PLEASE REVIEW THE BELOW PROCEDURE VIDEOS AS SOON AS POSSIBLE. WATCH ALL OF THEM IN ONE SETTING. THIS WILL TAKE YOU APPROX 20 MINUTES. PATIENT PROCEDURE VIDEOS
Pa#ent referrals start with pa#ent educa#on and understanding of what it is we do. Please review both of these videos together. First the consult video, followed by the report video. Then align what you are doing or saying in both as close to these as possible. The more so you do, the more they will understand, which translates into more new pa#ent referrals to you!
LIVE PROCEDURE VIDEO : How to do a proper new pa5ent consulta5on. hFp://
youtu.be/FubySdbxNgA
LIVE PROCEDURE VIDEO : How to do a proper new paLent report of findings. hFps://www.youtube.com/watch?v=Q7qkX7_OBVg&feature=em-­‐upload_owneR
LIVE PROCEDURE VIDEO : PaLent Finances/ Collec5ons. hFps://
www.youtube.com/watch?v=DZMoq_tE3WQ
LIVE PROCEDURE VIDEO: PaLent Scheduling/ Mul5ple Appointment Card hFps://www.youtube.com/watch?v=GK-­‐irV_pyXo&feature=em-­‐upload_owner
LIVE PROCEDURE VIDEO: Re exams and Re reports hFps://www.youtube.com/
watch?v=e6RvkL4wtbk
LIVE PROCEDURE VIDEO : Pa5ent Transporta5on to the AdjusLng rooms and back to the front. hFps://www.youtube.com/watch?v=J0w7k7pTW18
LIVE PROCEDURE VIDEO: New Pa5ents hFps://www.youtube.com/watch?
v=n7VFYRTRS_A
Conver?ng Pa?ents-­‐ It’s not rocket science. ConverLng potenLal new paLents is not rocket science, however it does require a format. My chiropracLc mentor once told me it is beFer to copy what works, rather than create what does not work. Please note that I have used the word CONVERT, rather than CLOSE. Its semanLcs of words, however to me close indicates shugng something, I prefer opening something. There are 5 basic fundamentals to a successful prac?ce. These are:
1-
A regular new patient flow
2-
A fair fee system
3-
Managing the patient
4-
Low overhead
5-
Enjoying practice
The purpose of the following is to focus on Managing your paLent. First let’s talk the history of this. James Parker DC was really the first person to teach Chiropractors to focus on office procedure. In specific, a solid consult, exam, report of findings, and recommendaLons. One of his first students was Charles Gibson DC who took this to the next level in teaching these procedures in a specific seminar format. From those early years, many have expanded on these principles and procedures however the basic structure of what work’s remains. There is nothing new under the sun in this area however these procedures have been tweaked, and improved. You might say they have evolved over the years. The following represents the specific outline of the first two days the paLents experiences in your office. DAY ONE
1-
The patient will enter your office with a specific complaint or set of complaints.
Often this person will not tell you the entire story, so as to avoid spending
money and or time. It is your job to dig deep to get the facts and history.
2-
In consultation on day one let the patient tell you the reason they are in your
office. After they do so ask them if there are any other health concerns.
Symptoms, etc. So lets assume they came in the office for Low back pain, you
would ask , “ what other health issues are you having, or have you ever had?”
List them.
3-
After getting this list ask the patient which of these issues concerns them the
most, and on a scale of 1-10 how important it is to them to get rid of it. This is
important so you can judge the level of seriousness and commitment the
patient has.
4-
Next ask how long these issues have been occurring. Most patients will give
you a short timeline, understand in most cases this is not accurate. So you
have to dig deeply. Ask if there have been accidents, falls, work issues, etc.
99.9% of the time there will be a combination. You must dig deeply here, do
not skip over this.
5-
Next ask how often these issues occur. One a week, daily, etc.
6-
Establish the fact with the patient that having issues such as these are not
healthy nor normal. This is important because many people thing they have
“normal morning headaches.”
7-
At this point ask the patient what they have done to date to try to fix these
issues. Then ask what the results have been.
THE OBJECTIVE TO THIS POINT IS TO ESTABLISH ALL OF THE REASONS THEY ARE IN YOUR OFFICE. WHAT THEIR PRIOROTY IS, AND JUST HOW SERIOUS THEY ARE ABOUT CORRECTING IT.
8-
Ask the patient to describe the pain, condition, etc, in detail.
9-
At this point ask them what in their life this situation is negatively affecting.
Sports, kids, hobbies, family, work, etc. DIG DEEPLY.
10- After establishing the extent of how this affects their life, ask the patient what
their life would be like with out these negative conditions. Get them to describe
it.
11- At this point ask the patient if they feel there is a need to make a change in
their lives to address these issues. Get their level of commitment to change. I
like to ask the scale of 1-10 question. 10 if a high level of commitment, 1 is no
commitment, where are you?
12- At this point examine the patient and take x rays.
13- After step 12 is complete release the patient to day two. In specific “ mr jones
what I want to do at this point is study your exam and x rays, and with your
permission I do not want to rush that. Your health if far too important to me.
With that in mind I have my work cut out for me and with your permission won’t
be able to do any more today. I will however be ready for you tomorrow. We
will schedule you a time tomorrow so you and I can review your exam, x rays,
and get a plan to get you better. Do you have any questions?
14- At this point the doctor reviews the first days fees, make sure that these fees
are not too high, and easy for the patient to pay cash for. It is highly
recommended that you do not wait for insurance to pay for this first visit, this is
cash. Explain that the patient can leave their insurance info with the front desk
and your office will review it and share the details the next day at the report.
15- Before exiting explain to the patient that you do require their spouse or
significant other to attend the day two report, so that all question can be
addressed as a team.
16- Warmly release the patient and send them to the front desk. At this point the
front desk collects the first visit fees in full and gives the patient an
appointment card for the second visit.
DAY TWO 1-
Warmly welcome the patient and spouse back to the office. Thank the spouse
or significant other for attending and explain its import.
2-
Review the reasons why the patient entered the office.
3-
Review the affect this has been having in their life.
4-
Review the exam findings.
5-
Review the x ray findings.
6-
Explain what a subluxation is. Show a plastic spine model. (Please note, if
you do not like the word Subluxation, pick your own word. Don’t get hung up
on this step.)
7-
Go to the patients spine and touch it, make comparison to the plastic model.
8-
Explain what a subluxation does, nerve pressure, IVF openings ( call this
nerve channels) and their connections to organs, etc.
9-
Make the tie in how pressure on these nerves can cause symptoms, and or
conditions such as they have.
10- Make a specific tie in with the patients conditions and their subluxations.
11- At this point ask “ If we can help you get rid of this without medications or
surgery would that interest you?
12- Review the x rays. Show normal, and compare that to the patients x rays.
Make the point that their x ray/ spine/ posture etc, is not normal.
13- Ask if there are any questions to this point?
14- Ask the patient at this point what they are wanting you to do for them in
specific, what are your goals here?
15- Ask the patient if you can fix it would they be committed to doing so?
16- Review good news versus bad news. The bad news is your spine is not in
good shape, good news is we can help you. It’s a matter of correcting your
subluxations and getting the pressure off of the nerves causing your
problems, does that make sense?
17- Explain the consequences of doing nothing. Permanent , surgery, drug
addiction, etc.
18- Get the patient to agree they are subluxated and explain to you how this is
causing their issues.
19- Give your treatment/ care recommendations. It is recommended that care be
more frequent in the beginning when the patient is more motivated. A
minimum of 3 times a week for several months, down to two times etc. I
prefer daily for at least one week.
20- Explain that length of care is simply how the body heals. It does not happen
overnight and cant be short cut.
21- Get the patients commitment to the schedule. If they do not commit, go back
and review the steps. In specific: what brought them in, what it is doing in
their life, how their life would be better with out these issues, etc.
22- Explain what each visit in your office will contain. Be specific and be
enthusiastic.
23- Explain the re exam procedure every 30 days. Be specific and be
enthusiastic.
REVIEW FINANCES
1-
It is highly recommended you get paid in full up front. When the patient
commits financially, as a rule they stay on schedule, don’t miss, refer, a host
of other positive things when finances are out of the way.
2-
So you need to establish a case fee. It is suggested it not be below $2500.
This covers 6-8 months care. The specifics are up to you.
3-
From this case fee subtract the amount you expect the insurance to cover
should that apply. It is suggested you underestimate this as insurance
companies tend to under pay.
4-
Get a sub total.
5-
Option one is to pay in full and receive a 20% discount. Via Card, cash,
check. Stop there, do not discuss option two at this point. STAY SILENT. DO
NOT FURTHER TALK UNTIL THE PATIENT RESPONDS.
6-
If the patient accepts, which they will 60% of the time, have them sign your
financial agreement. (for a sample ask me)
7-
If the patient does not agree go to option two: four payments over 4 months.
Card, Post dated checks, etc. And receive a 10% discount. AGAIN STAY
SILENT. WAIT FOR THE PATIENT TO RESPOND . Approx 25-30% of the
remaining patients will take this option.
8-
If the patient declines, they go visit to visit pay as you go and pay in full. If the
patient choses this option go back and review option # 2 and suggest they
take this option.
9-
If the patient baulks and the cost of care, compare that to the cost of not
getting care, and staying the way they are, or getting worse.
10- Once the patient commits, have them sign a financial agreement.
11- Explain to the patient your office procedures, sign in, adjust , etc.
12- Explain the multiple appointment schedule and card.
13- Adjust the patient.
14- Take them to your front desk person and have the multiple appointment
schedule set up. Place this on a card at least 12 visits in advance.
15- The front desk asks which they prefer “morning or afternoon?” Give them an
option of two preferred times. Never say when would you like to come in.
(The financial options present here are this that have been proven to work. If you
choose to not use a case fee plan, do not get hung up on this.) (Please check with
your individual state board to make sure your financial plan fits in your states scope of
practice. If it does not e mail me and we can discuss it.)
IN REVIEW
1-
Consultation check list.
2-
Major complaint
3-
How long?
4-
How often?
5-
Accidents/ injuries
6-
Treatment to date for this?
7-
Results?
8-
How does it affect your life?
9-
What does this prevent you from doing?
10- What do you think will happen if you do nothing to correct it?
11- On a 1-10 scale how motivated are you to correct this?
12- Concerns? Money, time, etc.
13- Report of findings, exam and x rays
14- Care plan
15- Commitment
16- Financial close
17- Adjustment
18- Multiple appointments.
19- Re exam and re report.
1.
PATIENT MAKES PHONE CALL TO OFFICE AND CA ANSWERS
“Morgan Chiropractic Offices, this is Lori speaking may I help you?”
2.
CA MAKES THE APPOINTMENT
“Yes, I’d like to make an appointment with the Doctor please.”
“Well great! When was the last time you saw Dr. Morgan?”
a.) IF THE PATIENT HAS NEVER SEEN THE DOCTOR BEFORE SAY:
“That’s fine. Would you prefer to see him today or tomorrow?”
b.) IF THE PATIENT HAS SEEN THE DOCTOR BEFORE SAY:
“Is this the same or similar condition to what you were in for before?”
“That’s fine, Mrs. Jones. Would you prefer to come in today or tomorrow?”
“Tomorrow would be better for me.”
“Would the morning or afternoon be more convenient?”
“Afternoon.”
“Okay, lets take a look here… we have an appointment available at three o’clock or four
o’clock, which would you prefer?”
“Four o’clock would be great.”
A.
CA GETS NAME
“Can I have your complete name please…?”
“Judy, please spell your last name for me…”
B.
PHONE NUMBER
“What is the best number you can be reached during the day…?”
C.
FIND OUT WHAT KIND OF PATIENT (PI/WC/REGULAR)
“Are you consulting the Doctor for an auto accident, a work related injury or something
else, Mrs. Jones?”
“An auto accident.”
“Oh, I am sorry to hear that.”
D.
REFERRING PATIENT
“Tell me, who referred you to our office Mrs. Jones?”
“Mary Smith.”
E.
CA MAKES REFERRAL STATEMENT
“Is Mary a friend of yours?”
“As you know, she is a wonderful person who has gotten fabulous results…”
“You know she has referred a lot of patients to our office and we just love her for it.”
1|Page
F.
CA GIVES INSTRUCTIONS ON HOW TO GET TO THE OFFICE
“Mrs. Jones, do you know where our office is located?”
“Yes, I think I do.”
“Tell me where you are coming from.”
“Okay, you want to take… and we are right there on the corner.”
G.
CA TELLS PATIENT SHE IS HAPPY TO TALK TO HIM/HER
“Okay great! We look forward to meeting you in person tomorrow afternoon at four
o’clock, Mrs. Jones.”
3.
PATIENT WALKS IN THE FRONT DOOR
“Hi, I am Mrs. Jones.”
4.
CA GREETS PATIENT - Lll
“Mrs. Jones, I’m Lori. I’ve been so anxious to meet you ever since we spoke on the
phone yesterday.”
~OR~
“Hello. You must be Mrs. Jones. Welcome to the Morgan Chiropractic Offices. My
name is Lori. I’ve been so anxious to meet you ever since we spoke on the hone
yesterday.”
5.
PATIENT HAS TO FILL OUT ENTRY FORMS
“I need you to sign in for me. I also have some special forms here for you to fill out as
completely as possible. You can have a seat here in the reception area to do that. As
soon as you are finished the Doctor will be ready to see you. If you need any help at all,
please let me know and I will be happy to help you.”
PATIENT FILLS OUT CONFIDNTIAL QUESTIONNAIRE. CA LOOKS OVER
FORMS FOR ALL PERTINENT INFORMATION AND IN CASE OF ANY
AUTO ACCIDENT SAYS:
“Thank you very much; I have some additional forms that relate to your auto accident.
The first one is for your attorney if you have one. “
“I don’t have an attorney. Do you think I should get one?”
“Well that is something for you to discuss with the Doctor and you can do that later, but
we’ll go ahead and have you sign it now anyway. If you get an attorney we will send it to
him, and if you don’t get an attorney it will stay in your file.” This other form is for your
insurance company and this authorizes them to pay your bill.”
“Come with me Mrs. Jones.”
6.
CA PUTS PATIENT INTO CONSULTATION ROOM
“Have a seat right over here Mrs. Jones. The Doctor will be with you in just a moment.”
2|Page
7.
DOCTOR GREETS PATIENT
“Mrs. Jones, I am Dr. Morgan and I’m very pleased to meet you and have you in our
office.”
8.
DOCTOR MAKES REFERRAL STATEMENT
“Mrs. Jones, I noticed that Mary Smith referred you to our office. Is she a friend of
yours?” ~or~ “Does she work with you?” ~or~ “Is she a neighbor of yours?”
“You know she has really been a good patient in this office. She’s gotten wonderful
results here in the office for her headaches and she has referred a lot of patients to us.
We really appreciate her for it. “
9.
DOCTORS DOES CONSULTATION
“Mrs. Jones, tell me about your auto accident. I want to know everything.” ~or~ “Tell
me about your headaches. I want to know everything.” ~or~ “Tell me about your low
back pain. I want to know everything.”
DO A COMPLETE CASE HISTORY REGARDING THE ACCIDENT AND/OR THE
PATIENTS COMPLAINTS.
10.
DOCTOR ASKS ORGANIC QUESTION
“Do you suffer from constipation, allegories, insomnia, etc.?
Think of eight questions to ask your patients.
11.
DOCTOR SAYS “WOW” FACTOR
A.) NON-EMERGENCY PATIENT
“Mrs. Jones, we are going to examine you thoroughly right now. In fact, we are going to
do a complete physical, neurological and chiropractic examination. Frankly, Mrs. Jones,
when we get through with you we are going to know more about you than you know
about yourself.”
B.) EMERGENCY PATIENT
About 33% of patients that come to you will need emergency care and it is necessary
that you treat them on the first day - at the end of the consultation if you perceive
that the patient will need emergency care then you should tell them at that time and
say:
“Mrs. Jones, we are going to examine you thoroughly at this time and we are going to XRay you and do an emergency reading of the X-Rays. We will provide emergency care
for you today. We will do everything in our power to try to give you as much relief as
possible.”
12.
DOCTOR DOES COMPLETE PHYSICAL, ORTHO, NEURO &
CHIROPRACTIC EXAM
3|Page
13.
DOCTOR MAKES X-RAY STATEMENT
A.)
ASSUMPTIVE:
“Mrs. Jones, it is necessary to X-Ray you at this time, so please come with me.”
B.)
DESCRIPTION:
“Mrs. Jones, you have a very severe whiplash and as a result you have severe spinal cord
pressure and severely pinched nerves. Because of the injury and the possibility of
permanent damage, it is necessary to X-Ray you, so please come with me.”
C.)
RADIATION STATEMENT:
“Mrs. Jones, the body can pass off approximately 1200 mill roentgens per 90 day period.
The amount of radiation you will receive from these X-Rays is less than 1/6th of the
maximum dose. So, in your case, it is perfectly safe to take X-Rays.”
RESISTANT PATIENT: (Female)
“Dr. Morgan I hope X-Rays are not necessary today.”
“Well I don’t know if they are or not. Are you pregnant?”
“No, I am not.”
“When was the last time you were X-Rayed?”
“About four years ago.”
“Okay, I will tell you what we are going to do. We are going to examine you and if XRays are necessary, I want to assure you that you will only receive about 200
mill
roentgens of X-Rays. We use very high speed machines today, and they are very modern. The
human body can absorb and reject about 1200 mill roentgens of radiation in any 90 day period.
of your maximum
If it is necessary to X-Ray you, you are going to receive about 1/6th
dosage. So it is safe.”
RESISTANT PATIENT: (Male)
“I don’t want X-Ray’s!”
“I understand and I am glad that you feel that way because we don’t like to X-Ray unless
it is absolutely necessary.”
CONSULT AND EXAMINE THE PATIENT AND THEN US A DESCRIPTIVE
EXPLANATION OF X-RAY AND SAY:
“Now Mr. Jones, I was hoping that we would not have to X-Ray you. However, you do
have spinal cord pressure right here at the base of the brain stem and you have a nerve
that is pinched rather badly under your left shoulder blade and because of that and the
possibility of permanent damage, it is necessary to X-Ray you. I highly recommend to
you that we do so, so why don’t we do so right now.”
PATIENT IS STILL RESISTANT:
“As I said before, you now have spinal cord pressure on the brain stem which is very
delicate, and you have a very seriously pinched nerve. Because of that and the possibility
of permanent damage it is necessary to X-Ray, so why don’t we do that right now.”
PATIENT IS STILL RESISTANT:
“Well, I understand perfectly Mr. Jones, and under the circumstances I cannot take you
as a patient. One thing I want you to know is that you are a dynamite guy and if I can
ever be of service to you I’d be glad to do so. So you have a super day and by the way,
there is no charge for any of the things that we’ve done today.”
4|Page
14.
DOCTOR DOES X-RAY
A.)
AFTER X-RAY:
“Mrs. Jones, wait right here. I want to make sure that your X-Rays are okay.”
AFTER DEVELOPING:
“Mrs. Jones your X-Rays are going to be fine.” (SEE RELEASE STATEMENT)
B.)
15.
EMERGENCY CASE - DOCTOR TREATS PATIENT
A.)
AFTER X-RAY:
B.)
HAVE PATIENT LIE DOWN ON A TABLE AND
PUT ON SOME PHYSICAL THERAPY AND SAY:
“Mrs. Jones, I am going to do an emergency processing of your films and I will be back
in a few moments. Are you comfortable in that position?
AFTER DEVELOPING: DOCTOR COMES IN 10-12 MINUTES LATER AND
SAYS:
“Mrs. Jones, I have done an emergency reading on your X-Rays and you have a very
seriously pinched nerve right here which is causing your back to go into spasm. The
nerve is inflamed and we are going to begin the process of correcting it. I want you to
understand that when the nerves are inflamed or when the tissues and disc are swollen,
or, if there is any soft tissue damage, even though we are beginning the process of
correcting the problem by adjusting you, until the inflammation begins to let up, the pain
will not let up.”
“Mrs. Jones, have you ever been to a Chiropractor before?”
IF YES:
“Well then of course you know what an adjustment feels like.”
IF NO:
“Now Mrs. Jones, adjustments are not normally painful, and as a matter of fact they are
very pleasant. However, when a person is in as much pain as you are sometimes it can be
painful, but only for a moment. Secondly, when we begin the process of correcting this
pinched nerve and putting this vertebra back into place you may hear a cracking noise. If
you do, that is normal so don’t be alarmed, it’s okay. I want you to lie on your side
facing me.”
C.)
D.)
ADJUST PATIENT:
HAVE PATIENT STAND UP AND TELL
HIM/HER TO WALK THE LENGTH OF THE
ROOM & BACK AND SAY:
“Mrs. Jones I want you to sit on the edge of the table.”
RELEASE STATEMENT:
“Mrs. Jones, you are in tough shape. We have started the process of correcting this
pinched nerve in your back. The nerve is highly inflamed and your muscles are in
massive spasm. Your back is very weak at this point so the first 24 to 72 hours is critical.
You must be very careful because if this first adjustment holds there is a pretty good
chance that you will be feeling improved tomorrow. Mrs. Jones if the adjustment does
not hold you may feel just as bad tomorrow as you do today.
5|Page
“Now Mrs. Jones, I’m going to give you instructions - you must be very careful. Be extra
careful when getting in and out of your car. As soon as you get home lie down and put
on this ice pack for 15 minutes at a time. Take it off for an hour and then put it back on
for another 15 minutes. Do this as often as you can. Be sure to put something light
between the ice pack and your skin so that you do not burn your skin.”
E.)
“Lay down in your bed when you get home - By the way, is your bed firm? Do not lie
down on the couch and whatever you do, do not sit in a soft chair because you run the
risk of pulling your back loose. Get up every 30 minutes and walk around just enough to
get the stiffness out if you can. If you want to sit a little bit that will be fine, but sit only
in a straight back chair and not for very long. Obviously, do not do any bending, twisting
and lifting of any heavy objects. Mrs. Jones, do you have any questions?”
DOCTOR HANDLES FEES: (See following)
16.
ROUTINE CASE - DOCTOR RELEASES PATIENT
A.)
RELEASE STATEMENT:
“Mrs. Jones your X-Rays are going to be fine. It is going to take several hours to
develop and analyze your X-Rays. Then of course we have to study them very carefully.
Therefore, we will not be able to do any more today, but we will be ready tomorrow. At
that time, I will give you a complete report, show you your X-Rays, explain everything to
you in detail and get down to the business of getting you well. Do you have any
questions at this time?”
DOCTOR HANDLES FEE:
CASH (AND MEDICARE)
“The charge for the examination is $30 and the X-Rays are $49. This is payable in the
beginning. You can take care of this with Lori at the front desk and at the same time
make an appointment for tomorrow’s visit. Plan on spending at least 45 minutes with us
tomorrow.”
INSURANCE
“Mrs. Jones, before you go I’d also like to help you with your insurance. Now, do you
have a deductible?”
IF YES, ASK “How much is it? AND “Have you met your deductible?”
PI TO LIEN - 100% COVERAGE
1.) “Mrs. Jones, we will be filing all necessary insurance claims on your behalf. In your
case, since you do have liability insurance, we will be very happy to wait for payment
until you settle your case. As you know, when you settle, both your medical payment and
the money for compensation will be involved in the settlement. Therefore, it will be
necessary for you to take the money from the settlement and pay your treatment bill here
at the office.”
~OR~
2.) “Mrs. Jones let me help you for a moment regarding your insurance. Fortunately you
do have full coverage and we will be filing the entire claim for you and doing all the
paper work so that will be taken off your shoulders. We will also be sending the proper
forms to your attorney.”
B.)
6|Page
“Incidentally, is it your intention to see an attorney? In your case, I would recommend
that you do. If you do decide to, I would be very happy to help you retain one. As you
know it costs no more for the very best than for the very worst and we know who the good
ones are. So if you decide to get an attorney, I’d be very pleased to help you.”
WORKER’S COMENSATION - 100% COVERAGE
“Mrs. Jones we will be filing all insurance forms on your behalf so you do not need to
worry about the cost. The Insurance Company will be paying 100% of your bill.”
C.)
DOCTOR HANDS OFFICE BROCHURE WITH APPROPRIATE FINANACIAL
PAMPHLET:
“I would like for you to have one of our office booklets which tells about what we do
here. It contains some information regarding chiropractic and also a copy of the
financial policy.”
D.)
DOCTOR GETS PATIENT TO BRING SPOUSE
1. FEMALE
“Mrs. Jones, I’d like very much for you to bring your husband with you tomorrow. It’s
very important. Where does he work? What does he do? What are his hours? Do you
think that you could get him to take off work for an hour or two tomorrow just this one
time since it’s very important? I’m going to be telling both of you the results of your
exam and showing you the X-rays. Also, I want him to know what you have been going
through.”
2. MALE
“Mr. Jones, I’d like very much for you to bring your wife with you tomorrow. It’s very
important. Where does she work? What does she do? What are her hours? Do you think
that you could get her to take off work for an hour or two tomorrow just this one time
since it’s very important? I am going to be telling both of you the results of your exam
and showing you the X-rays. Also, I am going to teach her how to take care of you.”
E.)
DOCTOR MAKES “WOW” STATEMENT
“The last thing I want to say is that I feel confident that we are going to be able to help
you and help you a lot. We are excited about having you as a patient here in the office
and frankly Mrs. Jones, I can hardly wait until tomorrow.”
F.)
STAND AND SHAKE PATIENT’S HAND
“So take care of the details at the front desk and I’ll see you tomorrow.”
17.
CA COLLECTS MONEY
IF CASH:
“The charges for today are 79 and that is payable in the beginning. How would you like to take
care of that? Cash or Check?”
IF INSURANCE:
“The charges for today are 38.70. How would you like to take care of that? Cash or Check?”
7|Page
18.
CA MAKES APPOINTMENT FOR FOLLOWING DAY
“Mrs. Jones the doctor wants to give you a complete report tomorrow. Four o’clock will
be best for our schedule. Does that work for you? Okay great!”
19.
PATIENT RETURNS – CA GREET PATIENT
“Hi Mrs. Jones, good to see you today. Go ahead and sign in for me. Great, now please
follow me.”
20.
CA PUTS PATIENT IN REPORT ROOM
“Mrs. Jones, you can have a seat over here. The doctor will be with you in just a
moment. Before he gets here there is a video he would like for you to see.”
21.
CA PLAYS THE VIDEO
22.
DOCTOR GREETS PATIENT AND SPOUSE
I.
WARM UP
“Hi Mrs. Jones. I am happy to see you today. Mr. Jones, I’m Doctor Morgan and I am
very pleased to meet you and to have you in the office. Thank you very much for taking
time off today from your work to come to the office and see the results of your wife’s
examination and X‐rays.”
23.
DOCTOR MAKES FIRST “WOW” STATEMENT ~ DOCTOR MAKES VALUE
CHANGING STATEMENT
“You know folks, I feel it is very important for the family to be together at times like
this.”
24.
DOCTOR GIVES THE REPORT
“Now Mrs. Jones, I am going to take a few moments to review the results of your
examination and to explain to you exactly what we found.”
II.
GOOD NEWS AND BAD NEWS
“In examining you, we found some very serious trouble (pinched nerves, injuries) in your
neck and back (as a result of the accident). We also found a lot of good things about
you. I am going to tell you about the good as well as the not so good and I am going to
tell you the good things first.”
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III.
IV.
REVIEW SYMPTOMS
“As you know for the past several months you have been having very severe recurring
headaches. You also have been having dizzy spells when you move suddenly, rise or roll
over. Your memory and concentration has been poor, your energy has been low, and
you have been irritable, nervous and sleeping poorly. Also, you have had neck pains
which seem to be associated with the headaches. You have had midback pain and a lot
of low back pain.” ~GO THROUGH AND REVIWE ALL SYMPTOMS~
REVIEW NORMALS
A. HEART, LUNGS, PULSE, BLOOD PRESSURE
“In examining you we examined your lungs and found them to be normal. By that I mean
there was no evidence of wheezing or congestion which is good. We examined your
heart; the beat was very strong and regular. We examined your blood pressure and that
was 120/80. That’s the blood pressure of a 21 year old girl. So that’s good.”
B. CRANIAL NERVES
“We also examined the nerves in your head. There are 12 of them and they are called
Cranial Nerves. They control the pupillary reflexes, eye movements, smell, tongue
movements, gag reflex, facial muscles, winking, smiling, hearing, swallowing, and
shoulder shrugging. These are normal and that is good.”
C. REFLEXES
“We also examined the reflexes in your arms, legs, biceps, and triceps, the extensor
digitorum, the patella, the Achilles and Babinski reflexes and those were also normal.”
“Now Mrs. Jones, the fact that your arm and leg reflexes are normal is a very, very
important and favorable finding. The reason I say that is because you have some
seriously pinched nerves in your neck and back that radiate across the shoulders, down
the arms, across the low back and down the legs.”
“When a nerve gets pinched, because the nerve root is so delicate, sometimes the nerve
will be injured. If the injury is permanent, the reflexes will frequently disappear. The fact
that your reflexes are active, brisk and normal indicates that if there is injury to the
nerves it is not too late – it is repairable, and that is good news. So, in spite of what I am
about to tell you and in addition to being a delightful person, before this accident you
were a very healthy woman and you now have some serious troubles.”
V.
A.
REVIEW ABNORMALS
RHOMBERG’S TEST
 IDENTIFY TEST
“On the other hand, we did a test called the Rhomberg test. You may remember this test,
when you stood with your arms outstretched and your eyes closed. If you weave a lot,
that’s a positive sign. You remember weaving a lot don’t you?
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 b. EXPLAIN SIGNIFICANCE
“When you have a positive Rhomberg as you do and, incidentally, this is also what your
X‐rays reveal, it means that the top vertebra at the base of the skull is misaligned and
causing pressure on the delicate spinal cord.
 RELATE TO PATIENTS SYMPTOMS
“When you have spinal cord pressure, it can affect you in many ways – headaches, dizzy
spells, buzzing and ringing in the ears, blurring of the eyes, loss of memory and
concentration , depression, crying spells, loss of energy and loss of sleep. Does that
sound like anyone you know?”
B.
FORAMEN COMPRESSION TEST
 IDENTIFY TEST
“We also did a test called the Foramen Compression Test where we pressed on the top of
your head in the left, center, and right positions.”
 EXPLAIN SIGNIFICANCE
“If it is painful it means that you have either tissue injury or nerve root pressure in the
middle or lower part of your neck.”
 RELATE TO PATIENTS CONDITION
“This can cause neck, shoulder, arm, upper back, and chest pain. It also causes loss of
strength, numbness in the hands and arms, and if bad enough, loss of functions.”
C.
SPASMS (RANGE OF MOTION)
“We also found massive spasms in your neck and back. A spasm is defined as a
sustained, involuntary contraction of a muscle or group of muscles. In your case, the
spasms were caused by the pinched nerves.”
“Because of the spasms, you have very limited mobility in your neck. You should be able
to bend your head 60 degrees and you can only do 40 degrees. You should be able to
bend your head backward 50 degrees and you can only do 30 degrees. You should be
able to rotate your head to the left and right 80 degrees and you can only do 40 degrees.
Also, you should be able to bend your head left and right 40 degrees and you can only do
20 degrees.”
“It was painful for you to bend your head to one degree or another in every direction.
The reason there is so much restriction in your neck is because of a misaligned vertebra
in your neck along with the accompanying muscle spasm.”
D. LASEQUE’S TEST
 IDENTIFY TEST
“We also did a test called Laseque’s. That is the test where you lie on your back with
your leg elevated.”
 EXPLAIN SIGNIFICANCE
“And that was painful in your back which means that you have nerves pinched in the
lower back.”
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 RELATE TO PATIENTS CONDITION
“And that causes low back pain, spasms in the back, pain down the legs, abdominal pain,
and even abdominal dysfunction.”
E. PSOAS MAJOR/MINOR
 IDENTIFY TEST
“We did another test and this test is very, very important. It is called PSOAS
Major/Minor. If you recall, we pressed into your abdomen on both sides.”
 EXPLAIN SIGNIFICANCE
“And that was very painful. There is a chain of muscles that lie to the front and side of
the spine as you can see on this chart. Imbedded in those muscles is the second largest
nerve plexus in the body called the interior mesenteric ganglion. It is like a switchboard
in that large nerves go in and hundreds of small nerves go out. This particular plexus
receives its nerve supply from the low back and distributes the nerve supply to the organs
of the abdominal cavity.”
 RELATE TO PATIENTS CONDITION
“If that’s out of balance too long, you can begin to have seriously abdominal
dysfunctions such as constipation, diarrhea, female problems, etc.
VI.
EXPLAIN X‐RAY
A. DEMONSTRATE SPINE
“I want to take a few minutes to show you your X-Rays, but before I do, I would like to
explain a couple of things to you. First of all, this is a plastic spine. It is an exact replica
of a normal spine. This is the pelvis, this is a vertebra from the front, that’s the disc, and
this is the vertebra from the back. This is called the spinous process.”
(REACH OVER AND TOUCH THE PATIENT ON THE SPINOUS PROCESS.)
“From the side, these are the openings where the nerves pass through, this is the nerve,
and this is the opening. You will notice that the nerve passes through the opening. The
opening is formed by the vertebra sitting in proper alignment with the one above and
the one below. When a vertebra misaligns like this, or any combination of those
movements, it will reduce the size of the opening as you can see. When it does it can
pinch the nerve. Let me show you.”
“Let me see your finger for a minute. Let’s pretend that this finger is a nerve and we will
put it right in the opening. And when you misalign the vertebra do you see how that
pinches? Now that is happening to you in a number of areas in your spine.” Let me show
you Mr. Jones.”
Reach over and extend your right hand to the patient’s left hand. Take the small
finger on the left hand, put it in the opening and squeeze it until the patient flinches
and then say: “Oh, I am sorry, I didn’t mean to hurt you.”
Pick up your ATLAS/AXIS SET.
“Now Judy, this is a cutaway of your skull right here.”
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Reach over and lightly touch the OCCIPUT.
“And these are the top two vertebras.”
Reach over and lightly touch the upper neck.
Take the patient’s large finger on the right hand, and put it down through the
center of the foramen magnum. Shift the foramen magnum and the center of the
atlas vertebra and cause pressure on the finger and say:
“This is what’s causing pressure on the delicate spinal cord, just like this.”
At that point, reach around the patient and gently palpate the neck.
“If there are spinal vertebra misalignments, the neck will be sore and this is why you are
having all those headaches. “
At this point, look at the husband and say:
“Let me show you what’s happening to your wife. She is having terrific spinal cord
pressure at the base of the skull in this area right here.”
Reach over and palpate him in the neck. If you find soreness and tender spots, stop
for a moment, look him in the eye and ask:
“Is that sore? Have you ever noticed that before? Are you having headaches, stiff or
sore neck or any symptoms in the neck of any kind?”
If he responds yes then say:
“You know it’s a good thing I put my hand on your neck because you are beginning to
develop a low grade form of spinal cord pressure which is what is probably causing your
headaches ~ This is the same type of condition that your wife has.”
If he responds no then say;
“It’s a good thing I put my hand on your neck because you are beginning to develop the
same condition as your wife, and even though it is not symptomatic it is important that
you get it fixed before you develop a full=blown condition like your wife. My
recommendation to you is that you get this examined and taken care of before it becomes
serious. And by the way I’d be glad to do that for you. In fact, I’d be happy to do that
today or tomorrow, which do you prefer?”
Settle the matter with him at that point. One out of every two will do it. One out of
every two will not. When the matter is settled, continue on…
B. MISALIGNMENT VS. SUBLUXATION
“I want to explain one more thing to you before I show you the X-rays and that is the
difference between misaligned vertebrae and a subluxated vertebra.”
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“A misaligned vertebra is out of place but NOT pinching a nerve. A subluxated vertebra
is one that is out of place AND IS pinching a nerve. The difference between the two
mechanically can be very minute but the difference in the way it affects the human body
can be very profound. Misaligned vertebra do not cause pain, they do cause the spine to
be crooked, which can weaken the joints and spine and eventually become subluxated.
Subluxations do all those things but cause pain and dysfunction as well.”
C. EXPLAIN X-RAYS
(Go over and turn the view box on, making sure that you show the entire spine from
the front or the side)
“Mrs. Jones, this is you. We are looking at you in this view from the back – this is the left
side, this is the right side, this is the neck, this is the neck, the upper back, the mid back
and the lower back. First of all, the spine is supposed to be straight.”
(Point to the chart on the wall)
“As you can see your spine is definitely crooked. Also, each place where you see a
wedge I’ve drawn in, is a vertebra that’s out of alignment.”
“It is either tipped this way or that way. You have 1, 2, 3, 4, 5, 6, 7 vertebrae that are
misaligned in your spine. Mrs. Jones there are only 24 vertebra in your spine so that
constitutes 25% of your spine. Many of those vertebra that are out of alignment are
pinching nerves.”
“This is you from the side. You see these black openings here, which is the normal size
opening for the nerve to pass through – notice how large these openings are. Can you
see the difference between the size of that one and the size of this one? Now look at the
bottom one – see how much smaller that is. That opening has been reduced dramatically
and that’s where the nerve passes through.”
(Reach over and Squeeze the patient’s finger with the thumb and forefinger of your
right hand)
“The vertebra is squeezing the nerve in the lower back and that is why you have the low
back pain and sometimes the leg pain.”
“I should explain one more thing to you and that is about transitory subluxation. That is
a vertebra that is out of place all the time but is pinching a nerve only some of the time
and that is why: (tie in with organic issues.) Because in the process of the day, your
back fatigues and the vertebra clamps down on the nerve.”
“Also I want you to look at the disc spaces. You can’t see a disc on an X-ray but you can
see the space it occupies. As a disc begins to deteriorate, the space will begin to narrow
and you will notice that your bottom disc is about 50% narrower than the one above.”
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“If you look very closely, you will notice that the surface of the vertebra above and the
one below is becoming very rough and you have a spur on the front of the vertebra. Not
only is it important to free that vertebra so that the pain will go away, but to keep it
mobilized so that the disc degeneration does not continue on.” (Tie in with organic
issues.)
“This is an X-ray of your neck and here, by the way, is an X-ray of a normal neck. You
will notice on the normal neck there is a nice anterior bowing and you will notice in your
neck the curve is totally reversed and that’s what a whiplash looks like. Let me show
you.”
Go to your gonstead whiplash chart – demonstrate the chart and say:
“Here is a lady sitting in her car minding her own business – when she is suddenly rearended. Her head whips forward and backward and she has a whiplash. You will notice
as the head goes back and forth, the curve is reversed. The only difference is that yours
is worse. Also, the top vertebra is pushed forward and is causing pressure on the
delicate spinal cord right here.”
Point to the ATLAS at this point and say:
“Do you have any questions about what I’ve shown you so far?”
If the patient says “NO” go to every condition in one of three states…
If the patient says “YES” or “can you take care of it?” Say: “Well, I want to talk to
you about that…”
VII.
ALL CONDITION 3 STAGES
1. NEW AND ACUTE
2. CHRONIC
3. PERMANENT
“Mrs. Jones, every condition is either one of three stages: NEW AND ACUTE; CHRONIC, OR
PERMANENT.”
“Your condition is definitely chronic. By that I mean it has been developing for a long time but
most of it does not have to be permanent. It’s the kind of things that can respond and respond
very well to treatment. It is also the kind of thing that, if ignored or if inadequate treatment is
provided for, it can go on and on and even get worse.”
OR
“Your condition is definitely new and acute. It is a whiplash and it is a severe one, but, it does
not have to be permanent. It is the kind of thing that can respond well to treatment. It is also
the kind of thing that if neglected or if inadequate treatment is provided, it’s going to go on and
on and even get worse. In your case, we have three challenges.”
1) RELIEF
“One is to get rid of the pain and make you feel good, and Mrs. Jones as bad as you feel
that process is going to begin relatively quickly.”
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2) CORRECTION
“The real challenge, however, is not to just get rid of the pain but to get your spine
corrected, strengthened, and rehabilitated, to the best of its’ and our ability and that is
going to take a lot of time – maybe six to eight months or possibly even longer.”
3) MAINTENACE
“Now, I don’t mean six to eight months for the pain to go away. I feel that is going to
begin happening relatively quickly, but you must understand the difference between
relief and correction.”
WHIPLASH
“I would like to point out one more thing to you and that is this: We have had hundreds
of whiplash cases come to us and get totally better. We also get approximately 10 to 15
new cases a month who have had auto accidents 10 and 15 years ago who are still
suffering from the residual effects of it. And we want to make sure that does not happen
to you.”
25.
MAKE LONG TERM RECOMMENDATION BASED ON LONG-TERM
CORRECTIONS AND NOT SHORT-TERM RELIEF
IX.
LONG TERM RECOMMENDATIONS
“It is necessary to see you daily for the balance of this week and next; three times a week
for four weeks; two times a week for eight weeks and then once a week for eight weeks.”
“If you follow through with your care, do some things we ask you to do and not do some
things we ask you not to do, and keep your appointments 9which is extremely
important), you have a very good chance of making an excellent recover.”
“Also, I would recommend that when you get in good condition again, that we institute a
program of periodic care so you will never regress to this position again.”
26.
ASK:
“Do you have any questions?”
27.
ASSOCIATE DOCTOR – ASSIGNS CASE AND MAKES SPECIALIST
RECOMMENDATIONS
“Judy, Dr. Smith is a specialist in your type of case and so am I. He and I will both be
seeing you so you are going to get the best of both of us.”
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28.
MAKE LAY LECTURE STATEMENT
“One of the conditions that we accept all patients on is that you attend a special program
to learn how to take care of yourself, there are no exceptions, and George you need to
attend also. There is no charge of course. It’s at six o’clock on Wednesday nights and
you only have to come once. What we’ll do is schedule your appointment for 5:30 to get
your treatment and we will have you stay for the class. We are going to talk about
exercise, home and work activities; as well as about sleeping habits such as mattresses,
pillows, and water beds; and many other things which you will really enjoy.”
“Now Mrs. Jones, you have been sick too long; so let’s get started getting you well right
now.”
29.
WRITE DOWN RECOMMENDATIONS ON PATIENT RECORDS AND ON A
SEPARATE PIECE OF PAPER
30.
PUT PATIENT INTO TREATMENT ROOM
31.
HAVE PATIENT GET INTO GOWN OR REMOVE SHIRT
“Now Judy, I’d like for you to disrobe except for underpants and put this gown on with
the opening in the back. As soon as you are dressed if you will open the door just a bit,
I’ll know you are finished and will be back.”
32.
POST X-RAY ON VIEW BOX (TREATMENT ROOM)
33.
GIVE CA THE MULTI-APPOINTMENT SCHEDULE
“Lori, this is Mrs. Jones Schedule.”
34.
TREAT PATIENT
Put Patient on the Table
“Mrs. Jones, have you ever been to a Chiropractor before?”
If Yes:
“Well then of course you know what an adjustment feels like.”
If No:
“Most people are a little nervous about getting adjusted for the first time – Don’t be!
Most people find it to be very pleasant and come to learn to like adjustments as well.”
“What we are going to do is to begin the process now of correcting your spine. Now I
want you to lay on your stomach. Let’s check you out… Do you feel how tense and tight
you are/ Boy, Oh Boy! The day is going to come when all of that spasm is gone.”
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“Now, when we adjust you, you may hear a popping noise but it will not be painful so do
not be alarmed by it. That is the vertebra going into proper alignment. Do you
understand?”
A. WHILE TREATING PATIENT – USE TOUCH AND TELL
In the case of the fifth lumbar – adjust and say:
“Mrs. Jones, that was for your low back pain and or constipation, etc.
In the case of low back and abdominal pain – adjust and say:
“Mrs. Jones, that was for your low back and abdominal pain.” (Insert organic tie in.)
In the case of leg pain – adjust and say:
“Mrs. Jones, that was for your leg pain.” (Insert organic tie in.)
Use this same technique when adjusting thoracic and cervical – whatever the
organic conditions that relates to the specific adjustment.
B. GIVE PATIENT INSTRUCTION SHEET ~ DO’S AND DON’TS
“Here are some things that I would like you to have. This is a special instruction book
on how to take care of you. Here are some general health hints I want you to follow and
here are some things to do and not to do. I have marked some specific things for you to
do in relating to your case. There are a lot of good instructions on how to stand and sit
correctly. How to care for your back, how to exercise, how to put your back (to bed), and
lots more.”
“There is one thing in particular that I want to make sure you read and that is, ‘Are you
eating more – but benefiting less?’ This is especially important for people who are
having difficulty with foods. Now I want this to be your manual!”
C. GIVE PATIENT EMERGENCY CARD
“Mrs. Jones, this is an emergency card for your use and it is very important. It is your Xray and code. I want you to carry this in your purse at all times. If you are ever out of
town and have to see another Chiropractor, give this card to him and he will know what
to do. Not only will it get you in that day, but it will also save you the expense and time
of going through another examination and X-rays.”
D. GIVE PATIENT LAY LECTURE COUPON
“I have a special ticket for you and your husband to come to our special back care
program on Wednesday and you know that you must come. So please make sure that you
schedule this will Lori as well.”
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E. MAKE “WOW” FACTORS STATEMENT
“The last thing I want to explain to you is this – you and I are going to be working
together for the next six to eight months and will get to know each other every well. I
would like to assure you that I will do everything in my power to get you well. We will
leave no stones unturned in our search to make you a whole and healthy lady. Whenever
you have any questions and need to sit down with me, just ask and I will be available to
you. Take care of yourselves, and now go out and make your appointments for
tomorrow. Mr. Jones, it was a pleasure meeting you and I am looking forward to taking
care of both of you, and also taking care of your neck.”(Tie in with organic issues.)
OR
“Mrs. Jones, you and I are going to spend a lot of time together over the next six months
in your search to get well and I want you to know that we will provide you the finest kind
of Chiropractic care and will commit all of our skills and knowledge in the pursuit of
getting you well. We will leave no stones unturned. I also want you to know Mrs. Jones,
that we feel privileged to have you as a patient and if there is ever a time that you want to
sit down and talk with me about anything, all you have to do is ask and I will make myself
available to you. It’s a pleasure to have you as a patient and I will see you tomorrow.”
35.
PATIENT RETURNS TO FRONT DESK
36.
CA GIVES PATIENT 12 MULTIPLE APPOINTMENTS
“Mrs. Jones, as Dr. Morgan just told you, it will be necessary to see you daily for the rest
of this week and three times a week for the next four weeks. I have gone ahead and put
that information down on this card with the dates. What we need to do now is establish a
time – 9:30 looks like it will work out well for us, would that be alright with you? Should
you have a problem keeping an appointment on a particular day or time, please just call
and let me know so we can rearrange it for you.”
37.
CA TAKES MULTI-APPOINTMENT PAPER AND PUTS ON A SPINDLE
WHICH IS TRANSFERRED INTO THE APPOINTMENT BOOK NO LATER
THAN CLOSING TIME EACH DAY
38.
CA TAKES PATIENT TO INSURANCE PERSON FOR INSURANCE
INFORMATION OR BILLING INSTRUCTIONS
“Before you leave there is one other thing that I need to go over with you and that is our
billing process. It will just take a minute so if you will come with me I will explain it.”
Isolate the patient in order to explain how you expect them to pay in your office.
They will be one of seven different types of patients’ who come in to your office (and
each will require a different dialogue):
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1.
2.
3.
4.
5.
6.
7.
CASH
MEDICARE
PERSONAL INJURY
WELFARE
INSURANCE WITH A HIGH DEDUCTIBLE
INSURANCE WITH A LOW DEDUCTIBLE
WORKER’S COMPENSATION
CASH PATIENT:
“Mrs. Jones, the charge for each visit is 26 and you can take care of that in one of two
ways. First, you can pay each and every visit now, or you may pay once a week at the
end of the week. What we ask of you is to have your check made out before you come and
we will take care of it before you go back to see the doctor. Which do you prefer?”
“Is it possible to pay every two weeks?”
“That is not a problem. We will just make a note here that you will pay once every two
weeks and I will also add that you will take care of that on the first and third Friday of
each month. Will that work? Great.”
(SEE INSURANCE BOOK FOR OTHER DIALOGUE’S)
39.
DOCTOR CALLS PATIENT AT THE END OF DAY
PATIENT FEELS OKAY:
“Hi Mrs. Jones, this is Dr. Morgan. I am calling to find out how you’re doing the first
night after your first adjustment. (Patient says they are feeling okay) That’s fine, that’s
why I called. Should you have any problems make sure you call me.”
PATIENT FEELS BETTER:
“Hi Mrs. Jones, this is Dr. Morgan. I am calling to find out how you’re doing the first
night after your first adjustment. (Patient says they are feeling wonderful, they are so
much improved they can’t believe it, it’s great) “Well that’s awesome – That is why I
called. I felt and hoped that you would – Chiropractic works miracles. Now makes sure
you tell your friends! We will see you tomorrow. Have a great night.”
PATIENT FEELS WORSE:
“Hi Mrs. Jones, this is Dr. Morgan. I am calling to find out how you’re doing the first
night after your first adjustment. (Patient says they are feeling worse, and not doing
very well) “Tell me about it.” (Low back pain is worse.) “Well I am glad I called you
because one thing I forgot to mention to you today – Sometimes patient’s will feel
temporarily worse the first night after their first adjustment. Here’s what I want you to
do…
MAKE SOME HOME RECOMMENDATIONS:
“Mrs. Jones in just a very short time you are going to begin to feel a lot better. I don’t
mean necessarily tonight, but very quickly. In the meantime, do not worry. We are going
to be taking care of you and you are going to be a whole and healthy lady very quickly.
We will see you tomorrow morning.”
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40.
30 DAYS LATER – TREAT PATIENT AND SCHEDULE PATIENT FOR REEXAMINATION
“Mrs. Jones, I would like for you to spend an extra few minutes with me on your next visit
because at that time we are going to re-examine you.”
IF PATIENT ASKS “WHY?”
“We are going to measure your improvements.”
41.
STICK POST-IT TO PATIENT’S TRAVEL CARD AND WRITE RE-EXAM,
DAY, DATE
Walk out to the front desk with the patient, hand it to the CA and say:
“Please schedule Mrs. Jones for a re-examination for Wednesday.”
42.
CA PUTS PATIENT INTO RE-EXAM ROOM
“Hi Mrs. Jones, it’s good to see you today. Do you know what today is? It’s the first reexam with the doctor. I need you to go back to room number six once you have signed
in.”
43.
DOCTOR GREETS PATIENT
“Hi, Mrs. Jones, I am happy to see you today. Mrs. Jones, we are going to take a few
minutes to re-examine you today to measure y our improvements.”
44.
DOCTOR RECONSULTS PATIENT
“Before we re-examine you, I am going to ask you a few questions relating to the way
you’re feeling now as compared to the way you felt a month ago. I would like for you to
answer the questions to the best of your ability.”
“If you recall when you first consulted us you were having headaches four and five times
a week, and they were quite severe. Tell me how your headaches are doing now.” (Try
to identify the specific and exact improvement.)
“You also had dizzy spells, tell me about your dizzy spells now.” (Identify specific/exact
improvements.)
“You also had low back pain. Tell me how your low back is doing now. Is it 25%, 50%
or 75% better?” (Identify specific/exact improvement.)
GO THROUGH THE LIST OF ALL SYMPTOMS OF ORIGINAL EXAM TO
IDENTIFY SPECIFIC IMPROVEMENT.
“Overall, do you feel that you are making good progress?” – “I’ll tell you what we are
going to do – we’re going to re-examine you and find out exactly how much improvement
you’ve made.”
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45.
DOCTOR RE-EXAMINES PATIENT
RE-EXAMINE EVERYTHING – NOT JUST THE POSITIVE TESTS EXCEPT FOR
THE CRANIAL NERVES AND THE LUNG AND HEART IF THEY WERE NORMAL
ON THE INITIAL EXAM.
46.
DOCTOR TREATS PATIENT
47.
DOCTOR SCHEDULES PATIENT FOR RE-REPORT FOLLOWING VISIT
“Mrs. Jones on your next visit I will sit down with you and give you a full report on your
re-examination. Make sure you give this to Lori at the front desk so we can set aside a
few extra minutes.”
“I am looking forward to thoroughly reviewing the results of the examination and giving
you the good news the next time I see you. Now you take care of the details at the front
desk and I will see you on Friday.”
48.
DOCTOR WRITES ON POST-IT THE RE-REPORT DATE
DOCTOR TAKES THE PATIENT TO CA AND TELLS THE CA TO PLEASE
SCHEDULE A RE-REPORT OF RE-EXAM FOR THE PATIENT. DO NOT REMOVE
POST-IT FROM TRAVEL CARD.
49.
CA SCHEDULES PATIENT FOR NEXT RE-REPORT
“Hi Mrs. Jones, I am happy to see you today. Go ahead and sign in for me. You know
you get to hear the results of your re-examination today with the doctor, so you can go on
back to room four.”
50.
CA PUTS PATIENT IN TREATMENT ROOM (OR CONSULTATION ROOM)
51.
DOCTOR GREETS PATIENT
“Mrs. Jones, I am happy to see you today. I am going to give you your treatment in a few
moments but before I do I would like to take a few moments to review the results of your
re-examination.”
52.
DOCTOR GIVES STRONG RE-REPORT
A.
GO OVER SYMPTOMS:
“If you recall when you first came to us you were having terrible headache’s several
times a week and had been for two or three years. In the last thirty days the frequency of
the headaches has reduced by 50% and also the severity has reduced as well. So that’s
good.
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“Also, you were having dizzy spells virtually every time that you got out of bed or rose
from a chair. You’ve reported to me that you have had no dizzy spells at all from the first
week of treatment.”
“Now Mrs. Jones, when you first came to see us you were having continuous low back
pain and to date you really can’t see that it has let up very much. So we are going to
have to pay particular attention and concentrate on that specific issue.”
“So, overall you are doing well.”
B.
GO OVER THE TESTS AND TELL THEM THE SIGNIFICANCE:
“Now, I am going to take a few moments to review the results of your examination. If
you recall in examining you we did a test called the foraminal compression test and that
is the test where we pressed on your head in the neutral, and in the left and right position
– do you remember that? If you recall originally it was painful in all three positions –
now it is mildly positive on the right, on the left, normal in the neutral position and it is
mildly positive on the right. This signifies a significant improvement in the neck area as
it relates to pinching of the nerves which is why your neck pain is reducing your dizzy
spells are gone and your headaches are improving. We are making significant progress
there.”(Tie in with organic.)
“In examining you in the low back we did a test called the Laseque’s test which is where
you lay on your back and elevate your leg. If you recall that was very painful when you
lifted your right leg on the last test. This time it is mildly positive; so even though your
symptoms don’t seem to be too much improved in the low back there is evidence that the
condition is beginning to turn around.” (Only say this if it was indeed true.)
IF THERE IS STILL A DEFINITE LASEQUE’S WITHOUT IMPROVEMENT
SAY:
“The Laseque’s test is still positive and this signifies that we are going to have to do
some special work in that area. I am prepared to do that and I am prepared to do it
today.”
GO DOWN THE LINE OF SYMPTOMS – TELL THEM THE TEST AND TELL
THEM IF IT IS IMPROVED OR NOT. Example:
“We also did a test called the Soto-Hall test. If you recall, that is where you lay on your
back and we pressed gently on your sternum and pulled the head forward. Originally
this was painful in the neck, it’s mildly positive now – so that indicated improvement.”
C.
EXPLAIN TO THE PATIENT WHAT YOU JUST TOLD THEM
“Mrs. Jones, if you were to ask me how you’re doing, this is what I would tell you – I
think you are doing fine. You’re not well yet but you are making significant progress. In
the neck and upper back area you’re improving right on schedule and for that we are
very pleased. In the low back area we have not been able to produce results yet but I am
not discouraged. I believe time in an important factor and also we’re going to change
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some techniques in that area as well and concentrate specifically on your low back for a
while.”
D. RE-AFFIRM THE RECOMMENDATIONS
“Mrs. Jones if you recall when I sat down with you three months ago I told you that I felt
that it would take about five months to bring about as much correction as possible. The
results of the re-examination fairly much re-confirms that. In fact, for your neck and
upper back the program is working very, very well. And while progress is slow in the low
back I am confident that it will advance. The program of care that we developed for you
is working just as you and I had hoped that it would. In fact, it is working so well at this
point we are not going to deviate from it.”
(DO NOT MAKE RECOMMENDATIONS THAT YOU CANNOT SUPPORT IN YOUR
OWN MIND AD IN YOUR PROFESSIONAL JUDGEMENT.)
E. RE-AFFIRM CORRECTIONS
“Now sometimes when patients begin to respond as well as you have they forgotten about
the correctional part. If you recall when we originally sat down I told you that we have
three challenges in your case. One was to get rid of the pain and make you feel good. I
told you this was going to happen relatively quickly and it has, just as you and I had
hoped that it would. I also told you that the real challenge in your case was not just to
get rid of the pain but to get this spine of yours corrected, strengthened and rehabilitated
so that you could have a whole and healthy spine and overall wellness.”
“Often times when patients begin to feel good really quick they forget about the
correction part and to do so would be a serious mistake.”
“So as I told you earlier the schedule of care that we developed for you is working just as
we hoped it would so we are not going to deviate from it. We are going to continue to see
you three times a week for another four weeks and at that point we are going to do
another re-evaluation.”
F. REFERRAL STATEMENT
“Mrs. Jones I want you to do me a favor. Tomorrow when you are at work and you are
telling all of your friends about how much better you are doing, will you mention my
name please?”
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