Chiropractic + Naturopathic Doctor

Keys to Your Practice: The Exam, Part 1

By Angelo Santin   

Features Clinical Patient Care

How many of you encounter a confused or resistant patient at your report of findings? If there was a way that you could examine a patient and have them want to start care on the spot, would you want to know about it? In the next two editions of Keys to Your Practice, we are going to take an in-depth look at performing an examination that is effective and leaves your patient with a clear sense of your purpose in offering care.

How many of you encounter a confused or resistant patient at your report of findings? If there was a way that you could examine a patient and have them want to start care on the spot, would you want to know about it? In the next two editions of Keys to Your Practice, we are going to take an in-depth look at performing an examination that is effective and leaves your patient with a clear sense of your purpose in offering care.

Personally, I have looked at many different techniques and methods in this particular area. The most thorough and results-proven exam procedure out there is the one developed by Dr. James Carter. I have had the pleasure, like many chiropractic leaders in Canada, of learning the exam directly from him. Thus I have had a firsthand look at what he chooses to focus the examination on.

Advertisement

Many of you reading this may wonder why there is a need to write about an examination. Is an examination not a grouping of orthopedic tests to apply to a patient based on our history in order to come up with our best diagnosis? Of course this is one aspect, but if employed alone, it has its drawbacks. For example the normal exam is performed strictly for our knowledge, while the patient sits there and has no feedback as to what is going on. The results then require a lengthy, wordy, information-filled report to try to explain what the problem is and what needs to be done. There has to be a better way than this! According to Dr. Carter’s method, the purpose of the exam is to demonstrate loss of function to the patient and the doctor!

KEEP THE PATIENT IN THE LOOP
Dr. Carter developed a foolproof way of using traditional orthopedic, neurological and muscle tests to demonstrate to the patient how subluxation and degenerative changes have affected their function.

The exam looks and feels different from traditional methods right from the beginning in that palpation is performed immediately following the history. “Find it first and find it fast” is Dr. Carter’s mantra when it comes to palpation of the subluxation and area of primary complaint. Once you have located the subluxation, let them know you found it. This puts the patient at ease right away and lets them know you know what and where the problem is.

HONE YOUR FOCUS
Now, move on with the regular tests. I highly recommend having a staff member in to record your findings while you perform the exam. This allows you to stay focused with the person in front of you and to not lose the momentum of the procedures. During the tests, Dr. Carter mentions, it is important to conduct the test in such a way as to make the patient aware of their loss of function. For example, if you are doing a hamstring motor test, it is key to push and break through their resistance in order to fully demonstrate that the hamstring has lost power. It is important to verify that the patient is now aware of the loss of function. Some key questions, such as “are you aware you have lost function to these muscles?” will help confirm this. These questions bring a serious tone to the examination, which is necessary. Once you have run through your tests (range of motion and muscle tests) with good speed and intensity, it is important you end your exam by letting them know that they in fact do have spinal problems and it is important that they return as soon as possible for a report. This is also your time to recommend additional tests such as diagnostic imaging. Once you have done this, it’s important to exit the room immediately and leave the rest of the procedures for the staff to take care of. Don’t hang around for the intensity to drop as this will detract from the patient’s memory of the examination. If there are any pressing questions, mention they will be covered in the report unless they are an emergency. Shortening your exam time will automatically increase the focus and intensity and lead to better performance on your part.

When you are performing your exam well, there will be less chitchat, more focus and more intensity. This is because the exam is speaking for itself and demonstrating to the patient that there are problems that need to be addressed immediately. This makes booking their next appointment much easier for your staff and the report of findings really just becomes a formality and not the “sell” that it is sometimes made out to be.

I hope this helps your exam and more importantly inspires more people to get under chiropractic care and live more to their potential. I do recommend the more detailed version of Dr. Carter’s exam module, which is available at www.carteruniversal.com.

In part 2 of this series, I will be interviewing two giants from the chiropractic profession on this very topic, so stay tuned. Remember: when it comes to our practice, work from the inside out!

Key to Performing an Effective Patient Exam
Focus on finding the problem area and communicating the need to fix it to the patient.  

ACTION STEPS:

  • Shorten your examination time to increase your focus.
  • Begin your exam face down in order to locate the subluxation fast and first.
  • Demonstrate loss of function due to subluxation through your testing.


Dr. Angelo Santin is a 2006 graduate of the CMCC. He operates a busy subluxation-based family practice in Thunder Bay, Ont., and is currently serving his second year as president of the Thunder Bay Chiropractic Society. Dr. Santin is one of a small number of international Carter Universal proficiency-rated chiropractic coaches, and draws on his success, along with the experience of the most renowned experts in this field, to provide time-tested, effective and patient-centred ideas for every chiropractor. He can be reached at angelosantin@gmail.com or 807-344-4606.


Print this page

Advertisement

Stories continue below