Educate and demonstrate
Anthony LombardiFeatures Clinical Techniques
How to make your patients trust in your care
The key to any patient acceptance of a concept is education and demonstration. This combination develops confidence in those who witness and experience it.
Having said that, the best way to retain new patients is to show them you are different by getting tangible results on their first and second visits.
In Ontario, the population has not grown as fast as the number of chiropractors has. The utilization rate has remained unchanged from 1990-2013. In 1990, there were 10 million people in Ontario compared to 14 million in 2013 – an increase of 40 per cent. In 1990 there were 1,600 chiropractors in Ontario compared to 4,300 in 2013 – an increase of 169 per cent. So essentially there are now more chiropractors competing for the same patient pool.
Thus, if you give patients a reason to believe that you are different from everyone else, then they are more likely to follow your recommendations.
Many chiropractors and chiropractic students ask me what my game plan is when I approach a patient. Naturally, I’m happy to share. The neurofunctional approach to patient care is not only becoming more popular – it’s becoming what patients are asking for in our results-oriented society.
If you watch any of my YouTube videos and especially my EXSTORE and Acupuncture Clinical Videos, you will see that I explain concepts simply in terms the patient will understand. I explain what motor inhibition means, and how acupuncture works, and why the clinical trial is twice per week for three weeks.
In fact, when they fill out the patient intake form online, a 90-second video plays explaining the importance of completing care. Every concept – from findings during assessment to types of treatment, and the concept of tissue healing – needs to be explained at the intellectual level of a 13-year old. It’s because if you do this, then everyone understands, and people who understand feel better about themselves because they feel smart. If they feel better about themselves they will feel better about you performing your treatments.
I preach this often and only because I have been doing it with great success. You need a consistent, reproducible assessment system if you are going to get outstanding clinical results. I’ve seen an average of 12 new patients per week for the last four years. The first visit is not only key – it is an absolute necessity because it’s here they realize I’m different.
For my practice, I use EXSTORE – but it can be any sytem that is functional or that clearly demonstrates dysfunction to the patient. From there, you need to reveal and demonstrate a tangible limitation – something anyone could recognize as different. For example, you test one gluteus maximus and it’s strong, and then test the other and it’s very weak. Patients of all ages and any walk of life can appreciate the difference in their strength.
You need to demonstrate how you correct the functional, mechanical limitation. I use acupuncture and or myofascial release because it’s easy to target the peripheral nervous system using motor points. In this case, once I correct the gluteus maximus weakness, patients are usually totally astonished because they see what was once weak is strong again.
Then I use acupuncture and myofascial release to break up adhesions and to restore joint range of motion. Then voila! Just like that, they have experienced something totally different than what they are used to. This sets the stage for future visits because you have explained, demonstrated and delivered. This generates confidence in the patients’ mind and they look forward to following visits.
Once motor inhibition is removed, it is important that you begin to target segmental regions – both at myotomal and autonomic levels – in subsequent visits. This helps maintain motor function as well as ensure perfusion to the area of injury. For instance with a shoulder injury, the myotomal target would typically be C4-C7 while the autonomic vascular levels are T1-T5.
Secondly, it is paramount to target the peripheral trophic changes in the injured tissue. Using manual techniques to remove adhesions and reduce release of neurogenic inflammation from the sensory axon in the dorsal root ganglion of the spinal nerves will help promote nervous and muscle tissue healing.
It is important to understand and explain to the patients the autonomic vascular system. For instance, T1-T5 are the spinal levels of the sympathetic preganglionic neurons that, via the cervical sympathetic ganglia (postganglionic neurons), will end up innervating the arterial network of the head, neck, shoulder girdle and upper extremity.
If there are abnormal signals occurring at those vertebral levels – such as a long standing segmental articulo-muscular dysfunction – it is believed that these abnormal signals will interfere with the normal sensory-motor-vascular integration that takes place at every spinal level. Abnormal signals can contribute to all kinds of progressive undesirable effects, including:
- motor inhibition on muscles supplied by those spinal levels
- abnormal proprioception on those muscles
- amplification of nociceptive signals arriving at those levels from anywhere: muscle, skin, periosteum or viscera
- neurotrophic changes in the somatic territory corresponding to the arterial levels supplied by those sympathetic fibers
Therefore, it is advisable to make these paravertebral levels the targets of our acupuncture, myofascial release, or joint manipulation interventions in order to normalize sensory-motor-vascular integration at those levels, thus interrupting the negative effects that the abnormal neurological signals from these segments may be having on the peripheral tissues.
When I explain this complicated concept to patients, I point out that the muscles at the T1-T5 levels house the nerves that control the blood vessels that supply blood to the head, neck and arms all the way to the fingertips. Notice how I have just summarized three paragraphs into one sentence?
Factors that skew neurofunctional approach
At times, chronic pain, neuropathy, litigation factors and mental illness will influence the outcome of your treatments. Be sure to make note of the following factors that can delay or impede a positive response to your treatment:
- Ongoing pain for greater than one year
- Underlying systemic illnesses
- Psychogenic factors
- Dependence on pain medications or recreational drugs and alcohol
- Neuropathic pain syndromes
- Been to multiple doctors within different disciplines
- Patient has financial gain at stake
When approaching a patient you must remember that you as a physician have the responsibility of investigating and improving their current condition. As such, we must prepare ourselves to be consistent in the assessment, treatment and explanation of our services. Doing so will help our patients build the bonds of trust, security and confidence which they will link positively to your chiropractic care.
Dr. Anthony Lombardi, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information.
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