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Framing the Conversation

Consultation vs. ReportI’ve been making an assertion at my recent speaking gigs that, to date, no one has disputed. My claim? That the initial patient consultation is more important than the report of findings.

Seems that many chiropractors invest an inordinate amount of energy on their reports. And while that’s great, by the time a patient gets their report, especially if it’s on the second visit or later, they’ve already decided to follow you. In fact, if anything, the relationship is yours to lose.

Why the focus on the report? Hard to say. But it seems that for many who coach the profession, the report of findings is perceived as a crucial sales event—getting the patient to buy something. Or do something. Or commit to something. If they show up for your report they’re doing all three. And there’s little you can say or do at this stage of the relationship to secure more than a couple more “test visits.”

Seems to me that if the consultation is handled properly, reports can be shorter and considerably less stressful for you and the patient!

If you’ve been to the Louvre in Paris, or any other major museum, you’ve noticed that most paintings, especially the older, larger ones, are placed in frames. Many are especially ornate, hand carved and embellished with gold leaf. These frames set off the painting, separating it from the background—almost defining a window in which to see the painter’s reality. It might be helpful to think of the consultation as a “framing” for your relationship with a new patient.

Why is this even necessary?

1. Patients enter your practice with a lot of wrongheaded ideas about chiropractic.

If you don’t regularly take excursions into your community to explain what chiropractic is and what it isn’t, new patients are largely selecting your office based on the prevailing cultural notions about chiropractic. Namely, it’s a last resort for neck and back pain after conventional methods fail. Use your consultation to reframe chiropractic as a discipline that attends to the integrity of the nervous system.

2. Patients are inclined to superimpose their medical doctor experiences onto you.

Based on their experience with allopaths, most patients are inclined to surrender their headache or ache and pain to you with an implied, “Here. Take it. I don’t want it.” If you have any hope of having healthy patient relationships, use your consultation to explain the purpose of pain, why pain is never the problem and that pain is the body’s perfect response to the circumstances of their life.

3. Establishing clear boundaries avoids assumptions and clarifies responsibilities.

You’ve heard the old adage that good fences make good neighbors? Same thing here. It’s crucial that you define the terms of your relationship; what’s theirs and what’s yours—what you’ll do and what you won’t do. Offer hope, but be clear that if any healing is going to happen, they’ll be the ones doing it, not you and certainly not your adjustments. Make sure they understand that every patient responds at a different pace, determined largely by what they do to support your care.

4. Patients buy the messenger before they buy the message.

Use the consultation to “plant your flag.” Obviously, listen to their story. When they’re through it’s your turn. Explain what you believe to be true. The objective isn’t to get them to believe what you believe, but to reveal your worldview. Why? Because you’re going to touch them! So, after you’ve had a good listening as they describe their particular health complaint, it’s your turn to return the serve. “Sounds like you’re an excellent candidate for chiropractic care. And just so you know, here’s what I believe and the lens I look through as I attempt to help people who choose our office. I believe…

Health is normal.
Your nervous system controls and regulates your entire body.
Interference to nervous system control produces ill health.
The nervous system can be interfered with from physical, emotional and chemical stresses.
The body’s response to these stressors is called subluxation.
Chiropractic care locates and reduces the effects of these stressors.
Because of its focus on the nervous system, chiropractic care can have whole body effects.”

“Gosh Bill, I cover most of this at my report of findings. Why do it at the consultation?”

Two reasons:

1. Not explaining what makes you different from their medical doctor is deceptive.

2. Keeping your philosophy secret, but revealing it after they’ve paid for an examination, is a form of entrapment.

Perhaps the fear is that you’ll divulge what makes you different and the patient will bolt for the door. Unlikely. Turns out that by the time a patient makes it to your office, they’re fed up with the medical model. They want something different. Use your consultation to reassure them that you are different.

Comments (9)

Exactly correct Bill, the consultation/ exam should be when all the truth is told and the patient makes the decision as to wether or not he wants to move forward with you. The ROF should be a simple explination about what you found and what you reccomend for the patient. I believe a space between the consultation/exam and ROF is needed for the patient to absorb the information that you give on the first visit and to allow them to reflect on the experience that they had in your office. If the patent decides that they like what you have to say on the first visit, the ROF is not a sales job, just one more step towards better health.

Dr Brian Deal:

A proper Consultation and ROF are necessary. I don’t take Bill to be saying that neither is indicated. It’s just that each has its place. The ROF should be just that, an ROF. It is not a sales pitch. The patient deserves an honest conversation about what you found. Then they deserve the right to make decisions about the care that you recommend. And you should be recommending what they need. Not what you think they will accept. This process in and of itself is what separates us from the MD. The consultation is an opportunity to accomplish many things. The patient decides if they like you. They decide if you understand. They decide if you are truthful. They decide if you are competent. Usually in the first 5 minutes! As far as making recommendations on the first visit you are in my opinion selling yourself short. If you can make a snap judgment about care the patient will typically equate that with something not very serious. It’s not their fault, it is the fault of a medical system that just writes a prescription on the fly. First aid care if you must. Don’t fall in the trap of minimizing the effect of long term subluxations. If you do so will your patients.

Tony Russo:

I seem to remember you waving extolations to the ROF. I felt inferior if I didn't do them. Now you recommend getting all that done on the first visit. Well , I've been doing that for years. And I've tried to find the underlying reasons for good and not so good business. And in the end, it wasn't ROF or some esoteric reason that only a management consultant could extract blood from my veins to reveal to me. It was "passion" and concern for that person I have in front of me. I just gave the secret that others have paid 10's of thousands of dollars to have revealed to them. It's no script. It's passion and concern. And applying one of your earlier advises, Bill. The 2 R's of a stable practice: Referrals and Reactivations. That's the secret. And by the way, thanks for making it OK not to have do the ROF (necesarily). It was a real pain in the arss. And it wasn't winning me any fans. Thanks for all the advice.

My clinic advisor turned me on to this website. I'm a chiropractic student at Life University. Last night I was priviledged to a ROF given by my advisor to my patient. He was serious, yet comforting and very transparent. What I've read so far here is in line with how he spoke last night. I'm anxious to learn more...

Bryan Siegel, DC:

Great summation and recommendations here Bill; thank you, it's very useful and relevant. Having the pressure to sell someone on chiropractic care is heavy and unattractive. It's taken me a while to let go and place the trust back in the patient to make the decision about if they want care and how much of it they choose. I have seen quite a few not follow through with care, leave and return because I did not make them wrong. Creating a safe place for patients to fail is somewhat counterintuitive, however, makes all the sense in the world to me now. Thank you for your brilliant insights! The medicalization of chiropractic has delivered a crippling blow to what the founders intended for; it's up to future generations of chiropractors to secure if there will be a future for this profession.

Kreso Jug:

Not meaning to offend anybody with this comment, but I've always thought that the ROF is kind of similar to medical practice. Isn't that what the M.D's do? Lets do a whole bunch of tests and then you can come back tommorrow we can tell you how messed up you are. If we are going to start to differentiate ourselves from medicine this would seem like a great place to start. How about a great orientation performed in a loving way which not only explains chiropractic but applies it to the person's life and the life of their family. The people in our communities have been subluxated for years. Why keep them that way another day?

Dr. Dan Hestera:

I love it! The most effective communication of chiropractic is summed up in your "I believe..." The return serve as you call it must be delivered with confidence, simplicity and a very high expectency. What else needs to be said? Probably not much. Great first visit. Now when they come back for their ROF, even less needs to be said. Bill, you've just revealed the "secret to everyone's dream practice" and you forgot to charge us a bundle of cash for it. You da man! Thanks

Pack Miracle, D.C.:

"So your practice pokes along at five patient visits per day or maybe 50 a week. Getting and staying "up" for so few patients requires massive effort. It seems as if you've hit an invisible wall.

Realize it's not your location. It's not your lack of a front desk receptionist. It's not your hand shake. It's not your adjusting technique. And it's not your lack of a Yellow Page listing.

It's you."

I thought this might apply here Bill.

Todd Hackney:

As you've mentioned, Bill, COACHES or CONSULANTS are telling DC's how to talk to their patients with "scripts" or some treatment (read: PAYMENT) "plan". If a patient is suffering, WHY does that patient have to continue to suffer while the DC gets their "pitch", I mean ROF, ready?! I'm glad the local fire department doesn't abide by that policy! However, it does make sense to spend time to analyze the information garnered from the patient; it just shouldn't take another 24 hours or more to figure it out. But if the DC is paying a "coach" a percentage, who's probably no longer in practice, to teach them how to talk to patients, maybe it does....A ROF shouldn't stop after the initial visit anyway. We should continue to talk about the improvements the patient is experiencing and how their life has changed as a result.

I ask those DC's with the ENDLESS "wellness" plans (3 visits per week, for months on end is NOT wellness), if they or any of their family members actually seek out that much Chiropractic care? Somehow, I don't think so...

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From August 13, 2008 7:59 AM

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