Re-exams and Re-reports

I find that one of the greatest weak links in Doctors procedures is the re-exam re-report. There are many reasons which I won't go into right now but as always if we are really going to correct the problem we need to look at headspace and procedure, not just give you some procedure or script and say, "have at it!"

One of the big issues doctors run into is that we are afraid the patient won't want to continue care or they will reject our recommendations, in other words reject us. Therefore it is imperative that we do not set ourselves up to be rejected. And we are very clear with our patients what our recommendations are and why we are making such recommendations. And then as always, in the patient care model, we offer choice.

It is Crucial that we get clear, "This is where you are, this is where you want to get to this is what it will take to get there... do you want to get there? Then this is what it will take." If they want to get to a certain level of health but don't want to do what it takes to get there it just doesn't work. It is similar to a woman telling her doctor, "I want a baby but I only want to carry it 5 months..." it doesn't work that way.

For us to really deal with the Re-exam and Re-report issue we must start from the beginning.

Visit 1

In visit one, we must make sure we connect the dots for them. They must understand and fully experience the connection between their spine, nerve system, stress, lifestyle stress, health challenges and health goals. Of course we help them experience these connections with our visit 1 tape, pre-consultation, consultation, exam and TTAT. (Make sure you and your team are experts in each of these areas.)

Visit 2

In this visit we get the patient to write down on the "tape 2 handout," where they think their present state of health his in the "Wellness Continuum" or "Up the tubes, Down the tubes" chart. We get an idea of how healthy they want to get and how long they think it will take to get that healthy. During the ROF we make sure we clean up any mismatched expectations and that their goals are reasonable and together we agree on a plan of action to help them attain their health and wellness goals during a prescribed period of time. (Again there is a tremendous amount to doing this right, make sure you are accomplishing these steps.)

Daily Interactions ? TTAT

During the Daily Interactions we use TTAT or Touch Tell Ask and Teach to help make the picture bigger and help them experience the chiropractic story and their continued progress each and every visit. (Please read "Chiropractic and the Lost Art- Parts 1 & 2)

During the 2-3 visits before their re-evaluation we make sure we are clear where they think they are, how they think they are progressing and where they want to be. In other words, do they feel they are progressing and do they still have the same health goals they had when we started care?

We must then deal with if they think they are:

a. doing well

b. not doing well

There is a tremendous amount to discuss on this subject that I will not go into during this article, but here are a few tips.

If they are doing well and they are aware that they are progressing we want to "celebrate and educate." Our job is to remind them where they really are in the journey and help them to recommit to the entire process. This is where the "Wellness Continuum" or "Up the tubes and Down the tubes" chart comes in so handy. Something like, "Jill I am so happy you are coming along so well. Your spine and nerve system are coming along just as expected, your headaches are clearing up, your brain fog is going away and as we discussed last time you are starting to notice change in your digestion. This is all exactly what we would expect as your nerve system starts to function better. Let me ask you a question. Do you remember when you came in the first day you said that you felt you were right here (and point to the chart... lets say on a scale of 1-100 they put they were a 25) and you wanted to get up to here (at 100) where do you think you are right now?

If they say they are at 100 you have to let them know that you are so glad you asked and explain to them that really they just popped above the symptom line, or the crisis line. That really they are most likely around 50 or so and can they imagine how great they will feel when they really move closer to 100. (Of course if you are a Creating Wellness Center and you are using the Wellness continuum your scale is 1-200 and you will end up with a real number.)

The point here gang is to get a quick hit as to where they think they are. If they feel they are at 100 we need to educate them, don't make them wrong, let them know how happy you are that you asked and then let them know how happy you are that the re-exam is coming up in a few visits so you can re-do all of the tests and find out where they really are.

You can then remind them that their original goal was to get to 100 and find out if their health goal is still the same.

On the other hand if they say that they think they have just popped above the symptom or crisis line, or they are where you really think they are, just agree with them, let them know how happy you are with their progress, remind them of their original goal and find out if it is still the same.

Let them know that this is a crucial time as some less educated people stop care because they finally feel so good but of course the underlying real problem has not been addressed etc.

Day Before Re-exam

Remember to remind your patients why you are doing the re-exam. Something like, "Jill on our next visit we will be doing the re-exam. We will compare and contrast all of your objective tests that we did like ROM, sEMG, Thermograph as well as your subjective experience via the Questionnaire and we will discuss where you really are, where you want to be and come up with a new plan of how to get there. Sound good?"

Re exam

Hopefully you have your CA doing most of the re-exam assuming that is legal in your state. Your part of the exam should only take moments and can be done in the adjusting room. Again, you would remind the patient that next time they should be scheduled for their re-report and let them know that you are excited to go over all of the findings with them. Either because you know they are happy with care and you celebrate and educate or because you know that they have concerns and you will commiserate and educate.

Re report

a. Doing well... How would you know that they are doing well? First you spoke with them via TTAT every visit; you started communicating very specifically with them during the past few visits as to where they think they are and where they want to get to, you also have their OAQ. Start off by letting them know that you are excited that you have this time together. Next give them a quick overview of what you believe to be true. You can do a quick review of the OAQ, "This is how you feel you are doing, I see you are also noticing great changes here and here in your LIFE etc. please tell me more about it. Give them a chance to talk, remember to celebrate with them. Now look at the objective tests, remind them where they were, find out where they think they are on the scale now, help them understand where they really are on the scale and find out if they still have the same health goal as before. If so, tell them what they will need to do to accomplish that, if they change their goal, tell them what they will need to do to accomplish that. It is crucial that we follow this process. "This is where you were, this is where you are, this is where you want to get to, AND THIS IS WHAT YOU NEED TO DO TO GET THERE." Notice I am not saying, "I want you to come in this often, or I need you to come in this often." You don't need them to come in that often! The fact is it takes 9 months to create a baby. You can't say that you want a baby but only want to spend 4 months doing it... it just doesn't work. It is your job to help them understand if you want these health goals, this is what you need to do and this is how long it takes. These are the lifestyle changes you will need to make and this is how many adjustments it will take. If they don't want to make the changes or do the schedule of adjustments that is their choice and we don't have a charge on it. We simply help them re-evaluate their health goals and tell them the truth and consequences of their choices. There is a lot to this one and it is worth some personal coaching time.

b. Not doing well... Basically we are going to follow the same format. Start off by letting them know that you realize they are concerned about their... and you are excited that you have this time together. Next give them a quick overview of what you believe to be true. You can do a quick review of the OAQ, "This is how you feel you are doing, I see you are also noticing great changes here and here in your LIFE etc. please tell me more about it. Give them a chance to talk, remember to commiserate with them and then educate. Don't do the classic blunder of making it their fault or not your fault. If they realize that they are progressing but still have symptoms and you also agree that they are progressing just come up with a new plan. If they feel that they are not making enough or any improvement you must discuss the truth with them. Sometimes they really are moving in the right direction but they just haven't crossed the symptom line yet. Other times they really are not making progress and either way it is our job to tell them what we know to be true. Again there is quite a bit to this and is worth some private coaching time.

My hope is that this short discussion of the re-exam/re-report you realize that it is a process not an event. This is one of the key areas most doctors fall short of the mark. When this process is done right it leads to tremendous relationships, stellar retention and a boat load of referrals.

I hope this stimulated some thought and it helps you attract the practice of your dreams.

Russ Rosen, D.C. - Jul 13, 2005