OMG.... he booked more than one appointment!

Jon completely changed the way that I work. He had no idea that he changed it, but something that he did once completely revolutionised my work. He had no idea…..

Jon Howat was a chiropractor in Oxford. He had moved over here from Zimbabwe in the mid 1980s, bringing just his family and a few suitcases. He bought Ray Broome’s long-established practice in Headington. I have no idea how he paid for it. Presumably with future instalments. Because I was local to him, I met him while I was a student. He invited me to his house for lunch with his family. It was a barbecue, in typical Zimbabwe style. He was a generous host. When I started my own practice in 1989, I invited him to the opening party, and he attended, saying kind things about my new place. He invited me to come and observe him in his practice, treating patients and I took him up on this offer a couple of times.

Like his father before him, Jon graduated from Palmer College of Chiropractic in Davenport, Iowa in 1970, where chiropractic had its beginnings under the Palmer family. He moved back to Zimbabwe to work with his father, but soon felt the urge to continue his learning. He travelled all over the world, to chiropractic lectures and seminars. He learned about Sacro-Occipital Technique (SOT), and became a devotee of the technique, running seminars in Europe and influencing many chiropractors. Like many of the old-time chiropractors, Jon felt that chiropractic should have all of the answers. Most patients that I observed having SOT treatment, would lie supine on some ‘blocks’ to treat their pelvis, while the chiropractor would apply gentle pressure to the cranium to assist the normal cranial movements. End of treatment session. Come back in three months. Jon had a wall covered in an impressive number of certificates ( DC, DICS, FICS, FCC(Cranio), FCC(Paeds), FEUC(Craniopathy), FBCA). To an outsider, SOT looked a bit like a cult. Personally, I was never persuaded that it was anything more than just one way of looking at the mechanics of the pelvis and the cranium, even if the practitioner felt that they were doing more than that.

However, on one occasion that I was observing, Jon was treating a young man. At the end of the treatment session, Jon said to the patient: ‘book two appointments, once a month for the next two months. Make sure my receptionist puts them in the diary, because we’re really busy’. The young man seemed to me to be quite happy to follow this advice. This shook me up: ‘Booking more than one appointment at a time’! The interaction made me reflect on my own patient management style which at the time was extremely casual: ‘If you want to come back for a check up in a few months, that's fine’ was my advice to patients at the time. Thinking about this made me realise that while my casual comments about prevention might be quite appealing, they were also disingenuous. Really what I wanted to do was to see all of my patients, forever!

But I don’t think that you can see patients without a good reason: What’s the point? I realised that I needed to explain to patients WHY I wanted to see them. There might be an on-going issue with a degenerative condition. There might be lifestyle issues that would benefit from some monitoring and coaching. I would need to explain this explicitly to the patient. Furthermore, there were patients who would come back regularly for treatment, but I had no idea why they were coming back! I didn’t know why they wanted treatment. I was nervous about discussing this with them, in case it made them think that I didn’t want them to come back in the future. I was going to have to ask them about this!

So I decided to do two things with patients: Firstly, to explain to patients what I felt was going on with them, and how best to manage this. Secondly, I would ask them what their health hopes and aspirations were. Did they have any health goals? What did they hope to achieve by coming to see me?

I decided to formally mesh these two things together during an annual review. We would then create an agreed health plan with goals for the next year. We would then agree how often we would meet, and book up this plan in the diary for the next year, with another review at the twelve month point. I’ll talk more about this process in another blog post.

You could say that nothing changed. I might still be seeing a patient once every three months. But actually everything changed. We had a plan. The patient knew why I wanted to see them. I knew why they wanted to attend. It was a much less stressful way to work! My diary was also busier.

Jon never knew that this one thing that I observed him doing changed my patient management completely. I was never an SOT devotee, and so I was never in the fold. Nevertheless I credit him with being the catalyst that changed my patient management forever.

Image from The Howat Protocols of Cranio-Fascial Dynamics (where you can buy Jon's book, 'The Dislocated Brain')

Jon was in chiropractic practice for more than 50 years! After he retired, I wrote to him:

Hey Jon

I heard that you have retired! Congratulations! What an amazing career you have had.

I wanted to write and thank you for all that you have done for the profession over your long career. Moving over from Zimbabwe and taking over Ray's practice and building it up as a centre of excellence for SOT. All the thousands of hours that you have put into teaching SOT and acting as a mentor and a source of inspiration for hundreds of chiropractors. Well done, and thank you!

You were very kind in coming to see my small practice here in Abingdon when I opened it in 1989, and being a supportive colleague over the years. Thank you for allowing me to come and observe you in practice (twice, I think), it was very generous of you, and very influential in how I manage my patients.

I wish you a long and happy retirement Jon! I wonder what you will get up to?

Best wishes

Andy

He replied, of course:

Dear Andy,

What a lovely surprise to receive your very kind and gracious letter to me. We have not seen each other for years and to hear from you like that was a real blessing - thank you.

I retired in June last year at 75 and felt it was time to leave clinical work - however I have been busier than ever and recently launched my online course - The Howat Protocols of Cranio Fascial Dynamics (HPCFD - website) on how to treat and manage ‘traumatic brain injury’ supported with my new book - ‘ The Dislocated Brain’.

So I have kept very busy writing, filming and editing hours of filming in preparation of the launch two weeks ago. It is an 8 module course, 7 online and the 8th a face to face practical for 2 days with me learning the clinical application - which is going to keep me busy!

You have always been very supportive of all I have done and a really active colleague in our community.

How time marches on and we lose all perception of where it all goes.

I hope you are keeping well and still practicing the good work?

Andy, thank you again for your much appreciated letter and it's sentiments - so appreciated - thank you.

My sincere best wishes,

Jon.

I heard recently that Jon died last year. I had no idea. Gone. Like we all will be one day. Jon was on a chiropractic journey his whole life. After his family, chiropractic was his whole life. Respect to him. And thanks. Thanks Jon, for helping me to improve the care that I give to my patients. 

RIP Jon Howat

I am a chiropractor and sonographer. These days I mentor colleagues, helping them to become the clinicians that they want to be.