How To Conduct An Effective Examination By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. behapy@karlparkerseminars.com In the previous article we left off with the DC receiving and reviewing the preliminary examination, which had been completed by a trained CA. Now it is time to conduct a thorough examination, preferably including orthopedic, neurological, kinesiological and chiropractic examinations. A thorough, comprehensive examination provides distinct advantages for both doctor and the patient. Among these are greater doctor/patient rapport, increased patient confidence in the doctor and most importantly, information for a more complete and accurate diagnosis of the patient's health problem. The examination is also the point in this procedure when the doctor begins the change from a passive Functional-State (F-S) of, "I want to listen, know and understand," to a more aggressive, take charge F- S of, "I know what to do to find out the cause of your problem." A Functional-State that is appropriate for the consultation is not entirely appropriate for the examination. The doctor should maintain a F-S of caring, understanding, compassion and Loving Service with all office procedures. However, each PPP (Professional Patient Procedures) requires a specific F-S for the doctor to be the best they can be. During the examination the patient starts undergoing a change in their F-S from one of, "I want the doctor to listen to me and understand me," to a F-S of "I wonder what the doctor is finding in the examination." At this time the doctor is beginning to take charge of the office visit, the Patient, and the patient's problems. Another value of a thorough examination procedure is feedback. A detailed picture of the patient's original condition can be compared with subsequent tests and further examinations as a tangible, physical, unquestionable way of proving to both the patient, and to the doctor, the effectiveness of chiropractic, in general, and the doctor's treatment methods, in particular. By following PPP you also will be prepared in the event of the need for narrative reports, depositions or court appearances. There are several things that need to be done before the examination begins: 1. Have the examination room prepared. All equipment used should be laid out and organized. 2. Prepare the patient for examination if you have not already done this in preparation for a preliminary examination. 3. Prepare examination forms. All forms should be in a new patient folder in an organized manner. Make sure the patient's name and/or case number is on all forms. When the examination room is prepared, the examination equipment and paperwork organized, the patient is escorted into the examination room. If you have not already performed a preliminary examination, have a well trained Clinical Assistant (Technical CA) perform a general physical examination: height, weight Blood pressure, pulse, pulse pressure and any other simple test you may deem necessary. Preferably have a Clinical Assistant sufficiently trained to perform as many exams, and X-rays, as possible. A well- trained Clinical Assistant can perform all the tests with the exception of the chiropractic spinal examinations and evaluations. If a Clinical Assistant performs the examination, the doctor should review the entire examination with the CA before entering the examination room. The doctor should re-perform all positive findings or at least any questionable test results. This is also true if the CA only performs the preliminary examination and would be done just before the doctor begins the comprehensive examination. There are three methods of performing the comprehensive examination: I. Perform the different types of examinations separately. 2. Perform a standard basic examination that incorporates all the types of examinations combined together by patient position. 3. Perform a standard examination for different conditions or areas of the body. The first method is preferred because it adds value to the examination process. Each type of examination should be explained as you begin. For example, before beginning the neurological examination, make a statement such as "Mrs. Jones, I am now going to perform a neurological examination. The results of this examination will give Dr. Parker valuable information about the condition of your nervous system." Then perform the tests grouped by patient position. When the basic comprehensive examination is completed, whether by DC or CA, the final tests to be performed should be the Chiropractic spinal examination, which the doctor must perform. At this time the doctor makes a statement similar to the following: "Now Mrs. Jones, I am going to perform a spinal examination and analysis. The results of this examination will help me determine if there are problems in your spine that could be the cause of most, if not all, of the other positive tests we've found, as well as the cause of your symptoms." When the spinal examination is completed, the doctor makes a statement: "I'm glad we performed this thorough examination. I can see that its results are going to be very helpful in finding out exactly what's wrong. All these tests tell me there are some problems in your spine and that X-ray pictures will now hopefully let me see exactly what is causing the findings of our other examinations, as well as your symptoms. These tests also tell me that we also need... (at this point recommend any additional tests that you feel are necessary.)" "After Sandy (name of X-ray technician) takes and develops these pictures, I'll be able to evaluate and correlate what you've told me, what we've found upon examination and what the films show, then come to a conclusion and give you a report of our findings. Tomorrow is as quick as I can get all this done, so set up an appointment with Judy (name of front desk CA) for then." "I would like you to make your next appointment at a time when your spouse (or close friend or family member) can come with you. I feel that health is a family affair and my findings should be personally explained to both of you." At this point in the doctor/patient relationship, it is very important to continue to take control of the patient's health problem by taking more control of the doctor/patient relationship. To do this, make a statement similar to the following: "Now Mrs. Jones, I want you to know that we do not accept all patients for care. We only accept those patients who meet three basic requirements: 1. We can find the cause of your problem, 2. it is a problem chiropractic/we can help and 3. you will give us your full, complete corporation if we find we can help you. "If you think of anything else that might help us get to the bottom of your problem, write it down and bring it with you on the next visit. I'm looking forward to seeing you tomorrow and I sure hope I have some good news for you then." A fee slip is filled out with the charges marked for the examination and the X-rays to be taken. The fee slip is given to the X-ray technician or to the patient to take to the X-ray room where the appropriate X-rays are taken. Be sure the charges are explained to the patient in private before giving instructions to go to the front desk when they are dressed and make an appointment for a report of findings. If you have so far correctly followed PPP, the patient will be so favorably impressed after the first visit that their state of mind, their attitude - their functional-state will have changed. It will change from "I want you to listen to me," to one of "I want to know what the doctor found out and will the doctor accept my case." The doctor's F-S will have also changed from "I want to know what the patient knows about their problem" to one of "I now know what the patient needs and I can (or can't) help them." The doctor's F-S goes from being a big ear, listening and wanting to know to a F-S of confident, knowing-authority. Proper collection and first visit close-out procedure will be discussed in the next article.