Example of: The Four Day Report of Findings

By: Dr. Timothy Gay

fter years of doing a 15-20 min ROF with times changing toward cash and doctors not having the

balls to confront patients and their issues I have decided that the best way to do a report of finding is over a period of 3-4 days to build trust , a relationship, and get a result with the patient. That way the person has a much better understanding of the care that you want to give them, they understand why long term care maybe necessary, they are also

feeling better as time goes with the adjustments that they are receiving for the duration of the ROF. There are five questions that need to be answered for the patient, for them to understand why they should come to you for care and continue to a wellness program. These are the five questions that you need to answer if the patient is going to want to continue to have you as their doctor of choice. 1) What is my health problem? 2) Can Chiropractic help my problem? 3) How long will it take to fix my health problem? 4) How much will it cost? 5) How much will my insurance cover. There are a few things that you need to

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have in order to educate the patients for the need of their care. These are posters that you should have in your ROF room Forward Head Translation, The Road to recovery, large posters of the stages of degeneration from normal lateral cervical thru the various stages of degeneration, the Chart of Effects, and are you De-evolving. Purchase a pre report DVD that is called The Big Idea or one that is called Welcome to Chiropractic Pure and Simple. It is important the patient understands the basics of what chiropractic is and what it is not.

Day 1: The report of findings is done on the following day after the consultation, examination and the x-rays were completed on the patient. The x-rays are

up in the view boxes or if you are forward thinking enough and have a digital x-ray unit they will be viewed on a big screen TV. The patient has watched the pre report DVD and understands the basics of Chiropractic and is waiting to find out more about why they are having the health problems that have brought them there. After coming in and reintroducing yourself to the patient. It is important that the patient understands the findings, of the tests, such as any positives on spinal range of motion, touch and tell with palpation, any orthopedic, neurological or chiropractic testing that has been performed and the seriousness of each of the test performed for their health problems and

conditions. The first thing to do is go to the illustration of the normal x-ray of the cervical spine and give the patient a complete explanation of what normal looks like, the cervical curve, the angle of atlas, spacing of the discs, the space between the atlas and occipital regions. After the

patient has an understanding of what normal looks like, you show them their lateral cervical x-ray and ask those questions about it and have them tell what the differences are between the normal and their x-ray. This is where we reintroduce the term subluxation and give them an accurate understanding not only how subluxation maybe effecting their health, but a dose of Philosophy 101 eg. The safety pin cycle, innate intelligence, the body is self

healing if given the opportunity if you have any or know any philosophy or the definition of your practice, so the patient understands the type of care they are coming to the office for. Next we talk about the term “spinal decay” and how that has long term effects due the actual breakdown of the bone, causing wear and tear on the joints. The next poster to be reviewed is the forward head translation poster to determine how much forward head tilt the patient may have and how these problems maybe contributing to their overall health. If the

patient has low back issues go over the x –rays as well to give them an understanding that this issue is also being addressed. After explaining the x-ray findings the patient is then told that over the next few days you are going to adjust them to find out how much corrective care they are going to need and to help them to understand better their condition but most of all start making some spinal correction to alleviate their health problems. Ask at this point if there are any questions that need to be covered before you go to the adjusting room. In the adjusting room the patient is then laid down on the table and you start to check them. The conversation then goes to asking a few

questions, the most important one is, how long do you think this spinal decay and health problem has been going on? This question can go 2 ways, the patient may think that it just happened or they understand that this has been going on for a long time. The answer boils down to cause and effect, structure and function rather than just pain relief. During the

consultation the patient may have talked to you about past injuries or accidents, this is a time when it is important to do a great consult so that you can explain to them why long term problems may need long term care for restructuring and rehabilitation to get back to being healthy and more productive. Give them a pamphlet talking about 6 reasons why they should utilize chiropractic. Make sure that this being their first adjustment to give them a full explanation of what you are doing and why. This is the patient’s first opportunity for care so you want to explain that they may have some soreness or they may feel great. Let them know that you will be calling them tonight to see how they have responded to their first adjustment. Let them know that if their partner in health could not attend the first visit of the ROF it is important for them to be involved with their care and to understand the need for extended care. At this point after the adjustment and clarification with the patient that they will be back in tomorrow for the continuation of care and further discussion the patient then goes out to the front desk and the CA set the patient up for the next 3 consecutive adjustments.

Day2: When the patient arrives back for today’s adjustment they are put into the adjusting room. When the doctor comes in, he first asks the patient if there are any questions that need to be answered before the adjustment. This gives the doctor and opportunity to further explain the mechanism of the adjustment and what happens and why they may be feeling better or worse. At this time the patient is put on the table for their second adjustment. At this time the next question is asked and that is, how long do you think it will take to fix this problem? Once again the question can be answered in two ways, the patient may think that it won’t take long or they will have an understanding that this may take a while to change, restructure and rehabilitate the problems that were reviewed on the x-rays. This gives the doctor another opportunity to tell the patient and reiterate the importance of the care they are receiving for the health problems that they have and the fact that in many cases such as theirs that it may take several months to restructure and rehabilitate the spine and alleviate the subluxations that may be causing many of their health issues. They should understand the difference between getting out of pain and the commitment to get their health problems resolved. The patient is then adjusted and sent back out to the front desk to make sure that they are scheduled for the following day.

Subluxation Degeneration Normal Spine Phase 1

Phase 2 Phase 3

Day3: The patient arrives for their third adjustment and is sent back into the adjusting room. The doctor comes in and asks if there are any further questions that the patient may have pertaining the care and adjustments they have been receiving. After all the questions have been answered, and the patient becomes more and more understanding as to what the doctor is doing, the questions should become less and less. The next question that is asked to the patient is about what they want to achieve as far as the health goals they may have for themselves. This is where the doctor understands what kind of goals they have for themselves based on long term or short term health and wellness. This a time when the doctor talks to the patient about patch care and fix care and the importance of getting the problems taken care of and the need for a wellness program to maintain good health. The idea at this point is to show the patient that the improvement that they have received over the last few days is the beginning of not only feeling better but the consequences of not continuing care and losing what you have already gained in this short period of time. Patients who truly get the significance of your care are in for the duration of care, those that are not ready for long term care or recommendations, still need some understanding and may be looking at an alternative to a long term recommendation. After hearing about the recommendation, it is important for the patient to understand their care beyond insurance coverage. We know that generally patients need more care then their insurance will cover. There is a deductable and a co-pay no matter what type of health care patients want to use it strictly boils down to how much they are willing to pay out of pocket and more importantly what kind of significance

you as a doctor puts on the care not just the number of visits but the cost for the patient. Your care is very valuable, however if you have a hard time believing in the amount of care or the cost of care so will they.

Day4: The patient is back in the ROF room to make decisions about where they want to go with their heath and it is up to you to help this patient make these decisions. This is the final day of the ROF, the determination of all of the x-ray findings, the recommendation of care, the financial consultation, the calendar of care, and moving forward with the patient. After gathering information, and having the opportunity to adjust the patient, build a relationship and show that they are gaining results from when they first came in, it is now time to sit down and discuss where the patient wants to go with their care and be ready if necessary to give the patients options on the

recommendations that you will be making for the patients in the ROF. This is when both the doctor and the patient have to believe in the care they are recommending and the care the patient will be receiving. At this time the doctor will review the x-rays more thoroughly with the patient and talk to the patient about long term problems reiterating to the patients the answers they gave to the three questions that had been asked over the past three days that the patient had come in for their adjustments. The patient at this time should have their questions answered and is now showing signs of improvement from the adjustments given by the doctor. The doctor asked the patient about any concerns they may be having concerning the treatment that they have been having and then goes into the three types of care they can receive. The long term plan is presented first and lays out the entire care the patient will need to regain their full health potential and that plan is based on the findings in the case. All patients need to understand that that their care is over their lifetime due to the fact that their problems in most cases have been long term. A plan is 3x a week for 3mo, 2x a week for 3mo, and 1x a week for 3 mo. Explain that during this time you will be doing reevaluations, adding stretching and

strengthening programs to help the restructuring and rehabilitation process. This will help to determine how soon we can start dropping their visits in their care plan. Let them know that has they reach 40% measured improvement based in finding not feelings. Then we can

start altering or rearranging their care plan it will depend on them to do what is necessary to get better. Once they reach 60% and continue to improve there is another opportunity to drop their care further.

The Script: Day 1 Report Room

ary nice to see you again, today you and I going to talk about what we have found during the

consultation, examination and x-ray findings particular to the problems that you have been having, it is obvious that they have been there for a while and that the pain that you are experiencing has gotten bad enough that now it is time to do something about it. (Depends on if the problem

is recent such as acute or something that has been bothering the patient for a long time. Alteration is talk to the patient in terms of an injury which changes the conversation but only slightly. It is obvious that this is something that has just happened but serious enough that it may take a while to recover from.) Today, I want to go over your findings and give you an understanding of what is going on and how you got here. Let’s talk first about the problems that brought you here. (The findings from the consultation) after a quick discussion and a review of the conversation the following will go like this: eg. It is obvious that some of the issues you have are affecting your health;

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your ability to sit, stand, play with your kids and really just have the ability to enjoy life is being hindered by what we had talked about yesterday. We are going to go over your x-rays, examination and show you some normal examples and educate you on what is normal and what is not and what has happened to you over a period of time. Let’s first look at this actual picture of an x-ray and let me explain what we are looking at. This is an x-ray of the cervical spine or neck and as you can see there is a curve that allows the skull to sit over and on top of the neck and gives support to the skull and allows you to move your head into a variety of positions. Two of the most important vertebrae

are the atlas or the top bone in the neck and axis which is the second bone in the neck. You can see the amount of space between the top bone in the neck and the base of the skull. Whenever that is crowded or out of alignment that is called a

subluxation and can cause nerve interference throughout the entire body. The top bone is just below where the brain and spinal cord come out at the base of your skull or foramen magnum. As we look at the normal you can see that all of the bones have even spaces between them and there is a normal natural curve that helps to cushion the neck in case of injury or whiplash due to an accident. Without that normal curve and the fact that with injuries, aggravations and time, there maybe signs of degeneration that shows up as wear and tear to the

bones the joints and the disks that we can keep from progressing by putting more mobility into your neck. So now that you know what normal is you tell me what you see on your x-ray and let’s compare this to the normal x-ray. At this point Mary will explain what she see that maybe different and you can help her to understand that this is serious problem that needs to be corrected. Go over the rest of the x-rays with the patient and if there are other structural issues make sure the patient has a full understanding of the x-rays and findings. Mary it is

obvious that you have some serious problems that are going to take some time to structurally change the easy part is getting you out of any pain or discomfort that you have and move into restructuring and rehabilitation to create a higher level of function. As we go through this process over the next four days, we want to see some progress in how you feel, I will be able to give you a better idea as to how long it will

take, what it will cost, if we can fully help you with the problem, and how we can work on health goals that will make more of a long term difference in the way you feel. What I want to do is see you over the next 4 days and make a determination as to how we can help you. Do you have any questions that we have not answered for you? Let’s take you to the adjusting room and get you adjusted.

Adjusting Room: Well Mary, today I want to explain what we are going to do to help you get on your way to recovery. We are going to put you up on this table and adjust segments of your spine that we have looked at on X-ray and determined them to be out of alignment, what is the word we used Mary? Subluxation that is absolutely right I really want you to understand what that means so your friends and family have a better understanding of what is going on in your spine and nerve system. At this point quiz Mary on what a subluxation is. Mary, how long do you think this problem has been going on? Mary may say it just started or it has been going on for a long time. Well in cases that we

have seen that are similar to yours and the current research that is available it shows that the type of problem that you have has been there for a while it just now is to a point where it may be causing a loss of motion or some of the pain you have been experiencing. Sometimes it feels like it just happened but in most cases it has been going on for some time, we have a tendency to ignore it not realizing that by ignoring the problem there maybe long term effects that may not show up until later like with

smoking or being overweight. So we are ready to give you your first chiropractic adjustment. You may hear some noise as I adjust you; it

won’t hurt unless you are in extreme pain as I position you for the adjustment. This will help to alleviate some of the pain you are having but understand as a Chiropractor I am more interested in the structure and the function of your nerve system. Now that you have been adjusted you maybe better worse or the same, did you like the way I covered all the bases. I will call again tonight to see what category you are in and we say that because some people feel really good after their adjustment so they go out and do things that may re-aggravate the problems, others may not see any change, and then there are those that have a reaction or a change due to the severity of the problem. Let’s hope you are in the first category, so I want you to take it easy and I will call you tonight and we will see you tomorrow for your next adjustment.

Day 2 Adjusting Room:

Mary arrives and is sent to the adjusting room and the doctor comes in and asks Mary how she was responding to her first adjustment and the conversation may go either way and that is better or worse. You would then make a statement pertaining to the response and put Mary on the

table for her next adjustment. The next question to ask is, Mary , How long do you think it is going to take to for me to correct the problems that we have found? Mary’s response once again may be days, weeks, or months. You explain that the problems that she has, have been determined to be either acute, chronic, or permanent, depending on

what was found on the x-rays and the examination. With an acute problem that has just happened Mary has to understand that this something that has just happened and the duration of care maybe shorter than if this was something that had gone on for months or years and had never been taken care of, She also needs to understand that there is a healing process that takes place with time, repetition of adjustments and the

process of restructuring and rehabilitation. Even though this is an acute problem the patient should be educated that the type of care she may need to reach and stay at optimal health may be further prevented if

after the initial care is done and she has reached optimal health that she continues with a wellness program of maintenance care. After the adjustment it is important for Mary to leave with the understanding that even though the problem may be recent chronic or permanent that in order for her to get the full benefit of Chiropractic care she needs to look at it from a long term standpoint. Answer any questions she may have and dismiss her and have her back in tomorrow.

Day 3 Adjusting Room:

Today we want to discuss the value and the benefits of the care you are going to provide to Mary. Just like the day before you discuss the adjustment and use the same routine that was done on the previous day. After Mary is face down on the table to get adjusted and the question becomes. Mary what are some of your health goals that you want to achieve? Mary may say just to get out of pain and that is when it is up to you to dig deeper, Mary what about the ability to work in the Yard, pick up your children? Go for long walks, dance? Whatever the case is Mary needs to have some goals and a feeling that there will be some milestones through care that she will see as she improves. Mary may not at this point want anything to do

with long term care she may only be there for pain relief, however she must understand the feature s and the benefits of what you do as a Chiropractor and the type of care that she has been receiving The next question is designed to see what value Mary has on her health and the value she is placing on her Chiropractic adjustments. Explain to Mary that the features and the benefits of the care she is receiving will reap big dividends in her overall health and at the same time give her the opportunity to do things that she wants to get back to doing over the long run. Once again after the adjustment you explain the improvement that you are making and how much better mobility and her overall symptomatic picture has shown improvement after answering any questions have Mary come back tomorrow at which time you will sit down with her, go over all the x-rays, the examination and a full recommendation of care and financial consultation to give her a full understanding of what she can expect and where we are going from here.

Day 4 Report of Findings Room:

Mary is sitting in the ROF room and you walk in and greet her with: Well today is the day we need to make some serious decisions in your health care and where we will be going from here. Just a few days ago

we started to adjust some of the major areas of your spine that we found to be serious issues on your x-rays and the examination that we have performed. Well I think over the past few days you are showing some good overall improvement in some of the problems that you came in with. Let’s look at all of the x-rays so that we can give you a thorough explanation as to what we found. At this point reiterate the loss of cervical curve any changes that have taken place with degeneration, the fact that his has been a long term problem and that all these areas of misalignment are subluxations and then make sure you explain that as well. Now go back and ask Mary about the questions she answered for you and ask her how serious she Is about getting these problems corrected and say Remember when we talked on Monday about how long you thought this problem had been going on and then we explained what was happening and then on Tuesday we talked further about how long it might take for me to correct the problem and you said… As Mary answers these questions it important

for her to understand that this is a process and that we are moving through to optimal health go over the Road To Recovery Poster and let her know that the first phase is to beyond pain and moving from the red area to the yellow may take anywhere from 8-12 weeks

of 3x a week care and to move into the yellow phase may take 8-12 weeks at 2x a week and to move into optimal health is a commitment of 6-9 months of care and the last phase is once a week care for anywhere from 8-12 weeks, Understand Mary that if you want

maximum improvement for the type of problems you came to us with, you will want to maintain your health afterward it is crucial to go through these phases of care and get to maintenance. As we go through this process we will be monitoring your progress with revaluations, scans, stretching exercise strengthening and rehabilitation exercises that you can do at home, we have some classes that you can attend and only one of them is mandatory so you have a better understanding of what we are doing, and eventually x-rays to compare where you were to where you are now. So we have set you up with a calendar of care and we will start today and get started, Sally will be in to talk to you about our financial consultation and give you an idea of how our programs work and what we want to do as far as payments. As we talked about your health and where we wanted to go it is up to you as far as what we have discussed and we have virtually set this program for you based on what you and I have discussed. Do you have any further questions about what we are doing and where we are going? This can go one of 3 ways and that is that Mary wants to start care, is not financially ready for care or has to think about it. At which time the scenarios are based on your ability over the last few days to have those questions answered.

Sally’s financial consultation:

Sally comes in and introduces herself to Mary. She goes over the 3 plans based on optimal health (Show examples of the 3 plans) Wellness made Affordable programs Beginnings, Development, and Ultimate. She explains Ultimate Wellness first and uses the development and beginnings as fall back positions for care.