Sample
Script Using the VIP Reporting System
In the following example, the patient is presenting with headaches.
The Inserts and other documents have been prepared, and two brochures (Headaches
and Whiplash), along with the completed Inserts still joined together along the
top, have been placed in the folder flap. After some small talk, open the VIP
folder and remove all of the previously completed documents. "I've
correlated the findings of your examination, and I've put it into a package that
I'm going to review and send home with you, so you'll know what we found and what
we're going to do to help you." You'll notice that on
the inside cover of the VIP folder there are four large words, "review, explain,
recommend and results." Many offices will begin the formal portion of their
reports by referring to these terms. "In the next 10 minutes
or so I'm going to review what we found, explain what these findings mean, recommend
a course of action and discuss the results you can expect from chiropractic care
in our office. Feel free to ask any questions as we go along." Telling
the patient how long the report is going to take allows them to "pace their
attention" so-to-speak. It also prevents guilty glances at their watch. And
as for encouraging questions, this helps keep your report relevant to the patient
and show that you're confident and interested in their understanding. Okay,
so you've used the inside cover of the VIP Folder to introduce your report. Now,
remove all the report documents behind the flap. The Examination Insert is on
top. "First a quick review. You've come to our office
suffering from frequent headaches, shoulder pain and occasional numbness in your
right hand. As I explained, we have had excellent results with these sorts of
problems. To locate the specific cause of your problem, we conducted a thorough
examination. Here's what we tested." Now, with the Examination
Insert positioned so you and your patient can see it, review the check marks in
the "What we tested" section, explaining why or why not each particular
exam was conducted and any positive findings. By the way, a quick note about positive
findings. To a patient, positive findings sound, well, good. So, be careful how
you refer to the test results. It might be better to say that you 'found something
significant' or that the findings 'revealed such and such' rather than say there
were positive findings. After reviewing both columns, refer to the other
Inserts to add relevant detail. You might start with the Spinal Curve and Postural
Analysis Insert. "One of the first things I noticed, and
what others first notice about you, is your posture. Here's what we found." Be
brief as you explain any notations you've made such as a scoliosis, loss of curve,
uneven shoulders, head tilt or uneven weight distribution. Make these findings
patient-relevant by mentioning the possible difficulty in getting clothes to fit
right or shoes that wear out quickly. Attempt to connect your findings to the
patient's presenting complaint. When you've completed your review, separate the
two copies. "One for you and one for me…" Then,
you might connect the bones to the nerves with the "Your Nervous System Controls
Everything" Insert. "This shows the back side of
the spinal column and the nerves that exit from between each spinal joint to the
major organs and tissues of your body. We know that when any of these moving bones
lose their proper motion or position, nearby nerves are affected. We found three
such areas during our examination, causing potential nerve interference, organ
dysfunction and other pre-symptomatic health problems. The key thing you need
to know is that we're actually more interested in the nerves than the bones. Think
of the nerves as wires in an electrical circuit and the bones as the insulation
to the wires. Like an electrician, we're more interested in the circuit than the
insulation." Some offices like the drama of actually circling
the subluxated areas in front of the patient at the report. Either way, when you're
through with the process of connecting the bones to the nerves, tear off the bottom
copy for your files and place the patient's copy on a stack that, later, you'll
put behind the center flap of the VIP folder for him or her to take.
"When you get home, I hope you'll review your copy of this document so
you can see how the spine can affect your whole body. Any questions so far?" If
you've taken X-rays, prepare patients to "phase
place" themselves before reviewing the Spinal Decay Insert. Go
through your files, or if you're new in practice, ask a colleague in your area
for copies of neutral lateral views that come close to textbook normal. Get permission
or opaque out the name and use these views to educate your new patients. Pointing
to the example of the normal cervical you might say… "This
comes pretty close to what we consider to be a textbook normal picture of the
side view of the neck. Here's the jaw, here's the shoulder and these white areas
are the bones of the spine. The dark areas between them are the discs. "And
this is the same view, but it's the side view of your neck that we took yesterday.
What are some of the differences you see between the textbook normal and yours?" If
you're unaccustomed to using the Socratic
Method with patients, you'd be more comfortable continuing your monologue
and controlling the report. But there is much to be gained by helping patients
truly own their problem by having them tell you what they see. You may need to
coach them or ask some leading questions, but avoid the temptation to do all the
work. Some patients will make it clear that they don't want to play, and if so,
no problem. Once the patient can tell you what he or she sees in their
X-rays compared to the normal, consult the Spinal Decay Insert. You've already
put red check marks in front of the phrases that describe the patient's X-rays.
"Now, when you compare the side view of your neck with one of these, Textbook
Normal, Phase 1, Phase 2 or Phase 3, which one comes closest to resembling yours?" When
the patient gets it right, and you'll be surprised how well patients can do this
exercise, use your red pen to circle the views that best match the patient's phase
of Spinal Decay. After the patient has completed the cervical view, go
ahead and circle the thoracic and lumbar views if you've taken them. Some offices
will add an arrow pointing to the right with the word "neglect," observing
what happens if the process is allowed to continue without intervention. Review
any notations or annotations you've written on the bottom "Comments"
line and detach the two copies as you have with the other two-part inserts. Now
it's time to return to the Examination Insert and review the "Significant
Findings" notations. This is a good time to make sure the patient is attaching
the same meanings to the words that you do. "So, under
Significant Findings I've written 'nerve pressure at C5-C6, reduced muscle strength
on right side, Phase 2 of spinal decay in cervical spine, pronounced head tilt.' "Now,
when I say 'nerve pressure,' what does that mean to you?" You
could use just about any term or phrase. The idea is to coax out of the patient
the meanings that they're attaching to terms you're using. Other terms that fall
into this category include, range of motion, scoliosis, contracted leg, adjustment,
even the word health. With the patient acknowledging and understanding
the major findings of your examination, it's time to bring it all together on
the next line, 'Vertebral Subluxation Complex at:' and there's a horizontal line.
Some offices put specific segmental levels such as C5-C6, T4-T5 and L4-L5.
Other offices simply put neck, upper back and lower back. It's your call. However,
this is a good time to circle the problem areas on the posterior illustration
on the left side of the document. The next entry is labeled, "Recommendations
for Care." You'll probably want to put a short-term goal and a long-term
goal. The short-term goal gives the patient hope and the long-term goal fulfills
your moral obligation to alert the patient that some type of ongoing supportive-maintenance-wellness-preventive
care is recommended. For our purposes, let's say you've entered, "Three visits
per week for the first four weeks. Reduced visits with improvement. Monthly support
care for life." "During the initial phase of your
care we'll be very aggressive, seeing you three times a week. At the end of your
first month of care, we'll conduct a progress examination, performing some of
the same tests we did yesterday. Then, you and I will sit down just like this,
compare where you were with where you are, and design a program that takes you
to the next level. Usually we're able to reduce the visit frequency as the healing
process unfolds. Because each visit builds on the ones before, the fastest results
are achieved by keeping every visit. Now, at some point, when it appears that
you've made as much progress as you're going to, we'll recommend a schedule of
supportive visits, typically one or two visits a month. That's designed to help
you stay well and avoid a relapse. But I'm jumping the gun. We'll talk about that
when we get there." This is where some offices will refer
to the Road to Recovery Insert that coordinates with the full-sized chart version.
Click here for scripting ideas. "Chiropractic
is a partnership to better health. There will be things I can do to help you and
there are some things you can do to help yourself. If you expect me to do everything,
it'll take longer. So, you have a job, and I have a job." Then
review your recommendations for what they need to do. That can include everything
from heat and ice to drinking more water, exercises, pillows, brisk walking, stretches,
diet, supplements; anything that you recommend that can allow the patient to take
an active part in their care. The last entry is enter the date of the progress
examination. Some offices prefer to enter a visit number, such as, "12th
visit." I prefer an actual calendar date. It assumes perfect patient compliance.
It gives a day that can be flagged on the appointment book. And with the staff
monitoring things, it can increase the likelihood that a progress examination
will even happen! If the patient misses a visit or two, no problem, just move
the date back as needed. "Any questions about what we
found, the significance of what we found, and what we can do to help you?"
Field any questions and then remove the bottom copy of the
Examination Insert for your file and place the patient copies of all the documents
you covered in their VIP folder. Turn the folder over and circle two or three
of the terms most important to the patient's case. Then, present the VIP
report package to the patient and complete the rest of your second visit procedures.
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