The Consultation

The Consultation


By Phil Mancuso, DC

By now you should have realized the importanceof an organized, canned, planned procedure in dealing with your patients. The consultation should follow in a similar manner. This is an important time in the establishment of the doctor-patient relationship, when the new patient has been left alone in the exam room awaiting the arrival of "thedoctor."

The patient's mood will have been set in a very comfortable and receptive way, to accept the doctor favorably. The doctor will wish to convey sincerity and honesty in a friendly yet professional manner.

*Note: the doctor reviews patient data forms before entering exam room, tucks clipboard under his/her left arm, and extends a warm, firm, sincere handshake to the new patient.

DOCTOR: Hi, Mrs. Jones, I'm Doctor________. I'm really happy to meet you (and mean it!) Who referred you to our office?"

PATIENT: I read your ad or saw your name in thephone book, or, I was just passing by and saw your sign.

DOCTOR: Well, Mrs. Jones, that's very unusual. You see most of the patients who come here are referred by other patients who have been satisfied with the results they have gotten here.


If patient states Alice Smith referred her:

DOCTOR: (compliments Alice again, makes a common bond with the patient) "Have you ever been to a chiropractor?"

PATIENT: responds with either "no, I haven't, or yes, I have."

DOCTOR: Well, you see, we work with the spine and the nervous system, and if you have any vertebrae out of position which may be pinching any nerves, then we may be able to help. The purpose of today's visit is first to find out your complaint, then to determine if yours is a Chiropractic problem. If it looks like we can help you with the underlying cause of your condition, then we will (with your cooperation) do everything we possibly can for you. If we determine that yours isn't a chiropractic problem, then we will refer you to the proper specialist so that you can get the help you need. I hope we can help you!

(look directly in patient's eyes as you say this and look for signs of patient diverting his eyes. Generally, if the patient looks right back at you and says, "yes, I hope you can help" then you may fairly safely presuppose that the patient really wants to be helped.)

*Note: if the patient looks down or away, you have a good indication that this person may have a no-help attitude, that is, he may not really want to get well,or may not want to cooperate. (His wife helped carry him in and he's much too macho to worry about this little pain!)

DOCTOR: Now, how can we help you? (let patient talk for about one minute.)

*Note: The doctor sits knee to knee, shoulder to shoulder with patient, and touches the problem area. For example, if patient relates a low back condition, ask questions about the immediate area of complaint, touch that area, then ask about organ problems which would refer to those spinal levels.

Remember: D.C. = dig for chronicity!

Now ask about any radiated symptoms: "Does the pain travel into your buttock or groin? Does it travel down the leg?"Touch - here or here? Touch the back above or below the main complaint.

DOCTOR: Have you ever had any pain, stiffness,or injury to this area? (go up or down the spine as indicated.) Lastly, ask if the patient has fatigue, tinnitus, etc. Ask rapid-fire questions. Is there anyone in your family that has a similar problem?

*Note: if the patient becomes wordy, it's always proper to interrupt him or her and ask about the specific condition. This may be done verbally, or by deep palpation of the painful area!

DOCTOR: Well, Mrs. Jones, it sounds like you certainly may have a chiropractic condition. What I'm going to do now is a thorough physical, orthopedic, postural, neurologic, and chiropractic examination on you to determine if we can help you.

The examination is now performed. It should be very thorough, and relevant to the patient's condition. It's helpful to have someone in the room to dictate to during the exam to save time and to get the patient used to hearing the names of the tests which are done.

DOCTOR: Now, Mrs. Jones, this is a Lasague test,and it usually causes pain if. . . This is a cervical compression test. We find this test to be positive quite often when a person has a problem with the vertebrae or discs in the neck, and may also be related to symptoms down the shoulder, arm or hand. Have you ever had any problems with those areas?"

Upon completion of the examination:

DOCTOR: Mrs. Jones, we've had some positive findings on your examination, and now we're going to take some pictures of your spine to see exactly where the problem is coming from.

*Note: if patient states any objections to diagnostic x-ray procedures, they must be reassured:

DOCTOR: Mrs. Jones, we wouldn't take any x-rays unless we felt that they were absolutely necessary, and in your case, your examination findings indicate that they are necessary. (If they really ARE necessary!)

After the x-rays are taken:

DOCTOR: Now, Mrs. Jones, I've completed your examination, and taken your x-rays and we need some time to go over our findings so thatI can make my recommendations in your case. As I stated previously, if we can help you, we will, and if we can't we'll let you know. Remember we share a common interest: your health and my reputation, and I wouldn't want do anything which would jeopardize either one of those things.

(look patient right in the eye again:)

DOCTOR: I hope we can help you!

Oh, by the way, when you return and we give you your report of findings, you need to bring your husband along so he can see what you've been going through. There will also be some instructions for you to follow at home which he may need to help you with if we accept your case. Now that will be thirty for the exam and fifty for the X-rays, and you can take care of that at the front desk. (Don't let the patient be unpleasantly surprised at the front desk. Let the patient know that you know what is expected of her right from the start.

(Don't shirk this responsibility.)

DOCTOR: Lucy will help you at the front desk.

Now the doctor offers another warm, friendly, firm handshake and says:

DOCTOR: Mrs. Jones, it was a pleasure meeting you,and I really look forward to being able to help you. Good-bye.

*Note: if the new patient is having an acute problem, then some kind of first aid or symptom relief care may be given, but only after much explanation:

DOCTOR: Mrs. Jones, we re going to bring you into one of our treatment rooms right now and put some (....) on that back of yours to (name the desired effect). Now, this is merely to help relieve your symptoms temporarily, and will not correct the underlying cause of your condition. (Obviously, if you don't use therapy, skip this part.)

You may also give instructions for home and give the patient something to do until the report. In the rare instances where the patient gets an adjustment on the first visit (patient has had previous chiropractic care in your office or another office, etc.)

DOCTOR: Mrs. Jones, we're going to make an adjustment of this bone to see if we can give you some temporary relief. You may get some temporary relief, but your symptoms may come back and possibly be worse for a while, so please be careful and follow my instructions faithfully.

At this point the new patient is escorted back to the front desk, money is collected, forms finalized, and the appointment is made for the report of findings. The report should be as soon as possible (usually one or two days) except in special cases as determined by the doctor, or in case of extreme pain on the part of the patient.

When the new patient returns to the front desk, CA states what was done then quotes the fee for those services. That was 30 for the examination and 50 for the x-rays, Mrs. Jones. Never use the word dollars. The CA should then look the patient squarely in the eye and say:

CA: Will that be cash, check, Visa or Master Charge? Accepting credit cards works out well for you and the patient. (See our booklet The Cash Practice Made Easy for details.)

The new patient is instructed to bring insurance forms in on next visit, and is reminded that he will be responsible for his charges until insurance eligibility is determined.

If worker's compensation is involved, the patient is given an authorization slip to be signed by the supervisor authorizing the insurance company to pay for services rendered.

The patient must sign an 'authorization to payphysician' form and any other necessary insurance forms at this time. This is to aid your insurance department in the efficient handling of claims.

If the patient is eligible for Medicare, have them sign the Medicare coverage letter and tell them that we will send a completed claim form in for them, and that they will be reimbursed directly. We do not suggest the acceptance of assignment on Medicare, due to the low rate of return, however, this may not hold true in certain cases.

If a patient has insurance coverage, have them fill out a claim form to submit for x-rays. The CA gives the new patient any pamphlets, lab slips, etc. that the doctor has checked off on the travelcard and checks them off on the card. Be sure to make copies of all labslips, back-to-work notes, etc. The CA makes the next appointment for the report and reminds patient to bring his or her spouse (if married) and closes contact with new patient by restating date and time of next appointment.

Introduction to Office Procedure | The Consultation | New Patient Procedure- First Visit | Sample Telephone Script

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