The chiropractic report of findings marks a pivotal moment in the doctor–patient relationship. It’s here that you share your examination results and outline a care plan designed to help the patient. Like all communication, this is a social skill.
We may be born with talent, but skills require practice to develop. This often involves a coach, feedback and repetition. If you’re learning public speaking skills at a Toastmasters luncheon, you can acquire the skills to express yourself in public pretty quickly. All three elements are present.
Not so with your patient report of findings. Unless you’re regularly recording your reports and asking other DCs to critique your efforts, you rarely get the feedback necessary to refine your skills. Patients don’t hold up a scorecard at the end of your report to rate your performance!
After listening to recordings, witnessing actual reports and hearing comments from chiropractic patients in focus group settings, here are some common mistakes chiropractors make with their patient reports.
1. Reports That Are Too Short
If you don’t invest enough time, you can communicate a casual and superficial tone that can compromise patients’ perceptions. An over-the-shoulder “I think I can help you” as you’re leading the patient from your examination room to your adjusting area may be expedient but shortchanges you and the patient.
Wielding your limited social power in this way is egotistical. Assuming that the patient wishes to begin care and rushing in for fear they will get cold feet or have questions objectifies patients. Relationships built on a strong personality are fragile and require massive amounts of energy to sustain. Worse, after your 40-year career, you’ll have little to sell to a buyer other than thousands of inactive patient files.
Effective reports of findings are long enough to show your respect for each patient.
2. Reports That Are Too Long
A far more common mistake is delivering a report of findings that, well, never ends. At least until you hear your CA tap on the door to break your trance and bring you back to reality.
How long is too long?
It was Mark Twain who observed that “No one was saved after 20 minutes.” Granted, he was describing Sunday morning sermons, but his wisdom applies here as well. And while you’re not trying to bring someone to salvation, with today’s short attention spans, longer isn’t necessarily better.
A report that is too long is usually the result of one, or a combination, of these factors:
Poor organization – Including irrelevant details is a self-indulgent luxury. Outline the structure of your reports so you can answer the four questions: What’s wrong? Can chiropractic help? If so, how long will it take? And how much will it cost? It’s a time-tested formula that brings order to your patient reports.
High patient interest – From time to time, you have a patient in front of you that is highly engaged. That’s great. But avoid the temptation of trying to turn them into a chiropractor. If they seem to want to go deeper, parsing out the details over subsequent visits will serve you and them better.
Unclear purpose – Can you succinctly articulate the purpose of your report of findings? Having clarity is essential. Otherwise, it can degenerate into selling, manipulation or attempting to extract a commitment for lifetime care before you’ve even helped them with their admitting complaint. Instead, your report should be a form of informed consent. It shouldn’t dissuade them from care but should supply evidence that your proposed solution offers the promise of success.
Self-hypnosis – This can occur when we’re in the zone and we captivate ourselves with our own words. You’re reminding yourself of how naturally right chiropractic is. You’re inspiring yourself about the possibilities of a nervous system free of vertebral subluxation. It’s so easy to get caught up in the vision that prompted you to become a chiropractor. Yes, be passionate and enthusiastic. And yes, communicate hope and confidence. Just be careful that it doesn’t become an emotional appeal—to yourself.
Not busy enough – If your practice isn’t as busy as you’d like, you might think you can afford to give a long report. It’s not true. This is akin to imagining the more money you spend on a wedding, the more likely the marriage will be to last. The reality is, if you want to be twice as busy, you must start delivering your reports (and patient care) in the time needed to help twice as many people. In other words, only after you create the vacuum will it be filled. If you wait to reduce the length of your report until after you get busier, you never will.
3. Reports That Are Too Technical
It’s so tempting to geek out when you have a captive audience. When you do, it’s easy to confuse data with information.
A cervical range of motion compromised by 15 degrees is data. The fact that you probably find it hard to look over your right shoulder when changing lanes turns it into information.
A phase two of spinal decay in the lumbar spine is data. The fact that the X-rays reveal they’ve had their problem for many years is information.
The fact that your bilateral scales reveal a weight difference of 13 pounds is data. That you can show their entire body is compensating for spinal problems is information.
The key is to convert your examination data into meaningful information. One way to do that is to connect your exam findings (data) with your interpretation of it with a connecting phrase such as “that means . . .”
For example: “The grip strength of your right hand is about half that of your left hand. That means there is some type of nerve interference either in your wrist, elbow, shoulder or more likely, in your upper spine.”
4. Reports That Are Too Verbal
The easiest mistake to make is to rely mostly on the spoken word for your patient reports. It’s convenient. You can mint word after word for free. And you can quickly adapt your message should you detect a lack of interest or if the reception room is backing up. Not to mention that most so-called education is little more than learned professors yakking at students who are expected to take notes and regurgitate it on a subsequent test. It’s no wonder this communication style is so commonly used in chiropractic.
But it’s ineffective.
As a thought experiment, consider how you’d give your report of findings to someone who is deaf. Maybe you have. Your carefully practiced report is out the window, and you’ll need to improvise. Giving your report this way would probably increase its impact with those of normal hearing too.
You’ll need pictures and three-dimensional objects to make your point. X-rays, if you take them, are a good start. As are the printed scans from your thermography or sEMG. And, of course, your anatomical models. Get creative by employing actual pictures that can serve as visual metaphors. (Our free eBook 50 Ways to Explain Chiropractic So People Get It includes 50 of them.)
Stronger visuals are a great start. But there’s a far more serious issue: You must equip patients with the documents they will need to recreate your explanation to a spouse or loved one. Neglect this by sending patients home empty-handed and you’ve made it difficult for your patient to justify your care recommendations or generate referrals.
Chiropractic care is an intangible service whose quality and value is impossible to determine before the simultaneous production and consumption of your adjustment. Patients must use surrogates to evaluate the quality of your care—your office location, decor, cleanliness, appearance, clothing and virtually everything they encounter leading up to the adjustment. But what about their spouse who didn’t show and can’t experience those things?
Equip patients with the essential report documents, brochures and handouts packaged in a professional folder. This can serve to reduce information overload and help justify the investment of time and money you are recommending.
5. Reports That Are Too Manipulative
Many chiropractors think the intent of a report of findings is to get patients to accept and act on their clinical recommendations. They want to “counter objections” and “close the sale” and secure one more chiropractic conquest.
You do this when you need the patient more than they need you. You do this when you fundamentally mistrust patients and fear they will make the wrong choice. So you don’t give them one.
When you attempt “to control or play upon by artful, unfair, or insidious means, especially to your own advantage,” you have become the textbook definition of manipulative.
Yes, explain the nature and severity of their problem without exaggeration. Yes, offer care recommendations designed to produce the best results in the shortest amount of time. But don’t use guilt or shame or other means to seduce the patient. Even if you’re inclined to justify it as being in their best interest.
Place their goals above your own. Play the long game. You’ll enjoy more referrals and more reactivations, and you’ll be able to look yourself in the mirror.
6. No Reports Because You're Too Busy
The biggest report of findings mistake is not giving one. This is often justified by one or more of the following excuses:
“It’s a waste of time.”
“Patients don’t care; they just want results.”
“It doesn’t improve compliance.”
“It takes up time that I could spend actually helping patients.”
“It’s too much work.”
All perfectly justifiable reasons if you merely want a self-directed pain clinic. If your vision is to use adjustments to simply treat neck and back pain, then a formal report of findings merely gets in the way. You can help a lot of people by treating neck and back pain. And they will be appreciative. Maybe even refer others.
For a season.
Suddenly, the legislature changes the personal injury laws. Or deductibles go up to four figures. Or chiropractors can no longer service worker’s compensation cases. Or you name it. Things happen. You expose yourself to risks that practices with many cash-paying practice members just don’t face. Give your practice a more predictable future by consistently delivering a report of findings and avoiding the most common mistakes.