THE REPORT OF FINDINGS PHASE II THE WRITTEN & ORAL REPORT By W. Karl Parker, B.A., D.C., F.I.C.C., F.A.C.C. behapy@charter.net Before we begin the report of findings procedure, let's discuss the importance of presenting a written report of findings and recommendations to each new patient. A written report will help establish patient control as well as follow through and referrals as much as any other single procedure you can use (except for the in- house patient lecture). Can you have a successful practice without using a written report? Sure you can. The written report just makes it much easier. It makes the doctor take enough time to review the consultation, examination and X-ray findings to arrive at a proper diagnosis (analysis), prognosis and the program of care recommendations that is best for the patient. It gives patients a better understanding of the recommendations and provides them a way to remember what the doctor said, without misunderstandings after they leave the office. Making specific recommendations for treatment in the beginning allows the CA to better plan the appointment schedule. It also acts as a guide through the patient report so the doctor has written reminders as to what to cover next. Even if there were no other reasons for a written report, and there are many, the ones listed are enough to more than make a written report worth the time and effort. Now, let's pick up where we left off in the last article. The patient is in the report room, watching the pre-report video. The doctor has been given the written report of findings along with the patient's records for last minute review. Before entering the report room, doctors should make sure they are in the proper Functional-State of KCBF in their diagnosis (analysis), prognosis and recommendations. The doctors' F-S should convey to patients they are a Knowing Authority. There should not be even the slightest hint of hesitation or doubt about what the doctor will tell the patient. Keep in mind, in all procedures the doctors F-S should include: love, understanding, caring, compassion, the "You" attitude, courtesy and kindness. RECOVERY RECOMMENDATIONS AND REPORT OF FINDINGS. (As always, only use the parts of the following conversation that are correct and honest to each patient's situation.) 1. Greet patient and introduce self to the spouse or parent in attendance. "Good afternoon, Mrs. Jones. It is nice to see you again. (Shake hands.) Mr. Jones (know the relationship and the name of the invited spouse or family member attending before you enter the room) I am Dr. Parker. I am happy to know you. (Shake hands.) I sincerely appreciate you being here for this report of findings on your wife's condition. I feel it's important to be together at a time like this, for health is really a family affair. Please be seated." (If spouse did not come) "I'm really sorry your husband couldn't be here because I feel it's important to be together at a time like this for health is really a family affair." 2. Make a positive statement of findings. "For the most part, Mrs. Jones, I do have some good news. We have found what is causing your trouble and we feel we can help you." (Note response. If indications are that patient is not in the appropriate F-S, then follow procedures as discussed in the preceding article.) "The first thing we need to do is to show you what we've found and make sure you understand the problem. Then we will discuss what needs to be done to correct it." (If the patient was reluctant to have the examination and X-rays.) "Well, Mrs. Jones, I'm sure happy we did that examination and took those X-rays or I wouldn't be able to tell you that we have found what is causing your trouble, etc." You could also use the „good news/bad news¾ concept. The good news is like the above and the bad news is that it is going to take some time to correct this for it is that serious/has been going on so long, etc. 3. Present written report of findings. Use the written report as an excellent visual aid, educational and reference tool. Use it as a guide and go through it page by page while referring to the appropriate areas or the written report as the oral report is given. "We have prepared a written report of our findings which is an extra personal service we provide our new patients. By going through this report together, we will answer most, if not all, of your questions." 4. Re-State the patient's condition. a. Liabilities of Symptoms. "Mrs. Jones, you explained to me on your first visit that (re-state symptoms, using consultation form). That's correct, isn't it?" b. Assets of Symptoms. "Well, that's enough to be concerned about but you are fortunate that you are not suffering with (state symptoms that could occur if patient's condition were to increase in severity) which are problems that can occur in conditions such as yours." 5. Review examination findings. a. Review Assets of Health. "Now, as you will recall, Mrs. Jones, we performed a thorough examination consisting of (name the examinations you performed). Do you remember when we performed? (Name and explain a few specific tests performed that were normal.) Well, that's all good. These tests tell us what areas are not causing your problem. They also tell us your general health vitality is good and your body has the ability to heal - your condition has not yet become permanent. You see, you have a type of problem that can be described in four stages. Acute or new, chronic-acute, which means the problem is long standing in nature accompanied by acute flareups of symptoms, chronic-chronic, which means it is long standing with fairly consistent symptoms for a long time, and the last stage is permanent. Fortunately, these tests tell me that you are not yet in the permanent stage, and that is very good news." b. Review Liabilities of Health. "Unfortunately, other tests and your X-rays tell us that you are in the second stage, the chronic-acute stage. With proper care, further deterioration into the chronic-chronic and then permanent stages can be prevented. These other tests also tell us your body has not healed this problem and points to the basic underlying cause of your condition. (Name the abnormal tests, explain their significance and relate them to the areas and symptoms involved). These examination results also tell us there are disorders in your spine. We took X- rays to determine what those disorders were. Your films showed us some (fairly, very) serious injuries possibly producing increasing nerve damage that could well be causing most, if not all, of your problems." 6. Show and explain patient's X-rays. (Have patient and spouse/parents come up close to the view box.) "Now, Mrs. Jones, most doctors don't show patients their X-rays. However, I am going to show yours to you so that you can see for yourself exactly what the cause of your condition is and what needs to be done about it, Okay?" a. Mark and describe anatomical landmarks. b. Show and explain normal Xray findings. c. Show and explain abnormal X-ray findings. Show worse conditions first. Point out pathological conditions, abnormal bone development, curvatures, abnormal angles, etc., connecting to spinal cause. Use a marking system on X-rays and generally explain to patient. Point out osseous and biomechanical components of VSC, misalignments, pressure areas, kinks, bends, wedges, rotations, etc., and explain relationships to each other (compensations, etc.) and to the patient's symptoms. It is good to have a normal X-ray of the same views as the patient's to show for comparison. Point to one, two or three areas on the X-ray that demonstrate subluxations that relate well to the patient's symptoms and touch the same area on the patient's spine. Discuss symptoms related to each abnormal X-ray finding. Only if true, tell patients that their condition has been progressing for a long time and discuss what could develop if it was to advance further. Point out that problems such as these do not correct themselves spontaneously, but instead only become worse because of the effects of time and gravity alone, not counting many other physical stresses the patient might be under. 7. Explain full spine specimen. Use a plastic full spine and tell patient it is plastic' ' Point out landmarks, curves, etc., and relate to the. X-rays. Show relationship of vertebrae to intervertebral foramen to spinal nerve. Have patient insert little finger into intervertebral foramen and produce a misalignment so that patient feels the pressure. 8. Relate demonstration subluxation(s) to spinal nerve distribution. Preferably use an illuminated push button chart (Neuropatholators(R) are the best. It is wonderful to see the light of acknowledgment and understanding in your patients' eyes when they push the buttons on these excellent electronic charts. See ad in this issue for more information and have the patient push the buttons. If electronic chart is unavailable, use laminated "Spinal Nerve Distribution" Chart. Mark subluxations with red skin-marking pencil and trace nerve to areas of body involved and/or potentially involved. 9. Relate demonstration subluxation(s) to autonomic nervous system. Preferably use a illuminated push button chart (Neuropatholators(R) again, are the best) and have the patient push the buttons. If electronic chart is unavailable, use Laminated "Autonomic Nervous System" Chart. Mark subluxations with red skin marking pencil and trace nerve to organs involved and/or potentially involved. 10. State and answer the patient's most common basic questions. There are several of these questions that are best answered in advance to help ensure complete acceptance of your recommended program of care.