The Consultation
Step One: Developing an Enduring Rapport
  
By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. 
behapy@karlparkerseminars.com
  
  
Although every contact and procedure is very important in making a 
favorable professional impression and reaching the ultimate goal of 
helping restore the patient's health, there is one that is of utmost 
importance ... the consultation.  The doctors first encounter with the 
patient in the pre-admission consultation is so important because it 
sets the stage for all the Professional Patient Procedures (PPP) that 
follow. 
  
In most cases a new patient's first impression of chiropractic and 
the chiropractor is made by the CA's voice, attitude and words.  The 
physical appearance of the office, the outside of the building and the 
reception area, make the second impression.  The CA's personal 
contact with the patient and PPP including forms, brochures and 
pamphlets, make the third favorable or unfavorable impression. 
  
Up to this point there has already been three opportunities to 
impress the new patient and the new patient hasn't even met the 
doctor.  Only one of the six primary objectives of PPP has been 
completed (an appointment has been set and the patient is in the 
office), and another one of the six (making a favorable professional 
impression) is still in progress. 
  
It is now time to move the patient to the consultation room.  Even if 
the patient's impression at this time seems to be unfavorable, the 
fact that the patient is in the consultation room waiting to see the 
doctor means something is going right and there is still hope.  
Details of PPP for moving patients to this point have been discussed 
previously.  However, let me reemphasize the importance of the CA 
remembering to maintain courtesy and continue removing fear of the 
unknown, a major consideration in all PPP. 
  
One of the reasons the first doctor/patient encounter is extremely 
important is because this encounter forms the patient's "first 
impression" of the doctor, personally.  To help insure a favorable 
impression, the doctor should be in a frame of mindãFunctional 
State--of Loving Service and wanting the best for the patient.  The 
doctor's concern and attitude should be the same for the new 
paatient as it would be for the doctor's mother, father, brother, 
sister, or child.   
When there is a CA available, the CA should precede the doctor into 
the consultation room where the patient is waiting and introduce the 
doctor.  "Mrs. Jones, this is Dr. Parker." Or, if a CA is not available, 
the doctor introduces self to the patient.  "Mrs.  Jones, I'm Dr. 
Parker." In both cases, the doctor's introductory comment should be 
"I am very happy to know you." This is one of the best, if not the 
best, person meeting phrase.  Make eye contact, be sure to smile and 
move forward to shake hands offering your hand with your palm 
turned partially up.  Use a firm grip and a double handshake.  These 
are the highlights of a very specific four-step procedure taught at 
KPS which requires the visual seminar presentation to master this 
important procedure. 
  
A special note on making eye contact ... hold eye contact only as long 
as the patient holds eye contact.  If you try to hold eye contact 
longer than the patient prefers, they will feel you are starring and 
become uncomfortable. 
  
Another reason this first doctor/patient encounter is so important 
is because this is when the establishment of a long-lasting rapport 
between the doctor and the patient begins.  Establishing an enduring 
doctor/patient rapport leads to the patient developing enough KCBF 
(Knowledge, Confidence, Belief and Faith) in the doctor, to make the 
decision to follow the doctor's recommendations and instructions.  
Yes, the doctor should learn and use as much skill in guiding the 
development of a strong doctor/patient rapport as used in 
administering quality chiropractic care.  You can't get sick people 
well if you don't influence/persuade them to follow your 
recommendations and instructions. 
  
However, the ability to influence another person is a serious 
responsibility, and you should make absolutely sure you influence 
the patient with integrity and for the patient's greatest good. 
  
When new patients enter the doctor's office for the first time they 
are in a general Functional-State (F-S) of: „ I want someone to 
listen to me, I know where I hurt, pay attention to me, care about 
me, be interested in me, understand me." When the doctor walks into 
the consultation room, in addition to the general F-S of Loving 
Service and wanting what is best for the patient, the doctor should 
be in a specific F-S of-.  "I care, I am interested, I want to 
understand, I want to listen, I want to know about your problem, I 
really want to help you." The doctor should also be in a state of 
heightened sensory awareness in order to be aware of the patients¼ 
nonverbal communication.  When the doctor is in the proper F-S 
during the first encounter with the new patient, a doctor/patient 
bonding begins immediately.   
The next step in developing an enduring doctor/patient rapport is to 
establish a "common bond".  This is something that the doctor and 
patient have in common they can discuss quickly to begin bonding.  If 
referred, mention your association with the referring person.  This 
is one of the best "common bonds".  Such as, "I see you were referred 
by Mrs. Green.  She's really a wonderful person (etc.). We really 
appreciate her for referring (so many patients) to us." Also, if 
applicable, mention other areas of interest i.e., profession or 
vocation, place of work, hobby, church, lodge, neighborhood, name, 
etc.  The doctor can make statements and ask questions similar to 
the following: 
  
"I see that you are a self-employed brick layer.  How long have you 
been in that profession?' 
  
"I see you work at Safeway, have you been working there long?  What 
do you do for them?  We shop there frequently (if applicable).  Do you 
know Joe Johnson?  We get a lot of patients from there." 
  
"I see that you like golf.  Where do you usually play?" 
  
"I see that you are wearing a Masonic ring.  What lodge do you belong 
to?" 
  
You have a very interesting name.  I like it." „etc.¾   
This will give you the idea.  Make statements and ask questions that 
are appropriate for each patient. 
  
To further bond and establish rapport, one of the first things you 
want to know about the patient is how they communicate.  There are 
several ways to classify people in relationship to how they 
communicate to others and understand communication received from 
others.  These classifications also relate to peoples' methodologies 
or "filters" of perception of their world.  And what we perceive to be 
our world, for us, is the world.  The three most common ways people 
communicate and understand their surroundings are Visual, Auditory 
and Kinesthetic--See, Hear and Feel.  You will be provided with 
additional training on this through future communication and at KPS. 
  
To most effectively communicate a person you must determine how 
they communicate and you must then follow the "Platinum rule of 
communication..."Do unto others as they would have you do unto 
them".  This rule is a more specific application of the all important 
"Golden" rule. (I'm not talking about the one some people seem to 
believe..."he who has the gold ... rules!") In the "real" Golden rule, you 
do treat people like you like to be treated.  With the "Platinum" rule, 
you develop the skills of knowing the different ways people like to 
be treated, and you treat them the way they want to be treated, 
which may be very different than the way you want to be treated.  
Doctors should take the time and effort to learn these skills because 
they truly care about their patients and want to develop positive and 
beneficial doctor/patient relationships. 
  
You don't have to be an expert to be able to generally classify a 
person's communication style.  There are a few simple things that 
will guide you in knowing how a person prefers to communicate so 
you can follow the platinum rule.  See the patient, really see the 
patient.  Notice how they are sitting, standing or moving around 
when you walk into the room.  Do they make eye contact or do they 
look away?  Are they obviously in pain?  Hear the patient ... listen, 
really listen.  Listen to how they respond to your introduction or 
questions.  Do they talk fast or slow or in-between?  Do they 
hesitate between words?  Really pay attention to the patient as to 
what you see, what you hear and what you feel. 
  
To most effectively communicate with the patient, talk the way 
they talk--fast, slow, high or low pitch.  Use their words back to 
them in as close to the way the patient used them as possible.  
Beinng respectful of a patient's communication style and 
communicating effectively with the patient is a major step in 
building rapport. 
  
Another step in building rapport as rapidly as possible is for the 
doctor to model and mirror the patient's physiology.  Sit the way 
they sit; if their legs are crossed at the knee or ankle, cross your 
legs similarly; if they hold their head slightly tilted, slightly tilt 
your head, etc.  Be as much like the patient as you can.  This will 
help build rapport very quickly. 
  
In a busy practice, the challenge is how to establish a common bond 
and use other methods to build rapport quickly with a person you 
have never met and know nothing about, except what is on the 
patient information forms. 
  
In the beginning stages of developing rapport building skills, it may 
take extra time and effort.  It won't be long, though, before you'll go 
into "auto pilot" and be able to develop long-lasting rapport in 
seconds instead of minutes.  Only when you have established rapport, 
is it time to gather information and get specific details by 
conducting a comprehensive, efficient consultation and case history.