Top 5 Chiropractic Questions
Laurie Mueller
BA, DC, CFMP
Patients Ask Questions
Have you ever had a patient put you on the spot with a question that left you stumbling for words? Most questions about appointments and scheduling are easily handled. However, sometimes patients will approach a CA with a question that is troubling them. Maybe they thought of the question after they left the adjusting room; maybe they were too shy to ask the DC directly. Whatever the case, it's always a good idea to have distinct answers in your mind to address patient questions and put them at ease.
This article is about questions that could seem a bit awkward or put you on the spot so that when you represent the office with your responses, you feel knowledgeable and confident.
First Rule of Thumb
The first rule of thumb is that you always have your DC as a final resource. If you don't truly know the answer to a question, simply tell the patient and offer to engage the DC. The doctor in your office is the final authority. The longer you work in an office, the more you will hear and become accustomed to questions that you can answer on their behalf. Until then, go back to the DC. Don't know the answer? Say something such as:
"Thanks for asking. I can see why you have that question. I haven't yet been trained in that area, so the doctor would explain things much better for you. If you can wait for one moment, I'll let the doctor know you'd like more information about XYZ."
If they can't wait or don't want to, let the patient know that you will ask, get the answer, and call with a response to follow up.
Top Five Questions List
Each of these questions could have a slightly different answer depending on "why"' a patient is there in the first place. Were they having a bit of back pain? Headaches? Did they suffer a sprain/strain injury? Were they in an accident? So before we jump into the questions, let's review a few points regarding care plans.
All of the mentioned scenarios will affect patient management, care plan schedules, and follow-up, depending upon the healing that needs to occur, the patient's resilience, and a variety of other factors. It is very typical for any new patient, or for an existing patient with a new injury, to be put on a "trial" of care. Trials will vary but may look something like "3x a week for a week," "2x a week for 2 weeks," "lx a week for 2 weeks," and then reevaluate. That plan could be much longer for something like a whiplash injury or a herniated disc that your DC wants to prevent from requiring surgery.
Once through the trial of care, if things look good, then DCs will often shift the patient over to a schedule of regular "check-ups," unless otherwise indicated. Physiotherapy may be involved too for certain patients with muscle tightness or injury or if a joint requires strengthening or retraining. Care plans are tailored to patients, and there will be some variety. If a patient asks a question, look at their chart. Are they there for an injury? An exacerbation of a prior injury? A check-up? It will help you better tailor a response.
Below, we have posed common questions and an example response to get the ball rolling. Just keep in mind that other factors may come into play when you craft an answer for individual patients.
NOTE: It's always good to reinforce to the patient that you are happy they asked, that it's a great question, or otherwise validate their concern. Acknowledging the validity of their question goes a long way to diffuse their doubt and misunderstanding.
#5 "Why are adjustments so expensive?"
A: "I'm sorry you feel like they are expensive, but thank you so much for asking. I can assure you that our office follows reasonable and customary fee schedules for the profession. Sometimes people think of having a chiropractor as a luxury, but like any other health provider (such as a dentist or dermatologist), our doctors studied for many years to learn their specialty and provide very specific health care for the spine. If cost is an issue, we'd be happy to sit down with you to discuss payment plan options that will fit your needs."
NOTE: This answer can be tailored to specific situations, such as,
• "Do you accept Medicare?"
• "Are you a cash-only practice?"
• "Is the DC an insurance approved provider/accept XYX insurance?"
When it comes to insurance, what the patient's policy covers is more likely the issue than the pricing on your fee schedule.
You might also provide your own analogy, such as, "I like to put it in this perspective. I know people don't blink when paying $40 to $80 for a haircut or $7 for a large latte. So in the scheme of things, the cost of staying adjusted is no more than what you'd pay for several coffee drinks, but it benefits your health immeasurably."
#4 "What makes that popping sound when I'm adjusted?"
A: "Thanks for asking. I actually get that question a lot. Sometimes patients think the bones are rubbing together, or that something terrible is happening. The popping sound is actually only nitrogen gas being released from the joint capsule. The tissues of your joints normally make synovial fluid to lubricate the surrounding area and protect them from abrasion as you move around. Nitrogen is a component of this fluid, and bubbles can form in the joints. When those escape, in a process known as cavitation, they can sometimes make a popping noise. This is most common with manual adjustments. Certain techniques, like the table with drop pieces, flexion-distraction, or Activator Methods, to name a few, are equally as effective, but you are less likely to hear the popping noise."
NOTE: For patients who are children, I like to refer to the noise as "popcorn" to make it more fun and take the scariness out of it!
#3 "Why aren't my adjustments holding?" Or similarly, "Are these treatments loosening my joints so I have to keep coming back?"
A: "That's a great question. Please know that adjustments do not loosen joints at all. Adjustments align your spinal joints into the proper position. If your spine has had issues for some time, it takes more than just one adjustment to retrain the joints, associated muscles, tendons, and ligaments. Muscle tissue actually has "memory," so if they have been holding your back in the wrong place for a while, they now think that is normal. So very often, your own muscles are pulling your vertebra back into the wrong position. That is why we recommend a series of adjustments, and sometimes physiotherapy at the beginning, so that all of the tissues can be retrained into holding the spine in the right position."
#2 "Why do I have to come back so often?"
A: "I know it can seem that way at first. Our doctors follow chiropractic best practices and typically put patients on a tapering care plan for a period of time. Then they reassess how you are doing and will discuss the next steps of the plan with you after the trial of care. The first few weeks, you are seen more often, and then appointments will spread out to check-ups."
#1 "Can I just adjust myself at home?"
A: "I am so glad you asked. The answer is an emphatic NO, and I'll explain why. First, it can be detrimental. When you come to our office, you receive a very specific adjustment by a trained professional who examines you and then moves joints into very specific proper alignment. At home on your own, you have not analyzed which joints are affected and determined what directions they need to be set, nor will you know howto check to ensure they are properly aligned. Even though a friend might get behind you and "crack" your back, or you pop your knuckles and get that nitrogen cavitation (popping noise), it is not specific and likely not aligned properly. If you see friends cracking each other's backs and exclaiming how great it is, they are making a popping noise by movingthe joint capsule (in what direction who knows) and instigating an adrenaline rush that may, at the time, seem like it feels good. Despite the short-term rush, they may even be doing damage by forcefully moving joints in an improper direction. Please always see a trained professional to care for your joints and ensure that spinal alignment is specific."
For this article, we've compiled a few of our favorite frequently asked questions. Feel free to discuss these with your DC, get their ideas, and ask them what other types of questions they commonly get in the office that you might be able to help answer.
Laurie Mueller, BA, DC, CFMP served in private practice in San Diego, California. She was the post-graduate director at Palmer College from 2000-2010; served as the ACC Post Graduate subcommittee chair for 6 years; peer reviewed for the Research Agenda Conference, and wrote the informal role determination study that aided in the development of FCLB's guidelines for chiropractic assistants (CCCAs). Dr. Mueller currently works as a private eLearning consultant with a focus on healthcare topics and functional medicine through her company, Impact Writing Solutions LLC, and subsidiaries www.CCCAonline.com and www. fxmedonline.com . She is a clinician, an educator and an expert in online learning pedagogy.
