February 2006

The new patient attracting image: Part 14

by Dr. Peter Fernandez

Progress Reports -- Are they really necessary?

Most professional and successful chiropractors perform progress examinations and give progress reports to their patients on a regular basis. By using a progress report procedure, patients always know how their health problem is responding to care and what to expect next. This keeps patients actively interested in their care, and mindful of their responsibility to help themselves get well. This, in turn, keeps the patient under recommended care, which helps him/her get well as fast as possible and turns the patient into a firm supporter and great referrer of the doctor.

Why do some DCs choose NOT to give progress reports to their patients? I have absolutely no idea. Why would a doctor not take the brief two to five minutes that a typical progress report requires, risk having their patients lose interest in their care, not follow their doctor's prescribed plan of care, and then blame the doctor when they don't get well or don't get well quickly enough?

Progress Report guidelines

***  A progress report should not take any longer than five minutes. Compared to the initial report, the progress report is a less formal procedure that can be conducted in whatever room the doctor chooses.

***  A solo practitioner will give a progress report to the patient immediately after the progress examination. A practitioner who has an exam doctor, will give a progress report to his/her patient on the visit immediately following the progress examination visit, i.e., if your exam doctor performs a progress examination every 10th visit, you will give the progress report on the 11th office visit.

***  The doctor always compares the objective findings of the most recent progress examination with the objective findings of the patient's initial examination.

***  The doctor first reports to the patient the "good" news ‑‑ those objective findings that have been corrected.

***  The doctor congratulates the patient and commends him on his cooperation which resulted in them getting rid of some of their health problems. Typically, the patient will try to refuse the credit and give it back to the doctor. At this point, the doctor emphasizes that no doctor can help a patient get well unless the patient helps him/herself by coming in for the care prescribed, and by following their doctor's at‑home/work instructions.

***  The doctor then proceeds to emphasize the importance of the next phase of care until all objective findings are eliminated, or until maximum wellness is achieved and maintained (whatever the doctor feels appropriate in that patient's particular case). The doctor will use an analogy that provides the patient with a clear understanding of why the next phase of care is necessary.

***  At the end of the progress report, the CA prepares and gives the patient a new multiple visit appointment card, and schedules the next re‑examination.

Following is a sample doctor progress report script.

Progress Report script

GOOD NEWS

DR: "Mrs. Jones, I have some really good news for you. There is a great deal of improvement in your examination test results. Let's go over what I found. First, in comparing the results of yesterday's orthopedic and neurological examination to the results of your first examination, I found that your first examination showed you had a diminished knee reflex, which indicated you had pressure on the nerves in your lower back. Yesterday's exam results show that we have been successful in returning the reflex to normal, which means we have been able to relieve the pressure on the nerves in your lower back enough to allow the flow of nerve energy to return to normal. Do you remember the test where I tilted your head to the side, and then pushed down on top of your head? That test is called a nerve opening (foramen) compression test. When I performed that test on you the first time, you had severe pain on the right side of your lower neck area, which indicated you had pinched nerves in that area, which caused numbness in your arm and hand, and the loss of strength of your right hand. On examining you yesterday, the nerve opening test was completely normal on the right ‑‑ there wasn't any pain or discomfort at all."

Continue to tell the patient how he was originally (the first exam's positive objective findings) and how some of those objective findings have been eliminated.

DR: "This is excellent improvement and it indicates that we have been successful in stopping the advancement of your (health problem) and in reversing some of it."

THANK THE PATIENT

DR: "I want to thank you for being such a great patient by following my care recommendations. Because of your cooperation you are doing much better."

PT: "Thanks, Dr. Fernandez, but you're the one who's getting me better."

EMPHASIZE PATIENT CO‑OPERATION

DR: "Well, thank you Mrs. Jones, but even the greatest doctor cannot get a patient well if the patient doesn't cooperate. I know it's not easy at times, but you are doing a marvelous job of following my recommendations and getting well as a result of it. However, you still have ..."

The doctor will then itemize the patient's remaining objective findings and explain their effect on the patient's body.

DR: "However, you still have these remaining problems (objective findings). Remember when I lifted your leg ....., etc."

DESCRIBE THE NEXT PHASE OF CARE

DR: "I'm now going to treat your (remaining objective findings) until they are all gone and to prevent your original (objective findings) from returning."

ANALOGY #1

DR: "Mrs. Jones, when you first came in to see me your health problem was going downhill (gesture with your hands). I have been able to stop the advancement of your problem and even reversed part of it (if you have). You are now on your way back up hill (indicate uphill trend with your hand motions). You're not at the top yet, but are much closer and much better than you were when you started. I am now going to treat you to keep you moving uphill and to stop you from slipping back down. Your (health problem) is half well (or percentage well). If I stop treating you at this time, your (health problem) will get worse, and it will return to the way it was when you first came in (if true)."

ANALOGY #2

DR: "It's like pushing a car uphill (gesture with your hands). At this point, I've pushed your car half way up the hill. If I stop pushing the car now, it will roll down the hill to where it started or even farther. We don't want your health problem to slide back to where it was when you first came in."

NEW CARE SCHEDULE

The doctor then provides the patient with a new prescription of care.

DR: "So I need to treat your spine (number) a week to correct the (remaining objective findings) and to keep the (previous objective findings) we've fixed from returning (if true)."

Doctors, how much is five minutes (or less) worth to you and your practice? I'm sure you'll agree that it's a small price to pay for a patient who will trust and abide by your care recommendations, and have rekindled excitement about what they have attained. Remember, excited patients refer more. Progress reporting at appropriate intervals, is a tremendous new patient attracting image booster that will go a long way to helping you build the practice you want.

Next time: The final installment of this series on "The new patient attracting image," where you'll learn about today's most effective recall and recapture procedures.

(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. Write to him at Fernandez Consulting, 10733 ‑ 57th Avenue North, Seminole, FL, 33772, call 800‑882‑4476, or e‑mail: DrPete@DrFernandez.com. Visit www.MBAchiropractic.com for free practice building newsletters.)