September 2009

The re-examination

by Dr. Joe Borio

Unfortunately, most doctors and staff never fully comprehend the importance of the re-examination for a patient. I hope this column offers a new understanding.

The primary reason for the re-examination is to establish value to the patient regarding his or her care. Yes, you as the chiropractor may surely get some insight from the examination, but know that the time you spend or your assistant spends with the patient needs to be geared toward value.

How is this done?

Start by explaining to the patient the need to perform re-examinations when you initially review the patient's care. Second, during the re-examination, always explain what you're doing and why while relating it to the health of the patient's spine. Example: "Now, Bob, we're going to have you move around in some specific directions to assess how well the spine and nerves are functioning. Anytime there's a loss in motion or pain we know there is still significant pressure and damage to the nervous system and this will always make you sick."

You can make this clear to the patient as you're checking motion but it's vital to explain the significance of what you're doing and why you're doing it (which you do with weight scales, thermography, posture, etc.) for this adds value.

Also, be sure to identify any finding or loss indicating whether or not there is improvement and further relating this to the nervous system. Example: "Bob you can see there's still a large weight imbalance on the scales indicating continued damage and pressure on the nerves in your lumbar spine. This is a concern to the health of the colon, prostate and bladder."

Following this appointment, you will always review the patient's x-rays during each subsequent re-examination. You'll ask the patient to identify what damage he or she sees, how long the damage has been there, and what organs are supplied by the nerves in these areas. Also ask what potential problems the patient may develop if these areas are left uncorrected.

This is a great time to check the initial history form to identify any and all health problems and to ask the patient which of these problems has changed or improved.

If the conditions have improved, it's important for you to direct the patient's attention to the areas of concern on the x-ray, communicating clearly that the symptoms are improving and while this is a good thing, damage to the spine innervating this area has been there for years and it will take a lot of care to correct or heal the area.

If the condition hasn't changed or has worsened, it's a similar discussion indicating from the x-ray there's a lot of damage and that it will take a lot of care and many more adjustments to reduce the damage to a sick and diseased nerve.

This is also a good time to briefly review the adjustment and what it does with the patient's immune system, stress response, and overall health.

The re-exam offers the best opportunity to ask for referrals, and family check-ups as well. Although we offer the patient a family incentive early when beginning care, not all patients have their family checked. For those that have yet to bring in family members, we offer a complementary family check-up and then walk the patient to the front desk to have the staff set up the appointments and hand the individual paperwork to be filled out at home.

Re-examinations should be done every 30 to 60 days with the first and second re-examination done every 30 days without exception.

You want to be sure to review how well the patient has followed up with your recommendations of care, and praise or caution him or her accordingly.

Now is your perfect chance to ask for a testimonial if the individual's health has improved dramatically. In the case of those patients who have a good presence and personality, who are engaging and excited about their care I always ask for video for the testimonial, which they're happy to give. We do this in the office and have a digital camera ready to go at any given time. Patients who lack the physical engagement in their personality or who are shy always get a written testimonial with a picture to attach to the words in your office or on advertising used outside the office.

In scheduling a patient's appointments out for a year as we always do, we will always list the patient's re-examinations on the schedule as well as identify when the patient is approaching wellness care.

In closing, I see far too many clients having to struggle through missed appointments and dropouts when it's the VALUE you're identifying to patients that will keep them committed to their care and allow them to leave with a greater or renewed appreciation for the chiropractic adjustment.

(Dr. Joe Borio is president of Chiropassion Consulting. For more information about the topics raised in this article and to learn about the company's services, call 866-441-7928, or e-mail drborio@cnymail.com . Visit the Chiropassion website at www.chiropassionconsulting.com .)