This is an era of patient empowerment in which informed consumers seek to play an active role in their health care. Because no television programs feature chiropractors as health care heroes and no entity in chiropractic has the economic viability to compete with multimillion-dollar pharmaceutical company advertising budgets, the responsibility for conducting an educational program falls upon the individual chiropractor. Great opportunities await those who can communicate with confidence, conveying a message credible in content and congruent with the expectations of the patient.
Most doctors of chiropractic who survive and flourish even in challenging economic times do so because of a systematic program of patient education, coupled with well-organized office management procedures that incorporate an effective clinical and business system that is understood by the doctor and staff. Although this should be an ongoing process, the initial visit and Report of Findings are crucial in educating patients about the benefits of chiropractic care. The long-term benefits of time spent educating patients are immeasurable: ease of patient management through enhanced cooperation, increased referrals, and reduced risk of malpractice exposure because doctor-patient bonding has been established.
PRECONCEPTIONS
Patients seeking chiropractic services enter the office with a variety of perspectives:
• Some have been referred by an enthusiastic, satisfied patient who understands the health benefits of chiropractic. “Word of mouth” referral is the way most people seek chiropractic services.
• Others have not been satisfied with conventional medical care for their condition but are also skeptical about chiropractic.
• Many have little knowledge about chiropractic and no strong negative or positive preconceptions about it.
It is important to remember that new chiropractic patients are not seeking to determine what is wrong with medicine but what is right about chiropractic. They want to know whether chiropractic can help restore and maintain their health. To meet this need, they must be provided with a factual and believable Report of Findings.
Patients need their basic questions answered:
• Can you help me?
• How long will it take?
• How much will it cost?
These questions must be answered in a way that removes fear. Patients may fear that they are not in the right office or that the chiropractor cannot diagnose or does not refer. Discussing not only the chiropractic approach to the problem but also the other possible options creates patient confidence. Learning that the chiropractor is cooperative and will work with the patient’s medical physician or other health care provider offers necessary reassurance.
IMPORTANCE OF PATIENT EDUCATION
Communicating clearly and warmly with every patient is imperative. Doctors must be conscious to make all that they say meaningful, informative, empowering, and educational. Patients who have grown up with the allopathic (i.e., traditional medical) model and have now opted to seek nonallopathic (i.e., complementary, alternative) care have taken a giant step and need to be supported in their decision. Effective communication by the chiropractor can bridge the gap between the cold, sterile health care system of the past and the new, humanistic system of the future.
How the message is conveyed is as important as the message itself. The nuances of presentation help the patient understand the message. Most communication will be verbal. The clinician should be certain that it is a dialogue, not a monologue; allow time for questions by the patient; and periodically inquire about the patient’s thoughts about what has been said. The questions will help to identify any underlying beliefs that the patient may not initially mention.
In addition, including visual and kinesthetic forms of delivery can enhance the effectiveness of verbal communication. Patients often provide clues to their preferred mode of communication by the very language they use: “I hear what you’re saying” or “I can see that” or “I feel that you understand.” Understanding patients’ communication styles enables the clinician to “touch” them with the presentation. For those patients who are primarily kinesthetic, a brief, reassuring hand on the shoulder when delivering a report or when they leave is received well. For others with a more visual style, providing charts and written material is ideal. Communicating in the fashion preferred by the patient will enable the clinician to effectively present the message and have it understood.
Patient education can be accomplished through a variety of methods. Some doctors use audio or videotaped materials to educate patients, whereas others give patient lectures or spinal health classes. Whatever additional methods the chiropractor may choose, the most personal relationship doctors can develop with their patients comes from direct one-to-one interaction. The most critical time to develop this relationship is during the initial Report of Findings.
REPORT OF FINDINGS
The first visit offers an opportunity to establish a bond with the patient that is unlikely to be afforded at any other time during the health care encounter. The case history, physical examination, diagnostic evaluation, and Report of Findings can provide the foundation for a long-standing relationship. Doctors must take the necessary time and use a well-documented, easy to understand, consumer-oriented program to educate patients. Providing a booklet or pamphlet to patients with their Report of Findings can substantially strengthen this effort. The material should be personalized and correlated to the findings, thereby becoming a document to which the patient can refer and show to friends and family to increase understanding of chiropractic care.
After the initial welcome, case history, physical examination, diagnostic testing, clinical review, and acceptance of the individual as a patient, the clinician should choose a special place in the office where the Report of Findings may be presented. This will help to develop a consistent, dependable process; it will also convey to the office staff the significance the doctor places on patient education. As with other aspects of chiropractic practice, over time the clinician will grow more comfortable with this routine and more effective in presenting reports.
It is very important that the doctor become familiar with the content of the written material used in the Report of Findings. The tenth edition of Sportelli’s Introduction to Chiropractic is specifically designed for this purpose, but the process and concepts discussed here apply, regardless of the material used. Other pamphlets, such as those published by the Foundation for Chiropractic Education and Research (FCER) or William Esteb’s Patient Media, Inc. may be suitable for patient educational purposes, depending on the clinician’s practice style and personal preference.
Personalizing the Booklet
The patient’s name should be written in the booklet to personalize the document. It can then be tailored to match the patient’s specific needs. When personalized, patients are unlikely to discard this material. Often, when patients return for their second or third visit, they will ask for another copy of the booklet for a neighbor or friend; it should be provided gladly. One of the most significant opportunities for patient education and referral is immediately after the very first visit. The patient’s interest in the particular condition is very strong, as are compliance and commitment.
Family, friends, and neighbors are anxious to know what the doctor said. The patient, using the highlighted and personalized booklet, can confidently answer this question. The clinician may take advantage of blank space in the booklet (e.g., the inside of the front cover) to write specific patient advice and recommendations to encourage patient compliance. These instructions are also an excellent way to help provide informed consent by way of illustration and instruction.
Black and red felt tip pens, highlighters, and tape flags are valuable tools for marking specific pages for emphasis. Of course, findings from the patient’s history and physical examination related to the presenting complaint should be noted in the patient’s booklet. In addition, the doctor should determine whether any preexisting lumbar or cervical problems or whiplash injuries exist that are not specific to the patient’s reason for the current visit. The clinician should be certain to highlight these past problems as well, because they represent chronic injuries that may delay progress or impede full recovery. Connections between a current condition and a childhood accident or a decades-old automobile accident are rarely something patients have previously considered. However, when they are pointed out and highlighted in the Report of Findings, patients become sensitized to the potentially long-lasting effects of past traumas to the spine and nervous system.
Either verbally or in the booklet used for the Report of Findings, patients should be informed about symptoms serious enough to warrant an immediate call to the doctor.
This caution could be conveyed as follows: “If blurred vision, dizziness, severe headaches, ringing in ears, or nausea are experienced, contact the chiropractic office immediately. If any of the previously mentioned symptoms persist, avoid putting the neck in a position that will require extension of the neck (i.e., looking up), rotation (i.e., looking over the shoulder), or both. If symptoms worsen and the doctor cannot be contacted, the nearest hospital emergency room should be consulted.”
This important advice may be significant in the event of litigation, because it will enable the clinician to provide evidence that the patient has been properly advised concerning symptoms that may be a potential problem, helping to mitigate a failure to provide informed consent.
Emphasizing Fundamental Concepts
The power of the body to heal itself is a key concept for the patient to understand. Health and wellness come from within, and the role of the doctor of chiropractic is to promote self-healing of the body. Through chiropractic’s more than 100-year history, practitioners have emphasized the body’s ability to adapt to its environment and the need to maintain the nervous system free from neurologic irritation. Although these ideas are second nature to chiropractors, they are new concepts to most chiropractic patients. Therefore it is essential for clinicians to mention them to patients at the first visit, because they form the foundation for all that follows.
Aside from emphasizing the significance chiropractic places on the role of the nervous system, it is important to note the importance of nutrition, water, rest, clean air, exercise, and a positive mental attitude. All are consistent with the patient’s current knowledge base and the increasingly holistic view of health care being reported in most popular publications. Regardless of practice style, if the doctor is determined to develop long-term relationships with patients and help them understand the value of chiropractic, they need to feel that the clinician is someone they can trust. One way to do this is to help patients understand the wellness and prevention concepts that can be supported by evidence.
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