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Give a talking exam
By Peter G. Fernandez, DC
Imagine what the initial exam is like for your average patient: He is in pain, he is afraid, and he is concerned.
Running through his mind are questions such as, "What's wrong with me?" "Is this the right doctor for me?" "Does he know what he's doing?" "Should I go to an MD instead of a chiropractor?"
To give patients the assurance they need, perform a "talking exam" that answers questions, educates, and puts them at ease. This exam establishes a strong doctor-patient relationship, which results in better patient compliance, happier patients, and increased patient referrals.
By performing a talking examination, you will reduce your patients' anxiety and, at the same time, impress them with your thoroughness and expertise. An excellent consultation and talking exam results in the patient being "sold" on you prior to your report-of-findings.
And once patients have "bought" you, they more readily accept your treatment recommendations.
To give a typical upper-extremity talking exam, follow these general "rules":
• Examine the pain part first;
• Explain your tests in simple words and describe them in groups, such as vascular tests instead of individual tests;
• Tell the patient what the tests indicate;
• Educate the patient about her health problems; don't scare her!; and
• Tell your patients, "That's a problem I can help," if this is true. (This reduces their anxiety.)
By talking your way through the exam, you'll find an increased number of patients who will follow your recommendations. You'll be happy with the results.
 Peter G. Fernandez, DC, has been a practice consultant for 27 years. He can be reached by calling 800-882-4476, by e-mail at DrPete@DrFernandez.com, or through his Web site, www.drfernandez.com.
| How to conduct an upper extremity 'talking exam' |
| Stage of exam |
What to say |
| At the beginning |
"This is when a doctor does his or her detective work to see what is wrong with the patient." |
| When performing spinal percussion |
"I am now checking to see if any of your vertebrae have been injured or sprained." |
| When you find edema at the spine |
"You have swelling here, which indicates there is a bone out of place." |
| Prior to palpating the upper trapezius muscles |
"I'm going to examine the muscles that start in your shoulder and attach to the vertebra in your neck. ... Please tell me if these areas are painful. If they are, you have an injured muscle." |
| When you find a muscle spasm |
"You have a muscle spasm here." (Tell the patient, don't ask!) |
| When palpating for edema |
"Now I'm checking to see if you have swelling around an injured area." |
| When examining the superior occipital nerves |
"I'm checking to see if the nerves going up the back of your head are swollen. ... Do you hurt here?" |
| When examining the cervical ganglions |
"Now I am going to check the nerve centers on the side of your neck to see if they have been injured." |
| When performing the range of motion exam |
"Now I'm going to test the motion of your spine. ... If the joints of your neck have been damaged, you won't be able to bend your neck as far as you should." |
When performing the maximum foramina encroachment test |
"If the nerves at the bottom of your neck are swollen, this test will produce pain here and possibly into your shoulder and down your arm." |
Prior to testing the cervical flexors/ extensors/lateral flexors, etc. |
"I'm going to test the muscles of your neck to see if they have been injured. ... Weakness indicates an injury." |
When examining the cerebellum |
"We are testing the back of the brain that controls your coordination." |
When examining for a thoracic outline syndrome |
"I am now checking to see if the blood flow is cut off to your arms." |
When examining the
nervous system |
"I am going to examine the nerves that control your skin, then those that control your muscles. If you have a pinched nerve, it will show up in one of these nervous systems." |
When performing the biceps/ triceps/brachioradialis reflexes |
"I'm going to test the nerves that exit at the bottom of your neck. If these nerves are pinched, they will cause a partial loss of reflexes in your lower arm." |
When performing the
pinwheel test |
"I am going to check to see if you have skin sensitivity because of a pinched nerve. If your skin feels numb or is hypersensitive, a pinched nerve is indicated." |
When checking muscle strength |
"I'm checking the nerves that control the strength of your muscles. If they are pinched, you will experience weakness in your legs or arms." |
When testing grip strength |
"I'm going to test the nerves that exit from the base of your neck and go down your arm into your hand. They control grip strength." |
When testing for carpal tunnel syndrome |
"I am checking the nerves and blood vessels that go to your hand. Weakness could indicate carpal tunnel syndrome because of pressure on the nerve that goes through the wrist." |
| When you find a problem |
"Here is the problem, or at least part of it. (If true,) I can fix that." |
When you don't find a problem |
"There is no problem with you." |
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