Routine Visit Procedures By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. behapy@karlparkerseminars.com Once the patient has been accepted for care and the first corrective chiropractic adjustment has been administered, the patient is then classified as a regular or routine patient. We will discuss many of the aspects of regular visit procedures that continue to re-enforce the all-important impressions that result in a life-long referring patient. This article on regular patient procedures will describe the usual procedures to follow on each visit with each patient. These routine visit procedures are designed to improve service to patients and to maximize the office's efficiency to better handle a larger volume practice. These are the usual steps recommended to take on each patient visit. When the CA first greets the patient on each visit, the usual and necessary social amenities should be performed. Be friendly and sociable and show sincere interest in the patient. Be sure the patient signs the sign-in register on each visit, always. When there is a lull in the conversation and the CA feels the patient feels properly acknowledged, ask the patient to be seated and then physically turn your body and go back to whatever work you have to do next. This process could be as short as "Hi Mary, it's good to see you again" with a similar quick response from the patient. It is not necessary for the CA to engage the patient in conversation until it is time to go to the adjustment room... and actually can be counter productive, resulting in the dreaded "counter leaner syndrome." The CA should use the 'What's better?" procedure on the first few visits (about 10). By asking the patient "what's better?" you are giving the patient the triple „A¾ (Attention, Acceptance, and Approval), for being better People generally focus on what's hurting and may not even realize they are actually much better Most everyone in patients' environments are programmed to give them sympathy for their discomforts. The CA, though, gets the patient to focus on what's better, a more optimistic healing consciousness concept. Sometimes this is not easy. You just have to gain and maintain the patient's confidence by constant reassurance. I like to say it this way... "Stand your ground, through all their frowns!" CAs should use this concept instead of the usual "How are you?" at least until patients are feeling great and your "What's better?" programming procedure has caused them to openly express how well they are doing. This is an excellent procedure to enhance the patients' health improvement, as well as referrals for chiropractic. The CA would then prepare the patient's records for utilization during the visit. The paperwork can be placed in a clipboard or left in a file folder and stacked to maintain patient order and can also be hung on or by the adjustment room door or placed in a folder holder attached to the wall or door. The patient's fee slip can also be placed with the visit paperwork. The fee slip should at least note the patient's name, account balance and the date and day of the next scheduled appointment (remember, you made advanced appointments with the patient in the beginning, very important!). When a room is available, the patent can be told to proceed to the designated room. The patient can be taught the procedure of taking the clipboard or folder with him/her and placing the clipboard on the treatment room door or the folder in the appropriate holder and enter the room. The patient then follows the normal adjustment preparation procedures taught to him/her on the first adjustment visit. The patient would generally bring the clipboard (or folder) back to front desk, after the visit. The doctor should review the patient's file before entering the room. Be sure to be aware of patients symptoms, in the beginning of care and recently, as well as recall the last treatment procedures, be aware of today¼s needs and determine the patient education needs for this visit (to be discussed in detail in a later article). The doctor then enters the room briskly, smiling and greets the patient immediately with a handshake, if feasible (if patient is lying face down, then a touch on the shoulder or upper back is appropriate). The doctor¼s attitude is one of Loving Service, being sincere, attentive, caring and showing concern for the patient's health. The first thing to do after properly greeting patients is to check them to see how their body is functioning and responding to previous care. Some of the ways to do that is with kinesiological tests, orthopedic tests, neurological tests, leg checks, and the old standby... palpation and visual analysis. Use whatever monitoring methods you have confidence in. Usually, the patient will volunteer a response of how they are feeling, but if not, then ask AFTER or as you are evaluating their spine, symptomatic areas or whatever method of evaluation you do. This procedure lets patients know that you are caring for their body based upon what's wrong with it, not by how they feel. I wish I could motivate all DCs to get this concept, own it and transfer it to all chiropractic patients. This one step can make a dramatic change in the growth and even the upbeat attitude of the practice. Why? Because with this attitude you have become a Doctor of Chronics, a health doctor, and have let go of being a Doctor of Acutes, a symptom doctor, Remember this: If you focus on symptoms, your patients are being taught by you that symptoms equate to health and when patients' symptoms are gone ... so are they! If you believe that symptoms are the criteria for determining people's state of health, then I heartily recommend a series of KPS seminars, in order to get some good old-fashion chiropractic KCBF! Whenever DCs come to better own and implement this concept, their practices go up commensurate to their level of understanding this concept. The DC should also ask the 'What's better?" question on the first few visits. If a positive response is not forthcoming, then be more specific about each symptom or use a pain measuring question, On a scale of 1 to 10... etc. After the visit evaluation is completed the DC should move right into performing the health care needed on that visit. Be sure to explain what you are doing, as you do it. This is the concept of "Touch and Tell". Always be sure to touch (palpate) present and previous symptom and cause areas, preferably before you adjust the patient, again explaining the connection. It is also an excellent procedure to follow up each adjustment with a positive exclamation. Say words like "great", "wonderful", "terrific" or at least "alright" or "OK". Be as gentle as possible and still get the best correction possible. Be as specific as possible and preferably only adjust the primary priority areas indicated by your evaluation. If needed, use the analogy of what it is like to listen to 10 people trying to talk to you at the same time. You can't get anything that¼s understandable. It's the same way with the body... and doing too many things to the nervous system at once. Better results can often be obtained by doing just the priority adjustment(s). It is also a good idea to talk as little as possible when giving adjustments. This communicates to the patient that the adjustment has great value and takes skill... and it does! A student once told me that he had planned to become an orthopedic surgeon. He had the opportunity to work with one who was famous for his knee surgery. After observing the surgery only five times, the student felt that it was so easy he could do it himself without the medical education. This caused him to look for something with more meat to it... and he found chiropractic. I asked him if he was able to learn to do an adjustment in five tries. Uproarious laughter was his response. It is best to not spend unnecessary time in the office visit with the patient, even if you have it available to you. It's also a good idea to keep a "touching contact with the patient as much as possible during the actual treatment. There just isn't enough space to cover all the reasons why I recommend these two points... just trust me, its important! One other thing the DC should do during each visit is to utilize a concept I call PERCS (Patient Education and Referral Communication System). Have an ongoing education program for your patients as well as a referral motivation system. There are many ways to do this and do something different on each visit. The Parker WayÅ system lays one all out for you, which will be discussed in a future article. At the end of the visit, complete the fee slip and confirm the next scheduled appointment noted on the fee slip (assuming you have the patient on advanced appointments. You can ask the patient to take the file back to the Control Assistant (front desk CA) and go on to your next patient. The CA then makes the collection, completes any special instructions or recommendations of the doctor told verbally to the CA or noted on the fee slip or patient records, confirms the next appointment, presents recommended pamphlets and then terminates the visit with positive remarks, a smile and possibly even a handshake. Ahhh, a routine office visit nicely, efficiently and productively conducted!