Closing The Consultation 
  
By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. 
behapy@karlparkerseminars.com
  
When the doctor has developed an enduring rapport and gathered 
enough information to understand the patient's problem, you would 
assume it is time to close the consultation by making further 
recommendations.  However, don't get in too big of a hurry.  This is 
where too many doctors make a mistake and either lose the new 
patient or more commonly, set the stage for the patient to be an 
early quitter and not get the results possible. 
  
You knowing is not enough.  The patient must know you know before 
it is time to make further recommendations. 
  
Make sure the patient knows you know by making a statement to the 
patient similar to the following: "Mrs.  Jones, let me make sure I 
understand what you have told me." At this point, show them the 
consultation form with the red markings on the human figure and ask 
them if this properly represents where they have pain or other 
symptoms.  Then summarize what you understand they have told you.  
"You said..., is that correct?" "You also said..., is that correct?" Etc.  
After you have made sure you have everything right, ask them one 
more time if they can think of anything else you need to know. 
  
It is very important during all of the gathering of information to 
keep in mind the way patients communicate and understand their 
surroundings.  The patients that "see" their surroundings tend to 
move fast, talk fast and want to see pictures.  For these types of 
patients, the consultation should move rapidly.  If the patients ask 
questions, answer them as soon and as rapidly as possible, do not 
hesitate or they will think you are not sure of yourself.  They will 
know you understand their problem when you show them the red 
markings on the human figure, point to the position of their pain and 
use "seeing" words. 
  
The people that "hear" their surroundings tend to move at a moderate 
pace, talk rhythmically and want to hear about their problem in 
detail.  For these types of patients, the consultation should move at 
a slightly slower pace than for the "seeing" patients, with more 
vocal explanation using "hearing" words.  They will know you 
understand their problem when you tell them about the red markings 
on the human figure and explain in words where their pain is. 
  
The patients that "feel" their surroundings tend to move slow and 
talk slow.  For these types of patients, the consultation should move 
slowly.  Ask questions slowly and give the patients time to think 
before they answer; and if they ask you a question, hesitate before 
answering, even if you know the answer right off.  If you answer 
without hesitation, they will think you did not give your answer any 
thought or did not think their question important.  They will know 
you understand their problem when you show them the red markings 
on the human figure and touch their area of pain.  You will need to 
physically touch their pain point and reproduce their pain, if 
appropriate.  Explain their condition in "feeling" words. 
  
If you understood and explained everything in a way the patient 
understands, the patient will know you know.  If you did not 
understand everything or did not explain it in a manner the patient 
understands, you want the patient to correct you.  Keep repeating 
this process until you know the patient knows you know.  Only at 
this point is it time to completely close the consultation and make 
examination recommendations. 
  
There are several approaches to making recommendations.  The most 
common is the assumptive approach.  You assume the patient is 
prepared to accept your examination recommendations.  Begin by 
leaning forward, making eye contact and a closing statement. 
  
A.    For patients who have not been to a chiropractor about their 
present chief complaint: 
  
            DC:          "Mrs. Jones, all this information indicates to me 
that there most definitely may be something wrong in your spine 
that could absolutely be causing almost, if no all, of your trouble.  
Now, at this point, we can be sure of one thing--if yours is not a 
chiropractic case, chiropractic will not help you.  But, if yours is a 
chiropractic case, then nothing elsse will likely help you.  So, our 
first job is to determine whether or not yours is a chiropractic case.  
We have had a number of cases like yours in the past and found that 
the first thing we need to do is to find the cause of the condition.  
We do that by performing a thorough examination including ... 
(whatever tests and exams you feel is necessary for the patient).  I 
surely hope we find that we can help you, Mrs. Jones.  So unless you 
have questions, we can begin your examination now. (Let¼s find out 
what's really wrong or let's get to the bottom of this and/or I think 
you've suffered long enough.)"   
B.  For patients who have seen another chiropractor for present 
condition, but quit or were referred to you because the results were 
not up to expectations. 
  
DC: "Mrs. Jones, I believe it is clear to both of us if we are to arrest 
your condition and bring it under control and therefore rid you of 
your symptoms, we must do two things. First, we have to precisely 
and specifically find the exact cause of your condition.  Secondly, we 
have to formulate a specific and precise treatment plan designed to 
correct the basic underlying cause in order to gain control of your 
condition and rid you of your symptoms.  Now, in order to do that, I 
must perform a particular examination, including tests that might 
not have been run on you before, plus evaluate these examination 
results from different viewpoints in order to come up with an 
answer to your problem.  So unless you have questions, I can begin 
the examination now." 
  
C.  For the patient who is transferring from another chiropractor, 
usually because of having to move, but who is satisfied with their 
results. 
  
DC: "Mrs. Jones, from what you have told me, in order to resume your 
care and your results as a new patient to our office, there are only a 
few additional tests I need to run in order to treat you.  I need 
(discuss items needed to properly care for the patient).  With this 
information, I'm sure we will be able to successfully continue your 
care.  So unless you have questions, we can begin right now." 
  
D.      For the transient chiropractic patient. 
  
          DC: "Mrs. Jones, from what you have told me, I will need a few 
additional tests in order to adequately take care of you, even 
temporarily.  I need (discuss items you feel are needed to take care 
of the patient).  With this information, I'm sure we will be able to 
continue your care, so unless you have questions, we can begin right 
now." 
  
E.  Whenever stating the sentence, "I sure hope we find we can help 
you," the doctor must watch the patient's non-verbal communication 
closely to see if they turn their eyes away and other such signs.  
This may indicate that the patient doesn't really want to be helped.  
The doctor knowing this can work toward instilling a desire in the 
patient to get well by frequently pointing out the benefits of being 
healthy.  The doctor should also occasionally monitor the progress of 
the patient's desire to get well by repeating the phrase after care 
has begun and watching their reaction. 
  
With the consultation properly concluded, the patient is ready for 
the chiropractic examination.  If all aspects of the consultation have 
been conducted according to Professional Patient Procedures (PPP), 
patients have no reluctance to complete and pay for a thorough exam.  
The patients will also be happy about their choice in doctors. 
  
The next step of how to perform the preliminary and regular 
examinations will be discussed in the next articles of this training 
series.