10 Most Common Report Mistakes
by William D. Esteb
One of the most important communication events in the doctor/patient relationship is the report of findings. Many subsequent patient relationship problems can be traced to what happens (or doesn’t happen) at the report. Here are some of the most common oversights.
1. Report Not Given
Believe it or not, there are still many practices that don’t give a report to their patients! Unless you consider the two-minute radiographic review and the muttered, “I think we can help you.”
Without explaining what you found, what can be done, how long it may take and how much it may cost, you’ve reduced your patient relationship to the purely physical. Patients have no other way of giving your care context than how they feel. Thus, they leave once they do. Besides setting the patient up for a subsequent relapse (for which they will blame you), more new patients must be secured to replace them. And while this medical approach of symptom-treating is largely what most patients expect, ultimately it does everyone a disservice.
2. Unclear Purpose
Maybe one reason some practitioners overlook giving reports to new patients is that they are unclear as the purpose of the time and energy needed to give one. I’m aware of three:
Tell your story. The first visit (even if it’s the same day) is devoted to listening to the patient’s story. This is when you find out what they think is wrong, their expectations of care in your office, their experiences with doctors; it’s giving patients the floor and listening. By doing so, you earn the right to tell the chiropractic story without interruption, “Yeh buts,” and toe tapping.
Make exam findings meaningful. By helping patients attach appropriate meanings to the tests you conducted, they can be more responsible and you can be less parental. “That sound you’ve been hearing when you brake is metal rubbing on metal. The brake lining has worn down and the rivets are in contact with the drum.” Explain your findings in relation to what prompted them to seek care in your office.
Offer choices. Rather than assume patients are automatically going to begin care, explain the other choices they have. Obviously, they could ignore the problem. They could go elsewhere and get a prescription to mask the problem. They could even consider a surgical solution. Explain the pros and cons of each choice, including that of chiropractic. “Those are your choices as I see them. What would you like to do?”
3. First Visit Reports
Anxious to rush in and prove chiropractic works, some practitioners try to orient the patient, conduct the consultation, perform a thorough exam, deliver a report and adjust the patient—all on the first visit!
This may be efficient, but it’s rarely effective.
Whisking patients from room to room where these functions are performed is unsettling to patients. The rushed report and perfunctory adjustment become a confusing blur. While attending to everything in one visit hastens the moment when the all-important adjustment can begin its influence on the spine, it overlooks the superior portion of the patient’s nervous system: their brain.
Slow down. Especially if you’re interested in creating a lasting, long term relationship. Doing too much, too quickly often compromises the patient’s experience.
4. Mostly Data
Because of your education and daily familiarity with it, X-rays with bone spurs, a 30% difference in hand grip strength and a 7 mm difference in femur head height are significant to you. They aren’t to patients!
Converting mere data, such as phases, millimeters, degrees of movement, angles of scoliosis and countless other objective findings into something meaningful to patients is vital. This is where amateur communicators usually fail. Always convert data into information that is relevant to the patient.
“You were only able to turn your head XX° to the right, instead of the more normal YY°. That’s why it’s hard to turn your head to look over your right shoulder when you drive.”
5. Telling Not Asking
If your motive is to “educate” patients during your report, you’re falling short of your goal if you’re doing most of the talking. Using your words as drugs in an attempt to change the patient’s behavior are time consuming, energy draining and largely ineffective.
Instead, look for opportunities to ask them questions along the way so you have proof your explanations are taking root. Create a report environment in which your teaching overtures are punctuated by educational experiences. You do that by asking questions.
“Even though you’re right handed, it’s showing up about 30% weaker than your left. What do you think that means?” Gently coach them to an understanding of the significance of your exam findings by asking questions. Don’t “hog the ball” by monopolizing the conversation.
6. Language Barriers
One of the biggest mistakes is using language that patients attach a different meaning to than the meaning the practitioner attaches. The most common oversight is using the word “health” with patients.
I bet you use this word hundreds of times during the course of a typical day. When you use the word, you probably mean “proper function,” “optimum physical well-being” or something similar. This is not what patients hear every time you say it. The meaning they attach is to “feel better.” Now you have an important clue as to why patients discontinue care when they feel better. They think they’re healthy, which is what you’ve been talking about since they began care.
7. Verbal Not Visual
Make sure you do more than yak at your reports. We have become a visual culture. Giving a largely aural FDR fireside chat to Sesame Street, MTV, fast-cutting TV commercial patient invites symptoms of adult onset ADHD.
Put an anatomical model in the patient’s hands to hold during your report. Use metaphors, pictures and dramatizations of pinched nerves and irritated nerves to actively involve the patient. Sure, you can mint your spoken words all day long without cost or frankly, much creativity. It may sound like you’ve communicated, but you haven’t.
8. Overlooked Party
These days, you often give your reports without the key decision maker even in the room! It may be easier to win the lottery than get both husband and wife to make a simultaneous appearance. This makes your communication challenge even greater.
This is why it is increasingly important to equip each patient with report handouts that can help them recreate your explanation to someone else. This helps affirm your patient’s decision to begin care, while reassuring the person you often don’t even get to meet. Even more significant, new patients equipped with the proper tools are much more effective at referring others.
9. Ignore Financial Implications
Like it or not, if you neglect to deal with the financial consequences of your recommendations, you’re either naïve or relying too much on miracles. It’s crucial that you identify the costs associated with at least the first phase of their care. Otherwise, patients are distracted by conducting addition and multiplication while you’re discussing progress exams and urging them to bring their pre-symptomatic children in for care.
If the patient has some form of third party assistance it’s mission critical that you make two key points during your report:
1.) Their policy won’t cover all the care they’ll need, and
2.) If they drop out once they feel better they’re likely to suffer a relapse.
10. Report That’s Too Long
Mark Twain summed it up by observing, “No one was ever saved after 20 minutes.”
While he was referring to Sunday morning sermons, there are similarities. Less than 10 minutes and you’re probably shortchanging the patient. Longer than 20 minutes and you’re probably boring them. Of course, patients are too polite to let you know. They simply smile and nod.
Patients use your report of findings to make sense of their problem and to evaluate the logic of your proposed solution. It is such a defining moment in the relationship, it’s something that deserves as much attention as your adjusting skills. Make a recording of your next report. And then the hard part: listen to it. Doing so is certain to prompt some changes that will make it more powerful and compelling.
Excerpted from
Connecting the Dots
Published in 2005
240 Pages
US $24.95
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