Communication, The Key to Practice Success

by Scott Heun, D.C.

 

            From the first contact with your office via the telephone to the first physical contact you have with the patient, you are communicating.

            Are you conveying the right message? Are you sensitive to the patient’s needs and wants, and are you communicating in a way that the patient understands?

            The platform you base your practice upon will determine your policies, and your clinical direction. As a CBP® advocate, I know that communication plays a key role in the management of the patient, from the first visit forward. What you say, how you say it and what you convey to the patient is critical to the success of the patient’s care. You do not want to destroy the patient’s opportunity for health and success in chiropractic care with inept verbal or demonstrative communication.

            Therefore, you must learn to deal with patients in a way that they can relate to as well as understand. The Total Practice Management© (TPM©) approach is to discern the personality style of the patient as soon as possible prior to extensive interaction in the office.

            Many authors have written on the subject of personality and communication. There are many varieties of categorization and systems on the “Business Section” shelves in bookstores from coast to coast. However, the book “Personal Styles and Effective Performance” by David W. Merrill and Roger H. Reid espouses a simple and easily implemented system which serves our purposes well as chiropractors and health educators.

            A simple breakdown of the four main personality styles is as follows:

            1. Amiable: Friendly, unassuming and easily approachable

            2. Expressive: Outspoken, the center of attention, “the life of the party”

            3. Analytical: Detail-oriented and focused upon every aspect of all situations

            4. Driver: The individual who is always right, and only sees the world through his or her own lens.

            The Amiable and Expressive personality styles are generally more reactive, and the Analytical and Driver styles are less reactive. In our application of these principles, we must realize that in some instances, wherein the patient is in extreme pain or stressed due to the functional challenges posed by their structural problem(s), they are in fact responding in an “emergency” situation where these further categorizations are of importance. The doctor who is sensitive to these factors has the opportunity to connect with the patient in a way that the patient understands and thereby, has an advantage in assisting the patient to better understand the chiropractic paradigm on their own terms.

            The phone rings. The “Front Desk” (receptionist, FD) answers:

Chiropractic Biophysics Office, how may I help you?

            Patient (P): I’d like to make an appointment to see the doctor.

            FD: When was the last time you saw Dr. CBP®?

            P: I’ve never seen him/her.

            FD: I need to get some basic information from you. Will you spell your name for me please?

            P: J-o-h-n J-o-n-e-s

            FD: Your street address, please.

            P: 123 Anytown, USA

            FD: Mr. Jones, may I ask who referred you to Dr. CBP®?

            P: Mrs. Smith

            FD: Ah, Mrs. Smith, she is a wonderful person. Would you like to see Dr. CBP® today or tomorrow?

            P: Tomorrow, if at all possible.

            FD: Would you prefer a morning or afternoon appointment?

            P: Afternoon...late afternoon, if you please.

            FD: 3:20 or 5:20 PM?

            P: 3:20 PM.

            FD: Do you know where we are located?

            P: Yes, across from the library.

            FD: Great, I look forward to meeting you in person tomorrow at 3:20 PM. Please allow 90 minutes for this visit, and if you have an insurance card, please bring it with you tomorrow. Thank you for calling, Mr. Jones.

            By the end of this call, in which the Front Desk has used a preprinted form to assist in gleaning the pertinent information from the patient, the Front Desk has derived an idea of the patient’s personality style. Obviously, the Front Desk must be trained to recognize the traits of each of the personality styles and their combinations. This is a learned skill that the doctor teaches the staff.

            The patient’s categorization is entered on the form (An, D, Am, Ex). In most cases, the patient is a combination of two or occasionally three personality types. The dominant style is written first (e.g. Am/An is Amiable/ Analytical and D/An is Driver/Analytical). The New Patient Assistant or the doctor, depending upon the hierarchical structure of the office, then approaches the new patient in a mild version of that personality style. This “softer” approach is used until the personality style is confirmed. Based upon the patient’s dress, mannerisms, and verbal style, a more thorough assessment of personality style category is achieved.

            All this thus far, is to prepare the doctor for creating a better first impression with the patient and to make the patient feel more comfortable. Once confirmed, communication with the patient can proceed in a much more efficient way.

            “Take the problem out of their back and put it into their life.” A simple concept. However, to fully address the effect of the individual patient’s problem, the LifeImpact Points© must be explored during the initial consultation. This information is simply noted. No teaching or additional comment is offered at this point in the process. Personality style awareness and mirroring is critical. The four basic categories to explore are:

            1. How the patient’s pain and or disability is impacting their ability to work.

            2. How the patient’s symptoms are affecting their ability to play or participate in hobbies or recreational activities.

            3. The effect this condition has on the patient’s relationships with spouse, family members, co-workers and/or clients.

            4. How the pain or condition is affecting the ability to perform household chores.

            The art of this “Socratic Method” of questioning is one of a number of skills which are part of the TPM© coaching program. These techniques are utilized in The 5 Minute Report of Findings©, MicroReport© and MicroReferral© as well.

            After obtaining the ever critical LifeImpact Points© from the patient and creating a positive first impression, the postural, ortho/neuro and radiographic exam can be completed.

The 5 Minute Report of Findings© can then proceed. By now, you realize that all the information gathered up to this point has, in a way, been to set the stage for you to present this most critical information to the patient in a way they can understand. It must be delivered in a simple, concise way that is sensitive to personality style in order to be most effective. This is not a sales job. It is an honest presentation of facts and options for dealing with the problem the patient presented to you.

            The patient wants to know the answers to five questions, which they will not always ask; yet you must always anticipate them and answer them by default.

            1. Did you find out what is causing my pain or what my problem is?

            2. Can you help me?

            3. What are my options for dealing with this?

            4. How long will this take and how much of my time is involved?

            5. How much does it cost? And does my insurance cover this?

            With the “Analytical” you might choose to use more references to details, numbers, percentages of loss of curve and the like. With the “Driver” you are best to be straightforward and avoid generalities. The “Amiable” will want you to be “soft” and caring in a demonstrative way, and not to emphasize the severity of the condition. The “Expressive” will be even more sensitive. Generalities are often best in order that you not alarm them or stimulate their “more reactive” nature.

            This is not a time for education, rather a time for presenting options to the patient which focus upon the simple questions posed by the initial examinations performed.

            The LifeImpact Points© will often become important here for purposes of focus, prioritization or reprioritization by the patient. You may need to reiterate the patient’s subjective complaints and their effect upon their work, play, and relationships. Remember, take the problem out of their spine and put it in their life, so to speak, in order that they avoid minimization of their problem. Remember also that there may be a bit of stress associated with this report of findings due to the necessary sensitivity to personality style and the patient’s body language and attitude.

 

            The patient ultimately decides upon a course of care once presented with the options you have derived from your Chiropractic Platform©.

            You will, in every encounter with the patient, employ his or her personality style. When you adjust, the MicroReport©, success will hinge upon your ability to communicate in the patient’s Personality Style and ultimately your overall versatility in dealing with multiple patients and multiple personality styles during the day.

            This article is in no way intended to make you an expert in the art of patient communication. It only serves to emphasize the importance of these skills to the overall care of the patient in a CBP® office. The patient will never give you the opportunity to help them if they do not understand why they need to stay with you after their pain is gone. You need every possible advantage in communicating with the patient to encourage them to stay the course with their care to achieve the structural changes desired. The art of patient communication is one way to “stack the deck” in your favor to help more patients regain their health with chiropractic care. Utilizing these techniques every day in practice has helped me to deliver much better care to my patients. I am sure your practice will benefit as well with diligent attention to this important skill.

            I read the book “Personal Styles and Effective Performance” a number of years ago. I found it to be a good foundation for understanding personality style effective communication. However, for a comprehensive presentation of this vital subject, specifically applied to chiropractic practice, I suggest you attend the TPM© seminar “Functional Philosophy, Retention and Communications.” TPM© can be reached at 608.462.4000.