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Why Your Consultation is More Important Than Your Report

consultation.jpgDuring some recent speaking gigs, and frequently during my telephone consultations, I will casually observe to chiropractors that your consultation is more important than your report of findings. I generally wait to see if I get any objections. I don’t. So either I’m onto something or my assertion is being dismissed as simply one more raving of a non-DC who doesn’t know what it’s like to actually practice chiropractic. It wouldn’t be the first time that such an accusation has been leveled.

No matter, I believe it anyway. Here’s why.

Before I explore the consultation, let’s consider the report, which in many practices, appears to be little more than a confirmation to the patient that they have a problem that a chiropractor is likely to address (the patient already assumed that) or it’s a sales session to get the patient to do something beyond what the patient had in mind. Or both. Either way, if a patient hangs around long enough for your report, or even more significantly, returns on a separate visit to receive your report, they’re already sold. The relationship is yours to lose.

This escapes some chiropractors who are often clueless what it takes to prompt a patient to call your office, show up and endure whatever procedure you and your team will administer to them before they get your therapeutic intervention. Most chiropractors seem oblivious to what a huge concession it is to come to your office in the first place. Not to mention what an imposition it is coming three times a week for whenever.

We’ve all heard the stories of the crusty old chiropractor who flips on the X-ray view box and says gruffly, “You’ve got a problem here, here and here and I can fix it, so let’s get started.” Switches off the view box, motions to the adjusting table and begins to do his magic. I’m not endorsing this style of practice, but there are many chiropractors who just don’t give a formal report of findings.

So let’s return to the rationale expressed by Dr. Larry Markson who has long suggested that the purpose of the report is to answer four questions that every patient has. You’ve undoubtedly heard them: What’s wrong? Can chiropractic help? If so, how long will it take? And, how much will it cost?” This wisdom has served thousands of chiropractors for decades. Yet, I still stand behind my original assertion that the consultation is more important. Why?

This is where rapport is, or isn’t, made.

Establishing rapport with a new patient is the first order of business. One of the most powerful ways to do this is to answer a common, unspoken question: “Why did you become a chiropractor?” If you have a story that includes becoming a chiropractic patient yourself, share it. Be courageous enough to admit any concerns, fears or unfounded beliefs about chiropractic that you may have had back then. Doing so will go a long way toward putting patients at ease, while addressing their hidden fears and concerns. Don’t have an inspiring story? Address their concerns more directly. “Many people have some wrongheaded ideas about chiropractic. So, before we get started, I’d like to put some of them to rest.”

Begin the healing process.

Assuring the patient that their particular problem is within the scope of your practice, and moreover, helping patients with their problem is so common as to be almost routine, is significant. Give hope without guaranteeing a cure; express your confidence without making a promise. “We see this sort of thing all the time.” “Chiropractic has been shown to be very helpful in cases like yours.” “I think you’re an excellent candidate for chiropractic care.” “We’re optimistic that we can help you and you should be too.” “We’ve helped a lot of people with problems just like yours.” Hope is an essential part of the healing process and it’s something you can invoke even before a complete examination and report.

It’s a flag planting opportunity.

The consultation offers the opportunity to contrast their medical doctor experience with what they can expect in your practice. “I think it’s only fair that I explain a little about what I believe to be true, and the lens we’ll be looking through as we evaluate your current problem and offer some help and direction for your improvement.” This where you explain your philosophy and your focus on the nervous system. The point you’re trying to make is that chiropractic is different from medicine. Remember, patients want different. They’ve more than likely already pursued the limitations of medicine.

Patients determine how safe you are.

Patients size you up during the consultation. Are you approachable? Will my secrets be safe with you? Will you make fun of my lack of understanding? Will you manipulate me with guilt or shame? Are you authentic? Patients take your emotional “temperature” during the consultation and make a determination whether they like you, trust you and will permit you to touch them—physically and emotionally. Hundreds of subtle clues are evaluated that form the amount of influence you will be able to wield.

Patients decide if the myth is true or not.

Virtually every new patient has heard the myth that once you go to a chiropractor, you have to go for the rest of your life. Put patients at ease by explaining how this myth originated because of the distinction between sick care (short-term diet of pain relief) and life care (wellness and health optimization lifestyle choice). “How long you decide to benefit from chiropractic is always up to you.” It’s helpful if you’re congruent with this obvious statement of truth as well.

You get to demonstrate your profound listening.

While I’ve explored much of the chiropractor side of the equation, the consultation is a time when you want the patient to do most of the talking. By demonstrating your ability to really listen—repeating in your own words what you’re hearing and asking for clarification when patients use unusual or meaningful terms, you communicate respect and understanding.

Make the first, most lasting impression.

You’ve heard the old adage that you “only get one opportunity to make a first impression.” And let’s not forget that the first impression is usually the longest lasting! This makes your paperwork, consultation and first visit procedures vitally important since it can permanently color their perception of you, your practice and chiropractic.

It may be time to reinvent your consultation, since it’s even more important than your report. What would you consultation look like, sound like and feel like if you were to create it from the ground up today?

Comments (4)

Great stuff Bill. As I evolve into the best chiropractor I can be, I have learned the very things your speaking of. When I first started in practice (27 years old), there was an overwhelming fear of being accepted by potential patients. I tried to make up for my apparent lack of experience with a grand slam of a ROF. Using Patient media VIP Folders/inserts of course, I would go over postural findings, degeneration and go on and on about X-ray findings. As I grew with the practice, I now realize that was all for me and not the patient. I still use the VIP folder/inserts but now I focus greatly on the initial consult. This latest post hit all nails right on the head. Most new patients think chiropractic will help them with their problem (why else would they come to see you?) They just want to find the right person/doctor. They usually make that decision on the first visit.

Dr. Martell:

Its about time someone adressed this!! I agree totally!! Been in practice 16 years and going stronger each day! I never liked the ROF, too used car salesman like for me! The patient is already "sold" by coming in the first place. Listen to them, what they want (not what you need) tell them about you (briefly,) be passionate and give them hope about THEIR condition! Treat people like you would like to be treated is my motto. Oh, did I mention listen to them (again)!! They'll come in, get better (at least 90% plus) of them, and they ALL refer! Tried a couple GURU ROF's, was not my thing! I know most Docs that will read this will be a little put off, but it works for me. Like I said its been working outstanding for 16 years and never been happier. What bad economy???

Tony Russo:

Re-invent the consultation? Hell, that's all I use. Bill, I've tried to fit in an ROF into my protocol, wait till after the ROF, give my side of the you said above, it doesn't come across as genuine, for me. So I do all my work during the Initial. You mentioned a couple of points above that I really take to heart. The patient coming into your Office has already been sold. Why take a chance on their second visit to lose the sale? So the first part of the visit, I listen....and I listen... Then I provide them with my interpretation of their problem and then I offer them hope, with no guarantees. My mindset from the beginning is that these are lifetime patients. And for the most part, they are. Sure, they leave. Then they come back. So there were a couple of very strong points you made above that support doing all your work on the Initial. And after 15 years of humbly trying suggestions otherwise, I have come up with the first visit Initial, Consultation, ROF and adjustment. What can I say, it works for me.


I remember hearing Reggie Gold speak about the same thing. He never like the ROF at all. He thinks it was too medical.

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From May 14, 2009 7:53 AM

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