I have to admit – I’m not a fan of The Cheesecake Factory restaurant. It’s got nothing to do with their food – it’s their MENU that drives me crazy.
The last time I was there, it felt like the menu was about 127 pages long, with about 30 options on each page. By the time I got to page 3, I forgot why I was even there.
What does this have to do with practicing chiropractic?
Do you ask your patients to rate their pain on each visit? When done right, it’s a great way to track your patients’ progress from visit to visit. But when done wrong, it’s The Cheesecake Factory all over again.
Apparently, the human brain can only take so much, and giving patients the task of choosing between 11 numbers (0-10) sends them over the edge.
It’s too many options.
Even when we explain to our patients that a “10” is the “worst pain imaginable,” they just love to reply with “Yep – that’s me.” So how can we fix this?
Mild, Moderate or Severe
For some reason, patients seem to understand, sort of, the adjectives of “mild, moderate and severe.” For each symptom, start with that.
“Mrs. Jones, do you consider your headaches to be mild, moderate or severe?” If Mrs. Jones answers with “severe,” it’s time to challenge her. I explain that “severe” means she’s at or on her way to hospital. “Would you like me to call an ambulance for you?” usually gets my point across even more. Most patients will back off the “severe” category, at that point, although I have had patients over the years (very few) who told me they were on their way to the hospital but they stopped at my office first. When they admit that their pain is “moderate,” I help them get to a number. I explain that moderate pain is between a 4 and a 7, with 7 being the worst. By them telling me their pain is “moderate” helps me eliminate 0-3 (mild) and 8-10 (severe). If the pain is closer to mild, it’s a 4. Closer to severe? Call it a 7. Kind of in the middle? Give it a 5 or 6. Now the number makes more sense.
Why is the number that important?
One of the requirements of our documentation is to note how each symptom is today compared to the previous visit. Using metrics makes that sooooo much easier. But if you give the patient too many options, like the Cheesecake Factory menu, they start making things up.
Track the intensity of each symptom, but make sure the patient is being honest with you and gives you a reasonable number. As one who reviews a LOT of PI records every month, whenever I see the numbers 8, 9 or 10, I get suspicious.