Improving Outcomes with Your Report of Findings
PERSPECTIVE
Brian Jensen
DC
NEW PATIENTS ENTER YOUR OFFICE FOR THE first time with their own set of experiences and expectations that will shape their perceived effectiveness beginning with the first visit.
These expectations set the stage for their level of satisfaction with your consultation, report of findings, and care. Anticipating and addressing what your new patients need to know is key to beginning a successful patient relationship.
Reports of Findings Can Establish Lasting Patient Relationships
A 2024 study explores low back pain (LBP) patients’ hopes and expectations prior to and immediately following their initial consultation with medical doctors, PTs, and chiropractors. The study reveals several important themes relating to what patients want and need from their consultation and resultant report of findings (ROT).1
The authors point out that “hopes” are what patients prefer, while “expectations” are what they believe will happen. Negative experiences result when neither hopes nor expectations are met, so it is incumbent upon the provider to be truthful in explaining that unrealistic expectations that are not consistent with the laws of nature will certainly result in a negative experience. Some patients are not good candidates for chiropractic care based on their beliefs, expectations, and unwillingness to commit to the process that it takes to overcome old injuries, chronic neglect, and poor health habits.
“Cryptic communication leads to confusion, frustration, and concern.”
In most cases, pain and disruption in lifestyle are the driving forces for seeking care. It is likely that the new patient has already attempted various self-care solutions, including OTC pain relievers, massage, and activity modification.
According to the study, a provider’s report of findings should clearly identify the cause of the pain, how the provider is able to correct the problem, and how long it will take to restore the patient to full health. Many times, touching the pain point is seen as a sign that the cause has been identified and can be resolved.
It’s important to help the patient understand their responsibilities in the healing process; it can’t totally be the responsibility of the provider. Hippocrates is credited as saying, “The patient must combat the disease along with the physician. Resuits are not guaranteed; they are earned by patients who are willing to work alongside the doctor.”
Their responsibilities may include learning to develop new dietary habits, showing up for all scheduled adjustments, performing specific corrective exercises, wearing stabilizing orthotics, and sleeping on a better mattress with a cervical support pillow. The things a patient does outside of the office are just as important, if not more important, than what happens in the office.
The initial consultation will need to clearly establish the provider’s position as a clinical expert capable of addressing their condition. Palpating and adjusting the patient as part of the initial consultation can effectively confirm the provider’s ability to understand and resolve the problem.
In their post-consultation assessments, the authors noted that as care progresses, “patients’ hopes and expectations regarding low back pain consultations evolve, shifting from a focus on clinical actions and outcomes to valuing interpersonal relationships and emotional support from clinicians.” Developing a strong doctor-patient relationship during initial care can contribute to continued maintenance care going forward.
Meeting Expectations Can Improve the Effectiveness of Your Care
Expectations play an important role in the success of care. Eklund et al. (2019) studied low back pain (LBP) patients from 40 chiropractic clinics to determine to what extent patients’ expectations could impact short-term outcomes.
Patients with high expectations were 58% more likely to report improvement by the fourth visit. These results were largely consistent regardless of pain intensity, psychological profile, or health status.2
The authors concluded that “patients’ expectations play an important role when predicting LBP treatment outcomes. Clinicians should consider and address patients’ expectations at the first visit to best inform prognosis.” A well-crafted, easy-to-understand report of findings goes a long way toward establishing higher expectations in the minds of your patients.
A secondary analysis from a randomized controlled clinical trial examined low back pain patients’ expectations about the benefits of specific forms of care. The authors found that patients expected greater benefits from exercise and manual therapy than from surgery, traction, rest, or drugs.3
Regardless of whether these expectations are the result of personal experience or opinions formed by others, the hands-on nature of chiropractic car e promotes higher patient expectations.
Clear Communication is Key
Since the end of 2016, the 21st Century Cures law has provided patients with quicker and easier access to clinical notes, lab results, and other health information via their electronic health records, often before meeting with their healthcare provider. A 2025 study examined patients’ ability to comprehend information found in typical medical pathology reports, revealing that a large percentage of patients couldn’t understand the information.4
Smuck et al. (2022) surveyed back-pain patients to determine what topics were most important to them when they communicated with their medical doctor. They also surveyed medical doctors on the same topics to see how they matched up.5
In order, the patients most wanted to learn about “what is causing your problem,” “improvement in level of pain,” and “improvement in ability to perform daily tasks.” The medical doctors underestimated the importance of “what is causing the problem” and overvalued “diagnostic tests,” “medications,” and “surgery.”
These results demonstrate an important point: effective communication is more about the patient and less about the care.
Cryptic communication leads to confusion, frustration, and concern. A well-crafted report of findings should include metrics and information presented visually in ways that are easy to understand. It should focus on what is most important to the patient.
There are a number of diagnostic devices that can provide doctors with information they can use when crafting their report of findings. Some of these provide metrics that can be meaningful when explained to the patient.
A few devices actually construct a report of findings for the doctor with data-based measurements and easy-to-understand infographics. These include those that collect data for posture, functional movement assessment, active range of motion, custom orthotics, and custom therapeutic pillows.
These reports of findings can be presented to patients in the office and emailed to them for reinforcement. The importance of an easily understandable report of findings is that it addresses the patient’s primary concerns:
• What is the cause of my problem?
• What can you do about my pain?
• What care will resolve my issue?
• How long will it take?
• How much will it cost?
By addressing your patients’ concerns and expectations in your initial consultation and report of findings, you will lay the foundation for a relationship of continued trust and care.
Dr. Brian Jensen is a graduate of Palmer Chiropractic College and owner of Cave Spring Chiropractic in Roanoke, Virginia. He has been in practice for over 35 years. As a Foot Levelers Speakers Bureau member, he travels the country sharing his knowledge and insights. For more information, go to www.footlevelers.com/more.
References
1. Madsen SD, Stochkendahl MJ, Morso L, Andersen MK, Hvidt EA. Patient perspectives on low back pain treatment in primary care: a qualitative study of hopes, expectations, and experiences. BMC Musculoskelet Disord. 2024 Dec 5;25(1):997. doi: 10.1186/s12891-024-08116-3. PMID: 39639259; PMCID: PMC11619672.
2. Eklund A, De Carvalho D, Pagd I, Wong A, Johansson MS, Pohlman KA, Hartvigsen J, Swain M. Expectations influence treatment outcomes in patients with low back pain. A secondary analysis of data from a randomized clinical trial. Eur J Pain. 2019 Aug;23(7): 1378-1389. doi: 10.1002/ ejp.1407. Epub 2019 May 20. PMID: 31034102; PMCID: PMC6767754.
3. Bishop MD, Bialosky JE, Cleland J A. Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. J Man ManipTher. 2011 Feb;19(l):20-5. doi: 10.1179/106698110X12804993426 929. PMID: 22294850; PMCID: PMC3172953.
4. Lapedis CJ, Kurnot SR, Bergholtz SE, Owens SR, Hawley ST, Morgan TM, Zikmund-Fisher BJ. Knowledge and worry following review of standard vs. patient-centered pathology reports. JAMA. 2025 Feb 25;333(8):717-718. doi: 10.1001/jama.2024.25461. PMID: 39745765; PMCID: PMC 11862968.
5. Smuck M, Barrette K, Martinez-Ith A, Sultana G, Zheng P. What does the patient with back pain want? A comparison of patient preferences and physician assumptions. Spine J. 2022 Feb;22(2):207-213. doi: 10.1016/j. spinee.2021.09.007. Epub 2021 Sep 20. PMID: 34551322.
