Feature Article:

Are You Educating or Indoctrinating?

By Shelley Simon, RN, DC, MPH, EdD
Founder, Beyond Practice Management

How often have you found yourself thinking — or even saying — any one of the following?

• I?m just trying to get this patient to understand why the course of treatment I?m suggesting would be good for her. Why doesn?t she get it?
• If patients understood what I understand they would realize that what I?m recommending is what they need.
• Why is it so hard for some patients to grasp the importance of committing to a full course of treatment?
• Just because this patient won?t acknowledge that he has a problem, that doesn?t mean the problem doesn?t exist. I?ve got to find a way to get him to see the value of treatment.

If these statements are familiar to you, you may be unconsciously engaging in patient indoctrination. All of the examples above share a sweeping assumption: That you know what an individual patient needs better than they know what they need. Now, you may be thinking, ?But I do know what they need . . . I?m the doctor!? Perhaps. But taking that stance will drive away the very patients you spend a tremendous amount of time and effort trying to attract.

In this issue of Practice Your Way we examine the difference between education and indoctrination and look at how each strategy impacts patients and the overall health of your practice. Then I?ll share specific behaviors and attitudes that you can begin practicing today that will help you move away from indoctrination (however subtle it may be) and toward the more effective approach of patient-centered education.

Studies abound showing that how a practitioner interacts with patients is at least as important as the practitioner?s clinical approach and technical skills when it comes to determining clinical outcomes. Patient receptivity or resistance is substantially influenced by a practitioner?s communication style. When one counsels or educates in a directive, confrontational manner (indoctrinating), patient resistance goes up. Conversely, reflective and supportive counseling (educating) results in less resistance, increased patient satisfaction, and more positive outcomes.

Let?s look briefly at the difference between indoctrination and education. To indoctrinate is to coerce, impose your values, and try to convince or teach someone to think the way you think — often in an effort to achieve your own objectives. Indoctrination says, ?Think like me, be like me, and trust me because I know what?s best for you.? Indoctrination tends to be one-sided and employs the use of selective data, misleading statistics, and metaphors and analogies stretched beyond reason. Perhaps worst of all, indoctrination may be used to elicit fear on the part of the individual being indoctrinated. For the parent attempting to get a three-year-old to eat their vegetables, this kind of indoctrination (hopefully minus the fear tactic) may be necessary. Not so with adult patients who have their own views, attitudes, and opinions about health and healthcare.

Education, on the other hand, involves presenting meaningful data in a balanced manner. Statements can be supported with facts and references when needed. Information and alternatives are presented from as many perspectives as necessary to support the individual receiving the information in reaching a conclusion. Education appeals to a person?s reasoning ability and speaks to their individual needs, not the needs of the person doing the teaching. The language of education promotes dialogue, exploration, and awareness. Explaining the complex nutritional qualities of green beans to a toddler probably won?t result in an empty plate and a full stomach, but relevant facts presented in an unbiased manner are very effective when dealing with adult patients trying to make informed decisions about their health.

An important point to keep in mind when offering patient education — one of your most valuable marketing tools — is that it must be based on the desires of the patient. Education can be perceived as manipulative when your underlying agenda is to convert the patient to a certain way of thinking or toward a particular action you want them to take despite their concerns about cost, need, or outcome. Adults learn only what they are interested in and ready to learn. Educating instead of indoctrinating requires self-awareness and skill, particularly if you?ve been subject to many years of indoctrination yourself.

Here are three examples to further illuminate the difference between education and indoctrination.

The New Staff Member: You?re delighted to have Suzanne working in your front office. She has years of experience dealing with patients and insurance companies, all of it in MD?s offices and hospitals. She understands that your office is different, but she?s not completely sure how. Suzanne worries that patient recall is intrusive to patients and she?s a bit skeptical about the kind of care you provide. Which of these two statements would most likely help Suzanne begin to understand the benefits of your service and become a valuable employee?

(a) We do things differently here and I really need for you to be on board. It?s part of all our jobs to keep patients on track. If we neglect recall they won?t come in, because they don?t always understand what is in their best interest.

(b) I?ve found that a good way to familiarize new employees with the benefits of our services is to have them experience care firsthand. By receiving care, you can get a sense of why our office procedures are important in supporting patients? goals. Is this something you?d be interested in?

The New Patient: Robert is in your office on the advice of a co-worker who has been a patient in your practice for a long time. He has a toothache and knows he needs immediate treatment. Other dentists have told him that he could avoid future problems with regular maintenance and preventive care. But he?s scared to death of dentists and deep down thinks most of them are mainly interested in extracting cash from his wallet. Which of these two statements do you think would be most helpful to Robert at this point in your relationship with him?

(a) You have more than a simple toothache; you have advanced periodontal disease. We?ll patch you up today but we?re also going to recommend a course of treatment that you?ll need to follow if you don?t want to lose your teeth.

(b) It sounds like you have some concerns about recommendations you?ve received from other dentists. How will your previous experiences impact your relationship with our office? What kind of information do you like to have when you?re making decisions about your health?

Your Mother-in-Law: Rose has always had a bias toward allopathic medicine. Indeed, both her second and third husbands were surgeons. While you?re not trying to win Rose over as a patient, you?d like it if she?d stop making snide remarks about your profession to friends and family members, and most especially to you. Which of the following two statements would be more effective with Rose?

(a) You are obviously biased and don?t understand what I do. Are you aware that one of the leading causes of death in the U.S. is related to medical error? Haven?t you seek Sicko?

(b) I notice that you have strong opinions about healthcare and I?m not going to try to change your way of thinking. But I bet you?d be surprised to know that I have collaborative relationships with a number of MDs, many of who had their own biases before we began sharing patients.

Can you learn to more effectively encourage patients to pursue better health? Is it possible to communicate in a way that supports patients in following through with the treatment and/or lifestyle changes you recommend? Yes, and yes. If, having read this far, you have a better sense of the difference between indoctrination and patient-focused education and want to shift your attention to the latter, here are twelve attitudes and behaviors you can begin practicing this week.

1. Keep reminding yourself the patient has one primary question: What?s in it for me?
2. Assess what the patient already knows. Ask several open-ended questions before launching into what you want them to know.
3. When someone expresses interest in the kind of care of provide, engage them from a place of curiosity about their needs.
4. Provide information based on what the patient needs now. Give the right information at the right time.
5. Slow down. Pause long enough to allow the patient to take in what you are sharing and formulate his or her own questions.
6. Use simple language without being condescending. Avoid jargon and tailor information to each patient?s level of understanding.
7. Practice empathy. Tune in to a patient?s emotional state and take the time to acknowledge and explore accordingly.
8. Avoid slipping into monologue mode. It?s the rare patient who comes to your office for a lecture.
9. Acknowledge that there is a place for a variety of healing methods and that they all have benefits and limitations.
10. Resist the urge to ?win over? everyone you encounter with your way of thinking about health and healthcare.
11. Let the quality of your care and the results you achieve with patients be your advertising.
12. Convey hope. It has a therapeutic value.

Patients arrive in your office with already formed opinions — about you, about their health, about the healthcare system. Yet, we rarely ask them their opinions or what they already believe or understand. If we want to encourage patients to become more actively engaged in their care and more accountable for their outcomes, we must adopt an approach of sincere, patient-focused education. In doing so we invite them to be involved, cause them to think, and support them to make good choices.

When we indoctrinate patients by trying to shift their beliefs about their health without first finding out what those beliefs are, we may be perceived as inauthentic, self-promotional, or disrespectful. Using indoctrination when we should be using patient-centered education undoes all of the good that our best marketing efforts seek to achieve.

By focusing on genuine education, rather than indoctrination techniques, you automatically build trust with patients. Practicing the behaviors and attitudes outlined in this article will help you gain strength in your ability to communicate and establish rapport. Imagine yourself as a true partner in helping patients achieve long-term health and, in doing so, you?ll acknowledge who they are and what they want for their health and their lives. Master this and you?ll have all the loyal, appreciative patients you could possibly want.

Read Online:

Marketing Article by Dr. Simon in Dynamic Chiropractic

Be sure to take a look at the September 24th issue of Dynamic Chiropractic. In it you?ll find an article by Dr. Shelley Simon, True or False: Marketing is a Mystery. This piece explores the five universal marketing challenges that chiropractors face, common marketing mistakes, and how to avoid those mistakes by developing a new stance and strategy around marketing. If you missed the print version of DC, read the article online here.

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