One of the great questions any physician faces is why one patient thrives, while another patient, under nearly identical circumstances, fails. As in any other profession, no doctor and no therapy can be 100% successful, but for the fully engaged physician, any missed opportunity to change a life is vexing. Not surprisingly, then, this is a question that I've put a great deal of thought into.
And after 18 years, I've finally come up with an answer.
But to understand the answer, you must first understand some of the principles underlying alternative medicine and my approach to healthcare in general.
Mainstream medicine demands passivity from the patient. It starts with the doctor-patient relationship, which is traditionally dictatorial. The therapies provided by a medical doctor are generally passive as well; you simply take the prescribed pill/potion and sit back. Or you go to sleep entirely while the surgeon rummages through your insides. Even when it does involve activity on part of the patient, for example with physical therapy, the patient is given specific directions on what to do, how to do it, how forceful, how many times and how often. And during each scripted PT visit, they are carefully supervised and attended to by the therapist.
On the whole, I cannot think of an approach that would be more dissimilar to mine. While patients seek me for my expertise, experience, and knowledge, I am mindful of the fact that the patient knows their own body and mind best. Beginning with the first visit, I develop a relationship with my patients that is a partnership rather than a dictatorship. I make recommendations rather than hand down edicts.
The chiropractic adjustment itself requires the active participation of the patient, as we need to coordinate breathing, muscular activity and even thoughts and emotions with the physical act of spinal adjusting.
When there is a nutritional component involved, in addition to recommending supplements and herbs, I discuss the patients' diet with them, seeking ways we can adjust their nutrition more efficiently with dietary changes.
Home care and active rehabilitiation in my office is often a review of different exercises, using the ones that the patient seems to feel most affinity toward, discarding those which receive less positive feedback, and general recommendations about timing and intensity. Our discussion on home care will range from driving habits to workplace ergonomics to hobbies and interests, as I will use alterations in any of those to help my patients get the desired changes. I also employ feedback from my patients as to the frequency of the care they receive.
This collaborative approach is jarring for some. Used to the mainstream hierarchical and cookie-cutter approach, to some patients my style comes across as too chatty, too lackadaisical, too laissez-faire. "GET ME BETTER!" they say, to which my reply is, "I can't do it without you."
And therein lies the secret of my success, and the source of my failures. The success of my treatment is predicated on the active involvement of my patients. But how is it that I can get engagement from a patient in their health care, yet still end up with a therapeutic failure?
That's where the 20-mile march comes in.
The 20-mile march is actually a concept developed by a couple of business writers, Jim Collins and Morten T. Hansen, in their book, Great by Choice. They found that companies with long-term success developed a game plan and stuck to it, changing little with the winds of fortune. They didn't try to grab success all at once, nor were they deterred by adverse environments. They reached their long term goals by establishing acheivable short-term objectives and then meeting that short term objective again, and again, and again, in the same way as a man might set out to walk across the continent by walking 20 miles a day.
This is the exact same way that good health must be acheived, by patience, often-strenuous repetition, and the ability to avoid overreaching.
Collins and Morten outline the core components that create an effective 20-mile march to success. They are:
- Clear performance yardmarks
- Self-imposed limitations
- Appropriateness
- Proper time frame
- Developed by the individual
While the authors were writing about corporations big and small, these same attributes apply nearly exactly to the health care plans which my patients and I implement. However, I had never before dissected my approach to examine exactly where it could go awry. Fortunately, Collins and Morten did it for me.
Let's examine some of these in more detail so that we can see how easily our plans may go awry.
Go a Minimum Distance Every Day
20 miles every day is the heart of the 20-mile march. It's a goal that is doable, but not necessarily easy. It stretches the boundaries of the individual's capacities, without causing damage. It challenges and forces creative responses to obstacles, but doesn't require an exhausting, all-or-nothing approach.
The classic example is with basic exercise routines. From fibromyalgia to flu prevention, I include exercise of one sort or another in almost every prescription, to force an adaptive change without relapse. For example, when I'm explaining to someone how to stretch, I tell them to stretch it until it hurts, hold for a while, and then stretch it a little bit more. To be effective, I tell my patients, a stretch has to hurt some -- but not hurt so much that you injure the muscle.
Or when I'm advocating cardiopulmonary exercise, I routinely tell patients that "I want you to be panting for breath and sweating. I don't care how cold it is. I want you to sweat, and I want you to be very tired when you're done."
I am often amazed by the number of people who have told me that they thought this level of exercise would be dangerous. That, somehow, sweating, panting and being so tired at the end of a workout that you've got to sit down and rest for a couple of minutes is bad for you.
It's not. It's generally the best thing you can do for your health.
So there we have it. Minimum, easily observable goals that constantly push at the boundaries a little bit.
Know When Too Much Is Too Much
This is a common point of failure for some people, as I well know from my personal experience. I am fortunate enough to have a constitution which naturally possesses a great amount of stamina and the ability to divert my attention from pain. This is why my career in the martial art of Aikido -- a low-contact, flowing martial art built around blending with the attack -- was pockmarked by broken bones, dislocated shoulders and concussions. I took far too much advantage of my internal environment, leading to injury and setback.
Similarly, some attempts at healthy changes do not recognize proper limitations. Diets fall into this category. I have seen patients, in their attempts to regain health, continuously refine their diets until, in the words of more than one patient who came to see me, "There's nothing left for me to eat!" In these cases, an otherwise healthy 20-mile march become unhealthy when the ante was upped to 30, 40 or 50 miles.
Everybody's Different
While I may know in my head that no substantive changes will be noticed until certain milestones are reached, the ability of my patients to reach these milestones varies greatly. Reasons, from the severity of their illness to psychologically self-imposed limitations, will inhibit progress, and for a while, the 20-mile march may only be a 10, 5, or even 2-mile march.
It doesn't matter, and it's my job to help the patient push at their inabilities until they become abilities. This transfer isn't always as much physical as it is psychological, a change in outlook or point of view, which enables my patient to see what they are doing more clearly and use that as their foundation. Sometimes it takes more than time and repetition to reach this point, and a certain level of creativity is needed to bring the patient to their starting line.
This is also the point behind that phrase I am so fond of, "biochemical diversity." When somebody asks me what a good diet is, I just shrug my shoulders. It depends on who you are, I say.
How To Walk 20 Miles
While the other elements are also important, the only other aspect of the 20-mile march that I'll talk about in this post is the need for consistency. To reach good health from the point at which most people arrive in my office requires time and persistence. All too often, patients will get overly optimistic by their sudden improvement after reaching my office. They don't know -- and I must convince them -- that this time of great expansion is limited, and it is only after walking a long and often trying road, with often no other signs of progress besides that 20-mile marker, will they reap the full benefits of their healthcare plan. As the I Ching puts it:
The Creative works sublime success, Furthering through perseverence.
Dr. Avery Jenkins is a chiropractic physician specializing in the treatment of people with chronic disorders. He can be reached at alj@docaltmed.com or by calling 860-567-5727.