Chiropractic Management: When Patients Won’t Stop Talking

By Dr. Russ Rosen | Patient issues

Patient communication is a vital part of chiropractic management. Knowing what to say, how to say it, and when to bring it up is a vital part of running a smooth operation.

With that being said…
Have you ever had a patient who just would not stop talking?

Have you ever had patients who just go on and on and on?

Have you had a new patient talk about every single ache and pain they have ever had, go on about every nook, cranny and orifice?

When you ask them when it started they say, “Well my great great grandmother came over on the Mayflower and SHE had low back pain!”

Do your regular patient visits going on and on with people talking about the weather, their beautician’s new puppies or the latest sporting event!?

This is such a challenge for so many of us! We don’t want to be rude but the truth is we must run on timewe hate it when we run behind and frankly these people can suck the life out of us!

Social Etiquette: Walking the Delicate Line

Doctors tell me all the time that they give it their best shot to get these people to SHUT UP and move on but they just don’t know how to do it without being rude. Often times, doctors will tell me that they just give up and sit there just letting their patient go on and on and they literally zone out, give up and know that they are just going to run late the rest of the day.

Is there a better way? Is there anything we can do to keep people on task and on time AND have them feel heard and well taken care of?

The answer is YES we can. Let me give you a few tips for patient communication.

#1: Doc, Don’t Do Your Own Pre-Consultation 

First of all: with a new patient, it really helps to have our CA do a pre-consultation. If our CA spends 10 to 15 minutes asking the right types of questions and responding in the right manner our patients can literally get “talked out” and feel heard so when we walk in we can get right to the bull’s-eye, spend much less time and our patients will have a tremendous experience.

#2: Summarize What You Know

During a chiropractic consultation, it is critical to let our patients know what our goal is for the day. We let them know that our main goal is to see if our patients are in the right place to get the care that they need. We let them know what will happen if we believe we can help and what will happen if we believe we cannot help.

If you will summarize what you know about the patient’s history from the pre-consultation or their history form and ask them what’s  going on and how can you help, you will find that many patients will not feel the need to reiterate all of the points that you just summarized for them.

Of course some of them, especially the real talkers, will just start right from the beginning and tell you everything all over again.

#3: Know What You’re Listening For

It is critical in your consultation that you are doing it by design. In essence, you must know exactlywhat you are listening for. We talk about listening for three different concepts. When you summarize what is going on and ask them to please tell you more, they will talk about one of three things.

    1. The first would be their diagnosis or lack of diagnosis. All you have to do is let them know that this is exactly what you’re going to do today. You’re going to try and figure out exactly what is going on and whether they are in the right place to get the care that they need.
    1. The second thing they may talk about is their pain. All you have to do is reach over and touch the area and go into your version of OPQRST of pain.
  1. The third and most common thing they will talk about is how it is affecting their life. We must dive deep into how it is affecting their work, home or play. After all, the truth is that nobody is there because of their pain! They are there because of loss or potential fear of loss and we must help them realize how it is affecting their life and what their greatest concerns are.

You will find if you are hitting the bull’s-eye’s and you are talking about what THEY want to talk about versus what YOU want to talk about you will get much better results in much less time.

#4: Write It Down

So what do we do with someone who is going on and on about something that we really don’t need to know about? There is really quite a bit to the subject but one thing that I would ask you to try would be to put your finger up right between your eyes and their eyes and say,

“Hold on one second – this is very important. Let me write this down.”

The odds are this wonderful talker will continue to go on and on. Now put your entire hand up as if you are saying stop and say,

“No really, please hold on.
This is very important and I need to get this down.”

This way they are not offended, you are not telling them to just shut up, instead you are letting them know how important they are and how important their story is. In fact it is so important that you need to write it down.

#5: Ask Closed Ended Questions

The next trick is to get control of the conversation by asking closed ended questions i.e., “Mary, can you point to where it hurts?” “Do you feel it more in the morning or the evening?”

More often than not, this can keep you and your talkative patient on track. The truth is sometimes they will not get the hint and they will continue to rattle on about things that you really do not need to know about.

#6: Let’s Not Waste Your Time

With these people, I find that this can work.

“Mary do you remember a few minutes ago I told you that our main goal was to see if you are in the right place to get the care that you need? Obviously you have so many things going on and the truth of the matter is if you have subluxations the odds are I can help and if you do not have subluxations there is nothing we can do. May I make a suggestion? Why don’t you come right over here and let me find out if you have these types of subluxations and whether or not we may be able to help you. With all that you have been through the last thing I want to do is waste your time.”

What About Regular Patient Visits?

Now what we do about our regular patient visits when our patients want to talk about the weather, sports or their beautician’s new puppies?

#1: Set Expectations at ROF

The first thing we must do is set the stage at the report of findings and let our patients know that we are NOT going to ask them for a laundry list of all their symptoms each and every visit. Instead we will ask them if there is anything new or different. If there is something new or different i.e. something is dramatically better or worse, they had an accident or a new health challenge has come up, then we must know about it. But the truth of the matter is they will notice there will be ups and downs throughout care and instead of wasting a lot of time talking about each and every symptom we are simply going to get right to it and not waste their entire day. We know that they are busy and have other things to do and we know exactly what we need to adjust when they come in.

#2: Be Careful What You Ask For

Then when our patients come in we do not make the mistake of saying, “How’s your neck today?” Or “How are you feeling today?” Instead we will do what we said we would do and ask if there is anything new or different. The truth is the first few times our patients may start to talk about all of their symptoms i.e. my neck is a little bit sore today.

Here is what will not work:

“Didn’t you listen to me the first time? I told you not to tell me about your symptoms, I told you to only tell me if there is something new or different, shut up and lay down!”

Again I do not feel that that is such a great practice building strategy.

#3: Be Hands On With Training

Instead simply touch the area and ask, “It is feeling a little bit sore right here? Right, so this is the area that we have been working on correct? Okay is there anything else new or different?”

You will see that in a very short period of time you can train your patients so they will really only tell you about things that are new or different. That will save a lot of time at the beginning talking about things that you already know!

For three years in my practice I let people know that we did not talk symptoms here in this office. I do not feel that this is a good or honoring strategy to grow a successful practice, so let me be the one to make this mistake and let you be the one to learn from it.

Focus on the Patient and Their Health

Now with these patients who have been cultivated correctly right from the beginning all we have to do is focus on them and their health each and every visit. If they do happen to mention something about the weather you can quickly comment on how beautiful the weather is and get right back to business. Lay your hands on their spine, tell them what you see going on, give them an adjustment, then give them a great coaching tip on the way out. We have a very specific four step process that will keep you and your patient right on track.

What About My Loyal Patients?

What do we do about our present patients who’ve been with us for many years and are used to talking about the weather and puppies?

In my experience, all we have to do is start to shorten our responses as I had just discussed above and get right to business. As long as you are focusing on them and their health you will find that that is really what they’re here for.

Yes, I do understand that you will have some patients who are really there more to just hang out with you. Often times the elderly – who no one else will listen to – will want to just sit and have a cup of tea with you and talk.

You must make a decision what you want to do with these people. You can either choose to spend time with them because you enjoy it (and of course you must let your team know so that they schedule appropriately). Or you must sit down and have a talk with them and let them know that although you love them and you love talking with them, the truth is you have found that you can give them much better quality care if you can just stay in the zone and focus on their health.

Yes I realize that this could be a difficult conversation but the truth of the matter is if you want to have the practice of your dreams you’re going to have to do some things that are uncomfortable.

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