Use these steps as a model to show your patients where they are specifically on the “road to recovery.”
As the chiropractic profession continues to refine its standards of care in the 90’s and to define the “minimum standards” by which we manage our selves, our staff and our patients, this article is especially appropriate and timely. As a sixteen-year experienced practitioner, I have had the occasion to work with many new doctors in practice and have encountered a common concern regarding how we arrive at a reliable and workable reference to judge our patients” progress. It occurred to me that most practicing chiropractors would enjoy the fresh and analytical perspective that was developed “in the field,” so to speak, when it comes to applying reasonable guidelines for patient prognosis as well as evaluating the patient’s progress along their course of care. You will find the following evaluation and re-evaluation process simple to apply and will quickly learn to value the information you gather about the patient’s current status in your ongoing patient management.
How often has a patient asked you only days or weeks into care: “Doctor, when am I going to be released?”
Something we frequently seem to forget or fail to accept is the fact that Americans are taught to think medically. Remember that we have six to seven years of schooling and multiple years of experience as we see their condition unfold to us during the consultation and then further clarified by the examination. The patient only gets a report of findings that is at best partly understandable to them while their minds are preoccupied, trying to figure our how they are going to afford your wonderful care. Go ahead–ask your patients only one week after the report what they remember about the clinical aspects of their condition.
When I tried this more than ten years ago in my office it was appalling to see that patients recalled barely ten percent–and you will find this to be true in your office as well. Validating the necessity of care in the 90s is also a concern of the managed care entities we must deal with in addition to the patients themselves, but this article is not about report writing; it’s about getting better patient compliance through better understanding of the patient’s needs and how to effectively communicate that to the patient directly. Wouldn’t it be nice to have a model that we can refer to, that shows the patient exactly where they are an the “road to recovery,” that does in fact apply to their case specifically? The following steps outline the criteria and protocols that accomplish those objectives:
Use a standard examination form that makes it easy to document your exam routine
Perform reevaluations of your patients once every month following the same exam format.
(Side note: Clean up your exam form so it reflects your type of practice. Believe me it’s a blessing to have it done right!)
Compare the changes in percentages. Enter the values of each measurable test on a “summary sheet.”
The more tests you can include, the more accurate the outcome of your percentages.
Plot on a gradient form the percent of change (usually improvements) for each re-evaluation. Here are the principle points to include on your summary sheet: We use these tests:
- Leg length
- Postural analysis
- Cervical ROM
- Thor. – lumbar ROM
- Motion palpation
- X-ray
- Neurological
- Cervical ortho-tests
- Lumbar ortho-tests
- Palpable spasms
Give the patient a “re-report” and explain their percentage of progress since their last exam; then show them what percentage you expect to see improved over the next month of care based on their own progress graph. They love it!
Re-Report Case 1:
“Mrs. Smith, your initial examination revealed some thirty specific findings that helped me arrive at a diagnosis and set up your treatment plan. In reviewing the re-evaluation results you showed improvement in your range of motion, number of muscle spasms and three orthopedic tests. That gives you a 40% improvement overall. Now according to your progress chart we expect to see you at 80-90% at your next re-evaluation in four weeks and you will want to be scheduled at three times for the next two weeks, then twice a week for the following two weeks.”
Re-Report Case 2:
“Mr. Jones, this is your second re-evaluation and you have continued to make the progress we have expected to see. You now show improvement in thirty of the forty original exam findings giving you a 75% improvement overall. We will be making changes in your treatment plan that include these additional exercises for you to do daily. I plan to reevaluate you in five weeks and see if you have reached the goal of 85% recovery before we discuss any maintenance recommendations.”
PROGNOSIS
The duration of a patient’s care depends on the diagnosis and on various factors such as the severity of injury, the chronicity of the condition, previous care, the general health of the patient, age, actual tissue damaged, etc.; however, there are general patterns that we commonly see in practice in which we can place value on their clinical worth.
Step One
Make a sound diagnosis and decide which graph the patient’s course will take.
Step Two
Plot the re-evaluation results and determine if the progress is acceptable.
Step Three
Show the patient their progress level and where they are expected to be next month.
You will find it very gratifying that the majority of the cases will follow these graph values; but equally as important you will also be able to see fairly early if it becomes necessary to alter your prognosis and thereby make additional clinical management decisions regarding appropriate consultations, change of treatment plan, etc. In today’s managed care environment it is nice to have a reliable guideline that represents objective determination of a patient’s progress and therefore the necessity for your treatment. If you think you can’t make the necessary time to gather or evaluate the data with a busy practice, think again. We simply delegate many of the tasks of this progress evaluation tool to a staff member or an associate; so all you do is use the results in your re-reports, as you gain more confidence about the validity and usefulness of this progress graph. I would like to give credit to Dr. David Singer for demonstrating this type of system to our office. We have enjoyed implementing and refining the concept. Most importantly we have seen patients more comfortable with the doctor’s recommendations…and stay through the end of their care.” “Michel Y. Tetrault D.C. practices in San Francisco, California. His e-mail address is mtetra1000@aol.com
