COLUMN KEYS TO YOUR PRACTICE The Re-evaluation A A powerful tool that demonstrates the need for ongoing care and will choose when to drop out of care based solely on this subjective information. Based on personal expe-rience, this gets frustrating over time. Here’s the second scenario: Jane comes in as a new patient, and after taking her history the chiropractor asks some key questions to determine how the subluxation is affecting her lifestyle. Questions include, “How has this slowed you down Jane?” or “What have you had to give up because of this?” Answers to these questions will give you a clearer idea of intentions and goals for care. For example, if she had to give up running because of her back, it would be a good idea to write this down. At the time of the re-evaluation, if the chiro-practor has demonstrated an improve-ment in flexibility in the back and power in the lower limbs, and the patient has been able to return to running, the chances of Jane staying with her pro-gram of care increases. By continuing this pattern with future regular re-eval-uations, the chiropractor increases the likelihood of Jane keeping up with chi-ropractic care as a lifestyle choice. BY ANGELO SANTIN lso called the progress exam, re-exam or re-as-sessment, the re-evalua-tion is an overlooked tool that can increase your practice’s ability to retain patients for the long term. All chiropractors perform these at the beginning of care to make sure the patient is on track. As time goes on, however, either due to lack of organi-zation with systems or just pure lazi-ness, these re-evaluations are not done as frequently as they should be. Unfor-tunately, this lack of attention to detail can heighten the risk of patients leaving your chiropractic office. What is the purpose? The true purpose of the re-evaluation is to demonstrate to the patient that chiropractic care is meeting their goals. If, therefore, the practitioner is not establishing common goals with the patient during the initial assessment, a re-evaluation cannot be effectively performed. The following are two ex-amples to clarify this point. Joe comes in with low back pain and the chiropractor performs some ortho-pedic tests on initial exam. Imagine if the chiropractor has not determined Joe’s true goals when it comes to his care. Down the road, when the chiro-practor performs the tests again on the re-evaluation, he or she will likely find things have improved. Without focus-ing on the patient’s goals and failing to demonstrate the orthopedic tests in a way that Joe can understand, the pa-tient will likely have no idea as to how much he has benefited from chiroprac-tic care. Joe will likely only judge the effectiveness of care by his level of pain, When should they be used? By College of Chiropractors of Ontario standards, re-evaluations must be per-formed every twenty-four visits as a minimum. It is a mistake to wait that long, however. At the beginning of a program of care, chiropractors should re-evaluate at the very least in twelve visits or even every six visits. Consider pre-booking them into a new patient’s schedule of care so it gives both parties (the patient and the chiropractor) a target to look for during their initial program of care. Re-evaluations are also effective when a patient is not responding to care. This is especially important with long-time maintenance patients. If, for whatever reason, their condition worsens, it is important to give them the same atten-tion as a new patient. Book them for a re-evaluation, demonstrate the sublux-ation’s effect on the body, schedule the program of care that is appropriate, and get them back on track. Another opportunity for re-evalua-tion is if a patient has been away from care for some time or has missed a number of visits in a row. The test re-sults will likely confirm their spinal condition has worsened and the chiro-practor will hopefully demonstrate to the patient the need for them to get back on their schedule of care. Lastly, re-evaluations should be used regularly through a patient’s mainte-nance schedule. The idea, again, is to pre-book their appointments with a re-evaluation at the end. The patients will be so pleased that their doctor has regu-larly examined them and demonstrated to them that chiropractic has continued to maintain their level of health. Too many times, too much focus is given on getting new patients that it’s easy to forget to take care of the ones that are already there. Performing the re-evaluations well will help build your practice by increasing the number of people choosing to stay under chiro-practic care. ACTION STEPS CHECKLIST Make sure you set clear lifestyle goals at the history stage, which can be revisited down the road Use demonstrative tests at the initial and re-evaluations Prebook regular re-evaluations with all patients in your practice www.canadianchiropractor.ca ANGELO SANTIN, DC, operates a busy subluxation-based family practice in Thunder Bay, Ont., and is president of the Thunder Bay Chiropractic Society. Dr. Santin is also a Carter Universal proficiency-rated chiropractic coach. He can be reached at [email protected] or 807-344-4606. 20 Canadian Chiropractor October 2014
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