A Report on the Report of Findings

by William D. Esteb

Members of the baby boom generation are increasingly showing up in chiropractic offices these days. This is the generation that drove Volkswagens in 60's and 70's with bumper stickers that said, "Question Authority." They're seeking second opinions. They're asking more questions than the generation before them. Their questions are similar to the questions asked by their four year old offspring: Why?

While it is beneficial in building patient rapport to explain what the examinations reveal as you're conducting them, answering most patient questions are reserved for the report of findings.

Amazingly, some doctors do not consistently give a report of findings. Left in the dark, patients must rely solely on how they feel as a guideline for their length of care. Rather than practicing chiropractic, the office assumes a medical posture as patients come and go, seeking drug-free, non-surgical relief of pain. This reduces the patient's benefit from chiropractic care by sabotaging an understanding of its preventive and wellness role in optimum health.

For doctors who recognize the benefits of improved compliance and follow through by educating their patients, the report of findings becomes the cornerstone in their systematized approach. Here are some techniques today's best communicators are using to maximize the full impact of their report of findings:

1. Use pictures. We are visual animals. We get most of our information about the world around us through our eyes. We remember images much longer than words. Virtually all of us are carrying around perfect images of Neil Armstrong stepping onto the surface of the moon. Images last. For patients, especially those raised on television, making your report more visual can have a significant impact on patient understanding. X-rays, spinal models, and wall posters are often used. But have you considered using pictures that illustrate the five components of the Vertebral Subluxation Complex? To help patients understand the spinal kinesiopathology you could use pictures of someone wearing braces (loss of normal motion or position), the tin man from the Wizard of Oz (stiff and not moving properly), the leaning tower of Piza, or a picture of a worn tire caused by the front end of a car out of alignment. Using metaphors and visualizations of key concepts can help patients from a wide variety of socio-economic and educational backgrounds understand this new approach to health called chiropractic.

2. Use a consistent structure. Since few patients hold up score cards at the end of your report like Olympic diving judges, you can't be sure how well you connected with your patient during the report for months later. By then it's difficult to remember what you said and what order you said it in. Adopt some type of consistent structure, starting with a review of the symptoms that prompted the patient's investigation of chiropractic and ending with a call to action to begin care. Use this skeleton outline of topics and personalize it for each patient by revealing your examination findings and treatment approach. This will keep you on track and avoid some of the time-consuming tangents and meanderings that often occur when you sense the patient isn't "getting it."

3. Avoid the X-ray view box monologue. The temptation is to turn a majority of the report into a stand up routine in front of the X-ray view box. Patients are intrigued by this view of their bodies and it is easy to squander valuable time explaining the heart shadow and intestinal gas bubbles and the meaning of all the lines and angles you've drawn. Worse, the static views taken in most offices tend to reinforce the notion that the patient's problem is merely a bone out of place. Since flexion/extension and other dynamic views of the spine can be difficult for patients to understand, this simplistic "bone out of alignment" notion can lead patients to think just a few adjustments will be necessary. Spend as little time as possible at the X-ray view box and concentrate on an explanation of the muscles and soft tissues involved that justify the necessity of non-symptomatic rehabilitative care and wellness care.

4. Answer the four questions. Patients begin your report of findings with four basic questions, What's wrong with me? Can chiropractic help? Is so, how long will it take? How much will it cost? You can put patients at ease and anticipate their unspoken concerns by telling them at the beginning that "most of our patients come to our office with four basic questions..." and explain that you will "...answer these four questions along with any other questions you may have..."

When answering the first question, you're correlating the symptomatic picture the patient can relate to with your examination findings. As you answer the second question, you're explaining what chiropractic care will involve in their case, such as the adjusting approach, any adjunctive procedures, visit frequency, etc. As you answer the third question you must give some type of reasonable expectations as to how long before the patient will know that their decision to select your office was a good one. How long before some type of relief can be expected, how long for the completion of rehabilitation, and what can the patient do to participate and speed their own recovery? The fourth question is usually avoided by doctors, however, my experience suggests that offices with excellent compliance and high patient visit averages are offices in which the doctor addresses finances.

5. Explain how long the report will be. This is an often overlooked piece of information that, when volunteered, can serve to improve rapport and participation. How long should a report be? My experience in successful chiropractic offices suggests that if your report is non-existent or less than 10 minutes, you're probably not giving the patient enough information to fully appreciate the nature and severity of their problem. Longer than 20 minutes and you're numbing the patients with too much detail.

6. Offer facts. If you want to avoid "selling" chiropractic care, you must offer facts and let the patient decide what they want. This is no place for scare tactics, yet you have an obligation to explain the severity of their spinal degeneration or the likely affects of neglecting their problem. The key is to offer facts that make sense to the patient and allows them to stay in control of their health. Selling patients something they don't want or understand results in buyer's remorse and ultimately damages your clinical credibility and word-of-mouth advertising about your office.

7. Involve the patient. While this is your time to shine and the spotlight is on you, ask questions along the way to test their assimilation of the material. The most obvious opportunity for involvement is to have the patient identify which phase of Subluxation Degeneration their spine is in at the X-ray view box. "I'd like you to compare your neutral lateral cervical view with one of these examples here. Which phase comes closest to matching yours?" Motivation comes from involvement. If you want motivated patients you must seek ways to get them involved in their case so your report doesn't become a lecture.

8. Give optimum treatment plan. By the time of the report, most doctors have an idea about the patient's financial resources or transportation problems that could interfere with their care. Taking these suspicions into consideration, many doctors present a less-than-optimum treatment plan to increase the chances of it being accepted on its first presentation. Not only is this not fair to the patient, it's presumptuous. How do you know that they don't value their health enough to get a loan? Or would be willingly make special provisions to get to your office at the visit frequency you recommend? Present your optimum recommendations, then negotiate modifications if necessary.

9. Outline patient responsibilities. Patient's won't regain their health with simply your single-handed efforts alone! They must keep their appointments. They need to report reinjuries. They probably need to make modifications to their lifestyles. What other responsibilities do you want patients to assume? Give cancellation notice? Refer others? Attend an orientation class? This is the time to outline them.

10. Present a tool to help them explain to others. There are countless people your patient will encounter who haven't seen the X-rays or heard your report. You must empower your patients to explain and defend their chiropractic decision to others outside your sphere of influence. Of course, the spouse or parent should be at the report. If they can't, equip your patients with a document or report they can take home to replicate your explanation to others. If you don't, many patients will be talked out of care. It should not contain the technical stuff that moves insurance companies! Remove the jargon. Instead of "cervical range of motion examination results" how about something like "you were unable to rotate your head to left by about 25 degrees less than you were able to rotate it to the right."

These ten points can help you present a more powerful report of findings. Yet the first step to take is to begin tape recording your reports and listening to them. It's excruciating to listen to yourself speak, however it's an easy way to enhance your single most important patient communication.

Buy the book
A Patient's Point of View
Originally published in 1992
240 Pages
US $19.95

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