Preliminary Examination
  
By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. 
behapy@karlparkerseminars.com
  
  
After you have concluded a successful consultation, it is time to 
perform a preliminary and a thorough Chiropractic examination.  You 
know your consultation has been successful when the patient knows 
you understand their problem and agrees to follow your 
recommendations. 
  
The establishment of the preliminary examination as a standard part 
of the chiropractic examination is important for a multitude of 
reasons such as: 
  
…            An excellent cursory overview the CA can easily be taught 
to perform 
  
…            Doubles for a "spinal checkup and Scoliosis screening exam 
  
…            Provides an extra-personal service for your patients they 
will appreciate 
  
…            Aids in motivating referrals (explained how later) 
  
…            Provides an opportunity between consultation and exam for 
DC to give adjustments. 
  
At this point, a Clinical Assistant (a designation for the CA who 
works with the doctor in the treatment area) takes the patient to 
the appropriate room and has them prepare for the preliminary 
examination.  The CA instructs the patient what to do and where to 
go when the patient is prepared (such as if gowning is necessary), if 
not already in the exam room. 
  
Remember, one of the most important responsibilities of the CA is 
to remove the patient's fear of the unknown.  The patient should 
never have to wonder about what to expect, what they should do or 
where they should go next. 
  
While the patient is changing or before, the CA makes sure the 
examination room is ready.  Everything necessary for performing the 
examination should be in the room in the right place and in the order 
they will be used by the examining CA and/or DC.  If a Clinical 
Assistant is properly trained to perform the preliminary 
examination, he or she should conduct this exam first.  Then have the 
patient get properly dressed for the thorough exam the DC will 
perform, while the DC reviews the results of the preliminary exam. 
  
We'll assume the CA is performing this exam.  The CA makes a 
statement similar to the following: 
  
CA:  "Now, Mrs. Jones, we are first going to perform a spinal check-
up and Scoliosis screening examination.  The results of this 
examination will give Dr. Parker a general overview of your physical 
and structural condition." 
  
The CA then performs the preliminary exam and completes a 
"Preliminary Chiropractic Examination" form.  When the exam is 
complete the CA explains: 
  
CA:  "Incidentally, Mrs. Jones, there is no charge for this portion of 
the examination.  We provide this spinal check-up and Scoliosis 
screening examination as a public service for family members of our 
patients as well as their friends and neighbors.  It is an extra 
personal service Dr. Parker provides that makes a general evaluation 
of the overall condition of the spine.  As a matter of fact, I will give 
you a couple of 'Spinal Check-Up Tickets', which you can use to mail 
or give to family members or friends whom you think might like to 
have this screening examination performedä at our expense."   
The CA then takes the completed "Preliminary Chiropractic 
Examination" form to the examining doctor to review before the 
doctor enters the examination room. 
  
The doctor reviews the preliminary examination findings with the 
patient and goes over each finding, positive and negative.  The doctor 
should stress the negative findings to emphasize the seriousness of 
their condition, and it is important to mention the good findings to 
give the patient hope. 
  
The extensiveness of this mini-report on the preliminary exam will 
depend upon the DC's available time and present level of practice.  It 
is wise for new patient retention and procurement to train a CA to 
not only perform this exam but also report its indications as the 
exam is performed as described below. 
  
This article will present an almost complete detailed method of 
reporting the preliminary examination: 
  
1.      Height, usual and actual. 
  
CA:  "I see your usual height is 5'7" but as you can see you now are 
5'6".  There are usually two reasons for getting shorter, and that is 
either that the spine is curving or the discs are thinning or possibly 
deteriorating." 
  
2.    Weight usual and actual. 
  
CA:  "As you probably know, Mrs. Jones, we are interested in our 
patient's weight because extra weight can put a constant strain on 
the spine and pull it out of alignment and also strain the back 
muscles." 
  
3.   Blood pressure, sitting and standing. 
  
CA:   "We are interested in your blood pressure because if certain 
nerves are affected, it can affect your blood pressure.  Also notice 
that when you stand, your blood pressure is supposed to increase 
which helps to pump the blood to your head.  But in your case, it .... 
This could mean that certain glands and nerves may not be 
functioning properly.¾   
4.   Pulse. 
  
CA:       "Your pulse rate is .... That is (above/below) what would be 
considered normal for you.  This indicates that something could be 
affecting  the nerve to your heart causing it to beat 
(faster/slower)." 
  
5.   Pulse pressure. 
  
CA:    Your pulse pressure is ... This is the difference of your blood 
pressure numbers.  Your pulse pressure is (above/below) what may 
be normal for you.  This could be because something is affecting the 
nerves that control your heart or blood vessels." 
  
6.   Review postural analysis. 
  
CA:   Make appropriate statements and explanations for each finding. 
  
7.   Short leg, apparent and true. 
  
CA:          Explain the apparent short or the true short leg and what 
that indicates and how it can affect the patient's nerves and 
muscles. 
  
At this point, the CA has the patient get dressed properly for the 
thorough exam to be performed by the DC and takes the completed 
„Preliminary Examination Form¾ to the DC to review before 
beginning the thorough examination (described in next article in this 
training series).