June 2005

The new patient attracting image

Part 7 ... Examination procedures -- The good and the bad by Dr. Peter Fernandez

The hallmark of a quality practitioner is the thoroughness of his or her examination procedures. The more thorough a doctor's examination procedures are, the more accurate the diagnosis (analysis) will be, resulting in a more effective care program. This all adds up to patients achieving maximum wellness and in the least amount of time, a gigantic boost to the doctor's new patient attracting image.

The examination is the single most important procedure in a practice, with the exception of consultation. Unfortunately, when practices gets busy and time is limited, usually the examination is the first procedure to get shortened. If a doctor only performs one or two tests on a patient who comes in with a "crick in the neck," this inadequate examination tells the patient he or she has a "'tain't nothin'" problem, one not serious enough to warrant any strict adherence to whatever care recommendations the doctor makes. In other words, the DC has effectively created a wellness barrier for his or her patient. This is a barrier that will keep the patient from reaching optimum wellness and that damages the doctor's new patient attracting image.

The percentage of patients who'll accept recommendations and follow through with a prescribed series of care is in direct proportion to the thoroughness of the doctor's exam, and the degree of patient follow through is in direct proportion to the number of referrals the doctor will receive from that patient.

Remember, the thoroughness of the examination, more than any other factor, will help the patient realize how serious his or her problem actually is.

The "overwhelming" examination procedure

In consultation, the objective is to have the symptoms lead the doctor to the problem or subluxation area. The purpose of the examination is for the doctor to find out exactly what's wrong, to what degree and to convey to the patient, "I know what's wrong with you." The following helpful tips are what today's most successful chiropractors use to meet these examination objectives.

During the examination, promise a little and give a lot! Often a "talking exam" is the most impressive and also eliminates patients interrupting the doctor with non‑essential chatter. The doctor's CA should be in the examination room to record each test as it is dictated. If the doctor has

just one CA who's needed at the front desk, a voice‑activated tape recorder can be used. The doctor explains to the patient that he or she is recording information pertinent to the patient's case.

The doctor explains to the patient, "This may be a little uncomfortable, but it will tell me exactly what's wrong." The doctor begins by telling the CA (or speaking into the recorder), i.e. "This indicates problems with the disc between fourth and fifth lumbar vertebrae...," "This indicates the nerve that runs down the back of your leg is swollen ...," "Reflexes are diminished on the right side indicating nerve damage...," etc.

The doctor performs all appropriate tests, and points out to the patient what a positive test result means. In partnering with patients and sharing the meaning of each positive test result as it's realized, by the end of the examination, patients have a good understanding of how serious or non‑serious their problem is. This point shouldn't be misinterpreted as using "scare tactics," which should never be used to frighten patients into getting the care they need. This is neither necessary or professional. For example, the doctor should not take the patient's blood pressure and then refuse to tell the patient the result until the report‑of‑findings. This is a cruel head game. If the blood pressure is high, the doctor should simply say, "Yes, it is a little high, that's why I wanted to know the exact reading."

The tests in a thorough examination require specific positioning of the patient ‑‑ standing up, sitting down, prone, supine, walking on toes, etc. While exhausting for the patient, it's necessary to give the doctor the information he or she needs to accurately diagnose, or analyze, and care for the patient. It also gives the patient a great impression of the doctor. By the end of the examination, the patient should think, "This doctor sure knows what he (she) is doing."

A doctor should not be over‑anxious to accept a patient. During consultation, examination and x‑ray, he or she is determining whether the patient is likely to respond to chiropractic care. If the doctor finds a condition that is out of his or her range of practice, the patient should be referred.

Doctors should use an examination form that facilitates doing a complete evaluation of patient health problems in a concise and efficient manner. They should practice their examination procedures until they can do them smoothly. Then, even though they can comfortably complete a chiropractic/neurological and orthopedic examination in 20 minutes, patients still feel it's the most thorough examination they've ever had!

At the completion of the examination, the doctor should write the patient's diagnosis on the

examination form and say to the patient, "I recommend we proceed with x‑rays (if necessary) to find out what's causing your health problem, and to see if it can be helped with chiropractic care. Come with me."

X‑ray procedures

Doctors should always x‑ray their patients' pain parts. AP full spine x‑rays are recommended because patients can relate better to this film than the smaller film. Some DCs, who don't have a full spine buckey or cassettes, substitute two 14x17 films (cervicothoracic and thoracolumbar) to make an AP 14x34 x‑ray. This procedure is acceptable.

Lateral x‑rays are always taken of an area to be treated.

X‑rays are a diagnostic tool ‑‑ not a money making tool. Only take necessary views.

By the end of the thorough examination and x‑rays, a doctor KNOWS what condition his or her patient is in, and the patient knows that the doctor knows. This makes the doctor's next job, the report of findings, just that... a report of the doctor's findings and not a sales job.

Unless you're a terrific salesperson with perfect psychic powers, the only way you can assure your patients get the care they need is to conduct thorough, comprehensive and patient educating examinations. If your patients don't get the care they need, you've failed them as their doctor, thereby killing your new patient attracting image. Nothing is perfect, but in striving for perfection you can reach excellence.

(Dr. Peter G. Fernandez, is a 1961 Logan graduate. His practice with five staff chiropractors and 12 satellite offices, was one of the country's largest all‑referral, high income chiropractic clinics. As a practice consultant for the past 24 years, Dr. Fernandez has taught practice building techniques to nearly 15,000 DCs, and consulted in the opening of approximately 3,000 practices. Doctors can get a FREE sample of an excellent exam form by contacting him and requesting a sample of the orthopedic/neurological/chiropractic ‑‑ C/O/N ‑‑ examination form. Dr. Fernandez may be reached at Fernandez Consulting, 10733 ‑57th Avenue North, Seminole, FL, 33772, by calling 800‑882‑4476, or via e‑mail: DrPete@DrFernandez.com. Or, visit him on the web at www.DrFernandez.com).