To help you enhance your practice and increase your bottom line, Dynamic Chiropractic PracticeINSIGHTS asks practicing DCs like you for ideas and solutions that have been tested in real-world environments. In this issue we asked: "When faced with an apprehensive patient, what steps do you take to educate them, calm their fears and help them to appreciate the importance of chiropractic for their overall health?" The following is important insight and varied methods we found most useful in answering this question.
Address Your Patient's Concerns
Jim McDaniel of Vermont warns doctors not to trivialize a patient's concerns. He writes, "When faced with an apprehensive patient, it is important to first, in a caring and compassionate way, try to fully understand their concerns or apprehensions. I may assume they are apprehensive about the adjustment but they may be concerned that they have cancer or they might need surgery.
"I feel it is important to then acknowledge the concern and let them know that such a concern is not uncommon (if it is indeed not uncommon) and calmly and directly give them the facts. People appreciate and trust statistics, so if you can quote a study or paper with a statistic, all the better. In my opinion, the worst thing one can do as a doctor is to trivialize a patient's concern or area of apprehension. A patient does not want to feel like the doctor has just patted them on the head and said, 'now you just don't worry yourself about that.'"
James Bortolotto of Alberta, Canada writes, "Never educate the apprehensive patient until you truly ask enough questions to fully understand their reasons (real or imagined ) for their fears. Always remember there are three basic fears in humans: fear of death; fear of losing control; and fear of humiliation or rejection. Discover which of these fears most applies with your patient, then collaboratively explain the risks and benefits of your chiropractic approach and possible treatments. Don't over-explain, but be clear and evidence-based. Finally, discuss all forms of available treatment options for their concerns and describe the chiropractic approach. Don't hard sell; just explain truthfully, sincerely and concisely. Usually, this will begin to reduce their fears."
Take the Time to Develop Trust
Wayne Whalen of California believes that taking the time to develop the patient's trust is key to calming certain fears. He writes, "There are no 'quick fixes' for dealing with apprehensive new patients. Everything about their experience, from the reassurance they get on their first phone call, to the office decor, to how they are introduced to staff and the doctor affect their perceptions and their comfort level. When I sense some apprehension, I let my new patients know that 70 percent of my new patients have never seen a DC before, and they are all nervous. This not only validates their feeling, but reassures them that they are not alone, and that I recognize their issue.
"I tell them I won't surprise them or sneak up on them, and that I'll tell them everything I am going to do, and why, before I do it. Then I do just that, in conjunction with a very thorough physical examination. I discuss what I think is wrong and why, and how I would approach treating it, but I also always give them options.
"I help them understand the relative risks and benefits, and in terms of manipulation give them options: some want more hands-on diversified treatment. Others need a visit or two to get more confident or trusting, and I can offer them soft tissue, Activator, drop-table or other approaches," Whalen said. "Once they see that I say what I mean and mean what I say, they are much more receptive to the bigger picture about chiropractic, and much more likely to follow through with my other recommendations. Bottom line: treat your patients the way you would want to be treated."
[pb]Clear Communication: Explaining What to Expect
Charles Clement of Quebec, Canada believes showing the patient what to expect helps ease their fears. He writes, "I work with an open-door policy. Many years ago a new patient was watching and when she saw a five-year-old come into the office, press the button and the table went down, watched me give the adjustment then pressed the button to come up, and then leave, the new patient told me how frightened she had been but when she saw the little fellow so unafraid, she lost her fears.
"I use the Activator technique and have for 20+ years. As a result of the above new patient, I invite all new patients to come into the treatment room, with the permission of the patient on the table, and explain what I am doing, how the Activator instrument is used, demonstrate it on their hand and go about the treatment. Patients are delighted with the approach, and only one person in about 15 years has asked for the door to be closed (and no, I could not invite the new patient in to watch). As there is no undressing, people are not shy and are quite pleased to share their experience. It takes a few extra minutes, but then I'm not concerned with rushing."
Keep Lines of Communication Open
Frank Lanzisera of St. Louis writes, "New chiropractic patients may not understand what doctors of chiropractic do or fear that chiropractic treatment will hurt. Excellent communication is the key to quelling the concerns of apprehensive patients who want assurances that their concerns and questions will be thoroughly answered in a well thought out, caring manner. The combination of caring staff members who communicate that they are there to help and a thorough, caring doctor make an unbeatable chiropractic patient team.
"Alleviating the apprehensiveness of new patients begins with a staff member explaining that before any treatment is actually initiated, the doctor will perform a thorough history and physical examination, with a specific emphasis on the function and motion of the spine, to determine if they have problems that are responsive to chiropractic care. This should include a thorough recording of the patient's blood pressure, pulse, height and weight, as well as an evaluation of reflexes, posture and strength, which are components of an examination that all doctors perform. The motion of the spinal joints will also be tested to see if each vertebra in the spine can move in the six directions of flexion, extension, left and right lateral flexion and rotation. In addition to lab work, X-rays may be taken in certain cases, if indicated by the physical examination.
"After completing the initial history and physical examination, patients should be informed that when they return for a second visit, once the doctor has had a chance to review all of the information from the examination process, a report of findings will be presented. During this second visit, the doctor should explain the diagnosis and examination results including results of radiographic and lab tests. The DC should also explain the recommended type of chiropractic treatment, as well as its goals, length and frequency, and the benefits, risks and alternatives of the proposed treatment.
"Before the patient is given a spinal adjustment, the areas of the spine to be treated should be pointed out to the patient on a model of the spine that is placed on the adjusting table. I like to tell my patients that each time I see them I will check their spines to feel how the motion is improving and teach them to feel the difference between the abnormal "stuck areas" and the normal, freely moving areas. In this way, they can understand why a series of spinal adjustments to restore function is needed and what cavitations noise associated with a spinal manipulation represents. If any physiological modalities such as electrotherapy, heat, cold, traction, Graston technique, and/or ART are recommended, these options should be thoroughly explained to the patient regarding their physiological effects.
"When apprehensive patients comment that they have never been examined so thoroughly by any other doctor and leave the office with a smile and reduced pain, chiropractic physicians know that they have done their jobs well and have initiated the creation of a doctor/patient relationship that will last a lifetime."
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