Implementing the Spinal Decay Chart
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We've bundled some of our most popular patient education tools into a convenient
package. Here's how most offices implement these tools and create consistent new
patient protocol. Like all office wall graphics, we recommend that you frame
this chart.
What's included
in the Kit? |  | |
How to "Phase Place" a Patient Using
X-ray views to "phase place" a patient is a communication strategy designed
to accomplish two important tasks: 1. Help the patient acknowledge
and "own" the condition
of their spine, and
2. Help the patient
recognize that they've had their problem for some time.
It
is not used to scare patients, justify a particular length of care or to manipulate
them into accepting a care plan they do not want. Obviously, phase placement is
not an option if you do not take X-rays! The patient's "phase" cannot
be determined by palpation, the patient's age or other less invasive means. Before
You See the Patient Effective phase placement begins by assuming the
proper headspace about the nature of spinal decay revealed by radiographic views
of the spine. Based upon several texts, including Anatomico-Roentgenographic
Studies of the Spine, by Lee A. Hadley, M.D. and Managing Low Back Pain,
by W. H. Kirkaldly-Willis and Thomas Bernard, Jr., we make these assertions: 1.
Structural changes to the spine that are revealed by static X-ray are the result
of neglected or uncorrected mental, physical or chemical stresses to the body,
and is not some "normal aging process." 2. Like attempting to
mend a broken bone, the body senses the structural stresses and deposits calcium
in an attempt to "splint" the joint and stabilize it. 3. Pain
or other obvious symptoms may or may not be present. However, the patient may
or may not notice reduced ranges of motion due to the affected joint. 4.
The resulting degenerative process begins with abnormal motion or position of
spinal bones, associated soft tissue inflammation (subluxation) and nerve involvement,
followed by changes in the architecture of affected vertebrae and calcification
of associated soft tissues until, given enough time, the affected joint fuses
together. 5. This degenerative process (spinal decay) occurs in increasingly
worsening "phases" or stages. Because it is a process, whether one chooses
a three, four or five phase model, all are correct. (We recommend a three-phase
approach which makes the differences between each phase great enough for a lay
person to more easily recognize.) 6. It is impossible to predict what, if
any, effect chiropractic intervention will have in the slowing, stopping or reversing
of this degenerative process. Anecdotal observations seem to indicate that appropriate
care in the early phase of this process, especially when combined with other forms
of active care (exercises, maneuvers, cervical pillows, weights, etc.) can produce
proper curve restoration and functional improvement. In later phases, it is hoped
that appropriate chiropractic care can stop or at least slow the process. 7.
A particular phase does not correlate with a certain number of visits or a length
of time in which chiropractic care will be necessary. In other words, it cannot
be used to justify care recommendations. 8. If you use X-rays to justify
your recommendations at the beginning of care, you have the moral obligation to
take periodic progress X-rays at appropriate intervals to remain accountable and
provide feedback for the patient.
It is from this belief system
that we make the following patient communication recommendations. In
Your X-ray Room Before taking pictures of the patient's spine, it's
helpful to mount a copy of the Patient Media Spinal Decay chart so the patient
is directly facing it at the bucky and you take their lateral view(s). Use it
to pre-frame the phase placement process you'll be conducting later, at their
report. (The Spinal Decay chart is available with either right- or left-facing
X-rays to match your technique.) After sharing your reasons for needing
pictures of their spine, along with an explanation of the fees involved, safety
precautions you take and the patient gowned and at the bucky facing the Spinal
Decay chart, here is a suggested scripting: "Now, we're
going to take a picture of the side view of your neck."
Splay
the fingers on one hand, touching the patient's jaw, neck and shoulder. With the
other hand point to the top row of X-rays shown on the chart. "It
will most likely look like one of these. Either what we call 'textbook normal',
Phase one, Phase two or Phase three. In fact, when I show it to you at your report,
I'm going to have you compare it with one of these and tell me which one comes
closest."
Repeat with a similar scripting for any other
lateral views you take. (For phase placement, we find lateral views are the easiest
for patients to use.) At the Patient's Report Many
offices will mount a second copy of the Spinal Decay chart beside their X-ray
view box. When you get to the portion of your report in which you show
and review the films you've taken, it is helpful to first offer the patient some
orientation. (If you show a pre-report video, much of this can be done before
the report.) | | | | |
"This
is the side view of your neck we took yesterday. This is the jaw, this is your
skull, this is the top of your shoulder and these are the individual bones of
your neck. The black areas between them are the discs which separate each bone.
Notice the equal disk spacing the gentle, forward curve. "I'd like
you to compare yours with these, the textbook normal, phase one, phase two and
phase three. Which one comes closest to matching yours?"
Then
wait for the patient to respond. (It may seem like forever, but it's an important
opportunity for them to fully own their problem, rather than you rushing in a
supplying the answer.) There are only a couple of different patient responses.
Here are some ideas to make you more resourceful: Patient response #1:
The patient says, "I don't know." Our culture is so wrapped
up in "being right" and looking good, that many patients will be reluctant
to share their perceptions for fear of getting it wrong. In this case, an Anthony
Robbins technique may come in handy: "Well, if you did
know, what which one do you think comes closest?"
This
can serve to give the patient "permission" to fail. The other
possibility is that of a patient in the Driver or Commander personality profile.
They resent having to play. In fact, their mentality may be "why-should-I-tell-you-after-all-I'm-paying-you-to-tell-me!"
Decide for yourself if it's worth forcing them to participate. Usually these efforts
are counterproductive. Patient response #2:
The patient overstates
their problem. Actually, this is quite common. Handle this correctly
so you don't make the patient wrong. Begin by congratulating them. "Wow,
good job! That's what I thought at first, but then I noticed ____ and ____ so
my conclusion was that we were looking at an early/late/mid Phase __. Do see what
I'm seeing?"
Patient response #3:
The patient
understates their problem. Again, be careful so you don't make them
wrong. As before, begin by congratulating them. "Wow, good
job! That's what I thought at first, but then I noticed ____ and ____ so my conclusion
was that we were looking at an early/late/mid Phase __. Do see what I'm seeing?"
Patient response #4:
The patient hits it dead on. For
sure, congratulate the patient this time! But be careful that it doesn't sound
like the "advanced Phase Two" they've identified is a good thing to
have happening in one's spine! "Good eye! Have you ever
considered becoming a chiropractor? Well, you are correct. So that means..."
Give
a quick rundown of potential neurological implications, how long they've had their
problem, why it may take a long time to correct, etc. Repeat with any other
lateral views you've taken.
Spinal Decay Poster
18" X 24"
$35/$40 laminated
Call (800) 486-2337 or US customers may order online:
Right-facing X-rays (As shown above)
Left-facing X-rays:
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