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Dynamic Chiropractic – December 16, 2008, Vol. 26, Issue 26

By Darin Stokke, DC

The report of findings is your springboard to creating significant changes in your patients' lives. For this reason, what you say and how you say it have equal importance. An ROF is an opportunity to not only communicate your findings and plan of care, but also to lay the foundation for future communication by establishing a common vocabulary.

It also helps to ensure that both you and the patient are working toward common goals.

Keep the ROF brief - approximately 10 to 15 minutes. After that, a patient's concentration level drops off, and the more you talk, the less they'll hear. Always treat patients as you would your own family members and loved ones by giving them your best recommendations for care, regardless of the level of insurance coverage they do or don't have.

Provide a Written Report

Most patients are anxious and in some discomfort when they begin care. Because of this, many will have questions after their ROF. A written report serves as a handy reference for answers after they have left the office that day. A pre-printed form, customized to each patient's specific findings, provides consistency and structure to the ROF. It also ensures that you don't forget to discuss any important points.

After reporting the specific findings of the patient's examination and radiographic findings (if X-rays were taken), a great place to begin your ROF is by discussing your treatment plan in terms of phases: relief care, corrective care, stabilization care and wellness care. Describing care in terms of its phases communicates the concept that health is a process that develops over time, and that recovery is also a process that requires time. Let the patient know, "Your body will go through several phases of care as health returns." This is also an excellent way to establish goals for care beyond pain relief and provides a frame of reference to communicate progress toward those goals once care begins.

Relief Care

Most patients come to your practice with the primary goal of pain relief. It has been said that true healing begins only once the pain goes away; however, it is essential to acknowledge pain relief as a priority in the first phase of care. Let patients know that the first phase of care is relief care.

Confirm that during this phase of care, all of the procedures you will perform are designed for one purpose and one purpose only: to relieve the patient's symptoms and discomfort. This will reassure the patient that you empathize with their situation and are working toward their highest priority.

As you know, chiropractic care often involves a series of visits over a period of days, weeks or months. This is quite different from the traditional medical approach to care, where the patient may see their doctor only once to obtain a prescription for pain-relieving drugs. For this reason, it is helpful to explain why repeat visits are required and that each visit will include a measurement of their progress.

During relief care, a chiropractic adjustment is performed, the patient is sent home and the results last for about a day. After one or two days, the patient will return for a check-up and another adjustment if needed. It's helpful to talk in terms of the spine "returning to its old habits" between adjustments. Patients can relate to this concept, and it supports the value of ongoing care.

Corrective Care

In this phase, the goal of pain relief has been achieved and care is directed toward correcting joint dysfunction. Let the patient know that during this phase of care, you will lengthen the time between their visits. It is helpful to use this wording to reinforce the progressive nature of care. You are not cutting back on the amount of care the patient is receiving; their body is making progress toward the ultimate goal of wellness and this requires less intervention on your part.

Tell the patient, "As your body begins to heal you'll come in and I'll check you, and we will find the correction that we are making has held. When this occurs, your body is in the corrective phase of care. In this phase, you will come in and I'll check you, and then apply a chiropractic adjustment. It will last one, two or three days. At that point, we will lengthen the time in between your visits."

Stabilization Care

The goal in this phase of care is to achieve stability. Something that is stable does not go in and out of place easily. The analogy of how an orthodontist uses braces to correct dental misalignments is a great way to communicate this concept. Ask the patient to imagine someone who went to an orthodontist and was prescribed braces for 12 months. Then ask the patient what they think would happen if halfway through, they decided to take the braces off? Of course, the answer is that the patient's teeth would go back to their original position. Explain that the same thing can happen to the spine if, once they have completed the corrective phase of care, they don't follow up with stabilization care.

Wellness Care

Wellness care is one of the best things about chiropractic; it's when our true paradigm of prevention is put into action. Research has shown that when the body is relieved of tension and stress, the immune system responds more efficiently. People who are under regular chiropractic care find that they don't get sick quite so often. And when they do, it seems that they bounce back much faster.

Tell the patient that once their condition has been corrected and their body has made it through stabilization care, you will offer them a program of wellness care. Once again, the teeth provide a helpful analogy. Let the patient know, "Just like you visit the dentist to have your teeth hygienically maintained with cleanings, you'll come in on a periodic basis to have your spine checked."

Once you have described the four phases of care, two important points remain to be made during the ROF: establishing the importance of attending scheduled appointments and emphasizing the value of a new-patient orientation workshop. This information should also be included in your written ROF handout.


Explain the importance of keeping appointments in terms of the benefits. Some chiropractors have a manifesto for their practice - this is what you will and won't do. You should stand on your truth, but also sell the sizzle (the benefits) to the patient. Say, "For your convenience, our practice runs on an appointment schedule. We do this to keep your waiting time to a minimum."

Let the patient know that if they should need to reschedule a visit for any reason, please phone your office in advance so that your staff can release the time they had reserved to another patient. Tell them that if they are unable to attend a scheduled appointment, you will gladly reschedule an extra visit for them so they don't fall behind in care. Never offer a patient a make-up visit. It sounds too much like detention. Besides, everyone likes something extra.

New-Patient Workshop

The best ROF is brief and focused. This doesn't provide sufficient time for you to discuss the big picture about chiropractic, and the value of having chiropractic care as a regular part of a healthy lifestyle. Your new-patient orientation workshop is the time to do this. Explain that you hold a workshop for all new patients and that attendance is mandatory. Tell the patient, "Normally, we will reserve the same time for you on a daily basis. On one special visit, I will set aside an extra 30 minutes from my schedule to conduct a workshop with you and a partner. Your partner should be someone who cares about you and about whom you care. At the workshop, we will teach you how to check your spine to monitor your progress. We will also teach you the long-term benefits of care, so that both you and your partner will be able to support the care that you are receiving." Right then, ask for and write down the name of their partner for the workshop, so you will have it for reference in the future.

Plant the Seed for Referrals

The conclusion of your ROF is a great opportunity to plant the seed for referrals. Patients are most likely to refer when they first begin care, so before you finish up and give the patient an adjustment, discuss referrals. Let the patient know, "Please tell other people about our practice. If you do the things that we ask you to do and stay away from the things from which we ask you to stay away, you should have a great response to care. And you are going to tell all your friends and family members about chiropractic and our practice. I want to thank you in advance. When patients come to us with your referral, it is the highest compliment you can pay us."

Each step of the ROF is important because it sets the stage for care and communication in the future. If you can establish the parameters of your relationship and do it with conviction in the beginning of care, you will find that patients will be more compliant later on. If you are wishy-washy in your delivery, patients will sense it. They can smell it just as strongly as if it were cologne you were wearing. When you operate from strength, integrity and conviction, patients will have a greater appreciation for the service that you are providing them. They'll know that you are there to serve them, and that the recommendations you make are to meet their needs and not yours.

Dr. Darin Stokke is a graduate of Northwestern College of Chiropractic. He has owned and operated chiropractic practices in Minnesota and spent five years hosting a radio talk show called "Back to Health." Dr. Stokke now resides in Florida and is a senior coach with Breakthrough Coaching (

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