The seven psychological traps every chiropractor must avoid

by Tom Ferraro, PhD and Phil Santiago, DC

All good chiropractors know the obvious. Patients are in pain and want to get out of pain as fast as possible. Patients want to know how long treatment will take and how much the cost will be. Chiropractors realize they must work quickly and thoroughly, exude a pleasant image, and have a clean office. But, as a psychoanalyst who’s treated many doctors, I recognize many hidden traps that can trip up the most well-trained and well-intended DC. In this piece, I spent time with noted chiropractic professor, Dr. Phil Santiago, and together we came up with the seven most common traps chiropractors fall into -- and developed some ways to avoid them.

A common trap you must avoid at all cost is the attractive patient who is out to seduce. If you give in to this trap you had better have yourself a good lawyer.

A critical, demanding patient can produce guilt and ruin a day. Make sure you can explain to negative patients that good care means long term work and that takes time.

Patient traps

We’ll start with the three patient traps.

• Trap #1: The Sexually Seductive Patient.This patient will flirt with you and cause you to get hot under the collar. Freud was quite right when he said that sex was an ever-present impulse that must be managed every day. So, how exactly do you manage the flirtatious patient? It fact, it’s quite simple. Remind yourself of the damage done by a sexual harassment lawsuit and this should be enough to cool you down. Remind yourself to act professionally and keep your distance. The doctor is the one who must know the proper line and not let the patient cross it -- ever. We’re the ones in power and must always realize that it’s never in the patient’s best interest to get intimate in any way.
• Trap #2: The Critical or Negative Patient. These individuals will complain from day one. “How come I’m not all better yet? My other chiropractor was better. I’m leaving.” Nearly all pain patients have hidden anger that will be expressed to the doctor through criticism. The unconscious purpose of their criticism is to deposit their own disowned self hatred into you, making you feel as bad as they do. The best way to handle this maneuver is to understand that it’s an unconscious game they’re playing. We call this projective identification and the moment you understand this unconscious defense on their part, you can release the self hatred that’s been deposited in you.
• Trap #3: The Demanding Patient. These are the patients who always make you feel depleted and drained. They demand special treatment, expect you to see them on off hours, and usually are bad payers to boot. These needy, demanding, and angry patients we often diagnose as borderline patients should never be more than 10% of your practice. You need to set firm boundaries with them and not get guilted into complying with their demands.

All work and no play can make you makes Dr. Jack a dull boy. Be sure to set a good example and get adequate rest and vacation time.

Laziness can destroy the most promising practice.

DC traps

And now for the four personal traps that you may fall into.

• Trap #4: The Overworked Doctor. This may be the most common psychological problem good doctors have. You start out with ambition, success in school, and mild obsessive compulsive traits. Add problems with insurance companies, an economic downturn, poor patient compliance and long hours, and you’re on your way to burnout. Burnout shows as fatigue, irritability, getting sick too often or being injury prone. The maintenance of health is of paramount importance for chiropractors since they set an example to their patients. Patients learn many things by observing their DCs. To avoid burnout, you must sleep eight to nine hours per night, exercise every day and get enough rest and relaxation to restore health. A balanced life of work and play is your right -- even your obligation -- to your patients.
• Trap #5: The Lazy Doctor. The opposite of the overworked chiropractor is the one who’s stopped learning, has a worn out office and may even have a drinking problem. It’s highly unlikely that this type would ever be reading an article like this, but in the event you’re here, this is what we recommend. Locate a hard-working and successful role model and begin to imitate that person. As a sport psychologist, I work with many players on the PGA tour and I guarantee you that Tiger Woods is the most incredible role model to ever hit sports. Many golfers have learned many things about preparation by silently observing this guy and his work ethic. And you can do the same thing in your field. Go find a successful doctor and observe what he or she does to succeed. Then be an imitator.
• Trap #6: The Anxious Doctor. High strung or anxious doctors usually panic over normal fluctuations in patient volume, staff changes or billing issues. I always recall an old friend of mine who was a chiropractor. We were both starting out in our prospective professions and when we got anxious about patient flow, she’d say “Remember, Tom, it’s not the daily numbers, it’s the weekly numbers. And it’s not the week it’s the month. It’s not the month it’s the year.” That comforting wisdom has always stuck with me. Have a broader perspective on patient flow and you’ll be greatly reassured.
• Trap #7: The Grandiose Doctor. Narcissism is an epidemic nowadays and chiropractors are certainly not immune. The grandiose DC will do all the work for the patient and then blame himself or herself when the cure is slow in coming. This can lead to exhaustion and depression. If you find yourself doing too much for your patients or micromanaging your staff, it’s time to realize you’re not God and have limits just like the rest of us. Ease up on your expectation and let your patients start doing some of the work for themselves. They need to take responsibility to exercise and diet properly. It’s not all you adjusting them three times per week.

There you have it. The seven psychological traps every chiropractor must sidestep. Patients will set their traps for you every day and rest assured, if that isn’t enough your inner neurosis will try to have its way with you as well. Just put these seven traps on the wall and refer to them from time to time. You’ve made far too much effort and spent far too much money getting a good education to have it all be dampened by the inner demons in your patients or yourself.

(Dr. Phil Santiago is an associate professor at New York Chiropractic College. A recipient of the “Sports Chiropractor of the Year” award from the American Chiropractic Association, he was the first Chiropractic Physician for the US Olympic Team in Barcelona and has been on the US Olympic Committee for 17 years.

Dr. Tom Ferraro is an internationally noted sport psychologist and a senior level psychoanalyst. Awarded the ING journalism award for instructional writing, he publishes in Asia, the US and Europe and works with professional and elite amateur athletes in numerous sports.)