File: Marketing Binder \ Patient Education
Patient Chiropractic Education Program
"Inform while you perform" sounds nice, but in actual practice, it often isn't done.
Every doctor has heard of the importance of patient education, knows that it is important, and has attempted it to some degree. But, as with many things, what should be done and what actually gets done are two different subjects.
Simply put, patient education can become a boring activity that goes by the wayside for many doctors and staff. This often happens with many new chiropractic practice procedures: they descend from their inception as new and exciting, go on to become old and boring, and finally they are abandoned and no longer used.
Chiropractic patient education is no different. Just out of school, the young doctors can't keep quiet about educating their first few patients. For the first several months, they tend to give doctoral dissertations to every farmer that comes in to their office. As the months go by, they learn how to abbreviate their communications to patients, and use simpler words. They may try augmenting their educational procedures by adding a spinal care class, posters, and a few videos.
But, as time goes by, spinal care class schedules are hard to keep, and they are quietly discontinued. This is a relief to everyone, as it means less work. The posters yellow but because they have been up since the Renaissance tapes first came out, by now they have become invisible and the doctor never notices. The videotapes broke some time ago, and haven't since been replaced.
Later, with the hope of getting more new patients, new videotapes and a new tape player are ordered, at the doctor's request by one of his staff. New posters are put up around the office. However, as neither the doctor nor the staff are personally interested in the videos or the new posters, the patients get the idea that these aren't very important. When the video breaks again, it is not replaced, and the posters are later replaced by some nice artwork that the doctor's wife selected.
The core of patient education is the doctor's personal education of patients. It is doctor communications. The doctor, as the teacher, personally instructing and coaching his or her patients on health care, can never be replaced by a video.
If you can keep this essential aspect of patient education alive, then all other forms of patient education will follow. To do so, the following has to occur:
- Develop procedures to ensure that the patient education is kept in place, no matter how routine or boring it becomes.
- Work out ways to monitor the patient education procedures.
- Assign someone to be in charge of the activity, and reward them for excellent work.
- Use personal discipline to keep patient education and communication new and creative. Find out new things that YOU want to tell your patients, that YOU want them to know. Constantly work on improving the activity as a challenge: how good can you make it?
EDUCATION STIMULATORS
To help the doctor personally educate the patients, a set of educational stimulators can be set up. These are simply reminders that help the doctor improve his or her in-room communications, often called "table-talk". We have two different types of stimulators that we use - one for new patients, and one for existing patients.
For New Patients
The doctor makes a list of topics that he or she feels that the new patient should know and understand. Each time the patient comes in, the doctor discusses a pre-selected and rehearsed topic with the patient. There are 5 parts to this program:
- The doctor has to personally commit to this program, and delegate authority for its success to a C.A. This CA is his Chiropractic Education Assistant, and she keeps statistics on the program, such as, a) Number of PEP (Patient Education Program) checklists completed, and b) Number of Internal NPs.
- List of topics. These should be integrated with a video program and the specific type of services of the doctor. Select about 10-18 topics, with the first two for the consultation and report of findings. The report of findings should include mentioning that part of the treatment program includes regular education on topics of chiropractic health care, as well as a videos, pamphlets, and a one time health care workshop.
- A PEP checklist of items should be attached to the patient card by the Front Desk CA. Each day, the doctor initials each item on the checklist after discussing the topic with the patient. The CA makes sure that he does so. (For each completed PEP card, the CA could receive a bonus of $10, more or less.) A relevant pamphlet could be attached to the patient card to be handed to the patient by the doctor.
- Complete scripts should be written by doctor for each topic. The doctor should memorize each script. Each topic should include symptoms, and a section where the doctor has to correlate the topic with the patient's own case.
- After each visit, the F.D.C.A. should check that the PEP card was initialed, and that the topic was discussed. She should also ask the patient what they thought of the topic discussed at that visit. If the patient says something positive, the CA would say something supportive, and compliment the patient for their extra effort in learning about how to improve and maintain their health. If the patient says "the doctor didn't discuss subject with me", the CA should politely get the doctor and have the doctor spend an extra few minutes with that patient going over the topic before the patient leaves.
Sample Topics
____1.First Visit. Pre-consultation video & consultation.
____2.Second Visit. Pre-report video & report & special script on PEP.
____3.Third Visit. Review Video. Vertebra, What it is, how it moves, fixation, fixation stick -- (spinal kinesio-pathology) (Discuss types of symptoms and consequences of non treatment, and how it applies to patient's own case.)
____4.Recovery Symptoms: Healing in the making, types of symptoms, caused by vertebrae moving back into line, freeing trapped nerves, pinched blood vessels, etc. (Discuss types of symptoms and consequences of non treatment, and how it applies to patient's own case).
____5.Nerves and nerve tissue. How they it get pinched. (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.]
____6.Muscles. What causes spasms, muscle atrophy, fibrosis, scar tissue, intrinsic versus extrinsic (Myopathology) (Discuss types of symptoms and consequences of non treatment, and how it applies to patient's own case.]
____7.Blood vessels and soft tissues. What is swelling and inflammation? Ligaments stretched or torn, discs bulged, herniated, or degenerated. (Histopathogloy) (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____8.Vertebral degeneration, calcification, bone spurs, and effects of subluxation degeneration (pathophysiology).
____9.Vertebral Subluxation Complex. (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____10.Exercises. Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____11.Chart of effects. (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____12.What are symptoms?
____13.Chiropractic Diagnosis. Exams, x-rays, progress exams, and progress x-rays. How they work, what is done, and why. (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____14.Three phases of care. (Discuss types of symptoms and consequences of non-treatment, and how it applies to patient's own case.)
____15.Progress video.
____16.Importance of referring friends and family for spinal checkup.
____17.Special needs of seniors.
____18.Special needs of infants, babies, and children of all ages.
____19.Extremities. (Carpal Tunnel)
____20.Immune system.
____21.Fevers, other conditions
____22.Importance of continue good habits for spinal hygiene
For Existing Patients
For maintenance patients, and as an additional educational stimulator, there should be weekly topics. Weekly topics can be obtained from chiropractic journals, magazines, books, or any other source that is relevant. The key to educating established patients is keeping the information "new" by changing it weekly.
"CHIROPRACTIC IN THE NEWS"
These can be planned out each month in advance. A bulletin board or cork strip can be placed in each adjusting room, with a title something like "Chiropractic In the News". Articles can then be photocopied and placed weekly in each room. (Examples of articles: 100 year anniversary, AHCPR, research, earaches, etc.)
While the patient is in the room, these newsy articles can stimulate the doctor to discuss some aspect of chiropractic with the patient. The patient may also bring up a question about the article, in which case the doctor would have to answer, and in so doing, educate the patient.
These two methods of educational stimulators allows the staff to better assist their doctor by actually directing the "table talk" by reason of the weekly topics they put up in each room, and ensuring compliance to the new patient PEP card.
Petty, Michel & Associates 1999 (1.1) Patient Chiro Edu Pgm.doc – Revised 6/30/001 of 4