Eleventh Edition Introduction to Chiropractic Revised January 2006
All new ORIGINAL illustrations throughout the book

People cannot accept what they do not understand. Of all the many and varied uses for the new Introduction to Chiropractic™, none is more effective or more significant to the patient than using this book as a Patient Report of Findings.

There is no question that today's sophisticated healthcare consumer has more information available to them than at any other time in history. There is also a significant change in attitude among patients in which they are taking a greater and greater responsibility for their healthcare and demanding more information about their condition and treatment plan.

Patients are very cognizant about how they will use their healthcare dollars, where to spend their healthcare dollars, and which provider to select as the most effective for their immediate healthcare needs.

The empowerment of today's healthcare consumer is reflected in their growing demand for information that can and will enhance and improve their health. New issues regarding patients' freedom to choose, right to know, and right to be informed are fundamental questions facing today's healthcare discussions.

How we communicate with each and every patient that enters the office is often the most significant "RISK PREVENTION PROGRAM" we can initiate in our office. Communication should be meaningful, informative, empowering, participatory and advisory. Communication bridges the gap between a cold and sterile healthcare system of the past and a new and humanistic health care system of the future.

Introduction to Chiropractic™ used as a report of findings will help you to empower your patients with information, extend your practice with education, encourage compliance with understanding, expand your referral base with motivation, enhance your community image with quality material, and enlarge your network of referring professionals with solid evidence.

Authorities suggest the single most important factor in establishing a sound doctor/patient relationship and helping immeasurably to avoid "risks" inherent in today's practice is one single word...COMMUNICATION.

As we enter the 21^st century, the movement toward wellness has gained significant strength and credibility among all segments of society...from the scientific skeptics, to the news media, to the general population with a health care problem. No longer are complementary and alternative approaches to healthcare viewed as strange, mysterious, or unorthodox.

The public is not only accepting this new model of healthcare, which is focused on wellness and prevention, but consumers are demanding that these healthcare services be available. The ability to provide a sound basis upon which patients can judge value and regard their chiropractic experience as one that is worthwhile and meaningful, is extremely important.

An important concept to remember is the ability to discuss with the patient, in easy to understand terms, what we do, who we are, how we help, and why they are in the right office. Finally it is important to provide a sound, logical rationale for how chiropractic can help the patient...help them to achieve relief from their pain, help them to understand their condition, and help them to enhance their quality of life.

Patients come to us for a variety of reasons. Some are pre-conditioned and positive about our ability to help them because of a direct referral from a satisfied patient. Others, however, are somewhat skeptical and suspicious because of what they may have heard or because of articles that they may have read or programs they have viewed, but they are willing to give chiropractic a try–often times out of desperation. There's a huge percentage, however, that have no knowledge of chiropractic, no bias for or against, they simply perceive no need for our services and until something comes into their world to educate them, they will remain oblivious to chiropractic care.

Introduction to Chiropractic™ can be a practical and very effective way to educate patients about how chiropractic can help them. The "first" patient visit is a very important and critical time for patient communication. A first visit encounter means completing the necessary intake forms for you to determine if they are a candidate for chiropractic care.

This is not the forum for a discussion about proper examination, office records, staff interaction with the patient, or how to enhance the experience of this patient who is now in your office. There are excellent texts on the market for that. This discussion is about a patient who is about to undergo a new experience in a different, non-traditional, non-allopathic healthcare model. Whatever fears or anxieties patients harbor, may eventually be discussed with you, or they may conceal underlying, nagging doubts, and simply remain silent and these deep-seated fears and apprehensions about being in a chiropractic office will remain a barrier to their progress.

Using Introduction to Chiropractic™ as the Report of Findings

After the case history, physical examination, diagnostic testing and clinical review, it is now time to present the "report of findings." You will find that using the new 11^th edition of Introduction to Chiropractic™ as the patient's personal report will be significant in the overall progress and management of this patient. It is advisable to have a special place in the office where the delivery of a report of findings can be incorporated consistently into the practice routine. This will ensure a dependable process and an appropriate place to perfect your delivery of this report of findings. It is also important that you become familiar with the content and concepts contained within Introduction to Chiropractic™ so when you begin to deliver the report of findings and utilize it as this patient's report of findings document (which you will personalize with their name and give them to take home), you will not have to flip through the book, looking for various paragraphs, specific sentences you wish to highlight, or special exercises you will recommend.

Personalize this book by writing the name of the patient in the space provided in the inside front cover. This is important because now you have conveyed ownership of this book to the patient.

Tailor make Introduction to Chiropractic™ to this patient's specific condition and patients will not throw it away, nor will they give it away. You will find, as many doctors have reported over the years, that many patients when they return for their second or third visit will ask you for a copy of the book for their neighbor or friend. One of the most significant opportunities for patient education and referral is immediately following the very first visit. The patient's interest in their condition is at an all time high. Friends, neighbors and family are anxious to know the answer to the question..."What did the doctor say?" Your patient now has a book you have highlighted and personalized, and they can proudly say, "Here's what the doctor said!" They can then begin to explain to their family and friends about chiropractic and how chiropractic care is going to help them.

You will also notice on the inside front cover there is a place right below the patient's name for your office label or name stamp. Additionally on the inside cover is a space for any special instructions which are important for the patient to follow in order to improve or avoid further injury. This space also enables you to write some very specific patient advice and recommendations to help ensure patient compliance.

During the case history, you may determine there's a lumbar spine problem, or more specifically, a cervical spine or whiplash type condition you may now wish to highlight in the book. It is now important to incorporate your findings from the history and physical into the patient's personal Introduction to Chiropractic™ report of findings book.

You will note in your sample book on Page 6, "What is Chiropractic?", the text provides the patient with some comfort, particularly if they are experiencing headache, neck or back pain. This concept is stated very clearly in the first paragraph, "Most people know chiropractic care is outstanding in the treatment of back pain, neck pain, and headaches." This statement alone will provide some assurance that if their condition falls into any of those categories that they are in the right place. While this statement alone is comforting to the patient, you will also note that the very last paragraph of this section, on Page 7, provides an equal amount of comfort to the patient by reassuring them "When necessary, your doctor of chiropractic will provide recommendations for consultation with other health care practitioners to obtain treatment(s) or proper counsel you may require."

Many myths and perceptions exist in the minds of the public that suggest Doctors of Chiropractic will not refer, do not cooperate, or are isolated from other health care professions. This simple but powerful commentary stated up front and very clearly helps to reassure your new patient that they're in competent and capable hands. Highlight this sentence and reassure your patient that this is your policy. Regardless of your practice style, if you are determined to develop long-term relationships with your patients and help them understand the value of chiropractic, they need to feel that you are the doctor they can "trust." Help them understand the wellness and preventive concepts that are consistent with current information.

The section on Page 8 entitled "Chiropractic Concepts of Health Maintenance" will provide an early opportunity for you to begin to help the patient to develop an understanding and importance of health maintenance. A brief quote: "Adequate nutrition, water, rest, clean air, exercise a positive attitude and a properly functioning nervous system are critical requirements for maintenance of good health." Highlight this statement and as the patient begins to read the book, they will realize the significance and sound basis for the concept that the body's ability to adapt to its environment is critical to maintaining health.

By highlighting these statements, you make it easy for this new patient to relate to these phrases when they are home reviewing with their family and friends what you have told them in your report of findings.

Introduction to Chiropractic™ is an attempt to incorporate the concepts of health maintenance in the minds of the patients. The personal benefit of improved health and quality of life for the patient, which may result from regular care as part of their overall healthcare program, will now begin to make some sense.

On Page 10, there is an illustration of the spine. Here you may wish to circle the areas of the spine where you found the potential problem, such as a muscle spasm, curvature, or perhaps degenerative joint disease. Write a word or two alongside the area of the spine to illustrate the problem, such as spasm, osteoarthritis, spurring or curvature, as it relates to this particular patient's condition.

On Page 11, use a highlighter to trace and illustrate if the patient is having pain radiating into their arm or leg from a cervical or lumbar involvement. You will then be able to illustrate the connection between the spine and areas of radiating pain in a distal extremity. These concepts, while simple to the doctor, are often difficult for patients to make a direct connection. Once they can see the connection, their understanding is increased and their fear is reduced.

Page 12 provides an opportunity to explain a functional visceral condition which you may have identified on the initial exam or the patient may have related in a case history. By spending a few moments on this area of the book, a wonderful opportunity is presented to initially begin to explain the connection between the spine and a functional visceral problem. The paragraph, "If you are suffering from a condition that is not responding to conventional care, you may benefit from a short-term trial of chiropractic care. Your doctor of chiropractic would be pleased to discuss your conditions with you to determine if care may be appropriate in your individual case." This short- term trial concept is excellent in order to dispel the fear of non-referral and to provide a rational basis for a short term trial to determine outcomes.

Take a moment to highlight the comment on Page 13: "other treatment you may have had (chiropractic, medical, osteopathic and other), what prescribed medications you are taking or any over-the-counter products such as herb, vitamins, neutraceuticals, botanicals, or homeopathic products." Talk about these issues and plant the seed of understanding and the connection between their health condition and the logic of chiropractic care begins to make sense. Not to be minimized or overlooked is the fact that the book discusses implementing care as a short-term trial of chiropractic and the reassurance of a referral, if necessary, is reinforced once again.

Page 13 brings into account the connections between an accident as a child or trauma 25 years ago or the impact to the spine from an auto accident many years earlier. This concept is often lost on the patient. When pointed out, however, and highlighted, they become very aware of possible connections between previous impacts to their spine and nervous system and how these previous traumas may effect their current condition.

The old adage, "The BEST surprise is NO surprise," could not be more appropriate. By explaining to the patient in advance what to expect, they are not traumatized or confused with their care you will provide. A few carefully selected and highlighted areas on Page 15 will help to dispel any doubts or confusion which may exist in the patient's mind. "The adjustment is usually given by hand. It consists of placing the patient on a precisely designed adjusting table, or chair, or other specialized equipment, and then applying pressure using specialized chiropractic techniques to the areas of the spine that are out of alignment or that do not move properly within their normal range of motion. There are other methods used by doctors of chiropractic to perform spinal manipulations. Special tables which provide continuous passive motion, as well as flexion-distraction, have been developed. Instrument adjusting has also been widely used by doctors of chiropractic to perform spinal adjustments with the ability to manually control force. The experience of your doctor in manipulative procedures will determine the type and frequency with which you will be treated."

If your practice style and this patient's condition warrant, supportive care, nutritional counseling, dietary advice or other lifestyle guidance are clearly outlined beginning on Page 16. Care is taken to accommodate every practice style with the statement: "Supportive therapy may or may not be utilized by your doctor in the course of your case management depending upon your needs." You may wish to highlight some of the areas on Pages 16 through 21 to explain in greater detail what you're about to do and why this is important to the patient. This can become a very individualized area of the book, not only unique to your practice, but also personalized to the needs of this specific patient as they relate to diet, nutrition, water intake, regularity and lifestyle interventions. Therefore, these sections will not only be helpful for this patient's individual condition, but will also serve to better inform the patient so that they can in turn explain the benefits of chiropractic care to others. The virtual epidemic of obesity hitting the nation has been addressed by this book and should also be utilized in counseling patients on this very serious health care issue.

The posture section on Page 22 has been given considerable emphasis because of the importance to the overall health a well-aligned human frame can represent. This is reflected in a statement on page 22: "Poor posture compromises the movements of the rib cage and does not allow the lungs to function at maximum efficiency in order to bring much needed oxygen to the tissues and eliminate carbon dioxide wastes. Other vital organs of the body are also restricted when the body posture is improper, producing structural stress."

A section on "Chiropractic Care For Children" on Page 24 is very important. A statement such as: "The strains to which children are subjected, can easily be a contributing factor in creating spinal subluxations (manipulations) and/or nervous irritation. Not all conditions will respond to conservative chiropractic management and your doctor of chiropractic is fully trained to recognize when referral and/or other interventions are needed," will begin to illustrate the structural connection to support chiropractic care for children. "Anecdotal evidence and case studies have suggested that common disorders of childhood such as colds, constipation, asthma, colic, enuresis (bedwetting), and ear infections (otitis media), may be helped through spinal adjustments and conservative chiropractic management." This statement does not make claims which are unsubstantiated but rather serves to discuss what occurs in clinical practice.

"Chiropractic Care For Senior Citizens" on Pages 25-26 will reinforce the overall basis that chiropractic care should be integral to the health of the senior citizen. Great care was exercised in dealing with these sections of the book in order to provide credible information in a believable fashion to the patient. No claims or suggestions were made in this book that all conditions respond to chiropractic care or that chiropractic is a cure-all for every condition know to humankind. A statement from Page 25: "As a person ages, the muscles which help maintain the spine in its normal alignment begin to lose the tone needed to maintain balance. When this occurs, the spinal vertebrae have a greater tendency to slip or move erratically. This affects the spinal nerves which lead to vital parts of the body."

Concepts which deal with the aging process and other factors such as muscle tone, lifestyles, nutrition, mental attitude, all impact on the overall health of the individual. Information on other healthcare alternatives are mentioned from acupuncture to meditation.

Considerable time is spent on cervical and lumbar disc conditions and automobile injuries because these conditions represent the most common ailments for which the general public initially seeks chiropractic care. It is important to recognize the significance of educating patients about these conditions because they are often reflected in malpractice litigation as a failure to refer, a failure to diagnose, or a failure to inform.

The section on Page 27-29 including indications for back surgery is important as many times the patient will experience these symptoms and not understand the significance or discuss them with you early enough. For example, "There are indications for surgery, which should be thoroughly understood and carefully considered. Intractable pain (pain which is not able to be relieved), recurrent crippling attacks of pain and immobility, which affect the livelihood of the individual and his or her "quality of life," and any significant neurological deficit (loss) in ability to walk, properly balance, or the ability to control bowel or bladder functions (this requires immediate surgical consultation) are signs of the need for a possible surgical consultation. You and your doctor will decide on a recommendation for a second opinion and consultation." These comments help to place some responsibility on the patient for reporting of any deterioration in his/her condition.

Page 31 has some excellent tips for Do's and Don'ts For Home Care For A Low Back Injury: "Do not apply heat, do not sleep in a soft bed, do not walk on rough terrain, etc." These can be individualized for each patient and are very important in preventing your patient from interfering with the healing process by engaging in activities which may be harmful.

Page 32 outlines "What To Do For Sudden Back Injury" with very helpful tips and instructions for the patient. Page 33 Highlight No 2 if you want the patient to use ice.

Page 36 outlines the "Whiplash Injury" and how the cervical spine can be affected. A list of signs and symptoms are included to show the patient what might result from such an accident. Knowledge of the injury and what to do about it are easily explained in terms the patient can understand.

On Page 38, "Instructions For Home Care For A Neck Injury," is very important. Perhaps one of the most important bits of advice you can give your patient is found in the No. 5 bullet instruction which clearly advises the patient to report to you any signs and symptoms which could be vascular in nature and also suggests some courses of action they should take in the event any of the symptoms occur. The specific instruction is as follows: "If blurred vision, dizziness, headaches, ringing in ears, or nausea are experienced, contact your doctor immediately. If any of the above symptoms persist, avoid putting the neck in a position which will require extension of the neck (looking up) and rotation (looking over your shoulder). If symptoms worsen and you are unable to contact your doctor, consult your nearest hospital emergency room for advice." This important advice could be significant in any litigation because it will enable you to provide evidence that you have properly advised the patient concerning symptoms which may be a potential problem. Similar caution is discussed on Page 34 no. 4 under the title Common Causes of Neck Strain.

Specific exercises should be highlighted and personalized for the patient by determining the number of sets and repetitions. It is important to bring an awareness of any potential complications or reactions which may arise from any exercise program.

This new patient now has usable practical, and sensible information about their condition and what they can and what they cannot expect from their doctor during their office encounter. Removing fear and providing assurance and guidance is essential in order to establish confidence and insure compliance.

Reaction following an adjustment is clearly explained on Page 38. This page will afford you the opportunity to discuss any and all reactions you feel are significant, tailored to this patient's condition, and this patient's specific needs. In a very forthright fashion, the book addresses some of the negative issues the patient may encounter. By alerting the patient in advance, they are also better able to withstand adverse comment or misinformation from well-meaning friends. Addressing these issues will essentially help to provide an informed consent in a most positive fashion.

Caution is emphasized, and this should be highlighted by you when suggesting to the patient they undertake an exercise program. The cervical exercises are marked and any adverse reactions are noted with a warning to stop and report them to you. The cervical exercises contain a Note of Caution: "Do not forcefully move your head when doing any of these movements. If you experience pain, dizziness, loss of balance, or similar symptoms, STOP the movement or exercise immediately. Contact your doctor for further advice."

For the average patient, references are not very important, however, to the more sophisticated consumer or health care professional, it is very important to know the sources of various statements and comments. Introduction to Chiropractic™ provides an excellent bibliography on Pages 51 & 52 for individuals who want to seek the reference sources. Additionally, throughout this book are listings of very informative web pages to enable patients to seek additional information on their own.

The "Facts about Chiropractic" on Page 4 as you begin the book will be important particularly when Introduction to Chiropractic™ is used as a handout publication in community or civic talks–or when this publication is used as a mailing brochure to community leaders, medical physicians, allied health providers, or the media. The various information sections will be easy to understand and accessed for those interested in further inquiry. This booklet is a tool, and like any tool, how it is used is very important.

When properly used, Introduction to Chiropractic™ will provide you with a tool that is credible, contemporary, easy to use, easy to understand, and reflective of a health care concept consistent with patient's understanding of wellness.

In order to be more successful, we must do more than adjust spines. We must reach the eyes, ears, minds and hearts of our patients. By delivering credible information, we will advance our individual practices and the chiropractic profession.