When it comes to developing a system for presenting a “report of findings” to patients, one size definitely does not fit all doctors. The report of findings is the chiropractic colloquialism for that office visit during which the doctor makes a formal presentation to the patient to describe what he or she believes the problem is, and then recommends treatment options.
Practice management consultants teach a wide variety of methods for giving the report of findings, and certainly there is no one method that is necessarily better than another. They are simply different. What works for some doctors often doesn’t work for others. This may be due to the fact that some practice management consultants teach methods that just don’t “fit” the personality of the doctor delivering the report.
The information that follows explains my variation of a common method for reporting a patient’s problem and making treatment recommendations. My introduction to the basic method of this report was made by Dr. Mark Radermacher of Total Practice Management.
Relief or Rehabilitative Care
The report of findings is typically given to a patient on the second office visit. During this visit, the doctor summarizes the findings from the patient’s physical and radiographic examinations. I practice a method of chiropractic technique known as Chiropractic Biophysics. Although this report is best-suited to a Chiropractic Biophysics practitioner, it can be modified slightly to fit virtually any practitioner’s technique.
A Chiropractic Biophysics practitioner such as myself will briefly review normal radiographic anatomy with a patient and then demonstrate, using the patient’s own radiographs, any ways in which their spine may vary from “normal.” In addition, we often demonstrate displacements of the patient’s posture using a full-length mirror, or Polaroid photographs of the patient’s resting posture. Typically, we will initially offer a choice of two types of chiropractic care: relief or rehabilitative care:
· Relief care may be defined as that period of time when treatment is focused on helping the patient get free of pain, or to reduce the level of his or her pain as much as is possible. During this period of treatment, a Chiropractic Biophysics practitioner will use a variety of methods to help relieve a patient’s pain and inflammation. These procedures usually consist of general manual manipulation and/or mobilization, activity restriction, applications of ice packs, and any other acute pain or inflammation reduction procedures.
· The second type of chiropractic care a patient may opt for is rehabilitative care. Rehabilitative or corrective care is focused on realigning the patient’s posture and vertebrae toward normal and training the soft tissues (muscles, ligaments, etc.) to hold the posture and vertebrae in the correct postural alignment. During this period of treatment, a Chiropractic Biophysics practitioner will use “Mirror Image” diversified, drop-table, and instrument-assisted adjustive procedures, “Mirror Image” isometric and progressive resistance exercise, and a variety of rehabilitative cervical and lumbar extension traction methods.
We inform patients that, on average, relief care can generally be achieved in a short period of time – usually four weeks or less. However, because studies indicate that damaged muscles, ligaments, tendons, and discs may take up to a year or more to properly heal, rehabilitative or corrective care takes a considerably greater commitment of time and effort.
For these reasons, I use the “Treatment Options” form that appears above when explaining the differences between the types of care a patient may initially choose in my office. I give the patient this form during the report of findings as I explain the treatment choices. This process allows the patient to make an informed decision about the type of care he or she will receive and allows the doctor and staff to set goals that match the patient’s in terms of frequency and duration of care.
Choosing the Treatment
After describing the choices of care and comparing and contrasting the types of treatment, I tell the patient, “I work for you. What do you want to do?” Whatever the patient’s choice, I do not attempt to alter the decision.
Patients make their choices based on their own set of values and desires. In the beginning, they may not fully understand the potential benefits of more progressive forms of chiropractic treatment. If they choose to “patch” their problem instead of trying to resolve the true underlying cause by making lifestyle changes (spinal exercise, etc.) required by any form of rehabilitative care, the chances are good they will be back eventually for round after round of additional relief care.
Early on in practice, I thought it was my personal failure when patients chose the short-term treatment of relief care. I simply could not understand why a person would make the “wrong” choice when I sincerely explained the benefits of long-term chiropractic care. I later realized it was not my failure. Many people tend to make decisions based on what they want, not based on what they need. Many patients want a quick fix. It may not be what they need, but you should respect their choice.
My experience is that after several rounds of relief care that do not give patients significant long-term help, they will often admit that they may have made a poor choice and will then opt to try to rehabilitate their spine. Whether the patient chooses relief or rehabilitative care, you are the winner because you provided the option for more care or less care.
Try practicing the “soft-sell” method I have described. You will be surprised and relieved at how much more effective and enjoyable your practice will be when you place the responsibility for your patients’ health back in their hands.
