When I began my practice, I had no experience or confidence coming up with recommendations for patient care.
When I began my practice, I had no experience or confidence coming up with recommendations for patient care. After examining patients, I had trouble determining frequency of care and often resorted to what felt like guesswork. Looking back, I am sure patients could sense this and firmly believed that it led to poor commitment to their care. Frustrated, I knew this weakness needed to be addressed.
Experience aside, how do we know what frequency of care patients need? There are several ways to make recommendations go smoother for both chiropractors and patients.
You cannot make a recommendation for care to a patient that you would not make for yourself or your family. Are you and your family members under a schedule of care? If you were injured would you be expected to be seen daily? Do you get regular chiropractic maintenance care? Take a minute to answer these questions. If you answered no to these questions then it will be hard for you to make the same recommendations to patients.
Cite basis for your advice
Experience is a key factor here. Over time, we can begin to predict how long it will take for patients to see results. Let’s take it a step further. Carter Universal’s Exam, for example, is made up of 65 orthopedic and neurological tests. Abnormal tests are counted to come up with a number that is used to guide treatment frequency recommendations. Under this protocol, a patient who has 20 abnormal tests would require more care than someone who has five abnormal ones. We are basing it on objective measurements. There are many other tools you can use to help you make a more accurate decision. X-rays, surface electromyography, thermal scans, hand dynamometer, disability indices or just simple range of motion testing can be very helpful in giving you confidence you are making the right decision.
Once you have the test results, go over them with the patient in a manner they can easily understand. If they can see and understand the need for care, they will be more apt to follow through with their appointments.
Once you have done your exam and work-up and analyzed the tests, it is time to write the care plan. When doing so, I suggest you over-recommend just a little. If you think someone is acute and needs three times a week, recommend daily. If we don’t deliver enough care we run the risk of the patient not getting better, which makes for a difficult time to recommend an increase in visits. On the flip side, if we have recommended too much care and the patient gets better quicker than first expected, then it is easy to cut back on the schedule. The patient will be happy and they will know that you have their best interests in mind.
Be willing to walk away
This can be difficult especially for new graduates or when practices are struggling. Sending a patient away, especially when times are tough, can be hard to imagine. This type of mental state, however, can be dangerous to a practice. When your thoughts are on your practice, the care then begins to focus on your needs and not the needs of the patient. If a patient needs chiropractic visits three times a week and wants to come only once a week, be willing to send them away. If you compromise from the start you lose your credibility.
Patients will get off schedule from time to time. When they do, please care enough to hold them accountable. If you are not confident in your confrontation skills (also known as “carefrontation” skills), practise them. People think this stuff just comes naturally to some and not to others, but I can tell you that this type of thinking is wrong. Holding your patients accountable by talking to them about it requires time and practice like anything else.
Developing scripts and practising them with your staff will give you a starting point to begin to have difficult conversations with patients. If you can have these conversations artfully with the best intentions for the patient, you will be well on your way to a very successful practice.
My intention for this article is to help increase confidence in you and your patients when it comes to your health-care recommendations. The more I practise, the more I believe in simplicity and in doing the big things that matter well. Communication is one of the big things, and communicating with confidence is an extraordinary skill to have in your toolkit.
Action steps CHECKLIST
- Get yourself and family under a schedule of care
- Base frequency recommendations on scoring of objective tests
- Practise “carefrontation” scripts and hold patients accountable
Angelo Santin, DC, operates a busy subluxation-based family practice in Thunder Bay, Ont., and is president of the Thunder Bay Chiropractic Society. Dr. Santin is also a Carter Universal proficiency-rated chiropractic coach. He can be reached at firstname.lastname@example.org or 807-344-4606.
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