Q: Dr. M For the first time, I have the opportunity to provide chiropractic care at a tennis tournament - along with a massage therapist who will be providing short massage sessions. What are your suggestions about providing care (i.e., adjusting without x-rays) and what type of services would best be received at an event like this. I will adjust patients in my practice when I do not feel x-rays are necessary, but I've never been in the situation such as this to provide care. Any ideas.... A: Thanks for the e-mail. Caution is always wise when you provide a public exposed service. Personally .. I would not do any cervical moves that warrant any twisting .. a rotary movement .. I would concentrate using the Activator if you have any. Any lumbar movement should be gentle .. it only takes one person and one bad move to create havoc. Most public events entail a screening not actual adjusting. refer to the massage therapist for immediate pain reduction and offer a further evaluation in the office. I've always sided being conservative and public adjusting would be radical for me. Screenings and having some information available would be better suited for the event. Below is from my Smart Start Book concerning screenings. It will not all pertain to your event but may offer some ideas. Have a Great Day Dr. M Screenings Screenings have been successful in reaching the public. If you have an alliance with a mall, or a retail establishment, screenings can be successful for both. You will provide a service and they will benefit from the curiosity seeker who will go within the store to take advantage of the screening. Typical chiropractic screenings have included, postural checks, blood pressure evaluations, chiropractic question and answer tables, etc. The following will guide you through your first screening. Of course, as with all the material given to you to date, create your own forms and establish your own tone and purpose. Reach out to everyone in all directions Outside events usual result in some form of confrontation. Many people do not share our enthusiasm towards wellness and chiropractic. Meeting the public takes skill and the ability to accept rejection and ridicule of your treasured a least understood profession. Don¼t be intimidated, instead be encouraged that the one or two people you can reach will greatly benefit. Screening Purpose Statement: This is your opportunity to evaluate as many people as possible. A Biomechanical and Fitness (Chiropractic) evaluation is usually a non entity to most members of your community. Your purpose and your goal is one and the same -- Evaluate as many people as possible o Many people walking by will be too busy or not interested o Be sure someone is the greeter and introduces your program o Those that show interest should be evaluated o Work with local people as many may be from far off distances o If they are too busy for a screening today, they may donate $10 or more to a charity for a complete exam in your office at a later date Note: There will be no appointment for an IN-Office examination without a donation to the charity. Checks are written out to the charity, and all cash will be sent to them. Therefore, No Funds Are Reimbursed Or Refundable. o Everyone completing their survey, will be evaluated on site, and those who make a donation of food or money are eligible for a special door prize. These prizes will be chosen at a designated hour. Winners will be called and can pick up their gift at your office. The purpose of the survey is to get a pulse of your community; those you speak to, and those you wish to serve. There are various methods of getting these surveys filled out. Some offices use telemarketing and have designated hours to call people .. cold calls. A person making these calls must have an ability to accept rejection, as many of the calls will be received with a hang up or possibly some negative feedback. Surveys are used to create a data base for your mailing lists. If people are in a hurry, they may have time to complete this short survey below, which should be printed on a card outlining what you¼re doing. They will be part of your mailing list and can be contacted at a later date. If the line to an evaluation is long, have some staff member go to the people near the end .. have them explain what the purpose of the screening is, the charity sponsor, as well as the end result .. people being evaluated for Stress and Fitness. If they are in a rush, go over the fine points of the survey and ask them if they would wish to forgo the screening and make an appointment, after the donation, and determine if they wish to come to a workshop. Screenings The following is a method of both training and the mechanics of a public screening. These may be at a Community Health Fare, Mall Show, Office Atrium, etc. Have your screening team prepared with the proper training. Each person should be aware of their role and in time management. If the crowds get too big, waste no time. It¼s best to practice short confirmation sentences, than trying to save the person that moment. The purpose of the screening is the screen, not to examine. Leave that for the proper time and place .. your office. o Stop People: Have a Drawing ---- Healthy Snacks for kids while parents stop o Fill out a survey and be in the running for a prize .. Use a fish bowl for surveys o Work with a Charity People Involved -- Have A Strong Support Team o Roving Person: Brings People over to be screened o Greeter Person: Most Important Role -- Gets People To Stop o Interns and/or Doctor: time is valuable -- learn scripts and the important close o Scheduler: makes appointments -- attempts to make sure they¼ll follow through o Roving Person: Rover walks around and tells them what¼s happening at your booth. Asks people if they have any health problems -- introduces concept- brings them to the screening: "Hi there, I¼m ____, with the Family Chiropractic Center. We¼re here today to raise money for the Atlanta Food Bank. We¼re doing is a health and fitness screening. If you want to donate money, or a non-perishable food product it¼s OK, if not, it¼s also OK, do you have any health problem that are a concern?" o Greeter Person: Stops People (Most important role) ** Sends only potential prospects for screening (not from out of town) Women do not want to be stopped by men -- Greeter should be a woman if possible " Hi, where are you from?" (If far away--thanks but no thanks .. Remember time is valuable) Greeter gives person a survey and brings them to CA to donate or not donate money or food products " Let me tell you what today is all about. We¼re here to relate stress to health problems. Do you have any health problems that concern you?" If they say no -- discuss the Six Major Complaints " Well do you have - Fatigue - Headaches - Irritability - Sleep Disturbances - - Digestive Problems - Pain Anywhere In Your Body - Allergies" IF NO: "Well let me ask you, have you been in an accident in the last six months?" If there is a line of people and they all are in a rush: "I¼d like to suggest something. Today we are having a screening, but I see from your survey, you have a number of problems. May I suggest I schedule you for a comprehensive examination at our office. There will be no charge." Book Them Interns and/or Doctor: "Is this your survey? Is this correct, you have this many problems? (Show concern) o Focus on the 4 major probbing questions: -- How Long -- How often -- _ When at it¼s worse, how does it feel ‚ _ -- How does this interfere with your life -- Don¼t sell Chiropractic or convince - this is not the place Maximize with each person -- Quality time not Quantity Memorize these phrases: o That sounds like it can be serious o That¼s not OK o That concerns me o This is not normal o That is unacceptable Remember, most people minimize their problems and therefore are known as minimizers. This is especially true in an open area away from the official "doctor¼s office." Therefore, be serious about their condition and be clear with your purpose ... assisting people to be at their peak potential via chiropractic care. "Now tell me, how long have you had these headaches? -- one year!" That concerns me " Do you get these more than once or twice a year? -- Yes -- really, that¼s not OK -- (Listen to what they say) -- let¼s do a screening evaluation of your spine to see if we can find out what¼s causing this." Note: This is not a gimmick, or parlor game tactics. If you are On Purpose of assisting the community in receiving the best care available, and allowing a person to evaluate their levels of subluxation, and how far they can benefit from chiropractic care, we must first introduce the concept, and give them the opportunity to discover if they can benefit. This is our opportunity to meet people where they work, shop, or browse. If you feel uncomfortable with any procedures, and/or have a disagreement or misunderstand a concept, clear it up prior to screening anyone. Your attitude will come across clearly Above when questioning about headaches, the question was: " Do you get these more than once or twice a year?" The answer was yes. Twice a year? Yes, it should be unacceptable for people to note headaches more than twice a year. Remember, mild headaches will not be remembered, therefore, start the process of winning over a skeptic by making them realize it¼s unacceptable and not OK! If they remember twice a year, it was probably more often and painful. Purpose of the Screening is to prove there is something wrong --only if IT IS! Remember: It is difficult for the lay person to relate their constipation to a spinal problem. This concept, although real to us, is foreign to them. Leave the visceral concerns to the office examination. Let them know they may have pressure to their nervous system, and that¼s what you¼re looking for. Also: Since you are an extension of this office, please do not promise any results, statistics of results, or anything like that. You may answer that chiropractic care has been very successful with their problem(s), but that should be as far as you want to go. Stay away from describing the nervous system in a analogous manner, such as: happy or sad nerves, foot on a hose, etc. We are dealing with Stress on the Nervous System .. If they have it, Chiropractic Care will help. Risk Management: Never discuss and admonish their medical care. Never tell them to or not to take their medication; take specific vitamins or herbs, or their doctor¼s diagnosis was wrong. These opinions are to be given, if at all, by the doctor and in the office setting. It seems far fetched to be sued over such trivial things, but the support staff is an extension of the doctor¼s office and he or she will ultimately be held responsible. Props used for the screening are: Chairs for Screening, Table for material and Sign Up, Charts of the Nervous System .. front and side view, Survey Forms, Pens, Office Cards Person fills out the survey form and gives the form to the Screener: Screening Test Routine: Patient is Seated "I see from your survey you have concerns about headaches, neck and lower back pain, is that correct? Well today, we¼re doing just a screening, this is not to take the place of a through examination, but I¼ll still be able to determine if you have stress on the nervous system, and that¼s what we¼re looking for. First, if whatever I or you do hurts, be sure to tell me. Okay? Great." 1: "First, I¼d like to check the range of motion of your neck. Can you place your chin on your chest. Now your head straight back .. right and left. Was there any pain? Comment if there was obvious restriction. Explain that the body is defending itself by "splinting" the muscles. 2: "Next, I¼d like to you to extend your arms to the sides." While they are doing this, show them a picture of a posterior view of the spine with the nerves traveling down the arms and the legs. If they have a problem, the time that you are explaining to them will aggravate any nerve root pressure coming from the area .. brachial plexus. "As you can see from this chart, there are nerves that exit the neck and upper back that travel down to the arms. If there is stress to the nervous system, you can develop pain, numbness, tingling and loss of strength down the arms. This may also is be involved in chronic shoulder pain. Do you have any pain down the arms now? 3: "I¼d like you now to raise your arms above your head." Watch the movement. If it is erratic and the patient hesitates, it is indicative of obvious shoulder restriction. Touch their shoulder blades and move their arms up. "Can you see the movement of these muscles when you move your arms up, again if there is pressure on the nerves that travel down the arms, it also affects the muscles that control movement of the shoulder." 4: "Now, we¼ll check the lower back. Again, be sure to tell me if there is any pain. Please bend down and try to touch the floor." If the patient¼s heavy and cannot touch the floor, have them go as far as they can. This conservative method of lumbar range of motion is not objective as in your office, but is less time consuming and less risky than having an elderly or heavy set person stand and touch their toes. Again, if they have a problem they will tell you. "Do you have any lower back discomfort? Again, this evaluation is very limited, but it seems there is pressure in the lower back. Also, you noted in the survey that this has been a problem for awhile, is this correct." After the screening, they should understand there is a problem: " Can you see from this simple evaluation we¼ve found something?" If the person says NO, they are not concerned Remember: Even if you did not find a glaring problem, a concerned person will want you to. They will seek your attention and advice and say yes, hoping to discover a solution for themselves. The Important Close: " If we can help get rid of your headaches, would you want to?" "I think we need to make an appointment, come to our office and see if we can help. There will be no charge for this examination. We are doing this in conjunction with this charity, although we would appreciate your donating to the charity." (check is written in charity¼s name). Remember: This is not a numbers game. Trust me, if you are spending alot of time on one person to convince them that they should come, in all likelihood, they won¼t follow through. Spend quality time, emphasize the Stress to the Nervous System. "Do you want to get checked?" "You know, we only have a limited number of these appointments. I¼d rather not make one unless I can be assured you¼ll be there." If their response is: "Let me call you" Your response: "Why would you want to think about it. You definitely need to come in. It seems you have a problem. If you make an appointment, will you come in?" Logistics: Walk over with them to make the appointment. There should be appointment times and cards available to place their date and time. Have a number of index cards with designated times allotted for the tests in the office. There are limited spaces and times for exams. "We still have times available." They can pick one. If there is a sheet with times highlighted, they can choose from these times as well. If they pick their personal time, it becomes special. "OK, which time is best for you. We¼ll make a note for ourselves." Scheduler: "If you like to come in for the exam, we¼d appreciate your donating something to the Atlanta Food Bank. If possible, between $12-25."