3 Steps to Improve Communication with New Chiropractic Patients | Podcast Ep. 214

Foreign hello and welcome to the Evidence Based Chiropractor. I AM your host, Dr. Jeff Langmaid. On today's episode, we're going to break down how you can have super productive conversations with your patients, specifically the new patients that are coming into your practice. I'm going to show a little bit behind the scenes and talk about a little bit behind the scenes of what I learned working with within multidisciplinary and interdisciplinary clinics, some of the frameworks that I used for those initial examination and evaluation questions and where I kicked things off and what my thought process was behind it. And the goal of it is for you to be able to better connect with the people who are coming into your practice, ask great questions and have a process and a system which makes your office run way more efficient rather than scattershot. We're going to talk about all that in a little bit more on today's episode. I really want to use this as an exercise to have you think about what you are talking about with your patients. So it's not necessarily about following every single aspect of the questions that I asked patients in a surgical capacity, but more in terms of what can you learn from that process and apply to your practice to make sure that you are serving your patients at the highest level possible. A few weeks ago, we talked about the AID IT formula and that was really about setting the framework for every interaction with your patients. But I want to get even more granular today and talk about how I approached the consultative process, if we want to think about it that way. So let me first take a step back and explain the capacity that I was working in at the time. So in a few different multidisciplinary groups, I was a practicing doc at a satellite facility in a large scale orthopedic group, you know, hands on care each and every day. As time went on, I joined an outpatient surgery group where I was doing a lot of imaging review as well as a lot of consultations with patients. So patients would call in and essentially I was used before a surgeon to help guide the patient towards the best plan of care, the best action steps they could take. So the way that that worked was, and again, I'm gonna get really granular. I'd see between, typically between 15 to 25 patients in A. So from a volume perspective, that is what I was seeing. And I had a medical assistant with me and the medical assistant would go in with the patient before me and really fill out what I'll call a abbreviated case history. So they would fill out, you Know, what's the patient dealing with? What are the challenges? Where's the pain? You know, is the pain shooting? Is it numb? Is it tingling? I would have the general gist of information on the patient before I went in. And when I first started doing this, I'd actually review their imaging. Cause again, we were working in a surgical capacity. Almost everybody had imaging before I saw them. Or at least reports might be a little bit different for you, and we'll talk about that in a moment. But I would. When I first started, I'd review all the imaging before I went in. As time went on and I became super, super comfortable reading the imaging, live with the patients. I didn't do that. I would just read it, live with the patient. And I wouldn't do any of that work in my office before I walked in, which was. Saved me a ton of time. Made the process way more efficient. It just took a little bit to get there, getting your reps in, right? And getting comfortable reading that imaging. If you're having any challenges reading imaging, then I'd encourage you head over to the evansbasedchiropractor.com I have MRI essentials for the practicing chiropractor. It's an online course. It'll help get you up to speed. Super quick, super easy. Feeling comfortable reading advanced imaging, specifically spinal MRIs with your patients. But as I got comfortable, eventually I would not review the imaging before I went in. So then I'd walk in, and my medical assistant would make that transition. So the medical assistant would take all that information. Dr. Langmid will be with you in just a moment. Let me go get him. Right. She'd leave the room and come get me. And then when we walk in again, I want you to really understand these nuanced points, because this process was refined throughout tens of thousands of patient interactions. So there are very specific points here with transitions and handoffs that matter, and they matter in your practice as well. So when we'd walk back in, the medical assistant would reintroduce me. Hey, Joe, you know, here's Dr. Langmaid, you know, and that was a transitional point where then I could say, hey, Joe, great to meet you. You know, we're gonna do three things together. I wanna learn more about what your. What the. What your challenges are and what you're dealing with. Second aspect is I'm gonna review your imaging with you and see what's going on on the inside. And then the third part is we're gonna develop a plan of action. So you have a plan that you can get care and treatment and get well starting today. So that would really be my agenda setting. Right. So I'd go in there and let the patient know that we're first going to talk a little bit about what they're struggling with and what they're dealing with. Right. So that was a recap of the history that I'll dive into momentarily. The second aspect is, I would say, and then we're going to review your imaging. Now, in your case, if you don't have imaging, that's easy to be able to say something to the effect of, then we're going to do an examination. Right. Just exactly as you would in your practice, but you're letting the individual know what to expect. Going into a new doctor can be very, very, very intimidating for patients. And having a process and having a system in your head is one thing, but verbally explaining it in a concise fashion to a patient is a completely different thing. And it is critically important to that patient's psyche as they're going through that process, to whether or not they believe, hey, this guy's got a handle on what's going on. This isn't his first rodeo. I feel comfortable and confident in this environment. Those things play a huge, huge role and how you verbalize what's going on every step of the way, especially during that first interaction with the patient. Again, it's critically important to their perception of you and your practice. So setting that agenda. Hey, Joe, great to meet you. I'd love to learn a little bit more about what's going on with you first. Then we're gonna check out your imaging, see exactly what's going on on the inside and what might be the cause of your pain or problem. Again, you might exchange exam or evaluation for imaging there. And then the third part of today is we're gonna give you a plan of action so you know where you can go to take the next step and get on the road to recovery. Very, very simple, very straightforward. Three steps, not too much to remember. And that was the framework by which we jumped from. Right. So first, I would basically have looked at that one sheet by my medical assistant, as I said. So I'd know a little bit about what's going on with the patient. So that's a great opportunity to ask a pointed question. Hey, Joe, it seems as though, you know, Tara told me that you're struggling with some pain that starts in your neck and it goes down your arm, and you've been dealing with it for a few weeks. Can you tell me A little bit more about that. And then I'd pause. Right. So I'm going to ask a question and just reiterate. Here's what I understand is going on with you, right. AKA, here's your chief complaint, as it's been told to me. Can you tell me a little bit about that? That's a very, very powerful question. Because how a patient responds to that can give you a massive amount of information in terms of where they're at in the process. Are they frustrated? Are they coming out with negativity and the fact that they've seen so many bozo docs that haven't got them where they need to be? Are they feeling great? Gosh, I've dealt with. I got over it. I can't wait to get back in the gym. When you ask the question, as far as letting them know, hey, I understand that you're dealing with this. Can you tell me a little bit about that? The response that they give you is super, super important and can really be an eye opener to what kind of patient is this going to be in your practice? Right. Are they coming back super negative? Are they sounding positive? Do they sound like they're just bummed out because they're dealing with something they don't want to deal with? It's an exceptionally powerful question that I would encourage you to ask, if you're not already asking in your practice, the second aspect of what we would go through. And then I might ask a few more questions. Right. We're going to dive into things from there. The second part of it is imaging review. Right. So, imaging review. I won't go too far into the details on this podcast, but if you're going to do an examination or an evaluation, like in lieu of or with an image in image review, I'd highly encourage you to make sure you talk through it and keep it simple. Right. So here's an example of that. I'm gonna bring up the patient's MRI on the screen, and I might say to the patient, this picture is just as if I took a picture of you standing sideways. These big squares are the bones. The discs go in between, and down the backside are where your spinal cord and nerves are. So I'm keeping it very simple and letting the patient know what I'm looking at and what's going on. Again, I would very much utilize this same strategy and process. If you're doing an examination, even if you don't have a medical assistant in the room, talking through your examination is a great way to get the patient up to speed on what you're finding, number one. But number two, it's very. It's a critical step in terms of patient education. I don't mean patient education like old school patient education. I mean letting them know what you're finding. And. And then as you go through your plan of care, the third step we'll talk about in a moment, it can tie back and it's not foreign to them. They've heard you doing this as you go through your exam. Right. So, for instance, you might ask the patient, you know, to, to be seated. And then you might, you know, say to them, I'm gonna put my left hand on your low back. I'm gonna be feeling the spinous process, the backside of your bone, and I'm gonna have my other arm across your shoulders. I'm, you know, instituting a Kemp's test by, you know, right now, so I'm gonna give a little bit of pressure. Do you find any discomfort with that? Oh, that, that's a little. That's a little painful. Okay. Tenderness at L4, L5 could be indicative of. Right. If you talk through it in that fashion, that gives you a massive advantage when you go through your plan of action for, again, the patient not to. Everything doesn't seem foreign to them. You've talked through the process, you've told them what you're finding. As I was going through my imaging again, I might say, hey, you know, Joe, this is a picture right here. As if you're standing sideways on the other side of the screen right here. As if is if we kind of, you know, chopped you and looked down at you that way. Obviously the axial view, right? So the big squares are the bones, the discs reside in between, and the nerves go down the backside. I'm going to read this to my medical assistant, then I'll tell you exactly what I find. Right. So I might have said at that point to the medical assistant, 3, 4, 4, 5, 5, 1, degenerative discs. 4, 5, disc herniation apparent left sided foraminal stenosis and, you know, facet hypertrophy. Right. So simplifying it down, but I might said all the technical words. Then I turn to Joe, you know, the patient in this case, and say, what I just said to Tara was, you know, see how this disc is really dark and see how this one has a dark rim and a bright white center. That tells us it's a well hydrated disc. So you see how these are dark? That's a degenerative disc. You see how this disc is Nice and flat on the backside. That's the way it's supposed to look. The disc should hang out underneath the bones. But you see this one? See where it's sticking way out the backside? Yes, I see that. That's a disc herniation. You see how it's taking up space in that hole? See that circle? And I'd show them that circle should be nice and wide. When this disc is pushing back into that space, that can decrease the amount of space a nerve has to go through and it can actually pinch or compress that nerve, which is why you're dealing with X, Y and Z. You can use those same strategies with your examination and your evaluation as you talk through it in simple terms with a patient. I find so many docs out there, evidence, informed docs, rehab based docs, great docs that get so hyper technical with their explanations. That's a great thing to be thorough. But don't talk over the head of your patients. Make sure that they understand. And then the third part about, you know, how I'd go through my consultative process would be again creating that plan of care. And at that point that's really just executing on what you found during the examination and during the history. Right. So pretty straightforward as far as that's concerned. I would give them exactly what I thought that their best plan of care was. If I thought they were a surgical candidate, I'd explain that to them and I'd explain a little bit about what I thought may be a surgical recommendation. Of course that's always going, going to be, you know, signed, sealed and delivered by the surgeon, him or herself. But I'd give a, you know, advanced warning there if I thought the patient was great for conservative care and they did not need to be seeing me or need to be seeing specifically any of our surgeons. I would be super clear there as well and let them know, hey, I think you are a great candidate. Your best next step is to go see a chiropractor because they will be able to do X, Y and Z. Or your next best step is to go see a physical therapist. You know, you really just need some rehab to get here. Your range of motion looks great. You don't have any limitations or disc pathology, you know, again, whatever it might be. I'm sort of just riffing right now, but I'd explain to them here's where I believe you should go and what they may do to help you improve. And that is a take home message for you as well as you explain your plan of care. Be sure to explain, hey, here's what I anticipate we'll do in our practice for you. And here's the benefit that we can expect when you start to lay things out like that. And now they know. Again, we're going to go through all three of those very quickly here. Number one, you've taken time to learn about what they're dealing with and you've gotten a great vibe for who they are and what their expectations are. Number two, you've done your examination or your imaging review and talked through it with them so they are an active participant and hear what's going on. Very, very important. And then number three makes it makes number three super easy. When you start talking about a plan of care, you tie it back to the history and examination, you tell what you were going to do and the expected result with it. That is a great way and a great process. I hope you get some nuggets there that you can take and meld into what you're currently doing to make sure that you're having the highest quality conversations with each and every patient that comes into your practice. What we do as chiropractors is needed so, so bad with musculoskeletal issues, with chronic pain, all of that and our utilization is just too low. So how we change that is we continue to get out there to other physicians in our community. If you need help, become a member of the evidence based chiropractor building those referral relationships. Get out online if you need help with that. All of our automations with the smart chiropractor and having great conversations with the patients that are already in your practice. And I hope today's podcast episode gave you a couple ideas and maybe even an item or two that you can bring into your consultation. Your examination process to again make sure you're having high quality conversations with patients. Make sure that you are accurately explaining who you are and what you do and making sure you instill the confidence in them that you have in your ability to take care of them. Very, very important. Have fun this week in practice and I will talk to you soon. Thank you for joining us on this episode of the Evidence Based Chiropractic. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit the evidencebasedchiropractor.com and join our MD Marketing membership today.