Hindsight is 20/20: How I Survived Clinic (Internship)

I had a blast in clinic.  Make no mistake, it was not all rosy and smooth all the time.  In fact, like many of my classmates, I got kind of a rocky start.  At first, it seemed dismal and I was concerned that I’d never make it on time.

Indeed, a year seems like plenty of time.  But let’s face it, you also have a lot to do.  In my day, this consisted of: 200 adjustments, 24 exams, 35 physical rehab therapy treatments, 10 new patient recruits (not readily-available information; they wait to disclose this until you’ve already enrolled), 30-35 x-ray reports (during a 2-week rotation), and a gazillion QAs.  Indeed, you’re up against the clock and if you want to graduate on time, you better haul some butt.

The biggest concern is recruiting new patients, because from there, all else flows.  If you have enough patients, you will be busier and you’ll get everything else done.  So let’s start there.

Everybody had their own strategy.  Some people had distinct advantages over others.  Without giving too much away, I was a licensed massage therapist prior to attending chiropractic school, so I had a small-but-loyal client base to pull from.  I had also waited tables for a while before that and made some lasting friendships.  Some got lucky with hand-me-down patients passed down by graduating interns.  Other people had been personal trainers with connections or clients at a gym.  Others gave health talks.  Still others did spinal screenings (which I’m not sure I’d ever do).  Ideally, you’re not supposed to pull in any of your friends or family, because (they claim) they’d rather you get used to the lost art of talking to strangers (frankly, I have other theories).  But most people pulled in whatever friends and family (and family’s friends) they had.  At tuition approaching $9k per term, you pull out all the stops to avoid staying another term.

And then, there was a booth at our local state fair.  Students could sign up for “shifts” to help man the booth.  They schmoozed the crowd and sold coupons for a New Patient Package Special to interested prospects.  Some went about it all wrong, making asses of themselves and turning people off.  My strategy was to let people come to me and ask their questions.  My goal was to make it about THEM, because after all, that’s what they’re naturally interested in.

And that’s the #1 secret right there: it’s ALWAYS about the patient.  I think it’s perfectly OK to recruit your friends to get through school.  No shame in that.  However, after you graduate, the chiro-bubble pops, and the world changes: it becomes sink or swim.  If you don’t paddle hard, you’ll drown.  Paddling hard means pounding pavement, getting OUT in the community, without chirovangelizing.  To develop finesse at this highly-refined skill, you can (and maybe should) practice doing this in school.  If you don’t have your hands on a patient (or your butt in a classroom chair, or your nose in a textbook), it’s a good idea to be out shaking hands with your community.

We didn’t plan to stay in the city our school was located, and we didn’t particularly care for that community much.  It was fickle and learning to relate to them was somewhat irrelevant, since the vibe of that community was so different from that to which we’d be moving.  Now, some may argue that we should’ve bitten the bullet and pounded some Big D pavement anyway, but we didn’t and we survived, so here we are.

Truth be told, recruiting your friends (and getting them to stick with their care) can sometimes be a bigger chore than accomplishing these same goals with people with whom you share no other connection other than that they are your patient.  Also, sometimes attempting a dual relationship (where your friend is also your patient) can be tricky, and both of you must be mature and professional enough to handle that.  In clinic, you’re their intern; outside of the clinic, you’re their bud.  Sometimes those two wildly different worlds can be difficult to separate and maintain.  Lines easily get blurred.  Relationships change.  Sometimes these changes are irrevocable.  Occasionally, the friendship itself can’t sustain such a big metamorphosis, and you lose that friend.  Think long and hard before recruiting friends.  At the very least, have a good heart-to-heart beforehand.

Never rely on hand-me-downs.  They look good on paper, but only “believe it when you see it” – i.e., when the patient actually comes in and proves him/herself reliable.  Never count your chickens or get your hopes too high, because often, these hand-me-downs are friends of graduating interns who were coming in to help them; now that the intern is graduating, the patient/friend’s help is no longer needed, and they may drop off the planet.

Faculty can be a good bet because they’re always close by, they can be there on short-notice, and since they often don’t pay for their care, you can tack on additional services and meet additional requirements faster.  This is a double-edged sword.  First, people who don’t pay for their care end up not valuing it sufficiently.  This is a simple, unavoidable law of nature.  This can turn faculty members into flaky people to tend to cancel on short notice or sometimes no-show altogether.  Second, sometimes two diverging tiers of care can easily form, where you end up skimping on your friends’ care because they pay extra for extra services and you’re attempting to save them money, and you end up giving deluxe care to faculty members because no matter how much you do with them, they don’t pay anything.  And hey, you’ve got requirements to meet, so on paper, it makes no difference to you whether they were achieved through a faculty member’s case or a friend’s.

State fair booths are usually what you make them.  Never expect anything or get too cocky.  Remember that people don’t come to the fair to get information about their health.  In fact, it doesn’t take more than a quick glance around at the crowd to figure out that most people at the state fair are in sorry states of health and that health isn’t usually a huge priority.  For this reason, state fairs can be tough crowds.  I approached the situation with the mindset that no matter whether I scored any prospective patients or not, I would talk to interested people and clear the air about chiropractic.  I would do my best to elevate chiropractic in the eyes of the person I was talking to by doing a few basic things: 1) focusing on THEM and not myself or the profession, 2) answering THEIR questions, 3) being 100% truthful, honest, and ethical, 4) explaining chiropractic using only RATIONAL, scientific explanations, keeping them short and sweet, and 5) never pressuring anyone or turning the discussion into a sales pitch.  I would offer my card or a brochure (always stapling my card to the brochure), always asking first.

The booth missed the boat on a few things, by offering free chair massage or free samples of Biofreeze.  I wasn’t there to sell vasodilator ointments or sign people up for a neck rub from a massage therapy student; I was there to talk to patients about their chiropractic-related problems and conservatively explain how chiropractic could help.  This wasn’t about massage.  It wasn’t about free stuff.  It wasn’t about computer-generated muscle spasm charts.  And it certainly wasn’t about the school, even though that seemed to be the emphasis the school wanted.  Nope, I dressed in proper clinic attire and explained how if you’re not in proper alignment, you can’t move or function as well.  And I took it from there, emphasizing points that would hit home with whomever I was talking to.  For most of them, it was a relieving breath of fresh air.  I probably talked to the fewest people of any intern there, and yet I signed up the biggest fraction of those I talked to.  They seemed cautiously comfortable, like they could trust me.

Don’t just stand around, don’t hound people, don’t dress sloppy, don’t look depressed, overcome your shyness, always be professional, don’t promise the moon when you know you can’t deliver, and don’t accost people from across the walkway.  Don’t use big words or long boring explanations.  Make it relevant, keep it real, and above all, don’t be weird.

In clinic, do thorough exams, keep good notes, and stay up with your patients.  They will tend to want to drop out, especially after the first month.  Give them what they need – have it spelled out in a treatment plan based on the exam, and stick to it.  Don’t overtreat, and don’t be a pushover and drop the ball.  Schedule their next appointment (or even the next 2) on their way to check out.  Now–if they say they need to take a break for a while or for some reason they call to cancel and don’t reschedule, check back with them in a week.  See how they’re doing – maybe they’re doing great and don’t need much care anymore.  If nothing happens, check in with them after a month to let them know that you’re closing their file and if they’d like to return to care you’re happy to open it and that if you’re no longer there when they come back, they can begin care under another intern.  Then thank them and be done.  DO NOT HOUND people.  If they want to come back, they will.  If you make it easy for them to leave, it’s easier for them to 1) come back, and/or 2) refer their friends with confidence.

Understand that mistakes will happen.  The fact is, you’re a student, and that’s the whole point of discounted care–the fact that you lack experience.  If you can’t give someone the sun, moon, and stars, don’t sweat it.  Always look for ways to learn from situations and improve your skills, but don’t beat yourself up over an unsatisfied patient.  Some people have unrealistic expectations.  Others don’t realize what little experience students have.  Others simply can’t be pleased and you happen to be the one treating them; with these people, the same situation would’ve happened to any intern.  Often, even a field doc will fail to please them.  So don’t lose any sleep.  You’re human, and so are your patients.  Learn, grow, and move on.  After all, that’s exactly what school is for.

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