February 2005

Managing the 'difficult' patient

by Dr. David Singer

When going over patient results from a re‑examination, you're usually faced with four categories of patients. There are those who've experienced some relief, and others who either feel 100% better, the same, or ‑‑ in rare circumstances ‑‑ worse.

The easiest patient to talk to is the one who, while having experienced results and knows chiropractic works, still has part of the problem remaining and therefore considers it logical to continue some form of care.

Obviously, the hardest case to manage is the patient who feels worse. Yet, patients who claim to be "100% better" are just as difficult to manage.

The following tips can be useful in helping you managing difficult patients during your re‑examination process:

***  Question #1: "Why didn't my x‑rays change?"

"Mary, as you can see from your x‑rays, there's been very little change in your structure, although your symptoms are much better. Our original goal was to correct your spine. I told you that the criteria we would use was a change when did your re‑exam, and there's been no change. Therefore, I'll make some recommendations for activities you should do at home to help ensure that a structural change does take place."

At this point, you should turn the conversation toward things the patient can do at home. Focus on the positive results and outline a more vigorous program in which the patient can participate. Your patients will see that you yourself are not satisfied and will feel there is more that can be done.

***  Question #2: "Why am I worse?"

Unusual though it may seem, there might come a time in your career when a patient has worse symptomatology upon re‑examination than when he started care. Rather than defend yourself or blame the patient, try this approach: Confront the issue. Don't pass the blame.

"John, you're not feeling better and that's not okay! It's not acceptable to me for you to be feeling worse at this time. Therefore, we have two options. I could refer you, or I could put you on a new program for a period of two weeks (or whatever time you feel is appropriate), and at the end of this phase, take another look at you to see how you're doing. If there's no change then, I will, of course, refer you."

The type of response that works here is the one that allows the patient to know you care, that you are aware of the problem and are willing, if necessary, to refer him or do something new and different, or perhaps refer him to another chiropractor.

Honesty, integrity and taking a genuine responsibility for the treatment you deliver are the keys to any successful patient communication. It's not always easy and some patients will not respond in the way you would anticipate or desire. It's part of your job to refer those patients as needed.

(Dr. David Singer is CEO of David Singer Enterprises [DSE] ‑‑ visit online at www.davidsingerenterprises.com ‑‑ a company offering an honest and ethical approach to building a practice through one‑on‑one consulting programs, products and practice expansion seminars. To receive "The Purpose Fax Newsletter," Dr. Singer's free fax info letter containing practice‑building tips and health research, call 800‑326‑1797, ext. 227. Leave your name, address, phone number and fax number and you will be sent a form that authorizes DSE to fax you a copy approximately every six weeks. Note: you must have a dedicated fax line, as this fax newsletter is sent automatically via computer.