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2 Part Consult ?

Exit forum ID Forum Discussion 2 Part Consult ?

This topic contains 5 replies, has 2 voices, and was last updated by   Carl Nottoli, DC October 19, 2018 at 8:36 am.

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  • #4922

    Adam Holen D.C.

      When doing an initial consult, I’m comfortable explaining to patients the purpose of today and what the next step would be if they’re a candidate. Take the 7 first order and any potential 2nd order that I may need right away (if things aren’t quite adding up).  My question is how do others close the consult?  I generally finish with “This is what I like to see, your problem is musculoskeletal, so you are a candidate for an exam.”  What else, if anything, should or needs to be said?  I find myself rambling too much about what the exam entails and even adhesion if they ask.  I feel like this is a situation where less is more and that I’m saying too much, making it look desperate even though it’s a qualifying visit.  I’m looking to say less and say it better to keep the excitement of being a candidate and not watering it down with detail, like a follow-up visit 1 min to recap/close.

      I’ve also had my front desk call self-discharge patients to (politely) figure out if they’re in or out.  If they say they’re good or we leave a voicemail and never hear back, we make a note in their file so if/when they call to get back in, it starts with another consult.  I have yet to do one of these, but the purpose is to protect my reputation for people that “tried” it, felt better and left or didn’t give it enough time (that’s on me for communication).  Trying to minimize any negative or even neutral word of mouth in the valley.  This consult is not for qualifying their problem, but more so making sure they’re serious this time around.  Are there any best practices or ways to explain the importance of seeing the treatment plan through? Again, I’ll take all the blame on not communicating progress/value, but there are plenty of patients that just flake for other reasons (money, time, vacation, no pain, etc.) which are the ones to go “ya I tried it and it was meh or didn’t work.”  Would the blood pressure/medication analogy be of value, explaining you don’t stop taking the meds just because you’re no longer dizzy? That their problem is likely to come back and worse if we don’t finish care.

      #4924

      Brandon Cohen DC, CSCS
      Participant

        I hear you on the first part. It has been an odd transition. Remember that you are setting them up for what to expect on that first visit when they schedule with your front desk, when they arrive at the office, and when you walk in the room. That’s 3 times. If they are expecting more than a conversation to determine if they are a candidate for the exam, they are missing a lot of signals.

        I usually end basically the same way you have. I’ll review the pertinent information by telling them their story back to them so they know I understand it, and say, “This is the type of thing we work with all the time, you are a great candidate for the exam.” Or, “A lot of what you have said sounds like what we work with here, let’s get you back for the exam to make sure.” Then end with, “We’ll talk with Ashley at the front to get you scheduled.”

        I’ve only been doing them for a month, and had one person cancel the exam. If I want to give them a chance to speak, before I tell them if they are a candidate or not, I’ll ask if there’s anything else they think I should know.

        As far as the follow up consult, I’ve questions. Are these people who have not had an exam? Are they people who did some treatment? If so, how much?

        I’ll typically do a new consult if they haven’t been in for 9 months and are coming in for a different complaint. If its the same thing, I’ll schedule it as an exam, which allows for time to cover the diagnosis again and make sure they understand that we won’t be participating in a failure, and we will either do it right or not at all. Not sure if any of that is good or bad, but its my current scenario.

        #4925

        Seth Schultz, DC
        Participant

          We’ve just started implementing asking a simple question like “what is your biggest concern with your problem?”. That seems to be doing very well so far and they almost feel relieved that someone is actually listening to what worries them instead of just collecting data.

          I like to end my consults with “I like what I am hearing, you’re definitely in the right place. What worries me is you have signs of a muscular problem but also an underlying (example) joint problem. We will know more about both of those when we do our exam. The exam consists of tests that compare where your x body part is and where it should be to be pain free”

          #4926

          Adam Holen D.C.

            Appreciate the responses, both very helpful. I’ll try to keep my initial consults more concise and have the front desk own the concept on the phone, in office, and after the consult.

            As for the washouts, everyone has done an exam and generally gets to about 3-4 visits in, but from then on it depends on the patient. Again, I need to step up my communication by showing them the map and emphasizing the value, but regardless most drop out because they either feel better or think it’s like a regular chiro and they can just come back when they have pain. I’ve run into a lot of people who are/were excited, but had a vacation or were gone for work and didn’t follow up again. So my goal is to own that this is different and not how we operate, but I want to handle it in as professional of a manner as possible.

            My focus is primarily on getting new patients and people who need this to start fresh, but I don’t have as big of a pool as more rural areas for turnover to keep the numbers up and growing. Admittedly this is personally frustrating because I know there are areas I need to improve on that will help with this issue. Was just curious how others handle patients who flake out (for whatever reason) and then want back in.

            #4927

            Michael Vibert

              I agree Adam that there seems to be some awkwardness closing out a screening consult. I’ve had my best success by saying some thing like “everything you’ve told me here tells me that your problem is musculoskeletal. That’s good news because I have a really good success rate in fixing musculoskeletal problems. The next step for you now is to schedule an exam and diagnosis consult where we will find out how complex your case is and what it’s going to take to fix it”.

              Also if I can sense that they are somewhat uncomfortable with the next step and why we are closing out the consult there, I sometimes tell them what my next steps are: Reviewing their case, developing a diagnostic list and coming up with a plan of action for their exam. It’s pretty hard to argue or be disappointed that someone is going through so much effort to get to the bottom of what is actually wrong with them.

              Oftentimes people will ask “what do you do to actually fix the problem” and this is where I’d like to hear what other clinicians say. It feels wrong to me to talk about adhesion here because that pre-supposes they have adhesion. And before I examine the patient I really should be totally objective and not colouring my exam by going on a search for adhesion.

              #4928

              Carl Nottoli, DC
              Participant

                Really great responses so far.

                Michael to your last questions about fixing the problem. “We need to discover what your diagnosis is before we talk about treatment options.”

                Again, any level headed person that has already failed other providers that rush the treatment process will understand that makes perfect sense.

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