The report of findings: Time to "show and tell." First, a chiropractor has an obligation to tell the public whether he is a musculoskeletal chiropractor or an alternative form of health care doctor. The report of findings will be different based upon the type of chiropractor you are. I am a subluxation-based chiropractor (alternative form of health care), so that is what this report will deal with.

A report of findings is a business meeting with a person about his or her health and should have an agenda, as all meetings should. You run the meeting, so it is your agenda. Plan it, think about it, and discover what works for you and what doesn't. As with all important meetings, you should not be interrupted, and the tools you need during the meeting should be prepared and easily at hand. My agenda is this:

• Understand. I let the patient know I understand his complaints or concerns and current situation.
• Cause. I relate to the person whether I can or cannot help him, and I explain what I believe to be the source of the problem.
• Options. I give the patient the benefits/risk of my recommended treatment and give him a realistic time frame for some demonstrable results.
• Questions. I answer any questions and ask if he would like to begin the recommended care.

Let's discuss each of these individually as well as discuss some tools I use to help me with these agenda items.

Understand

Letting the person know you understand his complaints sounds simple enough. It could simply be a reiteration of what the patient told you during the exam or what you read from the patient intake form. That, however, would be just a test of your listening abilities. It's akin to when your spouse says, "What did I just tell you?" That simply shows whether or not you were listening, but not that you understood what they were really saying.

To show patients you understand them, you will have had to already figure out their personality type. The Masters Circle and other practice-management groups are quite good at teaching you how to do this with a patient. It is not hard to learn, but it is a requirement if you plan on having effective communication, especially with an apprehensive patient.

For example, if I am talking to an "expressive" person, I am going to review their complaints, whether headache or dysmenorrhea, with words containing extremes such as, "awesome, crippling, overpowering" and other expressive words. For a "drivers" personality type, I might say, "I understand the headaches are severe and disabling to the point that you cannot complete your necessary tasks to keep your life on track. I think that is unacceptable, and we will begin helping you with that problem now."

Understand, this is an effective way of communicating with them, not an attempt to manipulate them. Remember that your ability to help them with any problem depends a lot on how much they like you. They will like you the more you are like them, or someone they want to be. Speaking their "language" is a must for effective communication. If you have been in practice for more than 5 minutes, you find that you click with some patients and don't click with others. This clicking is all a matter of your communication skills. So get into this and let them realize that you are right there with them and understand them.

Cause

At this point, you will tell the patient that he does, or does not, have a chiropractic problem. If you cannot help him, refer him out. If you are a subluxation-based chiropractor, you have a duty to explain to him the results of his subluxation scans, even if you cannot find any relationship to the problem he came in with. I have had several patients come back to the office years later with their scans in hand saying, "You told me I would be back someday to get this fixed."

If you believe you can help him, it is time to talk to him about what is causing his problem. I find it much better to let him discover it rather than tell him. A scan of the nervous system and an EMG of the paraspinal muscles make this seemingly extreme task very easy. I use the Insight Subluxation Station by Chiropractic Leadership Alliance. I like CLA's commitment to the advancement of chiropractic, as well as what I believe is a superior product.

The Subluxation Station has range-of-motion testing and other options for more advanced diagnostics.

The subluxation scan should be presented in several ways. First, I like showing it to the patient on a flat screen that swivels right in front of him from the wall. I review it with him briefly, something like, "Red is real bad, blue is not good, and green is not right. White is what you want." I again throw in the words to match his personality type. Give him a second to really look at it. At this point, I pull a printed version of his scan from a Patient Media folder made specifically for these tests. The folder explains all the details of the test for the "analytical" and has pictures for the "expressive."

Please, please, please use some sort of folder to hold the scan. It takes a sheet of paper and makes it a report. Anything that has been given to you in your life that is important comes in a folder. Also included in the folder is the chart from Patient Media that shows the spinal nerves coming off and the appropriate organs that the nerves correspond to. Back Talk Systems has a full spine real size chart that is also fun to use but does not fit in the folder.

I take out a highlighter and highlight the organs that have moderate or severe neurological disturbance going to them, and I will say, "Do you still have these organs?" A lot of times they don't, especially if it is in the reproductive area. "That explains why the nerve is upset," I tell the patient. If the patient is getting it, you can also ask, "What came first, the bad nerve or the diseased organ?" If he says that they do have the organs marked, I ask him if he is having problems with the function of the organs. The majority of the time the patients do.

If not, which is rare, I ask him to be acutely aware of the function of these organs, because as you can see, they are not getting the proper nerve input they require. You see how easy it is with a subluxation scan to take chiropractic from the back pain/bone model to the nerve function/alternative form of health care model. I'm not sure how you would do it without a scan. Further discussion shows aggravated muscles (again in red) and any muscular imbalance shown with graphical longitudinal bars. Simple, quick, and effective. The Subluxation Station also has range-of-motion testing and other options for more advanced diagnostics.

X-rays are a nice touch if you need to rule out contraindications for adjustments, but I believe they are becoming less of a requirement in subluxation-based chiropractors' offices. I would much rather have a Subluxation Station than an x-ray machine in my office, and in fact I only have the Subluxation Station. I only show patients their x-rays to point out the long-term effects of subluxation on the joints. I refer out for x-rays probably about 50% of the time. I have been on the Delaware Board of Chiropractic for 12 years through reappointments and a second appointment by the governor, and have never seen a complaint for "failure to x-ray." But I have seen many about the quality of the x-ray, the cost of the x-ray, or even missing something on the x-ray. If you do x-ray, use the newest technology, preferably digital. I saw one advertised by Bennett that has a digital system for $58,000 and can even plug into 110 volts. Also, consider having your films read again by a chiropractic radiologist.

Chart Their Progress

Here is where models, charts, animations, or tasks are necessary to graphically demonstrate a subluxation. I have seen frayed wires, high-tech computerized graphics, and colorful posters, all of which are good. Dave Majors, from Majors Marketing, twists the patient's finger just a bit while flexing and extending it to neutral, causing minor joint pain and discomfort. He then returns it to neutral and flexes it again while saying, "See how it feels and functions better because it is in the correct place." It explains the pain, muscle twisting, and even nerve destruction.

Options

For more on patient education go to the November 2007 article titled, "Posture: The Snowball Effect."

Now I like to talk with the patients, again in their language, of the risks of not adjusting the subluxation. All too often, we discuss the minute risk of having a complication from care, when we all know that the real risk is if the subluxations go unadjusted. I am happy to share with the patient the cost of my malpractice premiums for a year if they are an "analytical," or that everyone else in the world is getting adjusted if they are an "amiable." It is important to continue to speak their language.

Questions

Now is the time for the patient to ask you any questions they might have. If you have done your job well, they will and should have some more questions. I find that if they do not have any questions then I spoke too much or they did not get it. Two questions from them is my goal, preferably about the subluxation scan. They are, "When will I get rescanned?" and "Can (insert name here) get scanned also?" My answers are that we will perform a rescan in 6 to 12 visits, and that anyone can be scanned by setting up a subluxation screen appointment at the front desk. Then you get to ask the best question, "Shall we begin?"

Now that the patient has accepted care, the real education begins. Rescans of his nervous system and muscle system will show him the effects of my care. These rescans will allow me to discuss his emotional, chemical, and physical stresses with him, and show him how they affect his health. It is the introduction to the chiropractic lifestyle, or the chiropractic health system as I like to call it. The rest of the report of findings will take place every time they come into the office.

A report of findings is an important meeting where everything matters. It is important for the patient as it is probably the first time that he has heard of a subluxation. If you believe that subluxation is a serious detriment on the health of an individual, you have an obligation to use all the tools and capabilities within your means to demonstrate this effect. You are, quite possibly, saving their life.

Trent Camp, DC, practices in Middletown, Del. Contact him at .