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Doc I am in pain again

Have you ever experienced this scenario? A patient comes back into your office in a lot of pain. Their last visit was several weeks or even months ago and the last time you saw them you specifically told them that although they were feeling better they really needed to follow through the recommended treatment plan? Sound familiar?

If you have taken my LAASR course then you know I like to examine the blunders first. The classic blunder is to give them the "I told you so" speech. Now many of us aren't quite that blunt but you will want to really listen to yourself to see if you have just dressed up this tired old speech.

What are the effects on the patient when we tell them or insinuate the "I told you so" speech? Think about it. How do you feel when you realize that you did something wrong and someone says to you: "I told you so?" That's right; usually you don't feel too good. Trust me, neither do your patients. Therefore I do not recommend telling them in any way or fashion that you told them this would happen.

On the other hand some more non-assertive doctors won't even address the issue. They just seem to move on and start from today, just like nothing ever happened. Clearly neither of these approaches honors the patient in any way! And neither is good for your practice. It is imperative that we tell the patient the truth and consequences of their actions. The question is do we do it as the angry parent, the victim child or the adult?

Another common blunder is to give them a mini lay lecture. Maybe they just didn't understand it the first several times we told them the entire chiropractic story. Maybe they just need to hear it one more time. I DON'T THINK SO!!!

In my LAASR class I recommend using this metaphor with your patients. I hold my hand up near my head and say that up here is 100% health, or optimum health. I then hold my other hand down near my waist and say down here is death. I then take my top and bring it down to the middle between the two points, (around the level of my chest) and I say this is symptoms. You are somewhere here and I point to between the symptoms and death lines. I then go on to discuss the difference between just feeling better and popping above the symptom line and actually correcting the underlying problems and moving way up towards optimal health. There is a gray area between the symptom line and 100% health. We call it levels of wellness. I then discuss what happens as you regain your health and you move up past symptoms towards optimal health and what they can expect.

Let's assume that on their last visit several months ago, they came in and said that they were doing great. If you have taken my LAASR course you would know not rain on their parade by telling them that they still have to continue coming in, but instead you would celebrate with them and then educate them. I recommend reviewing the above story and doing the "here is optimal health, here is death and here is symptoms" story. I then simply ask them where they think they are on this continuum.

If they say they are up near 100% health I tell them how glad I am that I asked and I educate them further. If they say they have just popped above the symptom line, (which I would have been talking to them about during my daily interactions for the past several visits,) I would agree with them and let them know that this is a dangerous time because oftentimes people feel good and think they are actually better. I remind them that nothing could be further from the truth. The truth is they just aren't feeling pain any more. I also remind them that our original goal was to correct the underlying problem and move them towards optimal health and get them to recommit to the entire process.

Assuming this is what I did on our last visit, and they now come into the office with the same symptoms it is all too easy to do one of the above classic blunders. Instead I recommend that you greet them warmly, check in and see what is going on, and then simply ask them. Here is optimal health, here is death and here are symptoms. Where are you now? That's right, you are somewhere between death and symptoms. Let me ask you a question. Where do you think you were right when you started to feel better on your last visit several months ago? 99% of the time they sheepishly point to right above the symptom line. If they don't and they point real high near optimal health you will thank them and tell them you are glad you asked and re-educate them.

As I said, more often than not they will point to right above the symptom line. Then all you have to do is agree with them and ask one easy question. Where would you like to get to this time? Inevitably they will point much higher on the scale. Then all you have to do is ask them if they will commit to following the program this time and continue care even after they are feeling better.

This whole process takes under 60 seconds. It is non-confrontational and extremely powerful, and best of all you will help your patient realize the importance of this information without offending them.

Russ Rosen, D.C. - Jun 22, 2004