Patient centred, principle centred or both?

Sometimes, when things seem too good to be true, it’s because they are.

Imagine a perfect couple. He is a famed actor, noted for his good looks and adored throughout the world, women want him and men want to be him.

One lucky lady did get him, she is equally gorgeous and talented.

Only it turns out they are both bat s**t crazy, fuelled largely by drugs, booze and hate. They have blazing rows, leading to violence and language that would make your milk curdle. Most impressively, she gets so drunk and high, she s**ts the bed and blames the dog ( I guess that tiny Yorkie really can lay some serious cable….)

Amber Heard

I am, of course, talking about the charming Johnny Depp and Amber Heard.

Johnny Depp and Amber Heard

Frankly, they are as bad as each other.

They are both all about one person and one person only….themselves.

As practitioners, we should be interested in one person, the patient.

They have put their health in your hands (literally) and are paying you money to care for them.

The term “patient centered care” is common place these days, you can view any NICE guidance and that is trotted out at the start of all guidance.

Ironically, they proceed to then all too often apply a statistics based evidence drug approach that is then applied via a flow chart by GP’s as they wish.

In short, in my opinion often it is NHS/GP centered or maybe more realistically, pharmaceutical industry centered.

Within some groups, the alternative to being patient centered is being “principle centered”.

This effectively means they are focussed on the principles that underpin the style in which they practice, their philosophy and beliefs.

This can also mean they are focussed to some extent on what the practitioner wants rather than the patient.

This has sadly been part of a schism within the Chiropractic profession for many years.

The tragedy is they are not mutually exclusive, they are both correct, when used appropriately.

In fact, I would argue you cannot have one without the other.

Does being patient centered mean you do what the patient wants?

Bend to their whim and provide services or a schedule of care that you do not wish to

Clearly not!

Often, this may not be in the patients’ best interests for us to comply.

I will not allow patients to attend at a frequency that is less than I believe will allow care to work. Equally, it is not one size fits all.

My waiting time for a new patient is around 4-6 weeks and when they book they are obliged to prebook at least 5 follow-ups.


Because I cannot get them in for follow-up appointments for weeks on end unless they prebook their care. They will not get better if there are 2-3 week gaps between appointments when they are early in care. So the pre-booking is in their best interest (and mine, as I will not work my lunch or stay late to accommodate patients that are not willing to follow our instructions).

So, by being patient centered, I am also following my own principles on what I believe works for patients and also what is good for my own health (I need time to digest!).

So, yes, I am patient centered and my Chiropractic principles guide the care of patients very strongly.

Principles are a framework which we work with and “hang” new knowledge and clinical experience on. But the framework is flexible enough to bend to different patients, to a degree.

You cannot be all things to all people.

Some patients are just not a good fit for some practitioners’ care, but the nuance is it’s not one size fits all, it is a spectrum.

The reality is, we all have principles that guide us, how can you practice without them?

But we must have some flexibility to allow us to work with patients that may have different needs and wants or ability to comply with some of our suggestions.

So, in my opinion, everyone is principled, we have a framework of beliefs around the care we deliver.

But not everyone is necessarily patient centered.

And that is why I am so pleased to let you know that a member of our ACN – Core Concepts in Chiropractic Nutrition group, Chris Chippendale, has put together an excellent online course specifically on the topic of patient centered communication, called the happy patient project.

Click the link to check it out


It is an online course with an exclusive FB support group, designed to create lots of happy patients making informed decisions about their care and happy practitioners delivering care in an ethical way.

Broken down into short videos for easy learning, spread over 5 modules:



Whether you consider yourself a mechanistic practitioner or a wellness-based one, the reality is you need to be able to communicate effectively to allow patients to make the right decision for them in an ethical effective way.

So many of us leave university with good neuro-mechanical knowledge but very poor patient management skills.

This is bad for us but even worse for patients. Without a clear understanding of the issues and options, they will not be able to make an informed decision about their health.

This is a course I wish I could have taken when I first graduated. No doubt I would have built a successful practice with far less stress and fewer mistakes.

Early in my career, I took advice from too many American/Australian guru’s on “patient management” that left me feeling vaguely uncomfortable because really I was imposing a one size fits all approach to their care.

I also have fluffed many ROF which meant the patient never fully embraced what i could offer.

You can check out the walk through on the course here by clicking the link, as Chris takes you over the modules and all the bonuses he is including.



  • If you feel like you are struggling to get your message across to patients and are fed up with slightly unethical “practice building” gurus, Chris and the Happy patient project might be just what you need – Click the link


  • Never offer to pick up Amber Hard’s dog poo – you might need a carrier bag
  • If Johnny invites you over for brunch, probably best to say no.

depp's den

depp's den2

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