Practice Article - July 2008

“Patient Compliance”
Getting patients to comply is a most important phase of the patient encounter. Doctors
that fail in practice and students that struggle as an intern, have this problem. Solving
this problem is like fixing a swing fault in golf. The fault is usually caused by lots of
other faults that accumulate into the obvious fault, you wish to correct. It is like fixing a
loose floor tile, only to discover a leaky pipe under the floor, as an example for non
golfers. The key concept, as I have mentioned before, is that “the doctor and the patient
must have the same concept of the patients’ condition.”
I have just published with Amazon; a layman’s book entitled “Goodbye Back Pain” for
patients of doctors in our paradigm. Our doctors insist on getting a diagnosis to work
from, with an understanding of the state of the tissues involved.
Is there any pathology other than the inflammation?
What is the state of the tissues that will influence the S.A.I.D. response?
What are the biomechanical insults in the closed kinematic system?
What soft tissues need to be stretched?
What muscles need to be relaxed or strengthened?
What is a reasonable treatment plan?
What is a reasonable therapeutic goal (Outcome)?
When a patient is told to order this book from www.amazon.com and they easily read it;
they will realize your diagnos is is correct and they will understand why it takes a series
of specifically oriented treatments to bring them through the healing and then the
normalizing process. As the treatments change, the patient will be happy to have a
short term goal achieved and be enthusiastic about getting to the next level. It all
makes sense to the doctor and the patient.
I even discuss the diagnosis chapter with the patient, to be sure they agree. X-ray
findings show the level of pathology.
Surface EMG can record the muscle over activity.
Posture can be viewed as abnormal muscle activity.
Springing pain that lingers can be the location of the inflammation.

The non lingering pain of joint fixation, elicited by motion palpation, can detect the joints
to be adjusted and around which axes of rotation. Remember flexion/extens ion is
rotation around the X axis. Lateral flexion is around the Z axis and rotation is rotation
around the Y axis.
Decreased passive R.O.M. can detect the tissues that need to be stretched.
Trigger points can be checked by knowing the pain patterns.
Weakness of muscles can be tested and their recruitment order observed. Etc.
By this time, the doctor and the patient are on the same page and the patient will
comply with your recommendations.
This book is a revised edition of the 20 year old, first edition. Chiropractors were not
ready for it 20 years ago. The diagnosis of ”subluxation” was dominant and rehab was
for physical therapists.
I suggest you get a copy for yourself by clicking on our Links button. If you see the
wisdom in my compliance procedure, get the patients to order online. The cost to you is
zero and the increased results for the patient and your increased visits, will more than
please both of you.
Interns have this problem in “spades” as the saying goes. Students can get their few
back pain patients to comply and the referrals will flow.

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