship and a task relationship.
The social relationship is about how much you are vibing with your chiropractor. The perception or feeling that both of you are on the same page, like each other, etc. There is also the task relationship which is what you need to do to achieve recovery.
We talk about this a lot in sports coaching and less so when it comes to chronic pain management. It’s very important to be able to separate the two relationships if you are looking for value-for-money chiropractic treatment.
Take a few minutes to think of the teacher or the tutor whom you absolutely hated but turned out to appreciate the most because of the positive influence they had in your life.
Did your frustration, or perhaps teenage hatred towards him/her, make her work with you any less impactful?
I guess when we were younger, we didn’t have a choice and we were forced to sit in classes week-in, week-out regardless of how much we hated it. For most of us, this worked out well in our favour. This is the task relationship at work.
As long as you do what you are told, you will get the results you are gunning for.
Regardless of if you like or dislike the teacher.
Of course some of us are lucky in that we would have met teachers whom we both liked and also worked well with. This is when you have both a task and a social relationship with the teacher.
The point is that you don’t need to like the teacher to get the benefits of being taught.
Likewise, you don’t need to like the chiropractor to receive the benefits of good chiropractic treatment.
The problem with prioritising social relationship
Because we are adults and because you pay for my services, there may be a subconscious expectation that I should, at the bare minimum, make an effort to be likable to you.
Because chiropractors, and really all healthcare providers, are in a service industry, we are expected to consider what you want and/or what you like because you are paying.
I kinda of get where people are coming from but I am not sure if it will work out in your best interest if I were to do just that.
A sports coach once said that there’s a difference between building relationships by helping people to be successful vs building relationships so I can help people to be successful.
The former is a classic teacher you didn’t like but come to appreciate later in life situation. Essentially they built a relationship by helping you to become successful. Not by liking you like them.
I don’t have an example for the latter but it’s more of … I need the person to like me so I can help them become successful.
I think there’s some element of truth to that – if you like the chiropractor you are working with, you’re more likely to be compliant and by extension more likely to get results. We’ll come back to this later.
If a chiropractor’s first priority is to make their patients like them, it would probably mean getting the patients to do likeable stuff instead of what actually needs to be done. This is the most common reason why chiropractors or physiotherapists offer low value care.
Essentially, they are doing what the patients want rather than what is best for you.
Is customer service bad medicine?
Maybe you think I am making all of this up to justify myself being an awful, impossible to work with chiropractor.
Let’s take a look at the research.
The British Journal of General Practice published that in 2018 that prioritising customer service is a problem:
Regardless, today clinicians are being judged by their “customer service” skills. Patients may have their own agendas on their visits, and can call you bad clinicians for not obeying their requests. Reassurance can be wrongly interpreted as arrogance and poor listening skills.There is no one-size-fits-all solution to communication breakdown and customer dissatisfaction. Some patients may feel relieved that you reassure they have no illness, whereas some demand you give them the investigations and treatment they want. Some clinicians could eventually give in due to fear of receiving complaints and losing rapport with patients.
In the same year, the Journal of the American Medical Association published Association of Clinician Denial of Patient Requests With Patient Satisfaction:
For visits wherein patients’ requests for these services were denied, patient satisfaction ratings were 10 to 20 percentiles lower when compared with visits wherein requests for these services were fulfilled. The sizes of the associations suggest that clinicians who are less likely than their colleagues to fulfill patient requests for these services could face a penalty in satisfaction ratings, potentially affecting clinician career satisfaction, compensation, and handling of subsequent requests for these services.
The year before Quartz reported that American patients prefer doctors who give them what they want:
Hospital systems are switching over to models where doctors are paid based on patient satisfaction, as both government-sponsored healthcare and private insurance are including quality measures in their contracts to work with them.
We know that it is a problem when some patients insist on what they need.
Most chronic back pain patients do not need MRI scans. Clinical guidelines have recommended against that MRI imaging for YEARS and data has continued to show that unnecessary MRI imaging for back pain lead to higher healthcare expenditure, delayed recovery, worse symptom experience, and poorer quality of life.
That doesn’t make sense to patients because we are all about the root causes. We are so strong in our beliefs that sometimes it’s easier, and rewards the doctors better, when they just refer us to the MRI we requested for.
P.S. Of course there are chiropractors or even orthopeadic surgeons who are not evidence-based and highly encourage x-rays/MRI scans. They usually use a sales-based finding-root-cause narrative often to identify “wear and tear” so they can upsell you their services. This is unethical and not supported by the latest research.
Re-examine our chiropractor-client relationship
I think as a chiropractor I have over time learnt to embrace the social relationship I have with my clients.
I’ve realised that chiropractic adjustments and exercises are both inadequate at addressing the fullness of the biopsychosocial to health.
This is why I started to include coaching principles in my work. I now see that a whole-person approach is necessary for true long-term results.
It’s not just about the alignment or posture. It’s not just about the physical activity. It’s also mental and social well-being. It’s about your lifestyle, your communication preferences, your values, what is important to you, what are your expectations of treatment and trying to find a middle ground somewhere to help you achieve a meaningful recovery.
It’s about me being able to engage you to work towards our common goal – a meaningful recovery for you.
In order to make recovery work, we will need a collaborative relationship between us.
In fact, research shows us that therapeutic alliance can influence recovery success. Therapeutic alliance refers a sense of collaboration, warmth and support between the clinician and the patient.
A study published just earlier this year found that a strong therapeutic alliance increased adherence to exercise and general physical activity.
Sounds good doesn’t it?
Having a working relationship with your chiropractor or physiotherapist is important. It is also equally important to not mistake good customer service as patient-centred care.
You can hate me AND still get results. How good is that?
Remember, healthcare providers can do just what you want because they want to keep you happy. Being happy with what you get doesn’t mean you are getting the best bang for your buck.
Why evidence-based treatments matter
Evidence-based treatments is why you can get results despite hating me.
It’s about using a process that works and engaging in what actually works.
It’s kinda like ten-year series. You know, you just have to do it regardless of how you feel about the repetitive questions or the teacher who assigned the homework.
See, the thing I absolutely love about evidence-based practice is that if you follow the scientific method when you design your clinical trial, you will reach a similar conclusion to everyone else who follows the same process.
Regardless of where your starting point is.
You could be a psychologist looking at mindfulness for chronic pain, you can be a physiotherapist looking at exercise for chronic pain, you can be a chiropractor looking at chiropractic adjustments for chronic pain (which, to clarify, showed that exercise works better), you reached the SAME conclusion!
Exercise works the best. Education is super important.
Repeated after me: exercise works best, education is super important.
Anything that is administered to the pain patient (chiropractic adjustments, Tiger Balm or Salonpas) is NOT likely to work as well as active interventions … “Exercise works best, education is super important.”
I mean, how mind blowing is that? Everybody in the research community regardless of their professional background or their researching funding is pointing to the same conclusion!
We call this the confluence of evidence. And this is the beauty of evidence-based practice.
There are of course studies that don’t reach the same conclusion. Usually these are of poor methodology – cherry-picking data points, poor sampling, no-blinding, etc. They honestly do not have much weight in the research community.
It’s kinda like the silly article that went viral about how teenagers were growing horns in their skulls. People completely believed it despite being a ludicrous claim. Thankfully, major publications debunked the “research” within days.
Evidence-based practice is why a task relationship works even if you hate the task.
Let’s say if you live a 100% sedentary lifestyle and you were to start running with gradual increments in distance over the next 12 weeks. I am willing to bet you can run more and run faster at week 12 vs week 0. This happens even IF you hate exercise.
Let’s say if you are to cut your daily calorie intake by 20% and commit to the minimum physical activity recommended in health guidelines for 12 weeks, I am willing to bet you will weigh less at week 12 vs week 0. This happens even IF you hate your diet.
That is not to say your weight loss or increase in running speed will be a day-to-day linear improvement. We ALL have bad days.
Isn’t it marvelous? The reason we know it works regardless of a slow start or how many bad days you may have is because of science.
You may think it’s common sense. Well, it is indeed common sense now thanks to decades of healthcare research and effective public health policies.
Take a moment to consider the amount of people who are chasing fad diets and weight loss supplements with unsuccessful results. It’s not common sense for them.
If you were to look into the research behind these interventions, it will also support that they don’t work.
Likewise, science is telling you today that chiropractic adjustments or posture correction alone is NOT a viable long-term solution.
You can choose to reject science. You can choose to not believe me. Just don’t be surprise if you don’t get results.
The bottom line? You don’t need to like the tasks to get results. You also don’t need to like your chiropractor to get results. It comes down to doing what actually works.
Are you task-focused or are you social-focused?
I am not going to lie. I am a super task-focused chiropractor.
I will be super impressed if you start seeing me going around high five-ing my clients or telling you what an awesome human being you are.
Yes, I do always encourage positive self-talk and I 100% believe in the importance of nurturing a growth mindset.
I always try my best to remind my clients, whenever possible, how far they have come and the good results that they have experienced so far. However, giving compliments or niceties at the expense of what you need for a meaningful recovery is not within me.
I used to be completely, 100% honest upfront but I have since toned it down.
I now do see how complete honesty can conflict with a client’s sense of self-efficacy (the belief you have in yourself to recover). So, I try to find a balance and I am not always successful largely because of my task-bias.
(If you check out my one-star Google review, I was called “arrogant and stand off-ish” for asking the client “do you get it?” at the end of every explanation.)
Honestly, it’s a ridiculously difficult position to try just-state-the-facts and yet empower some one to take the right course of action for the best possible results.
At the end of the day:
• Having a relationship with your chiropractor is important. BUT you don’t need to like him or her.
• A good chiropractor can get you results as long as you work with them on the tasks required for recovery.
• A good salesman can get you to be happy with parting with your money AND be happy with mediocre results.
If you are struggling with where your recovery is going because of who I am as a person or how I make you feel as a chiropractor, please do speak to me. With the kind of money you pay me, it’s totally within your rights to discuss how you feel with me.
I cannot prioritise a social relationship above your recovery but I am willing to work towards making your journey to freedom from pain more palatable to you.
If you haven’t already watched the video at the beginning of this post, I do invite you to take the time to do so. The dynamics of task relationship vs. social relationship at play will become a lot clearer.
To discover the difference the a task-orientated chiropractor can make, book in an appointment at Square One Active Recovery using the form below. Remember, I will always choose your results first.
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Frustrated by the lack of results-driven and ethical chiropractic clinics in Singapore, Chiropractor Jesse Cai found Square One Active Recovery to deliver meaningful and sustainable pain solutions.
Our goal? To make our own services redundant to you.
*We do not offer temporary pain relief such as chiropractic adjustments, dry needling, or any form of soft tissue therapy.