QUESTION:  Are there strategies that can help in communications with new patients?

ANSWER:  Communications skills and the substance and integrity of your messages are key elements in your practice success.  Your serious consideration, planning and thought are needed to make sure that you utilize your communications skills as an effective part of the care and healing process.  Here is Part 2:

In Part 1, we covered the initial verbal communications of the introduction to the patient, case history, the initial consultation, the time of x-rays and what and how to verbalize during the initial visit's spinal examination.   In this process, it is important to remember that every patient is not only different, but also unique.  The collection of factors that define and explain the needs and condition of each patient requires you to be inquisitive, attentive and never to fall into a clinic routine that fails to explore the special needs and circumstances of every patient. The best means for accomplishing this goal is asking questions.  Those questions should be based on your objective and subjective findings, and you will need to follow up, sometimes tenaciously, until you are satisfied that you are fully informed of what is going on with any and all aspects of the patient's situation that might impact their spine and their spinal and general health.

It is important to have some sense of what the patient's expectations are on their initial visit.  Some people have fears and concerns that can be readily addressed through your reassuring communications and your professional application of your clinical skills.  Always, asking questions and providing concise, honest answers will eliminate any concern or discomfort a first-time chiropractic patient might have.  Society endows you with a great deal of cultural authority because of your "doctor" status.  This authority must be used wisely, never with arrogance but always with confidence, a delicate balance to be sure.  Your confidence in what you are doing sends a powerful reassuring signal to the patient that is, itself, an important part of the healing process.  It is important, however, to balance connection and communication with the patient with the flow of your procedures. Except for the initial consultation and the x-rays, all of this can be done within five minutes. 

The main focus of the first visit is your spinal examination.  This is a tremendous opportunity to communicate to the patient the detailed, serious and skill-based nature of your chiropractic evaluation. The depth and breadth of your examination is a message in itself.  It also provides a means to explain your examination procedures. For example, let's say you place the patient in the prone position on the adjustment table, do a Derifield Test, a Lumbar Test and a Thompson Sacral Check, verbally communicating with the patient what you are doing and what you are finding.  When you do nerve tracing in the cervical, thoracic and lumbar areas, you should be verbally telling the patient what you are finding and what each level controls. Then turn the patient over to the supine position for a supine leg check to see if they are subluxated in the cervical region or if they have spinal balance (holding in adjustment in the cervical area). Write down all of your findings so you can use them in your verbal and written patient reports.  Your records are very important and should never be neglected or postponed.

At this point in time on the initial visit, you will not have had the needed time to completely analyze (draw all the necessary lines, etc.) on your x-rays so you can know everything about the exact misalignment; the exact subluxation pattern; and possibly the one major subluxation involved in the patient's presenting problem.  Determining the exact number of degrees, the exact number of millimeters and the exact angles of each of the patient's subluxations take time.  And, with this information, you can therefore make the most effective, most specific correction of the cause of the patient's problem. 

You will have the time to do the proper analysis before the patient returns for their next visit, even if it has to be done after hours in your office or at home after your family has gone to bed.  Only after this analysis can you verbally communicate with complete confidence with the patient that you have identified what is causing the patient's problems.

Depending on the status of the patient, you will need to determine if it is appropriate to adjust the patient on the first visit.  Many practices do not, unless the patient is in a severe or highly acute condition.  The delay in providing the initial adjustment is related directly to the degree of analysis and your understanding of the patient's status.  If the patient is highly acute or severe, you can quickly, but accurately, analyze (draw the lines and make the proper measurements so as to know the exact misaligned positioning of the subluxated vertebrae) their x-rays and adjust them or schedule them back for a second and possibly third visit on that first day.   The nature of their case will govern the urgency of their needs.  But for regular patients, on the first visit, you may focus on analysis, get a case history, x-rays and do a nerve tracing, spinal examination, communicating verbally to inform and educate the patient on what you are doing and why you are doing it.  Then, as indicated, schedule the next visit and the first adjustment.  The seriousness, professionalism and confidence communicated through your office procedures will have the patient returning home impressed and confident about their future health and about their new Chiropractor!