Solving the Day 1/Day 2 Dilema

AKA The Show and Tell Exam

I have always been taught by management companies not to adjust on the first visit no matter what.  If you’re like me this doesn’t feel like good advice.  I’ll outline why they recommend it, and how I reconciled their recommendations with my own style of practice.

The big impetus behind my former management company telling their clients not to adjust on the first visit was that they believed it increased retention.  The idea is that if you have a patient wait another day, what you have to say will have that much more authority behind it.  Plus you get to explain why they need care before they get adjusted and fell better.  This never sat all that well with me.  It always felt a bit like I was being a used car salesman.

I do agree that you need to communicate key ideas early on in treatment in order for the patient to get the most out of care.  Those ideas include.

  1. What is wrong with them.  In my opinion, this must include more than a ‘bone out of place.”  That is the key of what we treat and what they need to hear, but you also need to communicate the other things that are going on.  Such as a disc herniation if you suspect it.
  2. How you can help them.
  3. How long will it take?  You also have to break this down between pain relief and corrective care and make sure they know the former will probably come before the later, and without the latter, they aren’t getting anywhere really.
  4. What will it cost?

You obviously can’t answer all those questions on the first day, but I have found that you can answer the most important ones and communicate the need for care on the first visit and get the rest on the second visit.  The main way I do this is with what I call the “show and tell exam.”

The Show and Tell Exam

Put yourself in the patient’s shoes for a moment.  They are in pain.  Enough pain to make them take action and see a doctor, but not just any doctor, a chiropractor.  I hate to break it to you Doc, but chiropractic is scary for a lot of people.  A lot of people think we are quacks.

They heard we adjust babies on planes and kill them.  (Yes, a patient of mine heard that from her mother.)  We talk about this thing called subluxation, and worst of all we snap their necks like Arnold Schwartennager on a bad day.

So with all that being said you need to do all you can do to set them at ease on their first visit.  I do this with a show and tell exam.  As I measure range of motion I point where it’s reduced.  As I perform orthopedic tests I point out what they mean when they are positive versus negative.  The whole time I am killing two birds with one stone.  I am gathering invaluable exam data and actually delivering my ROF at the same time.

I communicate the key points of what is wrong with them and how long it may take to correct the problem all before I adjust them.  And I do adjust them on the 1st visit because they need it (unless it’s not indicated clinically) AND I have communicated key concepts during the show and tell exam.  It’s a win-win for all involved.

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Please note: I reserve the right to delete comments that are offensive or off-topic.

  • Debbie Benlien-Cotten

    For me I have adjusted on the first day but I think it’s better to wait. I do Blair Upper Cervical Chiropractic and it speaks volumes to the new patient that what we do is so specific that it takes time to review the x-rays to know exactly what needs to be adjusted. I will say that if someone is in severe pain I will have them go get some coffee or come back a couple hours later to get the last 2 cervical x-rays taken so we can adjust them that day. The time away from the patient helps me to be a better doctor because I’m not rushed to get the x-ray measurements done quickly just because the patient is there waiting. It also helps the patient understand the importance of being specific. I understand that for each individual chiropractor the answer may be different. Some may choose to adjust on the first visit and others will choose against it because of the technique they use or the different types of people they are adjusting etc. I would like to hear what others have to say on the subject.

    • If my practice and technique were more x-ray dependent like yours then yes I would never adjust on the first visit. Thanks for the comment Debbie!