You’re the Bus Driver originally from June 15th, 2018 FPC Newsletter
Written by Dr. Trevor Botts
“You’re the Bus Driver”
Last summer my wife and I took a trip to Europe. We landed in France, spent a few nights in Paris, Versailles, and Chartres, and then headed into London by speed train for our final few days before heading home. By the last day of our trip we were pretty tired and sore, so we decided to buy a pass for a “hop on hop off” bus tour on one of those red double decker buses that are so popular in London. We enjoyed sitting on the top deck, soaking in the sun, and riding through all of London while a tour guide told us all about the history of the city. Our bus driver was particularly engaging and did a great job of interacting with the passengers. He got to know us and made us feel welcome, shared insights, answered our questions, and made sure that we were enjoying the ride as much as he was. Even though it was a “hop on hop off” bus tour and we could get off at any time, before we knew it, we had ridden across all of London without ever thinking about hopping off the bus.
Now I want you to imagine this same red double decker bus tour, but this time my wife and I are the only passengers on the bus. The driver has our undivided attention. He knows we’re there. He knows he’s responsible to take us on a tour. He also has destination in mind that he thinks we might enjoy, but he isn’t communicating with us to make sure we understand where we are going and that this where we want to go. Rather than engage us, he recites a memorized script. He also isn’t paying attention to see if we’re following along. At one stop, I lean over to my wife and say, “I don’t get it. This is not what I was hoping for. Let’s hop off and go get a bite to eat.” We get off and watch as the bus pulls away. Meanwhile, the driver continues to recite his script, seemingly unaware that he has lost his passengers. Four stops later, the driver looks up and says, “OK, we’ve arrived at our destination, how did you enjoy the trip?” Only then does he realize he is alone on the bus and has been talking to himself for the last 30 minutes.
Silly, right? Well, when we sit down for a consultation with a patient, we are like the bus driver. We have a destination in mind that we want to help the person reach. In order to get there, there are 9 stops along the way. At each stop, we need to evaluate if the patient has stayed on the bus. Are we on the same page? Are we in agreement? Or, have we confused them? Did they jump off the bus because we didn’t connect with them? There are cues that we need to pick up on to determine if the person is still “along for the ride”. Isn’t it frustrating when, at the end of an ROF, the patient says, “I need to think about it”? Well, this means they hopped off the bus at some point (or you kicked them off!). Unfortunately, it’s often too late to circle back and try to pick them up. We can’t simply blaze through the steps of the ROF, expecting that if we follow the script, that that is sufficient to motivate a person to take action. But, we can go back and review the entire journey and determine at which stop the passenger got off, so we can do better next time.
These bus stops are the 9 steps of the ROF. There is a purpose behind each step and we need to do more than just cover the material or follow the script. We need to make sure that the intention behind each step is being achieved. For example, when we “Set Expectations” (Step 2) we need to speak clearly, confidently, and with a caring tone. At the end when we ask, “Does that sound fair?”, we are asking the patient if they accept the terms of the consultation. Are they willing to get on the bus? When we cover “Health History” (Step 3), are we rehashing their entire life story, listing off every complaint, or are we focusing in on their primary concern so that we can build a strong “Emotional Connection” (Step 4)? Do we recite scripted statements of sympathy, or do we genuinely feel empathy and concern for the well-being of the patient? Do they recognize that their current quality of life is not where they want it to be? And if they don’t make changes it will likely only get worse? Are we in agreement that there is a need for change? These are signs that the patient is still on the bus. Did you paint the picture of a brighter future and give them hope? Are their goals clear? Do they believe you can help them get there? (Step 5) When we get to “Challenges” (Step 8) and you cover any potential challenges to getting started, how do you know when you’re ready to move on to “Finances” (Step 9)? Ask, “So it sound to me like as long as we can work out the finances, we’re ready to get started. Is that correct?” These transition questions are critical to making sure that the patient is ready to move to the next stop. As we continue to work on our communication skills, pay attention to how the patient is responding to your statements and questions. Watch for verbal and physical cues to tell you if they are staying with you. If you do this, they will naturally arrive at the conclusion that they are in the right place, and you are the right practitioner to help them reach their health destination.