Implementing the Spinal Decay Chart
Spinal Decay Chart Implementation
Why spinal decay? Unlike "degeneration" which suggests a normal aging process, "decay" is something that can result from neglect.
Not to mention, subluxation degeneration is nine syllables! It's complicated-sounding. Understandable to you, but not necessarily to patients.
The most effective chiropractic communicators are using the phrase "spinal decay" in their patient explanations. Because patients understand it. (Successful dentists refer to it as tooth decay with their patients, not "dental caries.")
Using X-ray views to "phase place" a patient is a communication strategy designed to accomplish two important tasks:
1. Help the patient acknowledge and "own" the condition of their spine, and
2. Help the patient recognize that they've had their problem for some time.
It is not used to scare patients, justify a particular length of care or to manipulate them into accepting a care plan of long term care! Of course, phase placement is only an option if you take X-rays. The patient's "phase" cannot be determined by palpation, the patient's age or other less invasive means.
In Your X-ray Room
Explain your reasons for needing pictures of their spine, along with an explanation of the fees involved and the safety precautions you take. Be sure to ask female patients of the possibility of pregnancy.
Mount a copy of the Patient Media Spinal Decay chart so the patient is directly facing it as you set up to take their lateral view(s). With the patient facing the chart:
"Now, we're going to take a picture of the side view of your neck."
Splay your fingers on one hand, touching the patient's jaw, neck and shoulder. With the other hand point to the top row of X-rays shown on the chart.
"It will most likely look like one of these. Either what we call 'textbook normal', Phase one, Phase two or Phase three. In fact, when I show this picture to you at your report, I'm going to have you compare it with one of these and tell me which one comes closest to matching yours."
Repeat with a similar scripting for any other lateral views you take. (For phase placement, we find lateral views are the easiest for patients to see the key distinctions.)
At the Patient's Report
Many practices will mount a second copy of the Spinal Decay chart beside their X-ray view box.
When you get to the portion of your report in which you show and review the X-rays it's helpful to offer the patient some orientation.
"This is the side view of your neck we took yesterday. This is the jaw, this is your skull, this is the top of your shoulder and these are the individual bones of your neck. The black areas between them are the discs, which separate each bone. Notice the equal disk spacing the gentle, forward curve.
"I'd like you to compare yours with these, the textbook normal, phase one, phase two and phase three. Which one comes closest to matching yours?"
Then wait for the patient to respond. (It may seem like forever, but it's an important opportunity for them to fully own their problem, rather than you rushing in a supplying the answer.)
There are only a couple of different patient responses.
Patient response #1: "I don't know."
Our culture is so wrapped up in "being right" and looking good, that many patients will be reluctant to share their perceptions for fear of getting it wrong. In this case, an Anthony Robbins technique may come in handy:
"Well, if you did know, what which one do you think comes closest?"
This can serve to give the patient "permission" to fail.
The other possibility is that of a patient in the Driver or Commander personality profile. They resent having to play. In fact, their mentality may be "why-should-I-tell-you-after-all-I'm-paying-you-to-tell-me!" Decide for yourself if it's worth forcing them to participate. Usually these efforts are counterproductive.
Patient response #2: The patient overstates their problem.
Actually, this is quite common. Handle this correctly so you don't make the patient wrong. Begin by congratulating them.
"Wow, good job! That's what I thought at first, but then I noticed ____ and ____ so my conclusion was that we were looking at an early/late/mid Phase __. Do you see what I'm seeing?"
Patient response #3: The patient understates their problem.
Again, be careful so you don't make them wrong. As before, begin by congratulating them.
"Wow, good job! That's what I thought at first, but then I noticed ____ and ____ so my conclusion was that we were looking at an early/late/mid Phase __. Do see what I'm seeing?"
Patient response #4: The patient hits it dead on.
For sure, congratulate the patient this time! But be careful that it doesn't sound like the "advanced Phase Two" they've identified is a good thing to have happening in one's spine!
"Good eye! Have you ever considered becoming a chiropractor? Well, you are correct. So that means..."
Give a quick rundown of potential neurological implications, how long they've had their problem, why it may take a long time to correct, etc.
Repeat with any other lateral views you've taken.
Purchase the Spinal Decay Chart with right- or left-facing X-rays.