The Socratic Sign In Sheet Commentary

Socratic Sign In Sheet
50 different questions
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Question 1

Most patients see pain as a bad thing. Help patients see the value and importance by playing a thought experiment during your discussion. "What do you suppose would happen if we didn't feel pain?" Help patients appreciate that pain serves as a warning that we have approached a boundary or limit.

Question 2

Most patients think they've only had their problem since "last week when I bent over funny." Because the body is so adaptive, help patients come to know that they've had their problem for some time. "How long do you think it takes to develop cancer? Or form a bone spur? Or have a heart attack?" What causes someone to be aware of these health problems? Obvious symptoms, precipitated by the patient reaching a limit to their ability to adapt.

Question 3

Most patients link "feeling good" with being healthy. Thus, if they're feeling good, they see themselves as healthy. So first, help patients attach the proper meaning to the word healthy. You might have a copy of Dorland's Medical Dictionary handy to show patients. Once they see the connection to function, turn the tables. "So, is vomiting, to expel improperly prepared food a sick response or a healthy response?" Taking Dorland's definition further, "Would the fear of public speaking be a sick response or a healthy response?" Ultimately help patients reach the understanding that true health is about appropriate function-something controlled directly or indirectly by their nervous system.

Question 4

I can't find any solid numbers on this sort of thing. You probably have better resources than I.

Question 5

This is usually a very disorienting question which can reverberate in a patient's mind for some time. Because if vaccination actually works, there should be little fear of someone who isn't vaccinated. Be prepared for patients to become angry as you confront a culturally-acquired belief that they haven't given much thought to. Be prepared with some literature to give parents that explain this deception in more detail. Search www.mercola.com for a variety of helpful articles. This question is a great way to brochure the subject of chiropractic care for children.

Question 6

Your most cynical patients see "three times a week" as a financially motivated recommendation. After you hear their theories about visit frequency, ask if they have any idea how you reached the conclusion that three times a week (or whatever you recommend) would the optimum frequency. Help patients come to recognize that visits too close together doesn't give their body enough time to integrate the previous adjustments, and too far a part and the momentum is lost. Explain how your recommendations serve as the "sweet spot" between the two extremes.

Question 7

Most people think the pollen is the culprit. If patients grasp the idea that some people are able to adapt to the presence of pollen better than others do, dig deeper and find out the patient's theory about what governs or affects one's ability to adapt to the pollen (environment). The nervous system of course. This may me an excellent time to review the three causes of subluxations: physical, chemical and emotional. Many allergic reactions are emotional responses. If you want to understand this in more detail, visit www.netmindbody.com the website for Dr. Scott Walker and the NeuroEmotional Technique.

Question 8

If you have come to believe that subluxations are the body's response to stress, then help patients see the three major categories of stress (physical, mental and chemical). The first chiropractor put it this way: "poisons, traumas and autointoxications." Ask the patient to name one of each types of stress they encounter on a daily basis. Enhance referrals by then asking them to name one of each type of stress their spouse or children encounter on a daily basis.

Question 9

Tackle the religious implications if you wish, but actually the intent here is to help patients put germs and the role of the immune and nervous systems. "When does a dead body begin to rot?" Obviously immediately. What if just seconds before someone dies, the surface of their entire body is sterilized with Benadine (just as they do before surgery), and placed in a sterilized plastic bag. No germs. "Will the body still rot?" Of course. The cause of the rotting is already in us, right now, before we die. It's our immune system, orchestrated by our nervous system that keeps these bacterium at bay.

Another approach is to demonstrate that healing is only possible in something that is alive. Cut a cadaver and it won't heal. Cut your finger and it will. "Have you noticed that as we age we tend to heal more slowly?" Why do you suppose that is?

Question 10

Uncover the real reason patients want their health back. You'll want to link this information with chiropractic so they see the two connected. Whether it be their golf game, sleeping through the night, getting back to work or keeping up with their grandchildren. Help patients see that continued care can not only return them to what they desire, but regular care can enhance their enjoyment after they become symptom-free.

Question 11

Ask this question to help patients see the distinctions between medicine and chiropractic, so they don't superimpose their medical experiences and expectations on their chiropractic experience. No need to make the medical model wrong or stupid. Most of us, especially patients, don't want to live in a world without medical doctors, hospitals and drugs. But they are two different disciplines with two very different objectives and philosophies. Without appreciating this difference, most patients are likely to think of you as a spine specialists, hamstrung by an inability to prescribe drugs.

Here's a head start. It's from the Patient Media Chiropractic is Different wall poster:

Question 12

Of course we all want to feel good. To help patients appreciate the distinction, ask them what a healthy response would be to eating improperly prepared food. Vomiting of course. How does one typically feel when they're vomiting?

This is also important to ask because when most doctors use the word "health," they think patients are ascribing the same meaning to it as they do. Not true. In fact, when you use the word "health" patients hear the phrase "feel good." Big problem! Huge opportunity.

Question 13

No real agenda with this question. Does the patient have a theory? Is it genetic, environmental, emotional, chemical or what? Does the patient know someone who has been touched by cancer? What are they doing to avoid a similar fate? Or do they think it's something that can't be controlled and out of their control?

Question 14

This can be a tricky one. How long will they need chiropractic care as opposed to how long will they want chiropractic care? Does the patient see their chiropractic experience as a temporary, short-term response or as a way of life? Ask the patient how they would explain the fact that so many of those who discontinue care as soon as they feel better so often have a relapse. If you have personally been under chiropractic care for some time, you might ask the patient why you have opted to continue receiving care.

Question 15

Does the patient know what the germ theory is? It's the theory that germs cause disease. Do they know who invented the germ theory? Louis Pasteur. Do they know that Pasteur recanted his theory on his deathbed, claiming that it was "the soil, not the seed." "What do you suppose that meant, the soil, not the seed?" Help patients come to realize that germs, if they don't have a hospitable environment, are powerless to "cause" a disease. Show the patient some flower seeds or beans and help them see that without the proper soil conditions they won't "germinate" and become a flower or bean plant. Same with germs.

Question 16

This is a two-part question originally presented in Million Dollar Questions. Since the patient will be unable to consult the latest polling data on health attitudes, they are likely to share their greatest misconception. "When your friends mention this, how do you explain to them that it's not true?" The key is to find out how well they can defend chiropractic and overcome the cultural myths about it-a factor in their ability (and willingness) to refer others. Be prepared to offer some coaching about how you overcome the myth they mention when you encounter it in your travels.

Question 17

The answers to this one will probably amaze you. You'll be surprised how many people mention "getting your hair wet and going outside!" Collect answers from your patients on a white board or Post it Note. Related to Question 15, this brings it down to real world patient concerns. Ask them how many colds they get each year. Compare their figure with how many you get. "What controls whether or not you get a cold?" (Immune system.) "And what controls your immune system?" (Nervous system.)

Question 18

Another way to play with this question is to restate it: "What happens after you feel better?" (Soft tissue healing and strengthening.) Use this as a springboard to remind patients that how long they decide to benefit from chiropractic care is always up to them and that should they opt to stop care once they feel better, that they are not to blame you or chiropractic for their subsequent relapse and that when it happens they'll be welcomed back and the process starts all over again.

Question 19

You might pose certain situations and see if the patient answers differently: "You have a broken arm and you go to the doctor and they put your arm in a cast. Who does the healing?" or "You discover you have stomach ulcers and you're given some medicine which seems to relieve the symptoms. Who does the healing?" or "You have frequent headaches and you visit our office and we adjust your spine and a month or so later your headaches have vanished. Who did the healing?" Make sure patients realize that drugs and doctors (of any type) can't heal. Only their body can do that-if there isn't any interference.

Question 20

While their answer can provide some important feedback, follow up with another question: "How could we have made your first visit more pleasant?" And then implement their idea!

Question 21

This is simply a referral overture. Help patients see how their improved health is affecting others. Another follow up would be, "What would we have to do so that you'd feel comfortable telling others about what we do?"

Question 22

Here's a classic "chicken or the egg" idea that gets patients thinking! It's a powerful question that puts muscle relaxers in a new light. In many ways, a muscle spasm is not unlike a headache or back pain. It's a symptom and an effect!

Question 23

Rather than some type of statistical proof (have that ready too), consider putting chiropractic care in the context of other things that most people consider safe. "Which is safer, chiropractic care or driving your car?" (chiropractic) "Which is safer, chiropractic care or back surgery?" (chiropractic) "Which is safer, chiropractic care or simple aspirin?" (chiropractic) "Which is safer, chiropractic care or taking a shower?" (chiropractic)

Question 24

Of course this one reveals a lot about your own beliefs on the subject. I believe the birth process is the source of our first subluxation. "How can something as "natural" as being born cause subluxations?" Use this opportunity to reacquaint skeptics with what so-called modern medicine has done to this natural process! While forceps delivery may be gone, drugs, suction extraction, Cesarean section, eager hands, and not to mention births that are "scheduled" to fit into the Monday-Friday routines of many ob-gyns. The logical follow-up to this question is to ask, "Have your children ever been checked for subluxations?" Help parents see the distinction between "being checked" and becoming a patient. Slow down. Take it one step at a time.

Question 25

This is about listening and coaching. Your patient's ability to refer others is directly related to their ability to describe chiropractic in a compelling, attractive and persuasive manner. How well can they do that? If they're having difficulty, you can provide some gentle coaching. ".I see what you mean. You know, when I have to describe what I do, like when I'm giving a talk or presentation, I explain that aspect of chiropractic this way." and then offer your coaching suggestion. Primarily, this is about getting feedback about your patient education efforts. What do you need to improve?

Question 26

This is more than a linguistic game. Helping a patient have a new appreciation for "normal" temperature, "normal" blood pressure or "normal" cholesterol is the point here. What's "normal" for one person can be abnormal for another, depending upon their circumstances. For example. If someone is fighting an infection, they're likely to have a temperature higher than 98.6° F. Which is a normal and healthy response. It's a simple idea, but a profound concept for patients to own.

Question 27

Most patients are likely to mention tonsils, appendix or gall bladder. Ask them if they know the purpose of any of the organs they mention. (Most don't know!) Be prepared to supply patients with not only their purpose, but also the segmental spinal level at which these tissues receive instructions from the brain. Ask patients to consider what would happen to their gall bladder if they had a subluxation at T4 and their gall bladder received a diminished nerve supply from their brain.

Question 28

There is a lot of confusion about these terms, not only with the general population, but with chiropractors. Many use them interchangeably and blur their distinction. This reduces their impact and meaning. Without consulting Webster's here goes:

Preventive care is primarily a negative, reactive vision of health. It is a response to some unseen enemy. It is a defensive posture.

Maintenance care is about trying to sustain or prolong some moment in time. Mechanistic in nature, it is about preservation and precludes the likelihood of further improvement.

Wellness care is focused on optimization and the possibility of something new and greater than what was. Being the best one can possibility be in the physical, mental, emotional and spiritual domains is the foundation of wellness.

In short, prevention is a fear of the future, maintenance denies the vitalistic nature of humans and wellness is an opportunity for something new and greater.

Question 29

There is probably no better gauge of the patient's future health than their answer to this question. If they see their future health as worse, why do they lack hope? Uncover their beliefs about their sense of a lack of control or possibility. If they see their future as better, what will they be doing differently to avoid a relapse? Help patients become conscious of the active role they play in their own future.

Question 30

Most drugs can only do one of two things: either speed up or stimulate a bodily process (laxatives, asthma medication, caffeine, etc.) or slow down or depress a bodily process (stomach antacids, sleeping aids, antihistamines, muscle relaxers, etc.). Most patients have never made this connection. It helps them see the artificiality of drug therapy and the wisdom of locating and correcting the underlying cause.

Question 31

This one is revealing. The typical response (if patients feel safe enough to tell the truth) is "when I'm feeling better." This is a good opportunity to future pace the patient to that moment when they're feeling better weeks or months ahead and pose this question. "How well is your gall bladder functioning? It's receiving garbled communications from your brain, decreasing its efficiency. What happens if you ignore this undetectable problem?"

Or, focus on the difference between "needing" chiropractic care and "wanting" chiropractic care. Needing is more of a crisis. Wanting is more proactive. Their choice. "We'll be here whenever you decide you want more chiropractic care."

Another approach. After you get their response, make an observation. "Most of the adults who seek care in our office come in after having their problem for many years and either neglecting the alarms their body was making or learning to accommodate and live with their problem. Because of that, many patients find that they "need" some type of ongoing supportive care for the rest of their life. But you may prove to be the exception to the rule."

Question 32

Amazingly, many chiropractors are just as confused as patients on this one! The mechanistic notion that the "bone is out" and the adjustment "puts it in" just isn't true. In the same way the body decides what to do with the sandwich the patient ate at lunch, the body decides what to do with the energy that is applied to the patient's spine.

One more reason why ignoring the underlying cause of the patient's subluxation (very often emotional or chemical) while attempting to "pound down the high spots" is an old fashioned, bankrupt idea. And why these days, reducing subluxations take so much longer than 50 years ago when we lived in a less polluted environment, were more physically fit and weren't subjected to the stresses of the 21st Century.

Question 33

Most patients have never heard of "super germs." This is a huge topic that can uncover the patient's belief in the germ theory, the illusion that killing enough germs will produce health and notion that illness is largely a pharmacological detail.

Another approach is to help patients realize there are two basic strategies to dealing with super germs or even the common cold. One is to take a proactive role, boasting one's immune system response and the other is a reactive approach that waits until there's an obvious problem before acting on it. Share the strategy you use and how you implement that strategy in your own life. Most off all, help patients see they aren't victims to unseen germs!

Question 34

Pretty obvious we're talking about the nervous system. Another reason you want to be sure patients see chiropractic care and what you do as something that deals with the nervous system. You're not a bone doctor, back doctor or a therapist for tight muscles and headaches.

Question 35

Another way to help patients see true health as proper function, not how they feel. See Question 12.

Question 36

You're probably not looking for a dollar figure! Instead, after the patient responds with the equivalent of ".a lot," follow up with a few other questions, "Name some of the people your health affects?" After they name the obvious, ask, "And who else?" Keep asking until they reach the conclusion that their health affects everyone they know.

"What are some of the activities that you enjoy that your health affects?" After they name the obvious things, such as their work and their hobbies, ask, "And what else?" Keep asking until either they (or you) reach the conclusion that their health affects everything they do.

Then pose the original sign in sheet question again. Their answer is likely to be a bit more developed this time!

Question 37

First make sure patients know what the word "health" actually means (proper function). In fact you might want to list these five items on a white board and have patients prioritize them from most influence (nervous system) to least influence (cholesterol). Be prepared to explore the genetic issue. It's the latest "germ theory" that's used to account for everything from personality defects and hypertension to chronic unemployment and food preferences.

Question 38

Trauma from the birth process, learning to walk, ride a bike and "growing pains" are the most obvious answers.

Question 39

The least common is a pinched nerve (compressive lesion) which disturbs the nervous system by creating a diminished nerve supply to an affected organ or tissue. The most common is the irritated nerve (facilitative lesion) which disturbs the nervous system by abnormally increasing nerve supply to an affected organ or tissue.

Question 40

Obviously, there's no such thing as a "side" effect. There are just effects. Virtually every drug has some sort of side effect. Ask patients to notice the so-called side effects listed by some of the drugs advertised on television. Or, create a list of the 50 most popular drugs and have a PDR handy. Ask patients if they know anyone taking any of these drugs. After they identify one, look up the "side effects" in the PDR.

Question 41

To determine which is most essential, ask patients how long they could live without each one. If they don't reach the conclusion that the most essential is the nervous system, take them back to the Wild West and ask them if they know how hanging someone actually served to kill them.

Question 42

Note that it's not "how" but "why." Help patients identify overriding principles rather than procedures or techniques. Why? Because every cell, tissue, organ and system of your body is controlled and regulated by the nervous system. When interference to the nervous system is reduced through chiropractic care, the body's inborn ability to be healthy is revived to the extent of the limitations of matter.

Question 43

Whether something is good or bad is merely a judgment based on the meaning that someone applies to it. (Steamed lobster can be either a luxurious delicacy or a deadly entree depending upon whether you're allergic to shellfish or not.)

Help parents appreciate the implications of giving their children drugs to feel better and how they'll explain the difference to them as teenagers that taking street drugs to "feel better" is inappropriate. Bottom line? The simple act of ingesting a drug has great philosophical implications that can have long-term ramifications. You might follow up with another question, "By the way, what's in your medicine cabinet at home?"

Question 44

This one is used to uncover the language your patients use when referring others to your practice. Remember those patients who claim that they tell all their friends about your office? Best find out what they're saying!

Question 45

This one helps patients see how "dumb" drugs are because in fact, taking a drug is a whole body phenomenon. Quite different from chiropractic which is specific in its intention and delivery. The fact is, the only way they "find the headache" is by affecting the entire body.

Question 46

Because they can be dangerous.

Question 47

The nervous system, of course.

Question 48

Most people figure it's to keep germs out of the surgical site. Of course with a little thought, it doesn't take patients long to figure that if the surgeon can breathe through the mask, that's not the real purpose. Rather than protecting the patient, it protects the surgeon! Not exactly what most patients think.

Question 49

The first had a hearing problem. The second had a heart condition.

Question 50

"We've learned that we can be most influential with our patients by what we ask, not what we tell."

"Questions help us uncover the beliefs of our patients and identify how we can best communicate chiropractic."

Socratic Sign In Sheet
50 different questions
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