I was listening in to the POD call on Tuesday when something clicked about influencing! For the first time in all these years I think I actually heard the message – our job on every visit, not just in the RYF, is to influence a single behaviour or action! Call me slow but I had never actually thought about the whole concept of influencing the patient after the first one or two visits. I had certainly considered connecting with the patient on each visit but that is not the same thing! True patient centred care should involve all facets of influence – (the 6 weapons of influence as Cialdini called it) and we are to use our intuition, technique, liszening skills etc etc to guide how we influence the patient at that time. Now I find it very easy with patients who show change, where you pick up different areas e.g T5 stomach etc, T/L twisting, mid Tx posture, swollen puffy ankles etc etc however my real struggle lies with the “no change” patients – you ask them how they are, they report “the same”, and you check them and it is the same? With these challenges this is where I am in danger of pounding meat! You ask have you been changing your position or whatever and the reply always comes back affirmative! In other words you could repeat yourself a million times with the same result! So what area or behaviour should I be trying to influence with these chronic patients! I trust that makes some semblance of sense? So how do you all cope?
Influence
(11 posts) (5 voices)-
Posted 9 months ago #
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Ed, I struggle with this also, the feeling of pounding meat. Maybe the influence is not influence but inform, "mrs jones why do you think you still hurt?" might get "i don't know" or "because i've had this problem for 10 years". then we can inform, influence or investigate other options. thank you for not letting me feel like i am the only one in this situation. Tad.
Posted 9 months ago # -
Are these patients that are not getting well? I think that is what you are referring to as opposed to the ones on cruise control. As far as cruise control patients I usually ask if they are working out still, etc. and half the time they say something to the affect that they have been slacking lately. (Not that I would ever do that personally) Just by mentioning it I feel it reinforces the positive behavior that got them to cruise control and I will usually say something along the lines of "Well you are getting away with it for now but you don't want to use up all your positive credits" They get it.
For patients that just won't get better, I view them from purely taking care of my half of the relationship. Have I done everything I can from an adjustment standpoint? Try to find a new tweak each time, etc. they are our true experiments. I have found many adjustments over the years that are not "in the book" while attempting to solve the impossible. Make it a challenge. As far as their lifestyle, if you think/know that is a major factor then are you and have you been brutally honest with what changes you think they need to make? Whether they make them or not, I don't care. That is not my half of the relationship that is theirs. So continuing to do your best for the patient in spite of their help may be the difference. If you are "pounding meat" then it could be like giving up on them just because they are too stupid to follow your advice. But those are the patients that are funding your children's tuition. Rejoice in their choice as long as you have done your part and continue to remind them of their part once in a while (not nag them about it).
That's my two cents and you may want change but there it is.
Posted 9 months ago # -
Oops and one last scenario. Some patients can't get ALL better. For them it does frustrate me too at times but then I look at it from the standpoint of how much worse off would they probably be if we didn't at least keep them going? I have had some of these patients give me the most sincere thank you's along the lines of they would not know what they would do with me blah, blah, blah. I know we all get that but it puts the uncured in perspective for me sometimes.
Posted 9 months ago # -
I follow you doc, the hard thing is to keep it fresh and exciting to me. the people i am thinking about are those have had a problem 10+years, just adjusted him as a matter of fact, mid back is a major problem most likely will never be 100%, his behavior style is S so getting feed back or validation from him isn't happening. what you mentioned is pretty much what I do with him, find an area to tweak, left shoulder last time, right shoulder this time, but as far as the influence part sometimes I feel I lack with him, just one of those things I notice when the day is slow and he comes in at that time.
Posted 9 months ago # -
I guess in that case it is just using the knowledge you have. He is an S so he won't talk much. Since he has been seeing you for 10+ years you might assume he thinks you help him in spite of what you think. As we are often told, S's vote with their feet. He is voting!! As much as my ego might like it, we can't cure the world so sometimes helping is all that is asked of us. The piece of mind of having done my best is what I try to go with and what ever happens, happens. Easier said than done I know, but it again comes back to not getting attached to the outcome. I know you know all this but as it is with all of us with the many pieces to the puzzle it is in the application.
Bottomline: STOP IT!!! :)
Posted 9 months ago # -
If I may say a very interesting topic for discussion. Twelve years and one week ago a patient herniated her disc. The next day I left my practice for two months to have my darling little daughter and when I went back to work she looked worse (extremely antalgic) EEEEK! Just yesterday after 12 years of chronic low back pain - she told me that she feels the best she has EVER felt for as long as she can remember! If I had of given up on her, or the healing power of the body where would she be today? I never knew whether she had severely limited matter; but I did know that she smoked; had an unhealthy work environment, and had several other things that weren't pointing her in the direction of the fast healing train. When I look back my purpose was to influence her to believe in herself (NOT ME) and know that she was worth the effort. The entire twelve years no matter how she felt - she knew she had a place to go where people believed that she had a potential to heal, and cared enough to listen. Last year she was in a nasty car accident and pulled through that too! Were there questions as to whether she could do it this time - sure there was - but it wasn't my job to decide whether or not she could make it. Even if one's symptoms don't go away or there aren't any perceived change by the patients, the body is still WAY better off for being adjusted than not! One thing that I always keep in my brain when adjusting and often tell patients is that the body will always work on what it KNOWS is most important......(and that just might be figuring out what normal cell division is!)
What we do is probably the most important thing in the world! It is continually offering another chance!Posted 9 months ago # -
Hi Tad thanks for coming to sit beside me at the back of the bus!! I was beginning to feel like Norman No Mates!! I am finding this a fascinating topic and even more so having listened to the POD call last night! Chris even though it pains me to admit it your insight and advice is a huge help, however I do believe Karen is actually typing everything for you! In the space of 12 short months you could not have got that smart!
Going back to your initial question as to whether these are patients who are not responding – I think I have issues with both – I think complacency (with me that is and not the patient) is a huge problem with the “maintenance” patients so your suggestions here are great, whereas the patients who are not responding goes back to the whole ugly issue of FEAR and control! So whilst I started with Influence I actually find myself coming back to the matter of caring for rather than carrying patients, or being responsible to NOT for the patients! I am like a broken record!! But therein me thinks lays my fundamental problem! So despite knowing full well that this is “Dr centred care” in the extreme I still really, really struggle to disassociate myself from the outcome, I find myself feeling guilty that a patient isn’t responding as quickly as we like. And so when a patient raises an objection or worse still I sense something, normally unfounded I hasten to add, such as my Fear that they will quit, my somatic markers go in to overdrive! And I struggle! Admittedly the good thing is my Self awareness has obviously increased, And yet knowing what Dr T mentioned that “the body is still WAY better off for being adjusted than not” is scant consolation. So my Care Tactics certainly become fear driven small talk!
So the idea of Influence and Wade’s “serious fun” has such huge ramifications and why I am benefitting so much from this Forum! Each and every comment provokes some reaction or rather action which is great!
So please keep the comments and suggestions coming! My need is great but the need of my family is greater still!!!!
Have a great weekend!
P.S. Now this maybe a very tactless question but I ve been meaning to ask Dr Julie this for ages since her post on the Blog page, and judging from her comment this did happen a long time ago so I hope this is ok - but did Stinkycat get his name posthumously or was his name just an unfortunate coinicidence?
Posted 9 months ago # -
Actually Ed, Karen reads these posts to me for time management purposes but I do write my own stuff (the jokes anyway, she's not that rude and much funnier).
I've been thinking about this influence stuff the past day, since you brought it up, and maybe another way to view influence is from the angle of to inspire. That may tip away from the tendencies to control(influence) toward the other end of the spectrum a bit more finding a better middle ground. I don't mean inspire in the sense of some lofty happy all over feeling but more along the lines of what Dr. T hit on with regard to giving hope. Patients knowing that we actually think they can be better than they are today, I believe more and more all the time, is what most of them are looking for. In our hearts we certainly should strive for perfection but in reality improvement and sometimes seemingly just support to not slip backwards. We don't know which knock on the door will open it up, we just need to focus on knocking on the right door. The body heals itself and we have the ability to help clear the path but that is it. So results are truly up to the individual and not always in their control either on a day to day basis. I remember discussing with Cathy Sovinsky at a Chicago conference two years ago that I have trouble getting "up" for the "basic" conditions and that I really only seemed to get excited about the challenges where I get to be the "hero" when no one else could help them. How pathetic is that? No offense (sort of), these less exciting cases are not any less important to the people living in those bodies and their families. So I have been there and "I get it" but other than snap out of it and stop thinking about what you get out of it (or notget out of it) as opposed to what they get out of it.
Whew! Has it really been over 13 years since leaving Life? I think I just had a flashback!
Actually I wanted to sincerely thank Dr. T for her post, the passion really came through for me. The part that really hit me was the last line, with regard to each adjustment.
"IT IS CONTINUALLY OFFERING ANOTHER CHANCE!"
We don't when, if, or on what level someone's body will improve we are simply selling opportunities wrapped in hope. Merry Christmas!!
Posted 9 months ago # -
Okay, so I have taken over the role as "Thread Killer" from Dr. Davis. :) Someone step up. As hard as it may seem for some of you to believe, I don't like logging in and seeing my own name on the forum. That means I don't get to read anything new and see what is going through someone else's vantage point, as frightening as that is at times. No Monday morning chuckles Ed? I am like an addict here. I need my fix. My birthday was Saturday, come on something.
Posted 9 months ago # -
Sorry to leave you in the lurch, I ve just been processing your advice! Plus I ve been looking for your jokes that you mentioned - the administrator must have removed them before I got a chance to see them! Anyway belated happy birthday! I will endeavour to add more questions in the morning!
Cheers All!Posted 9 months ago #
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