CHIEF COMPLAINT: OPQRST

Communication Objective: Differentiate between Symptom and Cause; Symptom and Problem; Symptom and Subluxation. Be cautious to not use these words interchangeably – and correct the patient politely, but deliberately if they do. Emphasize the words Symptoms, Cause, Problem and Subluxation to accomplish this. Continue to drill down on the “Life Effect”. Be sure to use the words that they used in the Meet and Greet. Provoke them to expand on how their symptoms / complaint / health is negatively impacting their life. Make sure that they own their problem. You may ask them…NAME, you have been struggling with this issue for # OF YEARS…Why TODAY?” This is another effort to unpack their Life Effect and their Value System. Again, listen to what they say and the words that they use.

Script: #

So PATIENT, let’s talk about your chief complaint so that we can find out what's causing that SYMPTOM…

Subluxation is a degenerative problem which means that typically it will start out silently and evolve over time until we do something to aggravate it and it becomes symptomatic. When was the first time that you remember experiencing this SYMPTOM?

Subluxation can not only cause symptoms but it also creates weakness in the spine. That means that usually there is a posture, movement, or position that aggravates the problem and makes the symptoms worse. What specifically makes the (symptom) worse?

What have you found that relieves the symptoms? Ice? Heat?

What you're describing sounds like nerve irritation. How would you describe it? Is it achy, burning, sharp, throbbing?

Symptoms of subluxation usually follow a pattern; it may be worse in the morning, it may be worse in the evening, or it can be constant. How would you describe your pattern?

PATIENT, we know that stress causes subluxation, whether it is physical stress, emotional stress, or chemical stress. What do you feel is the biggest stressor that could be contributing to your chief complaint?

I want you to stand up with me and take your index finger and point to the center of your symptoms…so if you had subluxation, where do you think it is?

This is a critical moment. The patient has shifted their focus from the symptom to the cause: pointing to where they think they may have a subluxation.
Does the pain/discomfort stay there or does it travel anywhere else?
So the nerves in that area go to State Body Systems and can very well be the cause of your CHIEF COMPLAINT…but those same nerves also go to RELATED SYSTEMS – your bowel, bladder, and reproductive organs, muscles of your back, lungs, and digestive system, muscles of your shoulders and neck, glands in your face and throat, immune system, and thyroid gland which deals with body chemistry …
Have you noticed any changes or issues in those areas?
So let me ask you – how bad are these symptoms?
What are they keeping you from doing? Work? Working out? Sports?
Or better yet, if you did not have this SYMPTOM – what would you be able to do more of?
Last question: What are you goals? What are you hoping to achieve by coming in to see us?
Listen intently to the answers to these questions: What is this symptom preventing you from doing / enjoying? What would you do more of if you did not have this issue? Life Effect – First Agreement

What are your goals here with us today? What are your goals ultimately? *AGREE ON THE GOALS: THE 2ND AGREEMENT Make sure that you agree on the objectives of care. You must be aligned when it comes to the goal(s) surrounding care – otherwise it will be a frustrating relationship / experience for you both. I like to get specific info on the patient’s goals: 1. Immediate Goals 2. Short Term Goals 3. Long Term Goals It is critical that you establish these goals with the patient and agree on what you are trying to accomplish. If today they are at Point A (Describing their symptoms and Life Effect) then their goals are point X, Y and Z. Your Recommendations will be The “Path” from A to Z. – The 3rd Agreement. Be sure to watch the TRP Academy Video Module on The 4 Agreements. This deep-dive study will teach you The Conversion Formula that will explode your conversions and re-conversions so that you can make a bigger impact in your community.

Ok, great, PATIENT. Thank you for sharing. This information will help me design and examination that is right for you. I think we have enough to get started. Let’s begin your exam now and find out what is causing that SYMPTOM.
*See TRP Academy Video Module #17

Procedure:
The doctor now takes the patient to the Bio-Structural Exam Center to conduct posture and balance assessment.

If the DC is turning over the exam to the Tech CA the DC should explain his orders to the Tech CA in front of the patient to give authority to the Tech CA.