http://www.patientcentred.co.uk/

Patient Centred Training, Sevenoaks (2025)

18/09/2025

𝐁𝐮𝐥𝐥𝐞𝐭 𝐓𝐫𝐚𝐢𝐧𝐬, 𝐊𝐢𝐧𝐠𝐟𝐢𝐬𝐡𝐞𝐫𝐬, 𝐚𝐧𝐝 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐄𝐝𝐮𝐜𝐚𝐭𝐢𝐨𝐧

Most humans approach problem-solving in a fairly standard way: break things down into parts, analyze them carefully, and then try to rebuild the solution from the ground up.

It feels logical, scientific, and works… most of the time.

However, that’s exactly what the Japanese engineers did when they were designing their high-speed bullet train… with no success.

The train was too loud, too unstable, and too inefficient.

No amount of tinkering with the calculations could solve it.

The breakthrough came from a totally different direction: the natural world (the kingfisher, in particular).

Most practitioners make a similar mistake when trying to explain care to patients - logical, structured, simplified into neat little chunks of information.

On paper it looks perfect, but in reality patients often forget it, miss the meaning, or simply don’t get it at all.

There’s a different way to think about it, that also takes inspiration from nature.

It doesn’t rely on logic, but instead on how the human brain have actually evolved to take in new information.

It’s counterintuitive, but I’m betting that once you try it, you’ll never go back.

I walk through the idea in this short video, along with some real-world examples that you can use straight away in practice.

16/09/2025

𝐀 𝐛𝐚𝐜𝐤𝐰𝐚𝐫𝐝𝐬 𝐚𝐩𝐩𝐫𝐨𝐚𝐜𝐡 𝐭𝐨 𝐥𝐞𝐚𝐫𝐧𝐢𝐧𝐠…

Many of you reading this will know Ulrik Sandstrom - some of you for his excellent muscle testing seminar (in fact he’s the only person I trust to teach it properly)...

… others for his work integrating chiropractic into elite sports and the 2012 Olympics.

But here’s something you might now know - his teaching methods can be a little… unorthodox.

In particular, here’s a little trick he shared with me a few years ago - he started sending seminar attendees a test 𝐛𝐞𝐟𝐨𝐫𝐞 they attended.

Not after, like most instructors - a full week before they’ve even met him.

On the surface, it makes no sense at all - why put people through a test they can’t possibly pass?

Well it turns out, it’s actually a surprisingly effective tactic - and the research backs this up.

As it happens, simply providing information to people is a pretty poor way to help them learn.

You can do it by brute repetition, but it takes a long time (remember those anatomy flashcards from uni?).

However, there is a way to get knowledge to stick - you need to get the student to attach emotion to the knowledge.

And one of the best ways of doing this is by creating tension.

Making them realise there’s a gap between what they currently know, and what they need to know.

This sets up an “open loop” within the brain that creates a little bit of frustration - the feeling they’re missing something (like when you put your keys down for a moment and then can’t find them anywhere).

Then when the missing knowledge appears, the loop suddenly closes, accompanied by a little hit of dopamine, and a sense of relief.

Subconsciously, your brain is basically saying “Hey, that must be important - remember it!”

The synapses get reinforced, and the memory of learning it is made much stronger.

A lot of skilful teaching comes down to the art of managing that gap - too little tension and it doesn’t stick, too much and the tension “snaps” and people give up (I’m looking at you, Year 3 Immunology module…)

That’s why Ulrik quizzes people before they know anything - he’s creating a gap, so when he fills it later during the seminar, the brain lights up — that’s the missing piece.

And because the memory is associated with that emotion, it stays.

Which is the exact same reason I asked you, last week, to sit down with a pen and write every factor that might influence a patient’s recovery… but didn’t reveal why.

I’ll explain why today, but first I wanted to highlight why I didn’t just give you both parts last week - because I wanted you to feel the gap first.

Also, so you’d understand this next part:

𝐈𝐟 𝐲𝐨𝐮 𝐡𝐚𝐯𝐞𝐧’𝐭 𝐭𝐚𝐤𝐞𝐧 𝐭𝐡𝐞 𝟏𝟎 𝐦𝐢𝐧𝐮𝐭𝐞𝐬 𝐭𝐨 𝐰𝐫𝐢𝐭𝐞 𝐭𝐡𝐚𝐭 𝐥𝐢𝐬𝐭 𝐝𝐨𝐰𝐧, 𝐠𝐨 𝐛𝐚𝐜𝐤 𝐚𝐧𝐝 𝐝𝐨 𝐢𝐭 𝐛𝐞𝐟𝐨𝐫𝐞 𝐫𝐞𝐚𝐝𝐢𝐧𝐠 𝐚𝐧𝐲 𝐟𝐮𝐫𝐭𝐡𝐞𝐫.

(Do not pass go, do not collect £200…)

If you don’t, just say to yourself “I’ll just read this now and do it after…” you’ll be robbing yourself of some real insights.

(Now, here’s the trick - one of the reasons why I didn’t reveal part 2 last week is because I wanted to set up some tension - by making you wonder “Where’s Chris going with this?”)

So now that you have, here’s part 2:

Take a look back over it and sort what you wrote into three groups.

𝐆𝐫𝐨𝐮𝐩 𝟏 - 𝐰𝐡𝐚𝐭 𝐲𝐨𝐮 𝐜𝐚𝐧 𝐜𝐨𝐦𝐩𝐥𝐞𝐭𝐞𝐥𝐲 𝐜𝐨𝐧𝐭𝐫𝐨𝐥.

This isn't just what you can influence - I mean these are entirely within your control. The obvious ones will have been there already: your diagnostic process, the clarity of your recommendations....

But you might not have thought about the less obvious - for example, how you respond if a patient pushes back or questions you.

(If you didn’t have that, no worries - just add it to your list now)

𝐆𝐫𝐨𝐮𝐩 𝟐 - 𝐰𝐡𝐚𝐭 𝐭𝐡𝐞 𝐩𝐚𝐭𝐢𝐞𝐧𝐭 𝐜𝐨𝐧𝐭𝐫𝐨𝐥𝐬.

You’ll likely have written down things like doing their exercises, or turning up for their visits.

What you might not have included is how much they value their health right now, or how much they trust you to give the right advice.

𝐆𝐫𝐨𝐮𝐩 𝟑 - 𝐰𝐡𝐚𝐭 𝐧𝐞𝐢𝐭𝐡𝐞𝐫 𝐨𝐟 𝐲𝐨𝐮 𝐜𝐚𝐧 𝐜𝐨𝐧𝐭𝐫𝐨𝐥.

This includes the classics: sick kids, their age, family stress…
… but you could include more subtle ones too - like how much bandwidth they have to focus on themselves right now, or a toxic work environment.

(Again, add it down now if you didn’t get them all)

Now, here’s why I had you do that.

Look at your 3 groups, and see how they compare.

I’m betting that group 1 is pretty small - probably smaller than most of us would like to admit.

(And if not, you’re probably now thinking of a bunch of things you missed for groups 2 & 3).

And yet those are the only factors you actually own.

Sure, you can influence some of the second group… some of the time… but you can’t control it.

This is where so many practitioners fall into the “90:10 trap”:

They treat Group 2 as if it secretly belongs to them - pushing, persuading, trying to drag the patient’s choices across into Group 1.

But influence isn’t control, and every time you act like it is, you shift your sense of success into someone else’s hands.

(You also risk frustrating and alienating your patients, too…)

You’ll recall from last time, this is what’s known in psychology as an 𝐞𝐱𝐭𝐞𝐫𝐧𝐚𝐥 𝐥𝐨𝐜𝐮𝐬 𝐨𝐟 𝐜𝐨𝐧𝐭𝐫𝐨𝐥 - and it’s a direct line to burnout.

Because suddenly your job satisfaction, your self-esteem, your enjoyment of practice… all of it depends on the actions of other people, instead of yourself.

And that’s no way to build a career you actually love.

So here’s the alternative:

1. Accept the fact that most factors sit outside that first group, and aren’t in your control.

2. Anchor your sense of success firmly inside Group 1 - judge your day by the quality of the things you controlled in the room.

3. Respect Pile 2, and make peace with Pile 3 - but don’t pretend they’re yours.

(𝘖𝘩, 𝘢𝘯𝘥 𝘣𝘦 𝘬𝘪𝘯𝘥 𝘵𝘰 𝘺𝘰𝘶𝘳𝘴𝘦𝘭𝘧 - 𝘢𝘤𝘤𝘦𝘱𝘵 𝘵𝘩𝘢𝘵 𝘵𝘩𝘪𝘯𝘨𝘴 𝘭𝘪𝘬𝘦 𝘺𝘰𝘶𝘳 𝘯𝘶𝘮𝘣𝘦𝘳 𝘰𝘧 𝘺𝘦𝘢𝘳𝘴 𝘪𝘯 𝘱𝘳𝘢𝘤𝘵𝘪𝘤𝘦, 𝘦𝘹𝘱𝘦𝘳𝘪𝘦𝘯𝘤𝘦 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦𝘪𝘳 𝘴𝘱𝘦𝘤𝘪𝘧𝘪𝘤 𝘪𝘴𝘴𝘶𝘦, 𝘢𝘯𝘥 𝘦𝘷𝘦𝘯 𝘩𝘰𝘸 𝘸𝘦𝘭𝘭 𝘺𝘰𝘶 𝘴𝘭𝘦𝘱𝘵 𝘭𝘢𝘴𝘵 𝘯𝘪𝘨𝘩𝘵 𝘸𝘪𝘭𝘭 𝘢𝘭𝘭 𝘧𝘢𝘤𝘵𝘰𝘳 𝘪𝘯𝘵𝘰 𝘩𝘰𝘸 𝘸𝘦𝘭𝘭 𝘺𝘰𝘶 𝘥𝘪𝘥. 𝘋𝘰𝘯’𝘵 𝘭𝘦𝘵 𝘱𝘦𝘳𝘧𝘦𝘤𝘵𝘪𝘰𝘯𝘪𝘴𝘮 𝘨𝘦𝘵 𝘪𝘯 𝘵𝘩𝘦 𝘸𝘢𝘺 𝘰𝘧 𝘢𝘭𝘭𝘰𝘸𝘪𝘯𝘨 𝘺𝘰𝘶𝘳𝘴𝘦𝘭𝘧 𝘵𝘰 𝘦𝘯𝘫𝘰𝘺 𝘸𝘩𝘢𝘵 𝘺𝘰𝘶 𝘥𝘰.)

That’s how you keep 10% of your patients from draining 90% of your energy.

P.S. In case you missed it, we recently released some additional tickets for my upcoming Clinical Confidence Masterclass with my friend Jason Gould.

If you found this helpful and want to take the next step in truly loving what you do, this is the perfect event for you.

To grab one of the last couple of tickets please see link below in the comments.

P.P.S. For those of you outside the UK, or who can’t make that date, don’t worry - I’ve got a big opportunity coming your way very soon… keep an eye on the posts ;)

11/09/2025

Turns out Tuesday's post really struck a chord - I got more emails and messages in response to it than any other post in the last few months!

Some were relatively recent grads like Nic, who felt it really hit home: “𝘎𝘢𝘩 - 𝘵𝘩𝘪𝘴 𝘳𝘦𝘴𝘰𝘯𝘢𝘵𝘦𝘴 𝘵𝘩𝘢𝘯𝘬𝘴 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘱𝘰𝘴𝘵 𝘊𝘩𝘳𝘪𝘴!”

Others were experienced clinic owners and seasoned practitioners like Mark, saying ”𝘛𝘩𝘪𝘴 𝘴𝘵𝘶𝘧𝘧 𝘪𝘴 𝘚𝘖 𝘎𝘖𝘖𝘋!!!! 𝘛𝘩𝘢𝘯𝘬𝘴 𝘧𝘰𝘳 𝘴𝘩𝘢𝘳𝘪𝘯𝘨 𝘢𝘯𝘥 𝘱𝘭𝘦𝘢𝘴𝘦 𝘬𝘦𝘦𝘱 𝘶𝘱 𝘵𝘩𝘦 𝘨𝘳𝘦𝘢𝘵 𝘸𝘰𝘳𝘬”

It makes total sense - personally, developing an internal sense of validation has been one of the biggest shifts in my own personal growth and development as a practitioner.

(If you haven’t read it, go back and check it out first on my page - otherwise today’s post won’t make any sense)

However, I also got some messages from colleagues who felt the pain of letting patients set their self worth, but wanted to know more about how to make the change.

So of course, I messaged back to try and flog them one of my courses… (just kidding 😉)

Really though, I was halfway through replying to one DC to suggest an exercise to help him implement this insight, when I realised this might be helpful to share more widely.

Hence why today' s post is a bit later than usual - I’ve bumped the video I was planning to publish to next week, so I could share this instead.

If you’re someone who felt the pain like Nic, this tip can help move the needle towards recapturing your sense of confidence and self-esteem.

And if you’re a clinic owner like Mark, you might want to share this with some of your associates (though I’d suggest doing it yourself as well, yo might be surprised in what you discover about yourself!).

Anyway, here’s how it works:

Grab a pen and paper, and find yourself 10 minutes of uninterrupted time (yes, go analogue - it’ll work better than typing / texting the notes).

Then, take a moment to write down every single factor you can think of that could play a role in someone’s recovery.
Not one particular patient, but any potential patient.

Think broad here - go beyond the obvious things like “age” and “general health” (but put those down too!

For example, you should absolutely include more left field stuff like “unwell elderly parents” or “disturned sleep rhythms from screens”

It doesn’t have to be something most patients will struggle with, just something that could play a role - you’re going for quantity here, not quality.

No-one is going to read this, and you can’t get it wrong - the only mistake is to not do it.

If you’re reading this and don’t have a chance now, grab your calendar and find the time now.

Next week I’ll share the next step, and reveal the purpose behind this.

And make sure to do it before then, otherwise you’ll be robbing yourself of the insight that only comes if you complete this first part (it’s why I’m not telling you yet!).

Do that and then check out Tuesday’s post, where I’ll reveal all…

09/09/2025

𝐀𝐯𝐨𝐢𝐝𝐢𝐧𝐠 𝐭𝐡𝐞 “𝟗𝟎/𝟏𝟎 𝐓𝐫𝐚𝐩”... 𝐏𝐭. 𝟐

𝘘𝘶𝘪𝘤𝘬 𝘍𝘠𝘐 - 𝘐 𝘳𝘦𝘤𝘦𝘯𝘵𝘭𝘺 𝘢𝘱𝘱𝘦𝘢𝘳𝘦𝘥 𝘰𝘯 𝘵𝘩𝘦 𝘔𝘰𝘥𝘦𝘳𝘯 𝘊𝘩𝘪𝘳𝘰𝘱𝘳𝘢𝘤𝘵𝘪𝘤 𝘔𝘢𝘴𝘵𝘦𝘳𝘺 𝘱𝘰𝘥𝘤𝘢𝘴𝘵 𝘢𝘨𝘢𝘪𝘯, 𝘵𝘩𝘪𝘴 𝘵𝘪𝘮𝘦 𝘧𝘰𝘤𝘶𝘴𝘪𝘯𝘨 𝘰𝘯 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘦𝘹𝘱𝘦𝘳𝘪𝘦𝘯𝘤𝘦, 𝘢𝘯𝘥 𝘵𝘩𝘦 𝘳𝘰𝘭𝘦 𝘵𝘩𝘢𝘵 𝘵𝘦𝘢𝘮 𝘤𝘰𝘮𝘮𝘶𝘯𝘪𝘤𝘢𝘵𝘪𝘰𝘯 𝘱𝘭𝘢𝘺𝘴 𝘪𝘯 𝘸𝘩𝘦𝘵𝘩𝘦𝘳 𝘺𝘰𝘶𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵𝘴 𝘴𝘵𝘪𝘤𝘬 𝘸𝘪𝘵𝘩 𝘵𝘩𝘦 𝘱𝘭𝘢𝘯 𝘰𝘳 𝘨𝘰 𝘦𝘭𝘴𝘦𝘸𝘩𝘦𝘳𝘦. 𝘗𝘭𝘦𝘢𝘴𝘦 𝘴𝘦𝘦 𝘵𝘩𝘦 𝘤𝘰𝘮𝘮𝘦𝘯𝘵𝘴 𝘧𝘰𝘳 𝘵𝘩𝘦 𝘭𝘪𝘯𝘬𝘴.

So, last week we talked about the myth of “90/10 trap” - the false but popular idea that “10% of your patients cause 90% of your problems”.

I explained the first of two common mindset issues that cause practitioners to fall into the trap - poor boundaries & expectations - and asked you to guess the second.

(If you didn’t read that one yet, go back and check it out first, otherwise this POST won’t make much sense)

As I predicted, some of you wrote back with great answers, but no-one quite got it.

Which makes sense - after all, this is a very common issue, and one I used to fall prey to myself.

Anyway, here’s the answer…

𝐆𝐢𝐯𝐢𝐧𝐠 𝐲𝐨𝐮𝐫 𝐩𝐚𝐭𝐢𝐞𝐧𝐭𝐬 𝐜𝐨𝐧𝐭𝐫𝐨𝐥 𝐨𝐟 𝐲𝐨𝐮𝐫 𝐬𝐞𝐥𝐟-𝐞𝐬𝐭𝐞𝐞𝐦.

In psychology, this is called an 𝐞𝐱𝐭𝐞𝐫𝐧𝐚𝐥 𝐥𝐨𝐜𝐮𝐬 𝐨𝐟 𝐯𝐚𝐥𝐢𝐝𝐚𝐭𝐢𝐨𝐧.

Here’s how it typically goes in practice:

You unconsciously decide that doing a “good job” means “the patient followed my plan.”

Or “they did their exercises.”

Or most commonly, they got better.

Sounds good - after all, we all want that, and if you had a day where everyone followed out advice and got better, it’s pretty natural that you’d feel good!

But there’s a big problem with this kind of approach - the moment you define success like that, you’ve given away your power.

Because all those things are outside of your control.

Sure, you can influence them (after all, that’s what I’ve spent a decade teaching colleagues to do!), but you can’t control them - ultimately it’s the patient's choice to follow or ignore your advice.

And when your self-worth as a practitioner depends on what someone else chooses to do, you’re doomed to forever battle low confidence and impostor syndrome.

Seriously, 𝐢𝐭 𝐰𝐨𝐧’𝐭 𝐠𝐞𝐭 𝐛𝐞𝐭𝐭𝐞𝐫 𝐰𝐢𝐭𝐡 𝐭𝐢𝐦𝐞.

Which means in the long term, you’re not just setting yourself up for disappointment, frustration, but ultimately burnout.

That said, I want to be clear about something: this is not your fault!

Like all of us, you were trained into it.

The healthcare model - even for alternative options like chiropractic - has always reinforced the idea that the practitioner is the expert, the authority, the one who “knows best.”

Sure, on the surface, it sounds noble - we want the best for our patients, and we can often see what would help them.

So it’s only natural that we try to push them towards it.

Problem is, your patients aren’t clones of you.

They’ve got their own values… priorities… histories… limitations...

And when we judge ourselves on whether they do what we want, not only do we doom ourselves to an endless battle of trying to feel “good enough”, we also end up infantilising them - treating them like children who need to be told what’s best.

It’s not patient-centred, and it’s not sustainable.

In reality, there’s decades of research showing that human beings thrive when they feel autonomous - when they feel they’re choosing for themselves

Psychologists call this 𝐒𝐞𝐥𝐟-𝐃𝐞𝐭𝐞𝐫𝐦𝐢𝐧𝐚𝐭𝐢𝐨𝐧 𝐓𝐡𝐞𝐨𝐫𝐲: if you take away autonomy, you get resistance, guilt, and disengagement….

… but if you respect autonomy and you get buy-in, motivation, and lasting change.

This is why the 𝐭𝐡𝐞𝐫𝐚𝐩𝐞𝐮𝐭𝐢𝐜 𝐚𝐥𝐥𝐢𝐚𝐧𝐜𝐞 - that partnership you and patient - is one of the strongest predictors of outcomes in healthcare.
Not the exact technique, or the accuracy of the diagnosis, but the quality and strength of the relationship.

So what’s the alternative to this “external locus of control”?

You bring the locus of control back to yourself - stop judging success by what the patient does afterwards, and simply judge it by what you did in the room.

Did you communicate clearly?

Did you lay out the options, and give them the autonomy to choose?

Did you offer the best care possible within their choice?

For me, that’s what success looks like.

This is why so much of what I teach is based on 3 core principles:

𝐒𝐡𝐚𝐫𝐞𝐝 𝐝𝐞𝐜𝐢𝐬𝐢𝐨𝐧-𝐦𝐚𝐤𝐢𝐧𝐠: you present the options, the patient chooses the one that fits their life.

Non-attachment: you don’t pin your self-worth to the outcome.

𝐔𝐧𝐜𝐨𝐧𝐝𝐢𝐭𝐢𝐨𝐧𝐚𝐥 𝐏𝐨𝐬𝐢𝐭𝐢𝐯𝐞 𝐑𝐞𝐠𝐚𝐫𝐝: you assume patients are doing the best they can with what they’ve got today, even if that looks “non-compliant” from the outside.

Together, those three will stop you leaking energy on that 10%, and put the goalposts for success firmly back inside your control.

And just like when you firm up your boundaries and expectations - when you practice this way, the “energy vampire” patients practically disappear.

The same people might turn up in a clinic, but they no longer drain you, because you’re no longer carrying the weight of their own decisions.

That’s been my reality for years now.

I used to feel exactly like the practitioners in that group I mentioned last week - drained, second-guessing myself, carrying frustration home.

Nowadays, I can count on one hand the patients who’ve really rubbed me the wrong way in the last three years (and even then, the frustration passed quickly).

So if you want out of the 90/10 trap, this is how:

Set proper boundaries to stop patients walking all over you.

Then, set an internal locus of control to stop you from walking all over yourself.

As always, hit reply if you’ve got any questions,

04/09/2025

𝐓𝐡𝐚𝐭 “𝟗𝟎/𝟏𝟎” 𝐩𝐫𝐨𝐛𝐥𝐞𝐦 𝐭𝐡𝐚𝐭 𝐝𝐫𝐢𝐯𝐞𝐬 𝐃𝐂’𝐬 𝐭𝐨 𝐪𝐮𝐢𝐭 𝐞𝐚𝐫𝐥𝐲

Recently I was hanging out in a Fb group for osteopaths (not sure how many of them have worked out I’m an impostor yet… 🤫), and came across a post from someone considering early retirement.

Not because they were ready, or that their hands were packing in - just because they weren’t really enjoying practice much anymore.

And in the comments, dozens of practitioners chimed in to say they felt the same, and had either cut their hours right back to a minimum or thrown in the towel completely.

One of the top replies summed up the biggest reason single line:

“90% 𝘰𝘧 𝘰𝘶𝘳 𝘦𝘯𝘦𝘳𝘨𝘺 𝘨𝘰𝘦𝘴 𝘵𝘰 10% 𝘰𝘧 𝘰𝘶𝘳 𝘱𝘢𝘵𝘪𝘦𝘯𝘵𝘴.”

On the surface, I could relate - we’ve all had “those patients”:

The ones who always show up late and throw out your schedule…

… or throw in a brand new problem at the end of an appointment and look surprised when you don’t have time…

… or won’t follow the plan, then get annoyed they’re not improving….

… you know the ones.

They eat up time, derail your focus, and make you second guess yourself.

Over time, the repeated frustrations start to drain you.

You end up finishing the day not “happy tired”, so much as “I’m done tired”, looking forward to getting home and crashing…

… except of course, you then carry them home with you, even after the clinic closes

And because it’s so common, most of us just knuckle down and accept it.

Sure, it’s annoying, but it’s not so bad that you feel you should quit, or make major changes.

It’s just… tolerable discomfort.

“It sucks, but what can you do?”

And because it’s not that bad, for a while you can deal with it.

But over time, putting up with tolerable discomfort for years starts eating away at you.

And though it’s rarely talked about publicly, it’s the reason so clinic owners cut back their clinic hours, “semi-retire” before they’re ready, or just quit practising entirely.

Which is a real shame, because unless you genuinely don’t like practicing at all, it’s completely avoidable,

This “90/10 trap” isn’t some iron-clad law of practice - it’s the result of two flawed thought patterns.
The first being poor boundaries and expectations.

As much as it might feel easy to blame "difficult patients”, the reality is that patients don’t decide the rules of your clinic - you do

And whether you realise it or not - you’re training their expectations every single time.

The problem is, most of us are unintentionally training patients - often in the complete opposite direction to what we want.

If you let someone run ten minutes late and still squeeze them in, you’ve just unintentionally trained them to think you don’t mind.

If you try and “quick fix” the extra problem they just brought up at the end of the visit, you’ve just unintentionally trained them that “this is how it works”.

If you don’t reset expectations when they expect a miracle in one session, you’ve just unintentionally trained them that a miracle is realistic.

That’s not their fault - that’s on you.

After all, why wouldn’t your patients assume you’d set healthy boundaries and expectations up front?

If you’re allowing it, of course they’ll think it’s normal.

And your poor boundaries just get interpreted as you being flexible.

I do get it - I used to get wound up by those patients myself, until I realised I was the one teaching them those habits.

One chap started running late for every appointment.

At first, I shrugged and made it work - I’d try to treat him quickly, and hope I could “make it up” over the rest of the shift.

But even if I managed to, it made the next few appointments stressful for me anyway.

Then one day, I finally drew a line - before he turned up 10 minutes late, I told reception I couldn’t see him, he’d have to wait for a colleague instead.

From then on, he was never late again.

The funny thing is, when you start setting boundaries and addressing expectations up front, those “energy vampires” so many DC’s complain about practically disappear.

In the past three years, I can think of only one patient who genuinely rubbed me the wrong way.

And even with her, I got past it (she came in last week in fact and the whole appointment went smoothly).

So, if that 90/10 line at the start got you you nodding your head, ask yourself this:

Is it really “difficult patients”?

Or is it boundaries you haven’t set yet?

“But you said there were 2 flaws Chris!”

I did - and the second is arguably even more important.

But what I want you to do is try and guess it yourself… then comment or DM me with your answer.

It’s an important one, but it’ll land harder if you take 5 minutes or so to mull it over first.

(And if you don’t feel brave enough to comment, just jot it down in a note somewhere - the important thing is you think it over, and write it down somewhere)

Give me your best guess, and then next week I’ll reveal the answer - and how you can fix it, to avoid all that unnecessary frustration and burnout.

But for the moment, consider this:

If you’re stuck in tolerable dissatisfaction, it doesn't have to be a life sentence… if you make a change.

02/09/2025

𝐘𝐨𝐮’𝐫𝐞 𝐦𝐨𝐫𝐞 𝐯𝐢𝐭𝐚𝐥𝐢𝐬𝐭𝐢𝐜 𝐭𝐡𝐚𝐧 𝐲𝐨𝐮 𝐭𝐡𝐢𝐧𝐤…

… in fact, most chiropractors are.

That was one of the surprise insights that came out of a recent conversation with a colleague, James Harrison.

It came about as a result of some of my recent videos on “Chiropractic philosophy for the rest of us”, and the identity crisis in the profession.

James shared some fascinating comments from his perspective, and we got chatting.

It rapidly became clear he’d been thinking about these issues more deeply than most of us ever will - so I decided to sit down, have a proper chat with him, and record it to share with you.

And if you thought those earlier videos were controversial… wait until you see this.

There’s a ton of great insights and concepts in the video itself, including:

1. Whilst Chiropractic has been busy trying to shove “philosophy” in a closet and pretend it doesn’t exist, other healthcare disciplines (including medical ones!) actually lean on theirs.

2. Why the legal profession turns the traditional “Hierarchy of Evidence” upside down, and prefers case studies to RCT’s.

3. Why professional politics cases most chiropractors to choose from “crappy set menu’s” instead of choosing our values “a la carte”.

The full interview is live now, until “Big Chiro” deplatforms us 😆…

Link for the full interview in the comments 👇.

28/08/2025

𝐇𝐚𝐯𝐞 𝐲𝐨𝐮 𝐠𝐨𝐭 𝐲𝐨𝐮𝐫 𝐂’𝐬 𝐢𝐧 𝐨𝐫𝐝𝐞𝐫?

On Tuesday I shared our recent visit to a little Greek taverna in Cyprus, run by an espresso geek - the kind of guy who can talk beans and grinders with the same passion some people reserve for fine wine, or CrossFit.

That evening he taught me something that’s stuck with me since - not because it blew my mind, but more because I felt embarrassed I’d never heard it before:

The Four M’s of Espresso.

It came about in Italy, and like classic Italian they had to make it sound poetic and have eerie words start with the same letter.

Each of these 4 M’s covers a key element in good espresso, on order of importance: “𝘔𝘢𝘤𝘪𝘯𝘢, 𝘔𝘢𝘯𝘰, 𝘔𝘪𝘴𝘤𝘦𝘭𝘢, 𝘔𝘢𝘤𝘤𝘩𝘪𝘯𝘢”

Here’s the translation for anyone like me who doesn’t happen to speak fluid Italian…

𝐌𝐚𝐜𝐢𝐧𝐚- the grinder. The most important of all, because if the grind isn’t right, you’ve lost before you even start.
𝐌𝐚𝐧𝐨 - the “hand”, or the barista’s skill. A good hand won’t save a bad grinder, but once the grind is right, skill transforms everything.
𝐌𝐢𝐬𝐜𝐞𝐥𝐚 - the blend, the beans. Quality matters, but you need a good grinder and good “hand” to get the best from them.
𝐌𝐚𝐜𝐜𝐡𝐢𝐧𝐚 - the machine (I got that one!). The flashy bit everyone obsesses over, but in reality, the least important.

Like I said, it’s a hierarchy - without the grinder, nothing else matters.

But even if you’re stuck with a cheap little machine on your counter, you’ll still notice the upgrade when you switch to better beans, or when the person making the coffee actually knows what they’re doing with their hands.

Simple, and obvious once he explained it… but I’d never heard of it before.

I wanted to blame the fact that it’s in Italian… but this guy’s a South East Londoner, and he knew it.

It does sound a lot better than the translation into English though - “The GHBM of Espresso” doesn’t quite roll off the tongue.

But the principle works in all languages.

It‘s been rattling around my brain since, and of course it wasn’t long before I started trying to apply this coffee-related concept to chiropractic.

So here’s what I came up with - “The Four C’s of Chiropractic” (No translation needed!):

1. Communication.
2. Confident hands.
3. Collaboration.
4. Cool toys (Yeah, I know, I’m reaching there…)

Same structure as the 4M’s, and same hierarchy of importance.

Communication is like the grinder - the foundation, the thing that everything else depends on.

Without it, you don’t really have a practice, no matter how sharp your adjusting is or how many gadgets you’ve got lying around.

And just like espresso, confident hands comes next.

The thing is, I’m going to upset a few people with this - because I’m evidence-based, into pain science, and always banging on about communication, some folks assume that I don’t rate manual therapy anymore.

But I actually think it matters enormously - far more than what the extreme “evidence-only” crowd would have you think.

Not just mechanically (but definitely also mechanically!), but therapeutically too.

Because palpation, adjusting, touch, the steadiness of your hands… those all communicate certainty and care in a way words never can.

Patients feel it instantly.

They relax.

They trust you.

And to have confident hands, you need to really know how to use them.

That said, confident hands aren’t just about 𝐡𝐨𝐰 you treat either - it’s also knowing 𝐰𝐡𝐞𝐫𝐞 to treat.

Good palpation, good feel, knowing how to read the tissues under your fingers - that’s what guides you to the right places, and helps you identify the areas that might not be screaming for attention… but are driving symptoms elsewhere nonetheless.

Skill with your hands is both the how and the where of using them.

The “blend”, or third factor, is Collaboration.

Just like the “blend” of beans in your brew”, this is where your practice starts to take on its own flavour - by working out how to combine not just different techniques, but different disciplines.

Do you like to do rehab yourself, or work closely with a trainer?

Do you hire an in-house podiatrist, or do you prefer to build relationships with local ones?

There’s no right or wrong way here, it’s a matter of taste - the same way one person loves a bold, dark roast and another enjoys something light & fruity.

This is what separates you from being just another “Starbucks Practitioner” - offering the same stuff everyone else does.

Collaboration between disciplines creates nuance, depth, and personality in your practice.

It’s definitely not worth starting point, but when you get to this stage, it’s what makes your particular blend stand out.

And finally, your “Cool Toys”

Shockwave, soft tissue instruments, massage gun in the corner, whatever gadget is getting hyped this year.

Just like amateur coffee enthusiasts, who think they need a good machine to get good results, this is the part way we tend to put way too much importance on.

(Don’t get me wrong, I love my Arthrostim - but in hindsight, new grad Chris should probably have spent that £800 on one another C…)

They’re fun, they have their place, but they still matter the least.

So that’s my version of “The Four C’s of Chiropractic”:

Communication, Confident hands, Collaboration, Cool toys.

Not a checklist, but a sequence.

If you want to fast track your career progression and help the most people, start at the top, get really good at that, and then work down.

And sure, enjoy the toys if you want them - but don’t expect them to make up for the rest.

And of course, it’s not a one-and-done process.

Even after I’d got better with my espresso technique, or discovered nicer beans, I still went back and upgraded my grinder (more than once, in fact).

That’s how it works - it’s to some degree cyclical.

You keep circling back, refining each element, and every time the coffee - or the chiropractic - gets better.

And just like the perfect brew, when all four come together… that’s where the real rewards are.

That wraps it up for this email - so have a think about which of the C’s you’ve been focusing on, and consider if you’ve been neglecting something higher up the list.

I’ve got something a little different next week for you - it’s a follow up to the incredibly popular (and somewhat controversial) video series I shared earlier this year.

Keep an eye on your inbox for that on Tuesday…

26/08/2025

“𝑾𝒆’𝒓𝒆 𝒏𝒐𝒕 𝒄𝒐𝒎𝒊𝒏𝒈 𝒃𝒂𝒄𝒌 𝒉𝒆𝒓𝒆 𝒂𝒈𝒂𝒊𝒏”

I look across the table at Cass and know she’s thinking the same as me:
“We’re not coming back here again”

We’re sitting outside a little taverna just outside of Paphos, halfway through dinner.

The sun set an hour ago, but it’s August in Cyprus so it’s still plenty warm enough for shorts and t-shirt.

And although I’d been looking forward to coming here for almost a year, I can’t help but feel disappointed.

See, we’d found this place on our last trip here in 2024 - a quirky little restaurant that was half traditional Cypriot, half American smokehouse.

Think: chicken gyro’s and smoked baby back ribs on the same menu - two of our favourite kinds of food… and they actually pulled it off.

Last year, we ended up going back three more times on that one trip.

But the food wasn’t the only reason - the guy who runs it is a huge espresso nerd, and had previously worked with some of my coffee heroes before moving out here a couple of years before.

At our last visit, we sat and chatted for a good half hour after paying our bill about beans, roasts, and our mutual love for all things caffeine-related.

As much as I enjoyed it, I think he might have even more - the specialty espresso scene hasn’t reached Cyprus yet, and it seemed he’d had no-one to talk to about coffee since moving.

It was one of the highlights of the trip.

So when we walked back in last week, I was kind of expecting a nod of recognition.

Or at least some vague flicker of 𝘰𝘩 𝘺𝘦𝘢𝘩, 𝘪𝘵’𝘴 𝘺𝘰𝘶 𝘨𝘶𝘺𝘴!

Instead… nothing.

Which, you know, is totally understandable.

It’d been a year, he meets thousands of people….

… but still - if I’m being honest, I was disappointed.

The menu had changed too - apparently customers only wanted Greek food, so most of the smoked stuff was gone.

And once the novelty wore off, it felt like… just another Greek taverna.

Friendly service, still good food, but that spark was gone.

Halfway through the meal, I said to Cass, “Shame really… I was looking forward to this”.

But then, right at the end, I mentioned the coffee… and his eyes lit up.

He 𝘥𝘪𝘥 remember us, and suddenly we’re back to nerding out again.

By the time we left, we loved the place again.

We got back a few days ago, and I’m already looking forward to our next visit.

On the drive back (after Cass finally dragged me to the car 😆), it occurred to me that I hadn’t realised how much of my experience was about the relationship.

The food was still good - they’d kept the ribs, thank God! - and the service was friendly.

But without that personal connection, it just didn’t feel the same.

I realise that as someone who has a career in teaching communication, I shouldn’t be surprised.

But even I underestimated how big a difference it makes when someone remembers you.

On the drive back, it also made me think about practice.

Like I’ve said before, being technically great isn’t enough to succeed in practice - your communication matters too.

But that said, it takes more than being warm, professional, and friendly.

If you’re not building relationships, and not encouraging that connection to grow - people notice.

Even if they don’t say anything, they feel it.

I’ve had moments in the past where a patient clearly expected me to remember something I didn’t.

Sometimes it was about them - like forgetting they had a big event coming up.

But other times it was me shot sharing something about myself - for example I can still recall the look of surprise and hurt on one patients face when I mentioned I was getting married in a couple of weeks:

“Wait… you’re getting married? You never told me all this time!”

From my perspective, it just never came up.

But to her, it felt like I’d kept it from her.

That stuff matters to people - in some cases, more than the quality of the treatment, or how well you explain the plan.

Connection is sticky - it's what makes people look forward to coming back.

When you think about “patient management”, “doctor patient-communication”, or “building rapport”, it’s easy to overlook.

But it’s almost always the thing that makes the biggest difference.

It’s worth thinking about - being a great communicator is more than just explaining well and offering service with a smile.

It’s about how much your patient feels they matter to you.

Oh, and one more thing - keep an eye out for my next email on Thursday - I picked up a great little lesson on espresso at that visit, that has some real insight for chiropractic too.

P.S. We’re down the last 3-4 tickets for the Clinical Confidence Masterclass in October.

If you or one of your team want to learn how to build more trust with patients both with your communication AND with your hands on skills, this is for you.

It’s a one day masterclass where I’ll show you how to overcome impostor syndrome, and my friend Jason Gould will share reliable and powerful assessment and adjusting protocols for the next and upper limb.

Tickets are almost gone, so act now if you don’t want to miss out.

Full info and booking link in the comments.

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