I was struck by the hat she wore throughout the seminar while sitting in the second row on Saturday during my presentation at the New Zealand Chiropractic College Lyceum. She wore a different one on Sunday. We don’t see women wearing hats these days so I was intrigued who this chiropractor was. Naturally, I was surprised when she approached me after the seminar and invited me to join her and her husband for dinner at their home. Even more surprisingly, I accepted!
Later, in the car during the 20 minute drive to her cozy suburban home, I revealed that I don’t normally receive such invitations and on those rare occasions when I do, I normally turn them down. She practically squealed with delight and went on to explain how on a recent visit to the United States that she and her husband had been impressed by the hospitality of the Americans they had encountered. “I just want to return the favor," she concluded.
I’ve just returned from my tour of New Zealand and Australia. Wow! Ostensibly it began with a several presentations at the annual Lyceum hosted by the New Zealand College of Chiropractic. From there, I facilitated three small group presentations in Brisbane, Melbourne and Adelaide. Limited to 12 chiropractors, our one day together was preceded by 40 days of homework assignments. Our day of “accountability” served as a means to get participants to become present to who they are showing up as with their patients.
Spending a day with these courageous chiropractors, willing to look at what they previously had been unwilling to look at was an incredible privilege. Instead of me standing in front of the room yakking all day, accompanied by a thoughtful PowerPoint presentation, I got to ask questions and facilitate an intimate conversation among a group of chiropractors who had tested themselves and monitored their internal environment.
Last night Marilyn and I were taken to dinner by a close business associate at a restaurant that I drive by practically every day on my way to the office, but had never been.
It was spectactular.
But what struck me throughout our delightful dinner was the couple at the adjacent table. From time to time I couldn’t help but notice that they were eavesdropping in on our conversation!
For about six hours each year the CIA headquarters in Virginia is opened to the families of employees. This is an opportunity for those unable to share their daily activities with their family to “show off” the hallways they walk, the security measures they must take each day and even the cafeteria they eat in.
After opening remarks by General Hayden, we toured the “spy” museum and explored the countless exhibits along the labyrinth of corridors used by the various intelligence groups headquartered at this facility. We were able to try on some body armor used by the folks in Iraq (40 lbs.) and inspect other tools used for intelligence gathering and analysis.
On our recent trip to Washington, DC they seemed to be everywhere. In fact, I’d ridden tour buses in London, Barcelona and elsewhere. You don't have to worry about parking and you get a great overview of a city so you can get your bearings. Better yet, you can get on and off whenever you want. Some people choose to stay on for the entire circuit. Others get off with a moment's notice or at the slightest whim.
Generals are often accused of “fighting the last war” and this is true also for chiropractors. The strategies and tactics used when most patients had generous health insurance are no longer working. Conditions have changed. And if you don’t (or haven’t) changed along with them, you’ll become a casualty.
There were only a couple of strategies back then. Most, a variation on the “extract-as-much-money-from-the-patient’s-insurance-policy-as-possible” theme. Even chiropractors with the highest motives found themselves avoiding the term “subluxation” in their insurance narratives, adding physical therapy or other services that were reimbursed by the patient’s carrier. Most chiropractors “followed the money” and now years later find themselves in a strange land. Some are understandably panicking like a child suddenly feeling lost at the shopping mall. But finding mommy won’t be easy. Because there is no mommy.
After my speaking gig at the UCA Autumn Conference in Birmingham, England this evening, I decided to leave the hotel for dinner at one of the dozens of restaurants surrounding the hotel.
After approaching the third restaurant and getting turned down, either due to an extraordinary long wait (I could see empty tables) or the lack of a reservation (half the restaurant was empty) it dawned on me. I’m not a desirable dinner patron!
He was an older gentleman with a full head of strikingly white hair. The twinkle in his eyes revealed a deep understanding and wisdom. His energy and vitality disguised his 72 years. That he was still practicing was even more affirming. I had the good fortune of sitting next to Dr. Stephen Owens at a pre-convention dinner meeting Friday evening.
I had been invited to deliver a talk the following morning entitled “The Post Insurance Practice.” The dinner invite was promoted as an intimate conversation with yours truly, offering suggestions on how the association could support their membership in making the transition from a reimbursement dependent practice, to cash. But after a couple of opening remarks, I think I was the one who benefited the most.
Used to be chiropractors were a wild breed. Radical. Unpredictable. They would espouse opinions that ran counter to the mainstream. These highly-certain healers often stood alone, hidden from view, but thriving on the periphery. They held the inborn healing ability of patients in the highest esteem. With their integrity to the principles of chiropractic and the results that applying the principles could produce, chiropractic was able to survive against powerful cultural forces, professional bias and for some, without licensure laws.
It’s hard to find too many purebred chiropractors anymore. Many have passed on, retired or have been defanged, domesticated and turned into docile therapists. Just how do you remove the rogue features in the genetic code of a chiropractor? Here’s how:
Many chiropractors have treated third party reimbursement like winning the lottery. And like the lottery, countless people who suddenly came into millions, lost it all.
Tales of the average Joe Sixpack losing his or her winnings after two or three years are common, it’s practically a cliché. Similarly, chiropractors who got the taste of generous reimbursement adjusted their lifestyles upwards, thinking it would last forever as the new “normal.”
As I spend more time and energy discussing the importance of patient financial education and the need to begin transitioning to a cash practice, there’s an important distinction that’s showing up. If you’re inclined to think that having a cash practice is about a new financial policy and telephone scripting to handle the “Are you on my list?” question, think again. Having a cash practice is about attracting cash paying patients.
In a magazine I was reading to pass the time before I could use my computer on the airplane after take-off, I ran across this ad for the Bellagio hotel in Las Vegas. It was the two-word headline that caught my eye: Superiority Complex.
Claiming to be superior is so un-PC these days. And while claims of superiority to other chiropractors or other methods is often specifically restricted by your state’s chiropractic licensing statutes, I don’t think that’s the source of the mousey, demure and inferiority complex that is so common among chiropractors. Some suggest it’s the result of rampant low self-esteem. I agree. However, we might part company about how to escape from this perceptual imprisonment.
On my most recent speaking gig, I and another speaker were invited to dinner by one of the attendees. As the dinner unfolded, I could tell I was dining with two chiropractors who take more of a short-term “catch and release” approach to patient care designed to ameliorate only the patient’s most obvious symptoms.
Eventually I asked how often both of them got adjusted.
It’s Election Day in the United States and it’s the usual showdown between conservatives and liberals. Some would assert that the difference between the two parties is a matter of great importance. Others, who are more cynical, see the choice as merely two shades of beige and the lesser of two evils.
I recently heard the terms liberal and conservative applied to the two major worldviews in chiropractic (mechanists and vitalists). As the terms were used, I surmised that conservative chiropractors are apparently those who limit their practice to the treatment of neuromuscular-skeletal complaints. And liberal chiropractors are those who think chiropractic can help virtually any health problem. This schism is what happens when politicians are in politics for power and chiropractors are in practice for prestige. Both overlook two factors far greater than the petty name-calling and the “I’m-right-and-you’re-wrong” division that handicaps this profession.
Because of their Denver hub, I’ve been flying United Airlines for years, racking up over a million miles with them. Because of my loyalty, I’m practically guaranteed a seat in their Economy Plus section. This is an area of Coach in which the pitch between seats is 5” greater than Economy, allowing you to cross your legs and use a laptop without the passenger in front of you reclining their seat into your chest. So I was taken by the gate agent auctioning off seats in Economy Plus for $41 prior to boarding the plane this morning.
"So Bill, I couldn’t help but notice that you’ve spoken in Orlando the last three consecutive weekends for the Masters Circle, Breakthrough Coaching and Ward Success Systems. So, which group was the best?
”
I couldn’t tell if he was fishing for some affirmation that he had chosen the “best” coaching program or looking for distinctions that made each audience different or asking me to rate the merits of the three organizations.
Our wonderful grandfather clock received service today. After 10 years of faithful service it needed some oil and attention. Mechanical (and non-mechanical) devices need an occasional tune-up. The symptoms? During the Westminster chimes, some of the notes were slurring. Not a serious problem, but one that portends future problems if ignored. So Tom showed up to do his voodoo. Towards the completion of his work, he called me downstairs to listen to his work. It sounded great.
“So tell me, what do you do?” he asked after demonstrating his handiwork.
In the popular book series, Rich Dad Poor Dad, author Robert T. Kiyosaki makes the distinction between assets and liabilities. Rich people invest in assets. Poor people spend their money on liabilities.
That came to mind as I was considering the wisdom of a chiropractor friend having a ball because he recognized the lifetime value of a patient. Turns out he “gets” the idea that his inactive patient files are assets. The names of people who know him, his personality, his results and his office location are a valuable asset. While other practices shuttle their inactive files first to the basement, then to the storage unit and then to the silver recycler, Steven understands that many of his inactives are merely waiting for an invitation to return!
I was speaking with a colleague this morning who, I suspect, is getting ready to change jobs. The reason I know that is because she complained about how she was being treated by her current employer.
After she ranted about working such long hours and being, not so much mistreated but unappreciated for two or three minutes, I stopped her.
“You’ve created this, you know,” I said.
(Long pause.)
“Yeah but,” and she continued her list of injustices and frustrations.
I expect she didn’t expect me to “fix” her situation, but needed a set of ears so she could speak what was true for her. Sometimes, it’s not until we utter the words that describe our circumstances and hear ourselves say what we feel, that we can finally accept what is; the first step to taking action.
The end of third-party reimbursement is around the corner. It was a great run. There is little evidence that the erosion you’ve seen in the last couple of years will slow, much less reverse. If you don’t adapt, you’ll jeopardize your practice and your livelihood.
Welcome to the future.
This is the first of several posts exploring patient financial education and the transition into a self-pay practice. Will you make the turn? Can your practice thrive in this brave new world? Ask yourself these vital questions:
One of the bright lights in chiropractic was extinguished over the weekend. Will Tickel, DC was one of my early inspirations. Perhaps our shared background in advertising and love of the English language brought us together. We would often exchange articles, thot pieces, as Will would say, in the hopes the other would either confirm our allegations and insights or provide clarity or direction for their improvement.
Inspired by his book, Down Right! Up Right! Chiropractic Inside-Out published in 1987, I asked Will to write the Introduction to my first book, A Patient’s Point of View. More recently, on the back cover of his second book One Liners, describes Dr. Tickel as the “Will Rogers of chiropractic.” That’s it! His folksy, unassuming personality showed up in his writing that while cerebral, was approachable and filled with “thot-full” examples and earthy frankness.
A philosopher. A chiropractor. A friend. I’m going to miss Will. Chiropractic is going to miss Will. I miss him already.
It’s been a combination of pride and cringing embarrassment. What could produce such an emotional mixture? Posting each of the chapters from A Patient’s Point of View and My Report of Findings to this website over the last couple of days. (The drop-down menu under “Books” above.)
Originally published in 1992 and 1993 it was difficult to avoid the temptation to do a little editing here, deleting a few paragraphs there, and generally freshening things up. After all, many of my ideas have matured since then. But I decided to post them as is.
The earlier post about a new practitioner asking about advertising for pain relief versus advertising for wellness prompted several public and private posts. Seems this issue may deserve further exploration.
How the public sees chiropractic will not be what visionary chiropractors say or claim chiropractic is. Perception is reality. If the public thinks chiropractors are “bad back doctors for pain relief only” then that’s what chiropractors are.
“Oh no, you’ve got us all wrong! We’re wellness doctors.”
You got through December. Now most patients’ deductibles have reset and you’re waiting for March or April to get back into the new patient groove.
Sounds like you may have a seasonal practice.
Are subluxations seasonal? Are physical, emotional and physical stresses seasonal? If they are, then if anything they actually increase at the exact time most offices slow down over the holidays. If you find yourself a migrant worker in the business of health care, this would be a good time to make some changes.
Your practice has dwindled. New patients are practically nonexistent. You have a lot of free time on your hands. But you’re not making enough money to have a viable business. You probably graduated toward the top of your class, but the clinical honors and hopeful optimism you enjoyed back then have long been sucked out of you. It’s crunch time.
Now that you’ve been humbled (or about to be), you have the possibility of becoming a tool that God can work through. Now that you’ve surrendered your dogmatism and egocentric view of the world, you can become a true servant. Now that you’re not so full of yourself, you’re empty enough to be useful.
California is in the midst of grappling with escalating health care costs. Early rumblings suggest that the California legislature is coming precipitously close to taking a path that is unsustainable and will serve to make the problem worse.
Here’s my radical proposal. And I use the word radical in its truest meaning: getting to the root cause.
Before there can be an intelligent conversation about health care costs and its increasing burden on California taxpayers, you must define your terms to effectively frame the debate. If the chiropractic profession’s contribution were merely to bring clarity to the language, this alone would be a Herculean accomplishment and advance its interests!
Seems that chiropractors with the greatest number of “tools” on their belt (nutrition, emotional work, rehab, orthotics, etc.) can go through a stage in which they seem to shun patients who enter the practice lacking the interest in pursuing these “extracurricular” resources.
Forgetting that the patient’s objective is symptom-relief (not wellness) and the patient’s focus is on results (not optimized health), it’s tempting to blame or judge patients for their shortsightedness and limited vision of what you can now do to help them.
Which causes your numbers drop.
Not exactly the affirmation you were expecting after having traipsed off to the weekend seminars, spent the money, bought the equipment or changed your examination procedures!
Yesterday I had the pleasure to speaking to Dr. Mark Doerrfeld’s class at Palmer College in Davenport. The evening before, I spent an hour or so with the Masters Circle Club. Having never attended chiropractic college as a student, being on the campus of any chiropractic college is always a thrill for me. Spending time with students genuinely interested, who ask great questions, is among my favorite speaking gigs.
Besides the fact that students appear incredibly young (a sure sign that I must be getting old), I was struck by the fact that many chiropractic college students seem to have lost touch with the original dream that prompted them to begin the journey of becoming a chiropractor. Locked deeply into their left brain, most students have their heads down, intent on learning the neurology and anatomy and getting good grades. And while getting high marks may be a source of pride, good grades have little relationship on one’s ability to successfully practice chiropractic. (Often, just the opposite.) A fact lost on most students.
Thursday I completed a new, one-day program in New Jersey called the Cash Patient. I generally find East Coast seminar audiences generous and attentive, and the program in Saddle Brook was no exception. During this program, I tried to make the point that a cash practice is an effect, not a cause; a symptom of making the practice relevant and meaningful to patients willing to pay for their own care. Proclaiming that yours is a cash practice is often done out of frustration and is more about eliminating insurance hassles for you, rather than making the practice attractive to those who value their health enough to pay you, and if they have a policy, file the claims and wait to get reimbursed.
Naturally, if you don’t see the chiropractic care as something valuable enough that a sufficient number of patients would reach into their own pocket or purse to pay you, then you have a more serious problem than the arbitrary claims cutting that makes it impossible to predict your cash flow.
Is an adjustment commodity? That is, is an adjustment delivered by Doctor A the same as an adjustment delivered by Doctor B? You and I know that even if the same technique is employed, they can be two very different adjustments. It’s easy to forget this distinction because of the spell cast by third party reimbursement. Carriers have chosen to look past this difference (even though cash-paying patients don’t). To carriers, the full body diversified adjustment, the one-bone adjustment and the energy focused tonal adjustment are all the same. To a carrier, an adjustment is an adjustment is an adjustment. A commodity. It’s easier that way. This has created a huge problem for chiropractors coming out of the third party trance: “How much should I charge?”
As the influence of third parties wanes, more and more chiropractors are placed in the position of having to do what other small businesses have always had to do: set the price for their goods or services. What is an adjustment worth?
As I was editing the previous entry about clutter, it occurred to me that most chiropractors probably don’t have a formal new patient lead generating system. Instead, most take a passive approach—like a spider, who spins its web and waits. This may produce the occasional meal for the spider, but it’s hardly a strategy for a thriving business. You could probably benefit from a formal lead generation system.
Many chiropractors fail to realize they are first a small business, with the need to attract and keep customers like any other small business. Getting on the “list” was supposed to solve this problem. In exchange for a lower fee, you were supposed to get a steady stream of appreciative new patients. Since that hasn’t worked out liked you had hoped, you need a lead generation system.
If you’re a bit disoriented because things that used to work don’t, you’re feeling a bit like Rip Van Winkle, waking up after a 20-year sleep. And while chiropractic principles haven’t changed, patients and the environment you practice in has. You’re dealing with a handful of issues that must be dealt with correctly or you’ll become the equivalent of the buggy whip manufacturer of 100 years ago: obsolete and irrelevant.
Here are some of the most significant issues that have changed and some action steps to deal with them. Your ability to recognize and adapt to them is essential if you have any hope of thriving in the years ahead:
The argument continues whether humans are responsible for climate changes, or that we’re simply experiencing a cyclical “slipping and checking” due to changes in the output of the sun or some other natural phenomenon entirely out of our control. As I see people choose sides (or simply ignore the conflict), I can’t help but see the similarities with chiropractic. (Naturally, I see virtually everything as a chiropractic metaphor!)
I see several connections.
1. Beliefs control the whole show. In the same way advocates who believe in global warming find it difficult to convince those who don’t, convincing those who fear germs or are afraid to have their neck adjusted is similarly difficult. Once you realize you can’t change someone else’s mind (only they can do that), you see that belief changing is an inside job. Like healing. You can create favorable conditions, but ultimately it’s out of your control.
After speaking at the Masters Circle Super Conference last October, Dr. Dennis Perman interviewed me for MasterTalk, their monthly motivation and information CD. (You should subscribe or get to one of their seminars.)
I remember leaving the interview feeling that it had only lasted five minutes (it was almost 17 minutes) and that maybe I’d been a bit too frank with some of the answers to his questions. So, it was with some trepidation that five months later I listened to it while exercising on the treadmill yesterday. You be the judge:
By the way, here are links to some of the resources I mentioned during the interview that you may find helpful:
If you don’t have at least a few patients choosing not to begin chiropractic care at the conclusion of your consultation, you’re probably not casting your net wide enough. If your new patient lead generation system (do you have one?) produce prospects who all begin care, you may be playing it too safe. Without a rejection or two on a regular basis, it means people in your community are prequalifying themselves before showing up. This probably means your new patient numbers are down, and the ones showing up are largely those with neuromuscular-skeletal complaints. If you want a wellness practice; if you want to see more visceral complaints; if you want to see more miracles—you’ll want to create a larger opening to your practice.
One of the common themes of my most recent speaking gigs is the idea that many chiropractors get into trouble by caring too much. It’s the occupational hazard of being a professional caregiver.
Caring too much produces a variety of practice pathologies, among them, taking patient behaviors personally, thinking their headache is your problem, resenting patients for poorly prioritizing their health and ultimately burnout, in which patients become the “problem” of practice. So, my advice has always been, “Care, but don’t care too much.”
Last night, just as I was about to drift off to asleep, I was struck by the thought of caring as a continuum, with three general types of caring.
If attempting to serve two masters doesn't dissuade you from taking assignment, consider the multiple passages in the Book of Proverbs that warn of the dangers of co-signing on someone else’s loan. It got me to thinking. In some ways, isn’t this pretty much what taking assignment is?
When you co-sign a loan, you’re agreeing to make the payments if the primary borrower defaults. Naturally, in the case of taking assignment, you’re not making payments—you’re delivering chiropractic care. But you’re doing so without the assurance that you’ll be paid, and if you are paid, when and how much you’ll get. When you “co-sign” with the patient to accept what the insurance company will dole out, the only loser is you. The patient gets what they want. The insurance company makes a greater profit by cutting your bill. And you get caught holding the bag.
After 26 years as a non-DC attempting to serve chiropractors by advocating the patient's point of view, it still astonishes me how much this profession is held back by its fractured in-fighting. And no wonder. After a recent seminar, in which I heard chiropractors using sloppy language while asking questions, it prompted me to identify some of the many distinctions that chiropractors make—either consciously or unconsciously, that produce the bifurcation in chiropractic:
When I wrote last week’s post (Why We Can’t Get Along) exploring the language barrier that exists in chiropractic, I had no idea that a low-pressure system was simultaneously blowing in one more attempt at unity between the ACA and the ICA.
My guess is that the ICA rejection of the overture initiated by Congress of Chiropractic State Associations (COCSA) wasn’t merely obstructionism or the inability to understand the savings that could come by eliminating redundant staffing, office space, lobbyists or the continuing confusion among lawmakers. It’s something much deeper.
The debate over whether to use the term subluxation or joint dysfunction, adjust or manipulate or care instead of treatment pales in comparison to a much larger conflict gathering on the horizon: national health care. More specifically, should chiropractic be included in any type of national health care plan, or should it remain outside whatever Congress and the next president concoct?
I’m guessing that the most recent push for merger talks between the major chiropractic political organizations is actually motivated by the hope that chiropractic will speak with one voice during the ensuing “negotiations” about what role chiropractic might play in such a plan.
One more thing about the upcoming national health care scheme you may want to chew on as the election approaches and you develop your position.
Remember, nationalized health care will be coming from the same folks who brought you the Swine Flu vaccination, the Just Say No! drug campaign and the Bird Flu hoax. Combine the waiting in line at your Department of Motor Vehicles with the waste of the Pentagon and you can begin to imagine the fodder for the comedians on the late night TV talk shows.
You want to be part of, and be identified with, such a system?
My parents had enough of a memory of the Great Depression to raise my brother and me to avoid any kind of waste. While we didn’t reuse aluminum foil, we were constantly urged to turn off lights, eat all the food on our plates and take care of things so they’d last. I’m reminded of this frugal approach as I see a growing number of chiropractors who think they can achieve prosperity by cutting costs. If you feel compelled to cut back, here are some suggestions:
“If I knew I'd live this long, I would have taken better care of myself.”
It’s an observation we could probably all make. Each of us could live more consciously, exercise more consistently, rest more deeply, eat more nutritiously and think more positively. Even with our occasional lapses and shortcomings, it’s still better than what most patients do.
Which creates a little problem.
If patients get even a whiff of a “healthier than thou” attitude from you, you’re toast. That’s because of two powerful emotions that are rarely discussed in the context of doctor/patient relationships.
Income down? Then you need more new patients. Gapping holes in your schedule? Then you need more new patients. Stressed out about the future? Then you need more new patients. Are patients ignoring your recommendations? Then you need more new patients.
But, more new patients will not solve your problems. Especially if you treat your next crop of new patients as you have the ones before. In fact, focusing on new patients creates an addiction that must be continually fed. Chiropractors with this addiction are constantly foraging for new patients. Most have tried every gimmick, every script and fallen for every shrill appeal in the chiropractic publications they read.
“Become a New Patient Magnet!”
“Pays For Itself With Your First New Patient”
“Get Up to Five New Patients Each Week”
“New Patients From Lawyers and MDs!”
If you find yourself lured by these promises, thinking your problems can be fixed by outside-in solutions, then you may have a bigger problem than you think...
This past weekend we completed The Conversation in Denver. What a privilege to spend the weekend with a small group of chiropractors willing to look at what they’ve been avoiding (even their weight) and explore how they’re showing up in their practices.
So this appears in my in box just 24 hours after we said goodbye:
Dear Bill,
At the risk of repeating myself. . . . i can't tell you how much this weekend has helped me. first thing this AM i was asking patients questions with ease and comfort. . . i didn't really plan on doing anything different but it just happened in a natural way. this weekend is the first time i have been able to identify the problem but, more importantly, figure out the solution, through a series of questions you and the others ask me. It was such a concrete way for me to learn how my patients can learn from me becoming truly an educator. THANK YOU, THANK YOU, THANK YOU!!!!!
I know. You get these sorts of love notes from appreciative patients all the time. But me? I provide patient education materials! To be part of this kind of healing that could influence hundreds, maybe thousands of others, is way cool.
The Conversation isn’t a seminar, it isn’t therapy and it isn’t an encounter. It’s peaceful, introspective, light and apparently, life changing. The next Conversation closes August 10th.
I just watched Sicko, the new film by Michael Moore. I’ve never been a fan of Michael Moore or his politics, but I have to admit I was taken by his documentary about “health” insurance in the United States. I already knew staggering medical bills were involved in most US bankruptcies—even people with insurance. While Mr. Moore’s conclusion seems to suggest that we socialize our health care system and model it after the Canadian, UK, French or even Cuban system, what we really have is a crisis in personal responsibility. However, he may be right about one thing. In France, and elsewhere, the government is afraid of the people. In the US, the people are afraid of the government. Which may be why nationalizing 1/7th of our GNP may not be such a good idea after all...
You may be feeling a bit apprehensive if you set up your practice with a greater emphasis on getting chiropractic patients than keeping patients. That’s okay. That’s where the money was back when third parties were picking up most of the tab. It didn’t make sense to squander valuable resources on anything other than what it would take to produce new patients. But now, years later, you have a burgeoning collection of brightly labeled file folders—but few cash-paying “once-a-monthers.” When you think about it, you had a “promotion,” not a sustainable practice.
There are going to be a lot of sevens in the date tomorrow. I got to thinking, why does seven show up in so many religious references, folklore and fairy tales? Why is it considered a “lucky” number. Here are some interesting facts I found:
God is said to have made the Earth in six days, then he rested on the seventh.
There are four seasons, 28 days in each moon cycle, so four into 28 goes seven times, making seven a significant number.
Others believe its importance comes from the ancient Sumerian and Babylonian civilizations, which identified seven planets and framed the seven days of the week around them. Very early among Middle Eastern peoples, seven became known as a "perfect" number, a symbol of completeness and goodness.
There were Seven Wonders of the ancient world and in pharaoh’s Egypt, seven was the symbol of eternal life and stood for the dynamic perfection of a completed cycle.
And let’s not forget the seven seas, seventh heaven, the seven deadly sins and the seven-year itch, the seven dwarfs, the seven colors of the rainbow, the seven Mercury astronauts, the number of openings into the human head (mouth, two eyes, two ears, two nostrils) and for us in chiropractic, the seven bones of the cervical spine.
How do you overcome the tendency for chiropractic patients to discontinue care (or not even begin) if their insurance won’t pay for it?
This question has been rattling around in my brain for the last six months or so. It’s a common source of frustration of many chiropractors. Angst about this issue prompts far too many chiropractors to succumb to accepting insurance assignment, surrendering their practices to claims adjusters who have little understanding, respect or interest in chiropractic.
I finally know what the answer is! But before I reveal it, let me pose a couple of questions:
Suggestion: You could consistently hand out brochures so patients could more easily tell others about chiropractic and your office.
“But that’s just not me.”
Suggestion: You could become a proficient public speaker and arrange to give talks to civic groups and service organizations about natural health care methods.
“But that’s just not me.”
Suggestion: You could urge parents to bring their children in for a chiropractic check up and help prevent some of the problems you see in adults.
“But that’s just not me.”
Suggestion: You could invite a couple of patients to lunch and find out ways you could improve your practice and deliver a higher level of patient-centered care.
I’ve been thinking about something I encountered a couple of Saturday mornings ago before a recent speaking gig in San Diego. I didn’t speak until after lunch, so I had the opportunity to take a self-guided tour of the aircraft carrier USS Midway. If you have the opportunity invest a couple of hours and take the tour.
What’s been rattling around my mind this last week is a little factoid I learned during the final part of the tour, explaining the refueling-at-sea process necessary to keep carriers battle-ready. In fact, one of the reasons the USS Midway had been mothballed and turned into a museum was because it was the last of two aircraft carriers known as “oil burners.” (The remaining diesel carrier, the USS Kitty Hawk is to be retired next year.)
Refueling at sea is done by “oilers” who pull along side and match the carrier’s speed. Lines are shot between each vessel that are used to support the 3” fuel line. It’s a rather serious maneuver, especially in the middle of battle operations!
The deeper I dig into what makes some chiropractors adored by their patients, the more I’m convinced that it’s who they are, rather than what they do. And while a lot of lip service is paid to “being,” I’m discovering that few are available for the introspection and self-examination required to “be” someone more attractive. Because like all healing, it requires going through, rather than around.
Most chiropractors have set up their lives so no one calls them on their stuff. The staff learns to keep their mouths shut and look past their boss’s practice-sabotaging beliefs and behaviors. Advice from a spouse is dismissed with a routine, “Honey, things have changed. It’s not like it was when you worked in the practice.” And your non-chiropractic buddies are unhelpful, recommending that you buck up, put your head down and just push harder.
One of the ideas I’ve explored in these recent postings is my belief that it can take most patients many tries of starting care and stopping care before they “get” the lifestyle benefits of chiropractic. Having spent their entire lives steeped in the medical model of symptom treating, most patients aren’t about to embrace chiropractic after one spellbinding report of findings and incremental relief that comes over weeks or months. Then, because patients see how deeply you care, many feel guilt or shame when they discontinue care. This, combined with the fact that most chiropractors are unwilling to keep in touch with patients during the dormant phase before their eventual relapse, creates a voracious appetite for new patients.
I get some revealing answers when I ask chiropractors, especially those still in chiropractic college, what they think an adjustment does. After a long, uncomfortable pause I can tell that they’re either not sure, have never thought about it or more likely, they’ve never actually had to put their own mental representation into words. Some, I suppose, are fearful that their working model of an adjustment might be amateurish or miss the mark completely. Yet, there is very little more important than being clear about what an adjustment is, what it does, what it doesn’t do and what your intention is when delivering one. Without clarity on this vital issue, you’ll resort to being a spine “fixer,” deluded into thinking you’re the one doing the healing! Many chiropractors have fallen into this trap.
If you have any hope of making lasting change with patients beyond the relief of their most obvious symptoms (inviting a subsequent relapse) you must facilitate a patient’s belief change so they see chiropractic as a lifestyle decision, not just a short term diet for pain relief. I use the word facilitate because you don’t have the power to directly change anyone’s beliefs but your own. In the same way I cannot change your beliefs, you cannot change a patient’s. We can attempt to make a compelling case for what we think is a more enlightened perspective (as I’m trying to do here). And we can make it emotionally “safe” to abandon an old idea and embrace a new one. But like healing, it’s an inside job that you can’t do for someone else.
I applaud Greg Stanley for so eloquently expressing a growing tension felt by many practitioners in his recent Dynamic Chiropractic article “The Sustainability of Chiropractic” Greg is a fellow non-DC, spending a similar amount of his life in service to the chiropractic profession. He may have overlooked an important distinction in his assertion that we may have an oversupply of DCs.
There may be too many DCs. But there are far too few chiropractors.
Many complain that after a century of great results chiropractic should be more fully accepted by now. These same chiropractors use this observation to advance their pet notion of the one thing that would be needed to permit chiropractic to finally reach the tipping point.
Their mistake is thinking that it’s just one thing that stands in the way.
Like Curly.
In case you missed it, actor Jack Palance was the crusty cowpoke Curly in the 1991 comedy City Slickers. Here’s the dialogue from the scene in which Mitch (played by Billy Crystal) learns about the one thing:
Curly: Do you know what the secret of life is?
Curly: This. [holds up one finger]
Mitch: Your finger?
Curly: One thing. Just one thing. You stick to that and the rest don't mean shit.
Mitch: But what is the "one thing?"
Curly: [smiles] That's what you have to find out.
According to David Seaman, MS, DC, DACBN in a recent article entitled, “It’s Time to Move Beyond Subluxation” published in Dynamic Chiropractic, the term subluxation has no place in the 2007 vernacular since we can’t measure pre- or post-adjustment changes. (Really?) Worse, “certain patients” don’t respond as expected after a so-called “treatment” for subluxation. (Of course.) Thus, subluxation is an anachronistic term we should put behind us; a remnant of an unenlightened bygone era.
Nice try.
This will be a tough sell, since according to a recent survey, an overwhelming majority of chiropractors said they want to retain the term “vertebral subluxation complex.”
“We need to give up the notion that adjustments have magical or supernatural healing outcomes,” continues Dr. Seaman.
I couldn’t agree more. But probably for different reasons.
Last weekend I completed another Debrief for The Conversation. With a half-dozen of these intimate gatherings under my belt, several themes are emerging. By creating a safe place for chiropractors to lower their guard and confront the issues holding them back, participants are able to discard some of the limiting beliefs standing in the way.
One such belief is related to the last couple of posts I’ve made here dealing with the adjustment. What it is and what it isn’t; what it does and what it doesn’t do. The second is a common strategy that some chiropractors use to influence patient behavior, showing up in their practice as the patient’s pal, friend or buddy.
Apparently, the worst pejorative that can be hurled at those who consider chiropractic more than just a mechanical treatment for certain cases neck and pack pain is to call them a “chiroevangalist.” I think this is meant to be a derisive term, suggesting that the chiropractor is mentally deficient, unenlightened or plain stupid by “believing” in or putting stock in certain metaphysical or even whole body effects of the chiropractic adjustment. I guess the thinking goes something like this: if it’s not found in the “literature” (scripture) with the blessing of anointed and properly creditentialed “peers” (disciples), than the chiropractic “intervention” (sacrament) can’t produce the result (miracle) that is claimed. Any suggestion that chiropractic might help one’s general health, improve organic conditions or enhance the body’s healing ability is dismissed as old school dogma, irresponsible wishful thinking and well, unprofessional.
Friday I had lunch with a nearby chiropractor who has been going through a rough patch. A divorce, staffing issues and a lack of new patients have created new, unfamiliar financial pressures. During our lunch, I heard three issues that seem to hold promise for his recovery. Whether he will have the courage to act upon them remains to be seen—after all, there is often a disconnect between knowing and doing.
The three issues were ownership, recreating the past and pride.
It’s popular to assume that virtually any malady facing a chiropractic practice can be solved with simply an injection of new patients. Income down? Get more new patients. Mid-day down times? Get more new patients. Higher co-pays? Get more new patients. Higher gas prices? Get more new patients. Higher rent? Get more new patients.
And while it’s true that a surge of new patients might temper the particular “ache or pain” your practice is experiencing, what about next month and the month after? A practice becomes stable from long-lasting relationships, referrals and reactivations. If you continue to have a voracious appetite for new patients after 10 years or longer in practice, you may have a new patient addiction.
Let me first confess that I’m not much of a fan of so-called comedian Bill Maher. I find his sardonic style and political leanings difficult to swallow. However, this brief rant about health and health care is not only on the money, but reveals a painful truth that all too many chiropractors seem unwilling to tell their patients about. Simply put, follow the money. And there isn’t any money in healthy people. Or is there? (Thanks Mark Franzen, DC.)
I was inspired to write this posting after thinking about how I used to be. For years, I tried to say the right things and do the right things to be liked, appreciated and for the ultimate desire: to be admired by others. In fact, if the truth be told, I lived for others. I suspect this trap has ensnared others.
Living life as a chameleon is not only hard work, it doesn’t produce the affirmation commensurate with selling one’s soul for acceptance. Worse, trying to show up in a way likeable to others is not only a draining, full time job, it surrenders your life to a beige mediocrity. Attempting to be liked by others is an endless game without half-time breaks or even a scorecard. Getting sucked into this vortex practically guarantees obscurity and ineffectiveness. It’s the perfect con that distracts us from making a difference.
I remember a very famous chiropractor who once admonished, “If you’re not pissing a few people off, you’re not doing anything!”
“It’d be a great business if it just weren’t for patients.”
Countless chiropractors lament about their frustration with patients who don’t “get” chiropractic or who refuse to follow the most rudimentary directions to enhance their recovery. Missed appointments. Self-sabotaging behaviors. Reliance on how they feel. Acting on the uninformed biases of friends and family. Dropping out of care when their limited coverage ends.
You know the list.
What many chiropractors overlook is that they actually attract the types of patients who show up in their office. It’s not some luck of the draw! You and your staff play an active part. You’re either doing things (procedures, scripts, policies, etc.) or showing up in ways that attract certain types of patients to your office. So, if you aren’t pleased with the types of patients who want to begin care in your office, you may want to make some changes. In you.
I just got back from a speaking gig at a chiropractic college. I had the privilege of spending two hours with students who are about to complete their college studies and, with the end in sight, have a heightened interest in the implications of actually applying what they’re learning.
Many are confused.
And no wonder. Not just because my presentation usually interrupts their left-brain dominated existence, but also because much of their education has a decidedly medical fragrance. The philosophy of chiropractic and its metaphysical foundations have been suppressed in favor of a more limited, mechanical perspective. Is subluxation real? What do patients want? What if chiropractic doesn’t work? Should I wear a lab coat? What will the insurance companies pay for?
I’m on vacation this week working on the next batch of Monday Morning Motivation broadcasts and some other cool projects. It occurred to me that life isn’t just digital (on or off, dead or alive) but shades of gray. Thankfully, because we subluxate rather than die when presented with certain amounts of stress, we each get to experience varying degrees of this thing called life.
Because our wonderful soul package (our body) is so accommodating to our mistreatment of it and our abuse generally takes years to erupt into obvious problems, we are often poor judges of our own well-being. Like the fish who doesn’t know he’s in water, asking a patient to describe their subjective well-being is an exercise in futility. That's when patients go digital. They are either aware that obvious symptoms are present or their lack of health hasn’t reached the symptomatic level yet. Yes or no. On or off. Symptoms or no symptoms.
There's been way too much energy applied to managing patients and way too little thought given to managing a patient's hope. Hope is an essential ingredient of the healing process that is often overlooked by those inclined to relish the technical aspect of when and where to adjust. Naturally, this reduces patients to mere spines, cases, insurance policies and practice volume statistics.
Patient hope exists on a continuum. At one extreme you find the "malingerer" and hypochondriac who receive too much secondary gain by not recovering. At the other extreme you see the patient who enters with the spoken (or unspoken) belief that they will experience a one-visit miracle cure. Somewhere between those two extremes are the patients who have "succumbed" to consulting a chiropractor and show up hopeful, but wary. Left and right of this middle range is where the majority of patients find themselves.
I was speaking with a doctor on the phone the other day who was lamenting about the state of his practice, recounting the different adjusting techniques he had employed over the years. More recently, his analytical bent had prompted him to pursue various postural and structural models of chiropractic. "But I was the busiest when my purpose was about finding and reducing subluxations," he confessed.
It's tempting to think that your practice volume is the effect of what you're doing; a technique, a procedure or a script. Perhaps initially, but sustained practice performance is the result of something far more subtle. Many chiropractors search for it at technique seminars and practice management programs. Predictably, they often see a brief bump in their numbers, but the practice fails to maintain this hoped-for increase. Experience these roller-coaster ups and downs long enough and you can become cynical and resigned. What is this elusive quality?
If your practice volume isn’t as great as you'd like, there's a good chance you’ve given considerable thought to how to turn things around. That search could send you down an unproductive rabbit trail to "causes" outside the four walls of the office and "causes" beyond the space between your ears. While it's convenient to blame the weather, the economy, the HMOs or the cheeseball advertising of other chiropractors, these are NEVER the real cause of slumping numbers.
Similarly, subluxations aren't the real problem patients have. They are merely the manifestations of poorly accommodated physical, emotional or chemical stress. Adding energy to their spine to put wayward bones back in formation is pure folly if you ignore the originating physical, emotional or chemical stressor(s), which may or may not still be present. Subluxation is merely a symptom.
Things that are scarce are considered more precious than things that are found in abundance. Thus, gold is more precious than sand; diamonds more precious than glass. Is this why new patients are so precious? Because they seem scarce?
But this principle also applies to your patient communications, especially the spoken word. The more words you speak, the less valuable (and less potent) your words become. Chatterboxes who mint words with abandon are seen as less powerful—little people. Those of few words and interestingly, short sentences, are seen as more commanding and authorative. The more you speak the more likely you over-explain, reveal insecurities and create a fragrance of defensiveness or the room-clearing stench of doubt.
Who awakens in the morning and proclaims, "Today, I want to be less significant. I want to be less important. I want to play a smaller role on the stage of life!"
No. For most of us, the reverse is true. We want a larger business. We want to play a more significant role in the lives of others. We desire greater impact, more influence and to contribute in more meaningful ways to those we touch.
Then why are some chiropractors so bent on minimizing chiropractic? Why are so many willing to reduce chiropractic to a localized therapy to improve spinal biomechanics? Why do so many decry the value of chiropractic for whole body health? Or its value for children? Or its use by those who are asymptomatic?
With chiropractic critics ramping up their fear mongering campaign, this new research out of Canada should serve as a breath of fresh air.
Published this past Saturday in Toronto’s Globe and Mail newspaper, the headline reads, “Chiropractors don’t raise stroke risk, study says.”
Turns out, when they looked at the 818 patients in the stroke study, comparing those who sought chiropractic care versus medical treatment, there was no significant difference. Patients were no more likely to suffer a stroke following a visit to a chiropractor than they would after visiting their family MD.
My guess is that his won’t prompt the Neck911USA folks to temper their “educational” campaign. Nor will it produce a flood of new patients, who have been holding off consulting your practice because of this common superstition. However, it's good news just the same.
If I were in practice, I’d have this article handy for those occasional few who refuse the most effective part of their care, the cervical adjustment. (Thanks Dr. Ron Nusbaum for the early heads up!)
What a thrill to meet two people I have admired for some time yesterday. Both were speakers at the New Beginnings Philosophy Weekend in Eatontown, NJ. Three times a year Dr. Jim Dubel and his crew put on a homespun celebration of chiropractic philosophy. When I accepted the speaking gig last year, I didn’t know that Dr. Dean DiPice and Dr. Kevin Donka would also be on the agenda.
A couple of months ago, an interview on CLA’s On Purpose introduced me to DiPice and his coaching program. What I heard was not only refreshing, but also stimulating. Dean and I had breakfast yesterday morning. I can see why his coaching program has taken off. He asks great questions.
Later, after I did my thing, I got to sit next to Dr. Kevin Donka at lunch. I’ve been a subscriber to ChiroThots for years. (To subscribe send an email to chirothots@aol.com with your name and the word "subscribe.") Each week Kevin shares a one-page essay about some facet of chiropractic philosophy. I enjoy how he takes the philosophical and turns it into a practical, down to earth handout for patients. We talked about writing and getting ideas. Unlike me, who stockpiles content for Monday Morning Motivation in advance, Scott spends about an hour each Monday morning crafting his message! (Be watching for his upcoming riff on “It’s a No Brainer.”)
Astute marketers know that what a new product or service is named can have a profound effect on sales. It wasn’t “The Promise to America,” it was “The Contract With America.” It’s not called death insurance, but life insurance. Who would disagree with an estate tax? That’s why opponents call it the death tax. Instead of “unwanted” effects, they’re called “side” effects, as if they were a bonus or something.
The importance of naming especially struck me this morning when I sat down to eat breakfast and was asked if I wanted my “pills” brought over to the table. I had forgotten my fish oil, acidophilious capsule and five Standard Process Catalyn supplements on the counter.
We had the Denver Debrief for The Conversation #6 this past weekend. Unlike previous sessions, the attendees were entirely male. It’s where I was introduced to the concept of Testosterone Poisoning. One of the symptoms of this malady is to define oneself by what one does. It manifests as an instinctual desire to fix things. Especially patients and specifically their spines. This, as participants of The Conversation discovered, is a serious trap. It ensnares many male chiropractors and invites two annoying problems that seem to plague chiropractors of the male persuasion.
Marilyn’s an animal lover. Except for the animals you eat, I could take or leave them. And I’m sure the various cats and dogs who live in our house can detect my ambivalence. They tolerate me. I ignore them.
Yet, I’ve noticed two recent behaviors among our household cat population that has revealed certain similarities with some chiropractors I know. The first deals with their communal food bowl.
I’ve asserted that sloppy language is a sign of sloppy thinking and sloppy thinking produces a sloppy practice (and life). Chiropractors sloppy with their own language are often unable to detect the subtle clues and nuances in a patient’s sloppy language. Language that not only predicts their behavior, but reveals their lack of commitment.
Combine sloppy languaging with poor listening skills and you have a practice that never gets out of first gear. Such practices are a constant struggle, rife with superficial relationships and only rare glimpses of the deep, personal satisfaction that was promised by helping others. All this self-effort produces an emotional drain that makes practice burdensome and leads to burn out.
Consider the following exchange between a chiropractor and a new patient during the course of a report of findings:
Another example in the Sloppy Language Department is the chiropractors who say that they “treat” patients or go into the “treatment” room. Naturally, if you wish to treat patients, you’re free to do so. However, you might want to be mindful of what it means to deliver a treatment and what it means to the relationships you have with patients. Looking past the implication of this word choice may invite unwanted consequences.
A treatment constitutes ministrations designed to alleviate a symptom. Taking a pain relief medication to suppress the symptoms of a headache would be considered a “treatment” for headaches. As is adjusting a patient for the purpose of relieving their headaches. Both are treatments.
“Yeah, so? Anyway, that’s why patients show up in my practice. What’s the big deal?”
I’m preparing my presentation for the Masters Circle New Patient seminar in Santa Clara later in March. This is a new talk and it addresses the topic of new patients in a way that I haven’t seen others touch. Anyway, while putting my PowerPoint together, I became present to a rarely mentioned bias I’ve noticed among chiropractors. From what I can see, there is a “pecking order” to the desirability of certain new patients!
Now, if you’re suffering from what appears to be a new patient shortage, and you’re anxious to help anyone with a spine, warmer than room temperature, this may be difficult to accept. But there seems to be different “classes” of new patients. With some being more valuable or sought-after than others.
I was interviewed this morning by a writer assigned by the ACA to explore the subject of cash practices. I think someone may have tipped off her editor that I had done some seminars about the cash practice in New Jersey and California and created a three-CD program for chiropractors called Converting to Cash.
While I love asking questions, I love being asked questions even more. And there were some good ones! Perhaps one of the most significant was, “What should a practitioner keep in mind before converting their practice to cash?”
Naturally, I talked about the income “dip” that happens temporarily afterwards and the importance of having one’s own financial house in order first. But something else came up that hadn’t come up before.
Sure, we were all told in elementary school that “there’s no such thing as a stupid question.” And it’s true, I think asking questions is the key to true patient education and understanding. But I think we can all agree that the question asked on many new patient admitting forms if not stupid, is at least ineffective.
The question has several variants, but generally follows a structure similar to this:
My goal for seeking care in this office:
[ ] Help with my most immediate problem
[ ] Help with my current problem and preventing its return
[ ] Help obtaining optimum function, health and well-being
At first glance, this appears to be a brilliant question, maybe even helpful in designing a care plan that will best reflect what the patient wants. Yet, give this question even the most superficial consideration and you’ll see why it’s such a waste of time.
Tomorrow morning I’ll be reporting for jury duty. It’s been awhile since I’ve been called and I actually enjoy participating in the process. Unlike many, I’m looking forward to it. I’ll bring my laptop and do some overdue writing and use the time constructively. It’s been over 10 years since I was called, and on that occasion I was actually chosen to serve.
It was a drug case as I recall. We gave the defendant his due process. The memorable part was watching the exchanges between the district attorney, the defendant’s lawyer and the judge. To suggest it was underwhelming would be an understatement. Probably because I had been spoiled by how courtroom drama is depicted on television and in the movies. I guess most of us are. In person, it all seemed, well, amateurish.
When you report for jury duty in Douglas County, Colorado, after filling out more forms you watch… a video! It’s an orientation to get everyone up to speed, reduce apprehension, explain the players and what’s about to happen. This effectively imbued the jury pool with the proper mindset and respect for the proceedings. I couldn’t help but notice the similarities with visiting a chiropractor.
Granted, volitionally going to a chiropractic office is quite different that being called to jury duty, however there are some similarities.
The trial ended yesterday. It involved stalking, breaking a restraining order, a childhood romance and the use of psychotropic drugs to control delusions. The defendant served as his own attorney, ostensibly so he could cross-examine the witness he had been illegally stalking!
Messy stuff.
Throughout the testimony, I couldn’t help but notice that most of the problems were caused by misinterpreting what others were saying and doing. Second guessing what others mean, or creating little stories to explain this or that, seems to be our nature. Naturally, there’s a sizable difference between misinterpreting the action of a patient who discontinues care without warning, and misinterpreting a restraining order requested by the 9-year old neighbor girl who now, thirty years later, has her own family and children!
Nevertheless, both scenarios are pathological. It’s merely a matter of degree.
Patients can’t ruin your reputation. Only you can do that.
There’s a popular myth circulating the chiropractic profession that “allowing” patients to miss visits, to drop out of care prematurely or generally overrule your recommendations, will somehow degrade your precious professional reputation.
It’s not true.
When your dentist recommends regular flossing, even supplying the floss, his or her reputation isn’t tarnished by the unused floss a week later. When your car mechanic recommends a tire rotation and alignment, but you overrule him and nine months later have to buy new tires, you don’t blame the mechanic.
After his warm hug, when you spend time with Dr. Fabrizio Mancini, the president of Parker College, you can’t help but emerge more positive and optimistic about chiropractic and the future of the profession. That was my experience today as I had the honor of being the featured speaker for this trimester’s all-school assembly.
After a tour of the school (it had been eight years since I was here last), Dr. Mancini and I had lunch. It was a stimulating conversation. I was immediately struck by the great questions he asked.
“So Bill, you’re not a chiropractor, but you’re deeply involved in this profession. What do you see as your purpose?”
I recently completed my 7th Conversation weekend debrief in Denver (The next Conversation closes April 18th). It’s exhilarating to be present as someone “connects the dots” and sees how their mistaken beliefs have conspired to create the constraining circumstances in their practices. I can only imagine how pleasing it must be for you to witness patients “getting it” and taking on greater responsibility for their well-being.
As I’ve been processing the direction this most recent Conversation took, I was struck by thought that most of us seem unwilling to change until the pain of the present eclipses the pain we imagine might happen if we make the change. In other words, most of us commit to change only when present circumstances become intolerable enough that it makes the unknown consequences of “pulling the trigger” attractive.
Soon after beginning their professional training, student chiropractors lose touch with the patient’s point of view. The result, years later, is a highly-trained professional who has effectively lost touch with the people they desire to serve. And while this has created a career path for me, this all-too-common phenomenon has produced a cadre of chiropractors who are finding practice more difficult than it was even just a few years ago.
Remove the “grease” provided by generous reimbursement and the true nature of your practice becomes glaringly obvious, especially if your practice was largely dependent upon insurance carriers.
This is partly because many chiropractors, weaned on a steady stream of patients with charitable policies, came to believe this was well, normal. And worse, that it would continue endlessly for the remainder of their career. Clearly, a miscalculation. If you find yourself in this position, here’s an observation that could help turn things around.
After a flurry of speaking gigs for several state associations it appears that many chiropractors are paying the price for years of patient coercion, manipulation and exploitation learned during the practice management era. At a time when insurance money was generous, at least compared with today, many chiropractors were urged to employ management tactics that were so abusive as to constrain the natural flow of referrals and reactivations; the foundation of a healthy practice.
And why not, there were more $100 deductibles waiting in the wing!
Referrals and reactivations are under the volitional control of patients. Which is to say, if you mistreat patients for short-term gain, even if justified as being in the patient’s “best interest,” you cut yourself off from the fuel of delighted patients telling others and those who return when they suffer the inevitable relapse from having discontinued care once they felt better. Pinch off these two sources of patients and you sentence yourself to the increasingly burdensome task of new patient procurement. You have to become the marketer, promoter and advertiser because you have obstructed the only process by which all profitable, self-sustaining small businesses prosper: repeat business.
Last week when I was in Spain, I became present to a subtle distinction that you might want to give some thought to. If my understanding is correct, it could significantly change what you do with every patient you adjust. Seems to me, becoming mindful of this observation could take the already excellent results you produce with most patients to an entirely new level. What could possibly be so revolutionary? A simple statement made by one of the speakers: “If you do the same thing, every time, with each patient there’s no art in your chiropractic.”
Profound.
We have conveniently divided the practice of chiropractic into its science, art and philosophy. The science and philosophy have often served as the battleground for the schism between the vitalists and the mechanists. However, the “art” of chiropractic seems to have been ignored, or at least relegated to the notion of “artfully” and masterfully delivering your particular adjusting technique. Yet, this too easily overlooks one of the most dangerous aspects of working with the nervous system: it learns.
Have you mistreated patients for the last couple of decades, using manipulative techniques that were justified as “being for the patient’s own good.”
Relying on fear tactics, using your limited social authority or imposing financial policies in an attempt to get patients to do the “right” thing (according to you) has prompted hundreds of inactive patients to avoid your office. They shun your practice when they experience their inevitable relapse. They fail to recommend you to their friends at work, saving them from your heavy-handed interpersonal skills.
What’s worse, you don’t see how parental and manipulative your tactics actually are!
A popular advertising technique for automobile dealers is to entice customers by suggesting that their used car has more trade-in value than it actually does. As in, “Do whatever you have to do to push, pull or drag your car in, and drive away in a brand new car.” Apparently, this suggests that if you have some clunker that’s not even running, you have something that the dealership values that will help reduce the purchase price of a new car.
Most of us can see through this ruse. We know that the purchase price of the new car is either inflated or there are such strict credit restrictions that few can actually qualify for the low monthly payments that are advertised. These types of sales overtures tend to seduce only the naïve and least discerning.
Do you use similar low-rent techniques to attract new patients?
I have a presentation coming up next week for the CORE Colorado group. I was discussing this speaking opportunity with a local chiropractor friend and asked if he had any ideas about what I should talk about in the hour or two that I’m going to have in front of a handful of Denver-area chiropractors.
“I don’t know if it’s just me or Bonnie at the front desk or what, but recently it seems that our patients are valuing their health less and less,” he confessed. “I don’t know if it’s the economy, gas prices or what, but what you might want to talk about is how we can help patients see how important their health really is. In fact, I bumped into my dentist friend in the grocery store last night and he said his numbers were down too.”
This, from a chiropractor who has been out in the trenches for more than 20 years and who is sitting on thousands (yes, thousands!) of inactive patient files.
There’s a game I like to play with friends that I sometimes initiate during those moments of awkward silence after the catching up and small talk are complete. I call it This or That? It’s simple to play. You pose two choices in the form of a question. Let’s play.
Rice or pasta?
Gold or silver?
Friday or Monday?
In other words, if given the choice, which would you prefer?
Uncovering someone's preferences a fun way to get to know them. Sometimes the distinctions can be quite small or reveal nuances that most of us rarely consider, opening up new topics to explore:
Sherbet or ice cream?
Tennis shoes or sneakers?
Dog or cat?
This little diversion and handy icebreaker came to mind as I was thinking about what a typical chiropractor would consider most important in their patient relationships. For example, how would your prioritize the following pairs?
As other jurisdictions (and insurance companies) have watched with interest, the New Jersey Supreme Court today decided that its state’s scope of practice laws “permit manipulation of articulations beyond those of the spine when there is a causal nexus between a condition of the manipulated structure and a condition of the spine.”
Whew!
Congratulations to the Association of New Jersey Chiropractors, their legal team and especially Dr. Sig Miller who, as Executive Director, has carried the emotional burden to help get the Bedford v. Riello case resolved to the benefit of all New Jersey chiropractors, but more importantly, New Jersey chiropractic patients!
If you haven’t joined the ANJC, doing so right about now would represent a profound vote of confidence and a loud “THANK YOU!” that could help take chiropractic in New Jersey to even higher heights.
My dad has just been diagnosed with lymphoma. It’s the same thing my mom died of 17 years ago.
As I contemplated researching his disease so I could suggest some action steps from a natural/vitalistic point of view, it suddenly dawned on me what a trap symptom treating actually is. Finding the “problem” and fixing it, is a mechanistic paradigm.
For example. If your lawn mower or some other mechanical device isn’t operating properly, it makes sense to uncover where the breakdown is occurring and fix it. Is it getting fuel? Is the spark plug producing a spark? Thankfully, it’s a logical checklist and fairly short. Get enough experience with small, internal combustion engines and you can diagnose and repair them quickly.
This strategy doesn’t work well with living organisms. In fact, you can become easily distracted by a patient’s symptoms and come to believe that that is their problem!
I was talking with a chiropractor who was commiserating about the decreasing reimbursement that he was receiving from his patient’s insurance carriers.
“What do you expect?” I asked. “Headaches and back pain treatment are small potatoes compared with the seriousness of heart disease, cancer and diabetes.”
While it can be argued that the neuromuscular-skeletal complaints that insurers have seen chiropractors as capable of handling are common, they hardly rise to the complexity and seriousness of the chronic lifestyle diseases that an increasingly aging population is saddling the medical profession with. That’s little consolation if you’re a chiropractor who has seen your income erode.
As I was thinking about why so many chiropractors have such brief encounters with patients, and thus an insatiable appetite for new patients, it occurred to me that it might not be caused entirely to the myopic, instant gratification viewpoint of patients. Or even the shortsighted vision of insurance companies. I’m increasingly suspicious that it may be partly due to the “story” the chiropractor is sharing with patients.
Regular visitors here know that when I use the word “story,” I’m referring to the Four Stories: the Pain Story, the Bone Story, the Nerve Story and the Lifestyle Story. These form the basis by which chiropractors communicate their vision of chiropractic to patients.
These delineations ring more true than some of the chiropractor-created stories, which usually involve generous hyphenation. Such as “principled-chiropractic,” “subluxation-based-chiropractic” and even “patient-centered-chiropractic.” These may be convenient for distinguishing one chiropractor’s philosophy from another, but do little to help patients appreciate the purpose of chiropractic care or its optimal usage.
What if patient retention was more about your vision of chiropractic (and how you communicate it) and less about insurance companies, HMOs and the economy?
Dr. Ross McDonald, who invited a number of us to come and speak at his third annual Edinburgh Lecture program, took all the speakers to dinner last Saturday evening. Sitting down to an incredible meal (that lasted four hours) with others who share the seminar “circuit” is one of the most enjoyable aspects of being a chiropractic gypsy.
I happened to find myself situated in a most wonderful place at this table of 11. To my right, Dr. Dennis Perman. To my left, Dr. Troy Dukowitz. Sitting across from me were Dr. Janice Hughes and Dr. Guy Riekeman.
As I said, sharing a meal with others who endure the glamour of cancelled flights, lost luggage, taxis and the time away from home, is one of the most pleasurable aspects of enduring the cancelled flights, lost luggage, taxis and time away from home. You might be wondering, “What does a high octane group like that talk about over a four-hour dinner?”
I was speaking to chiropractors in the England the Scotland last month, plus did a Conversation debrief and visited a couple of practices. It occurred to me during that whirlwind tour that one of the things that hampers many chiropractors from enjoying success (however they define it), is they impose a certain set of immutable conditions on their practice. And what makes it difficult to prescribe a specific set of action steps for each practitioner so they can enjoy the abundance they seek, is the incredible diversity of the conditions they insist the marketplace accommodate!
Like a modern day Henry Ford who insisted that Model T automobile buyers could have any color car they wanted, as long as it was black, all too many chiropractors impose a set of conditions on their practice and the patients they wish to manifest.
Here are five of the most fascinating conditions I’ve seen chiropractors impose on themselves and their practice members:
I’ve been making an assertion at my recent speaking gigs that, to date, no one has disputed. My claim? That the initial patient consultation is more important than the report of findings.
Seems that many chiropractors invest an inordinate amount of energy on their reports. And while that’s great, by the time a patient gets their report, especially if it’s on the second visit or later, they’ve already decided to follow you. In fact, if anything, the relationship is yours to lose.
Why the focus on the report? Hard to say. But it seems that for many who coach the profession, the report of findings is perceived as a crucial sales event—getting the patient to buy something. Or do something. Or commit to something. If they show up for your report they’re doing all three. And there’s little you can say or do at this stage of the relationship to secure more than a couple more “test visits.”
Seems to me that if the consultation is handled properly, reports can be shorter and considerably less stressful for you and the patient!
If Tiger Woods were a chiropractor, would he have a successful practice?
That was a question I wrestled with in a dream last night. (Sick, I know.) But it begs the question, what does it take to be a successful chiropractor? How would you define success?
I assert that producing symptomatic results with a sufficiently high number of patients, like a license to practice, is merely a baseline requirement, and not the essence of being a successful chiropractor. There are plenty of chiropractors who produce great results, but who aren’t successful. These are the chiropractors who will often lament, “I just get ‘em well too fast!”
Conversely, there are new graduates fresh out of college who produce excellent clinical results, yet aren’t successful as chiropractors. Hampered by poor tableside manners, low energy, fear of strangers or a host of subclinical personality disorders, they are unable to sustainably exchange their valuable skills at a profit.
So, just what is it that separates successful chiropractors from struggling chiropractors?
Regular readers may recall that from time to time I’ve leveled some harsh judgments about chiropractic colleges that seem more interested in tuition dollars and board examinations than producing gradates who can practice successfully. So along comes Life University, which has assembled an impressive curriculum entitled Principles of Practice and Business Management, designed to do just that. Moreover, imagine my delight when I was invited to participate in this program by delivering an 8-hour presentation to a group of students this past Saturday.
My host Dr. Brian Flannery was wonderful. The classroom venue was first rate. The weather outdoors was overcast and conducive to great attendance. And while the handful of students who actually showed up fought over the most distant seats in the back, they were generally polite, participative and from time to time, even appeared engaged.
But I learned something Saturday that caught me by surprise.
I’ve noticed that the chiropractic leadership in California is contemplating plans that could up the number of continuing education hours from 12 hours per year to 24. I’m sure there’s a good reason for this. But I can’t think of one.
Ostensibly, continuing education was instituted in an attempt to bring field doctors the latest breakthroughs and innovations that have occurred since their formal education. If you’re a medical doctor who has successfully shunned the office visits of drug reps, then sure, getting to the convention center might be valuable. Or maybe you’re a surgeon who could benefit from learning the newest techniques at limb prosthesis derived from success with veterans returning from Iraq. In medicine, these annual updates probably make sense.
What’s so new in chiropractic that it requires an additional 12 hours of post-graduate education every year? Newly discovered vertebrae? More accurate orthopedic tests? Advances in intra examiner reliability of motion palpation skills?
Yesterday, I returned from spending 2½ days with one of my chiropractic heroes, Dr. Larry Markson, attending his new program called The Cabin Experience.
The event, which takes place in a gorgeous lodge on an island in the middle of Salmon Lake in Western Montana, is the next phase in Dr. Markson’s evolution as a leader and influencer. Before I explain how I benefited (and how you would as well), I’m going to tell you a little about Larry—an individual who rarely prompts feelings of ambivalence and who, it seems, is either revered or reviled.
I’ve noticed an interesting shift in my seminar audiences when, during my initial introduction I review the five ways they can become offended by what I’m going to speak about. I’ll share these five ways in a bit. But why all the thin skins these days? Why does it seem so easy to offend others? Why have so many become so brittle?
I’m guessing that the political correctness that permeates our society is part of it. But being offended is a lot like claiming that guns kill people. Or that germs cause disease. (Neglecting the trigger pulling and depressed immune system requirement.) This is a refuge for the least discerning who find it expedient to make broad generalizations and then become uncomfortable or indignant when others find lapses in their crudely created and simplistic worldview.
No. Being offended is an inside job, like recovering one’s health or losing weight. If you get offended by what follows (or you already are), you did it to yourself. Congratulations!
Talked with a chiropractor who is going through a rough patch. He’s tried all the obvious things, such as reestablishing contact with his inactives, hiring the cheaper of the two recent new front desk CA candidates, putting his house on the market (bad timing on that one) and most recently, eliminating the monthly expense of the practice management coach that he’s had for the last seven years. These and similar strategies fall into the “save-yourself-into-success” category.
They don’t work.
Oh sure, reduce unnecessary drag on the aerodynamics of your practice by eliminating needless expenses. But doing so won’t turn things around.
We talked a bit longer and he revealed a thoughtless luxury that he has been indulging in each day that alarmed me. It began to partly explain why he’s been unable to get sufficient traction recently to extricate himself from his growing financial difficulties.
If your candidate won, I’m sure that life is about to get better. If your candidate didn’t win, I’m sure life is about to get better, too. Yes, the sky will be bluer, the sun brighter and the TV news more upbeat. With the election behind us, there’s one less variable hanging in the balance. It was a convenient excuse for inaction, but it’s time to get your head back in the game.
What’s your plan?
Although you may have used the subprime meltdown, election hoopla and the recent fear-based media coverage as excuses to put off facing the reality of a declining practice, it’s time to implement your plan to return it to its former altitude.
Oops! I forgot. With the holidays around the corner, you can’t be expected to pull your practice out of the ditch until after the first of the year. Oh, but then there will be the annual first-of-the-year deductible resets that will further delay any expectations of getting the needed traction. And let’s not forget the weather! So, by the looks of things, you may have until spring to take action. Can you coast that long?
One of the more common personas that many chiropractors seem inclined to assume, other than the “Fixer,” is that of the “Coach.” Apparently, so the thinking goes, showing up as the patient’s health care coach grants them the opportunity to employ whatever means necessary to “motivate” patients to do the right thing to regain and enhance their health.
Clearly, this stretches the social contract under which patients show up in your office. Foisting this role onto patients leaves a trail of patient misunderstanding and shame that often precludes future referrals (even after obtaining great results) and practically guarantees that there won’t be a reactivation when their problem returns.
If you show up as the Coach, you’re likely to find it difficult to populate a complete team. Your “scouts” must constantly find new players to fill the void created by a practice of “free agents” who immediately leave once they feel better. That’s because showing up as the coach, selfishly makes the relationship about you, not them.
You probably get them too. “Double Your Practice in 60 Days!” and “Boot Camp for Marketing Dummies” and similar email subject lines. My first reaction has been derision. But then it occurred to me. These sorts of marketing overtures must actually work or they wouldn’t appear in my inbox. Somebody must be responding to them to prompt their continued presence in my inbox! Who?
That got me to thinking. Perhaps this get-rich-quick-shortcut-to-success mentality is what constitutes a majority of the chiropractic profession! Silly me, taking the high road, thinking that chiropractic was about service, value and a natural solution to the symptom suppression of drugs or the maiming by irreversible surgery! Shame on me. How could I have not seen it all these years? Was I that blind?
To paraphrase Einstein, “Significant problems cannot be solved at the same level that created them.” Thus, when Wall Street expressed symptoms of an impending collapse, they sought relief from a higher level. Similarly, after the bumbling Detroit automobile manufacturers hit some black ice after years of running an uncompetitive business model, they have sought relief from the U.S. Treasury. Even American Express has expressed the need for help. Expect others to join the bandwagon.
I’m hoping that whether you favor these sorts of bailouts is not tied to your party affiliation or locality, but to the philosophy you exhibit in your patient care. Many well-intentioned chiropractors may have overlooked the connection between a government bailout and what they do each day with patients.
Since it’s a human foible to look outside one’s self for the causation of our problems and challenges, it’s not surprising that many chiropractors look outside themselves and their practices for the cause of their underperforming businesses.
Patients, who conveniently blame their genetics, divorced parents, the job they hate or an unlucky break for whatever injustice they face, are joined by chiropractors who blame the economy, the weather, their location or the attitude of their front desk staff.
In other words, few chiropractors blame their understanding of chiropractic principles as the root cause of their struggling practice.
Seems a week doesn’t pass that I’m not sent an email claiming the end of chiropractic. These epistles often use the eroding reimbursement from insurance companies as evidence that chiropractic is about to go the way of 8-track tapes and polyester leisure suits.
It’s true that swaggering chiropractic is almost gone. As is gold chain chiropractic and luxury automobile chiropractic. And sloppy chiropractic. And mindless three-times-a-week-until-your-carrier-balks chiropractic. And most-insurance-accepted chiropractic. History. Kaput.
Thank goodness.
As the profession contracts, there will be chiropractors unable to sustain a viable business without the price supports and “subsidies” offered by insurance companies. So while individual chiropractors will leave to pursue other livelihoods, the profession of chiropractic is about to experience a renaissance never seen before.
For my last post of 2008, I’d like to explore a troubling telephone call I had recently from a practice management coach. You’d recognize his/her name, but this person’s identity isn’t important, since I’m suspecting that many in the practice/management/coaching/training/consulting space make similar suggestions. At least I make this assumption based on the state of the profession these days.
“...I just tell them at the report that I’d rather not have them as a patient if they’re not going to take their problem as seriously as I do.”
“Really?” I asked. “You actually recommend that your clients say that?”
“I do. And it dramatically improves compliance.”
“Isn’t that kinda manipulative? When you shame them into care, doesn’t that attempt to override their free will?” I insisted.
“I guess so, but people are more likely to act in an effort to avoid loss than to achieve gain,” he countered.
Those who follow this column know that for the last nine months my dad has been wrestling with lymphoma, the same thing that killed my mom back in 1991 and her brother soon after. Now, after eight infusions of poison (at an oncology center he jokingly referred to as The Cancer Shoppe) designed to kill the cancer without killing him, the report from his PET scan yesterday revealed… no presence of cancer.
Praise God!
After the initial congratulatory portion of our telephone conversation last night, I asked my dad a question that stems from 28 years of hanging around the vitalistic profession of chiropractic.
“So, what did the doctor suggest that you do differently from now on to best assure that you remain cancer-free?”
Before I share the gist of my phone conversation with this chiropractor, allow me to install an uncharacteristic plug for my tenth book in the Patient’s Point of View series, Adjusting, Observations of a Chiropractic Advocate During a Time of Change. Between its 240 pages and the hundreds of blog posts here (click on Musings in the “Categories” index to the left) I give more complete direction for a way out. So if you find the following suggestions wanting, realize that this is merely a quick overview.
After I called Jim back and we exchanged pleasantries, I asked him a simple question. “So tell me, why did you become a chiropractor?”
It appears that economic forces are conspiring to root out those in the chiropractic profession who are irrelevant, inauthentic or just misguided. Naturally, this is painful for those whose dreams of helping people by delivering chiropractic care are being called into question. The open market can be a strict disciplinarian. For many who have practiced the majority of their careers under the “price supports” offered by insurance carriers, today’s realities can be a rude, if not harsh wake up call.
Price supports? Like the government that props-up the price of corn, wheat or soybeans, during the Insurance Era chiropractors benefited from insurance policies that paid inflated fees for services that few cash-paying (free market) patients could or would pay for. This prompted many chiropractors to toy with the notion of a dual (and illegal) fee system, charging patients with insurance policies a higher fee than those who didn’t have insurance or had exhausted their benefits.
This is a subplot of a far greater drama that plays out as some chiropractors go to extraordinary lengths in the pursuit of being “successful.”
Probably one of the most misleading movies used to inspire naïve chiropractors is the one with James Earl Jones and Kevin Costner who builds a baseball field in the middle of his Iowa cornfield.
“If you build it, they will come.”
The throaty whisper, combined with a healthy dose of 60s idealism makes for great drama as the Costner character gambles foreclosure on his farm in favor of following his passion for baseball.
It’s a movie! It’s made up. Yet, countless chiropractors emerge from chiropractic college with the notion that all it takes to heal the hurting humanity in their town is a highly-trafficked practice location, a back-lit sign and a spanking new diploma framed on the wall.
Is this merely a hallucination perpetrated by chiropractic colleges interested in enrollees with good enough credit to swing student loans? I doubt it. I think there’s something more significant happening here.
There are many practitioners whose practices are growing; having their best year ever. That may be hard to believe if you find yourself in the pit and feeling stuck.
The 51-minute Webinar is free and you can watch it by clicking here. (You may need to download the most recent Flash plugin to avoid the show stalling along the way. Get the Windows version here.)
I won’t give away the punch line, but I think you’ll find it a helpful collection of practical things you can do, and a couple of more resourceful ways of being. By the way, extricating yourself from the predicament of decreased patient volume, reduced income or questioning your career path is actually more about being than doing. Frustrating I know, since most of us, when faced with a challenge, instinctively look for something we can “do” to “fix” the problem. Fixing is big with chiropractors—whether fixing spines or fixing their circumstances.
Hope you enjoy the suggestions. Hope you’ll act on them. Hope you’ll let me know.
Before Y2K (remember that?) and before the dot com bubble burst (the other most recent economic downturn) the practice of chiropractic was different. Insurance reimbursement was on the decline, and phase two, known as the post-review audit hadn’t become so widespread. (One more reason to begin the process of Converting to Cash.) It was also before chiropractic supporter Arnold Swartzenager bailed on California chiropractors by effectively cutting them out of the state’s worker’s compensation program.
A lot has changed in 10 years. Chiropractic hasn’t changed. But how it is practiced certainly has!
Yet, countless chiropractors continue to practice as if it’s still 1999 or earlier. Do you make these common “adaptability” mistakes?
From time to time, (last week was one of them) I learn of chiropractors who are suffering from cancer or some other serious disease. Or who die at some unreasonably young age. Sometimes it’s the spouse of the chiropractor who has been afflicted. Whether chiropractor or chiropractic spouse, both have usually been long time beneficiaries of chiropractic care. In other words, they received chiropractic care and surprisingly, got cancer.
Based on the incredulous tone in which this revelation is made, it’s almost as if the chiropractor believes that receiving chiropractic care was, well, a guarantee that such a malady would never strike them. The shock of learning that they have cancer is compounded by the evidence that their chiropractic rabbit’s foot has failed them. As you might expect, this produces a crisis of faith in the principles that they have been applying to patients.
While I lend a more-than-compassionate ear, I suspect their sudden disillusionment with chiropractic is based on some wrongheaded beliefs about what chiropractic is and isn’t, and what it can and can’t do.
First there was Facebook. Then Plaxio. Linked In. And now Twitter. Will it ever end?
How can we be that interested in someone we see once a year at seminar? Is this a sign that we need a life of our own, rather than eavesdropping in on the goings on of someone who feels significant enough to take the effort to leave 140 characters about what’s going on for them?
Perhaps. Maybe this is the personal, decentralized version of American Idol, Australian Idol, British Idol, etc.
Too soon to know for sure. But there’s something going on here. Ready to play? Joint the rest of us who are apparently self-absorbed enough to document it on line! www.twitter.com. I’m billesteb. Tweet me. If tweeting is a verb. I think it is. Or at least it is now! Let's see where this goes.
There’s a difference between what you believe and what patients believe. You may have noticed that. This discrepancy is what is used to justify the patient education overtures in most chiropractic practices. Granted, most so-called patient education is merely ineffective outside-in patient “teaching,” but the objective remains the same: cause patients to acquire a new meaning for their symptoms and the value of using chiropractic to address them.
By failing to see subluxation as a short-term survival strategy; a defensive posture resulting from the body’s best efforts at accommodating threatening levels of physical, emotional and chemical stress, far too many chiropractors have fallen for symptom treating. They address the subluxation and rarely investigate the cause of the subluxation.
This corresponds nicely with the patient’s beliefs: “I’ve got a pinched nerve in my back. Will you move the bone and take the pressure off the nerve please?”
The highways are still clogged. I still have to wait for a table at my favorite restaurant. And on Saturday mornings I can’t find a parking spot at the mall. Seems that all that the fear mongering of the media about the current economic climate is doing is forcing patients to clarify what’s most important to them. And by the looks of things, many chiropractors seem to have attracted people who don’t value their health that much. After all, if patients will only avail themselves of chiropractic care if a third party picks up the tab, it doesn’t say much for the priority they place on their health!
Chiropractors who recognize this priority issue, expend enormous amounts of energy trying to get patients to more highly value their health. Most find this not only ineffective, but it distracts them from far more resourceful ways of investing their time and energy.
Turns out, there is little you can do to get patients to more highly prioritize their health. Scare tactics only last until the patient feels better. Annual care plans push away far more patients than they snag. So-called patient education (mostly yakking at patients) simply produces polite nodding. And the “ounce of prevention is worth a pound of cure” chat rarely manifests in the “twice-a-month” maintenance/prevention/wellness visits many chiropractors dream of.
Allow me to remind you of what does cause patients to reprioritize their health.
Dennis is a great interviewer and each time I get to speak for The Masters Circle, I can count on a follow up interview that usually turns into a delightful Vulcan Mind Meld with a fellow analytical. (You can listen to my previous interview with Dennis here.)
Hope you enjoy the interview. Leave a comment and let me know what you think.
Disoriented? In a fog? Feeling lost? Inclined to freeze and do nothing?
You may be suffering from an oppressive new pathology among chiropractors whose primary symptom includes a yearning for their (insert year here) practice from the past. They want to return to the good old days. Who knew that having your claims cut by only 30% would trigger such nostalgia?
In response, some chiropractors adopt a strategy that includes stopping. Waiting. Looking. Sizing up the situation. The thinking goes like this: If I postpone my decisions, keep my head down and a wetted finger up, I’ll avoid making a mistake. I understand this MO because for years I was the poster child for this style of decision making. (The solution? Make the best decision possible and then do everything within your power to make it the right decision.)
What these chiropractors fail to realize is that waiting and watching is a decision. And these days, an especially unhelpful-reactive-victim decision. If you find yourself in this unhappy place, look ahead, rather than over your shoulder.
From time to time, I encounter chiropractors who fear for the future of the profession of chiropractic. Ironically, these are often those who do not actually “profess” chiropractic.
If your notion of chiropractic is limited to joint mobilization, improved biomechanical function, spinal alignment or the treatment of localized neck pain and back pain, you have every reason to fear that massage therapists, physical therapists or even newly enlightened osteopaths will usurp your small vision of chiropractic.
The profession of chiropractic is not entitled to exist. It has a right to exist; even the privilege to exist, but no guarantee to exist. In fact, as a profession it won’t exist if fewer and fewer chiropractors profess and deliver the principles of chiropractic.
On Monday, it will have been exactly 10 years since I conveyed my half interest in the old company to my business partner to begin anew with Patient Media. Wow. Time flies.
The Small Business Administration reports that over 50% of small businesses fail in the first five years. I understand. I learned some of the most important lessons of my life during those difficult first five years as we struggled to find our voice, establish our tribe and face the cash flow issues that all new businesses struggle with. On several occasions I remember thinking that if I had known that it was going to be this difficult, I might not have sold a sure thing to start over on my own.
Of course, nothing is a sure thing. Especially these days.
We got a lot of help. A couple of critical speaking gigs exposed Patient Media to a group of new customers at a pivotal moment. A printer who came through at a particularly difficult time. And Bob Ashida, a graphics genius. Plus, an incredible support team that has included Leslyn, Sam, Mike, Maggie, Kim and Melissa. Not to mention our incredible distributors around the world, our affiliation with the Chiropractic Leadership Alliance and our chiropractors, Dr. Bill Henrie and Dr. Lou Jenik.
Thanks for being part of our 10 years of learning, loving and serving. We appreciate you more than you will ever, ever know. It’s an honor to serve beside you and we look forward to the next 10 years with even greater anticipation. After all, we’re just getting started!
As I hear from chiropractors whom I have considered excellent examples of the profession, privately confess that their new patient numbers are down, I’ve become interested in the new patient aspect of practice. Frankly, I’ve avoided this. I’ve generally viewed new patient acquisition, beyond the internal referral process, as the seedy part of practice. The “tenderloin” of the profession. Traditionally, this has included everything from bent pens and free spinal exams to lightning-bolt adorned yellow page ads and heavy-handed recall scripting.
I’m assuming that subluxations have little regard for the stock market or the economy. Thus, if chiropractic is suddenly less attractive these days, my guess is that many chiropractors have depended too heavily on the new patient lubrication afforded patients with generous insurance policies. And while coverage hasn’t dwindled precisely in tandem with the economy, apparently a patient’s willingness to pony up the co-pay has.
If your new patient numbers are down, it’s likely that you’re not very familiar to prospective new patients in your community.
Even though I no longer follow the media's interpretation of reality, even a quick glance, long enough to identify that the airport's monitors are tuned to CNN, reveals the latest fear mongering: swine flu. How delicious. On top of the financial "slipping and checking" that has infatuated the media, they can now fill the airwaves with something even scarier: an infectious disease. This is what advertising executives dream of, bent on reaching as many eyeballs as possible.
I don't give the medical-industrial-media complex enough credit for some type of conspiracy. This is merely their worldview, played out on glowing phosphorous screens around the world. As usual, their perspective turns everyone into a potential victim and little is done to put the current outbreak into perspective. Like virtually every other threat, armies are gathering for the obligatory "War on Swine Flu."
You and I know it won't work. Even if it appears to work, it won't work.
Why Your Consultation is More Important Than Your Report
During some recent speaking gigs, and frequently during my telephone consultations, I will casually observe to chiropractors that your consultation is more important than your report of findings. I generally wait to see if I get any objections. I don’t. So either I’m onto something or my assertion is being dismissed as simply one more raving of a non-DC who doesn’t know what it’s like to actually practice chiropractic. It wouldn’t be the first time that such an accusation has been leveled.
This last week I became aware of two aspects of chiropractic and Medicare that are sobering, to say the least.
The first came as an email from one of the state chiropractic organizations promoting membership in a chiropractic advocacy group to influence the direction of the national health care debate. Ostensibly, to make sure Congress doesn’t limit access to chiropractic, while also expanding the coverage of services offered by chiropractors that are reimbursed by Medicare.
The other was a 36-page document from the Office of the Inspector General entitled, Inappropriate Medicare Payments for Chiropractic Services dated May 2009. Since many believe that the so-called health care reform will be an enlargement of Medicare, I thought it wise to read this document and get the general mood of the legal arm of the Department of Health and Human Services.
We Americans seem to enjoy importing things British. In fact, some of our most popular television programming originated in England, including Who Wants to Be a Millionaire, the Weakest Link and The Office.
Let’s hope a recent development in chiropractic doesn’t make it to our shores. Namely, a formal complaint to the General Chiropractic Council regarding the website content of over 500 chiropractors in the United Kingdom.
Apparently, this complaint is the result of an orchestrated campaign against the British Chiropractic Association, its members and the chiropractic profession at large. If you have the time (or stomach) to read the postings of this effort, you can do so at www.zenosblog.com.
What content could possibly prompt a complaint to the regulatory body? Growing hair? Restored hearing? Regrowing a missing limb? No. Any mention of how chiropractic may help asthma, ear infections, allergies, birth trauma, whiplash, bedwetting, colic, fibromyalgia or other visceral or organic health issues that cannot be substantiated by research.
Which begs the question. How much research is needed and by whom must the research be performed?
It’s been my experience that those who want “proof” never get enough of it, or of high enough quality to be satisfied. Even more misguided it the notion that applying a linear, mechanistic intervention to a vitalistic organism is somehow going to yield an accurate representation of all such interventions anyway.
Try explaining that chiropractic is valueless for these various permutations of the effect of subluxations to the parents of children helped by chiropractors. Or pet owners. Or those who tried everything the medical profession had to offer and only got results at the hands of a chiropractor.
Granted, this is one more reason to avoid practicing chiropractic medicine. By that I mean, adjusting patients in an attempt to reduce or ameliorate a particular ache, pain or symptom. True, it requires the willingness to confront what patients believe. Because they think you’re treating their headache or whatever. Instead, a more accurate and intellectually honest approach is to remind patients “…that chiropractic is not a treatment for anything. Instead, chiropractors reduce tension to the nervous system. When nerve interference, usually along the spine, is reduced, it is often unleashes the body’s natural healing and recuperative properties and your symptoms resolve. Shall we get started and find out?”
Earlier today, I completed a one-hour telephone consultation with a chiropractor. The anger I’m feeling might be similar to what you’d feel when presented with a child suffering from vaccine damage or a patient who was maimed by a medical mistake.
Just what has produced this angst? The suffering inflicted on this coachable chiropractor at the hands of the top practice management organizations in chiropractic. Finally, I’m present to the far-reaching and deleterious effects of these well-intentioned “coaching” programs. I’m fed up with the manipulative techniques taught chiropractors that are justified by a do-gooder mentality.
It would be easy to use this space to take pot shots at this parasitic industry that has sprung up from the confluence of low self-esteem, third-party reimbursement, a lack of business training and old-fashioned greed. Instead, allow me to deprogram some of the more common beliefs that come from brushing up against these chiropractic cults.
Turns out my tantrum (Deprogramming Chiropractors) has inadvertently hurt some people that I love dearly. Secondly, I may have underestimated the attention these musings and rantings receive. (It’s not exactly peer reviewed, if you know what I mean.) And worse, caused enough doubt that it might have prompted a coachable chiropractor not to get some needed help. Allow me to clear up some misunderstandings.
While it was convenient for me to paint all practice management/consultants with a broad brush, the fact is, there are some shining examples of what coaching can and should be. In fact, I’ll name a few of them in a moment. But first allow me to clarify:
• I remain unwavering against manipulation in any form—whether done on an adjusting table, in front of the X-ray view box or by a well-intentioned relative.
• I believe that anyone who wants to get better at just about anything can benefit from a good coach. (I have one.) Yet, if the client thinks success is something you do, rather than something you are, it’s possible to pervert even the best advice.
• A solid, stable practice is the result of referrals and reactivations. Advice, procedures, techniques or patient policies that come from me or anyone else that thwart these important “votes-of-confidence” from patients are counterproductive and ultimately damaging.
Clearly, the chiropractic profession needs committed experts who can help grow and guide chiropractors who want to go from merely good to great. Here’s why:
One of my guilty pleasures, being a radio guy, is to listen to one of the best interview shows on radio, Fresh Air and its host Teri Gross. While generally heard on NPR stations, I monitor the current show on her website since I’m rarely in my car at 3:00 PM when her show is broadcast locally on KRCC.
One of her contributors (David Edelstein) recently offered a review of a new movie I’ll be seeing in Denver this weekend (and I urge you to see) entitled Food, Inc.
The content of this 93-minute documentary probably won’t surprise you or readers of Eric Schlosser’s book and movie Fast Food Nation. However, I share this to remind you that the tide is actually turning. There are a growing number of enlightened individuals in your town, in your state and in our country who are our brethren. They "get" the unhealthy influence of big farma and big pharama!
Remember, next time you’re at the grocery store, you’re voting. Remind patients that they’re voting too.
Seeing the delays that our summer evening storms produce for flights leaving and landing in Denver, I opted to take an earlier flight out of Denver on Sunday. The original flight offered a mere one-hour layover in San Francisco to connect up with the once-a-day flight to Sydney and then on to Auckland, New Zealand for the first leg of my journey. My revised flight would give me a comfortable three-hour window to change planes in San Francisco.
However, a mechanical problem with the aircraft delayed its departure from Denver. These things happen. With a three-hour cushion, I felt reasonably sure that my intuition to take an earlier flight would still prove to be wise.
However, as our wait continued and approached (and then passed) the departure time of my original itinerary, I received an insight that I’d never considered before.
After sleeping in to a luxurious 8:30 AM, I enjoyed the “free” breakfast included with my $49 room at the Grosvenor Best Western Hotel, just north of the San Francisco airport, compliments of United Airlines.
While it’s convenient to knock the airlines and draw broad assumptions based on a particular incident or airline employee, my perception is that airline travel has been largely commoditized. In other words, the logo on the tail, the color scheme of the interiors and the uniforms of the flight attendants are about the only distinction these days. Let’s face it, competition for seats has turned most airlines into upscale buses. In fact, many airlines fly aircraft manufactured by a European company called Airbus.
Once again, I was reminded that there is no such thing as a coincidence. Since I was still on the ground and not over the Pacific somewhere, I was able to answer some emails, solve some problems and do some writing. Then, my brother picked me up for an afternoon at the beach. Little did I know that more airline problems were still ahead.
The flight from Honolulu to Auckland was about 9 hours. The plan was to sleep on this leg so I would be fresh for my Conversation Debrief scheduled to begin an hour and half after I arrived. Naturally, sleeping makes the flight considerably shorter. However, with the exception of about two hours of fitful sleep, most of the flight was spent attempting to get comfortable.
The Auckland Debrief was held in the boardroom at the New Zealand College of Chiropractic. It was a diverse group. Among them were two college faculty members, an experienced chiropractic veteran of 33 years and a newbie in practice a mere three years.
Thursday, the following day, was a 6-hour presentation to the first and fourth year students of the college. Wow. Attentive. Respectful. And they asked great questions. Such a very different experience than I often experience at chiropractic colleges in the states. Further proof that not only does New Zealand have the purest form of chiropractic, the future of the profession appears to be in good hands.
Today, Ngaire Cannon, my Australian distributor and I are off to Melbourne. The almost four-hour flight on Air New Zealand was on a gorgeous Boeing 777. We’ll be making a beeline for the new convention center and setting up the Cannon Communications trade stand for the Parker Seminar.
Co-sponsored by the Australian Spinal Research Foundation and Parker Seminars, this event is a fundraising effort designed to help pay for chiropractic research. Thankfully, they realize that there is little need for more low back pain studies and have concentrated most of their work in the areas of organic complaints and quality of life issues.
When you’re a speaker, you get to see a different side of an organization than attendees (called delegates in Australia). And I must say, in all the years I’ve been speaking in front of chiropractic audiences around the world, I have never felt so well looked after. No fruit plate and card here! I came back to my room after the team appreciation dinner and my room looked like a fruit stand and someone had robbed the health food store. Amazing.
When I encounter something new that produces a “That’s interesting” response, and then come across it again a few days later, I’ve learned to pay attention and take such cues seriously. That’s what’s happened during the last week or so when I have heard two people suggest that at the consultation chiropractors should ask patients why they have chosen to seek the services of a chiropractor… now.
Many, especially those experiencing a bit of scarcity, might equate asking such a question as “looking a gift horse in the mouth.” Be thankful someone warmer than room temperature has shown up and get busy! However, if you have an interest in creating deep, long-lasting, influential patient relationships, such a question could provide valuable insights into a patient’s worldview and their motivations. It might even shed some light on the best way to frame your chiropractic explanations.
I suppose a related question would be, “What other methods have you tried in an attempt to solve this problem?”
In other words, when a new patient manifests in your practice, there’s much more going on than simply a patient who has wandered into your practice and wants the services of a chiropractor.
I’ve become present to the fact that the long plane flight from North America becomes a convenient excuse to avoid visiting Australia. I suppose that keeps some of the so-called “Ugly Americans” from showing up here. But Australia is worth the long flight.
We share a common language, however there are words and turn-of-phrases that we don’t have in America. After more than a dozen trips down here, I’m still learning to appreciate the nuances of Australian terms such as “bloody” and “bugger.” Even the word “mate” has a different meaning here. There are many other nuances, however when I travel here I notice a culture that appears to be a unique mix that combines the best of Britain and the United States.
The Conversation Debrief yesterday in Melbourne went great. Every session is different. I’m especially interested to see how the breakthroughs that we witnessed turn up in the lives of the participants! (Turns out Australian chiropractors suffer from the same issues that dog North American chiropractors!)
Tomorrow (Friday) I catch up on some writing and prepare for the Sydney Debrief on Saturday.
I’ve never lived in a large city. However, after three days in a downtown Sydney hotel, I can see the appeal. While nature is largely absent, save for some self-conscious parks, there is incredible access to just about anything you would want. My needs are sparse, so, being able to walk across the street from the hotel to buy some fruit and water from a vast underground grocery store, or duck into the adjacent Japanese restaurant for some fresh sushi, makes these outings quick and productive. Quite a bit different from living in rural Colorado.
Completing the 13th Conversation Debrief yesterday was as delightful as ever. While each one is completely different, this one was doubly so since one of the participants was an attendee of the very first Conversation held three years ago in Melbourne. And while some of the journaling assignments have been tweaked over the years, I was curious what showed up for Dr. Sandy Clark that was different this time from last.
The fact that he was practically beaming, constantly grinning through the entire day was the first thing I noticed. The second thing was a sense of confidence and “centeredness” that I couldn't remember from last time around. The feeling of accomplishment and pride that I felt must be something akin to what chiropractors experience when they see a practice member thrive, living life to the fullest with ease, peace and good health.
Onward to India to meet up with my Perfect Patients website business partner Steve Anson. It’s a long trip, which includes a plane change in Kuala Lumpur, Malaysia. Fortunately, my laptop, iPod and iPhone batteries are fully charged and ready for a productive flight. Anxious to see what turns up!
Every time I get together with Steve Anson, my Perfect Patients business partner, it’s nonstop work. It’s not actually work, but it’s what we do to add value to the business. This unique collaboration has attracted 27 employees located on three continents who all contribute virtually.
From Perth, in Western Australia, Steve has recently moved his family to Bangalore, India. Since I was so close (relatively speaking), we decided it would make sense to spend some “face time” together. As usual, it was very productive.
India is different. In fact, it is so different it’s virtually impossible to communicate the many distinctions with words. Or pictures. Or even video. Guess that’s why I don’t take many pictures—much to the dismay of friends and family who want to see pictures. “Go on the Internet and you can see plenty of pictures.” Apparently, that’s not the same. “We want to see pictures with you in it,” they clamor.
Is it because they don’t think I was really there?
When you travel to India, here are some of the things you can expect.
It might surprise you to learn that the airport security in Bangalore, India is, well, over the top.
You can’t even enter the airport itself unless you are a passenger. So, goodbyes are handled outside at the glass doors within handshaking distance of the machine gun toting militia member who is checking your airline reservation printouts and passports. That was repeated two more times between the front door and entering the aircraft, complete with separate lines for male and female pat-downs.
Clearly, the travel gods have been smiling on me, getting a surprise upgrade from economy to Business Class on the 8-hour flight out of Bangalore to Frankfurt. With a bit more space and the ability to recline just a little bit more than economy, it makes it easier to sleep. And that’s what my body wanted to do for about 5 hours, dramatically shortening the perceived length of the flight.
The Frankfort airport is large. A lot of walking to get to my connecting flight to London Heathrow. But everything went like clockwork. And after a short visit to the Star Alliance lounge at Heathrow to recharge my iPhone, I boarded the United flight bound directly for Denver. Boeing triple seven. My favorite aircraft.
Following the sun all day, starting at 2:00 AM will turn August 16th into a 36-hour day. In other words, the longest day of my life.
After circumnavigating the globe during the course of the last three weeks, I reach one obvious conclusion: we live on a planet of water. The soil you stand on is actually pretty rare. But then we are too.
Just had lunch with three Colorado Springs chiropractors. The original purpose of our meeting was to discuss potential meeting space for a monthly gathering of local chiropractors.
I’ve felt remiss by not investing in the chiropractors in my own community. I’m hoping to correct this and our luncheon was scheduled with that agenda in mind.
However, the meeting took a more philosophical tack as we each weighed in on several fundamental beliefs that this trio of chiropractors had taken as truth. For starters, is one adjustment better than no adjustment at all? And, of course my favorite, is a subluxation a good thing or a bad thing?
Stalwart is defined as “strong, muscular and athletic.”
That’s how Dr. Don DeFabio describes me when he interviewed me in the lobby of the Berkeley Oceanfront in Asbury Park, NJ (home of Bruce Springstein as I was repeatedly told) back on April 25th.
I was on the Jersey shore because of an invite from Dr. Sig Miller of the Association of New Jersey Chiropractors for their Spring Convention.
I’ve been thinking about why certain procedures and policies that are recommended by practice consultants seem to work well for some chiropractors, but fail miserably for others.
Naturally, it’s not just the “do” but even more important is the “who.”
And while that explains the apparent disconnect between what may be recommended during the weekly coaching or quarterly seminars, and what actually manifests in the real world, I’ve become present to one other dynamic that I’ve heard few acknowledge.
As I was flying home after presenting New Patientology in Calgary last weekend, I reflected on my recent experiences speaking to chiropractic audiences. Why do chiropractors go to seminars? And what are they expecting from doing so?
Some who claim to be self-professed seminar “junkies” have stacks of notes they’ve collected from attending a career’s-worth of weekend programs. Yet, their practices hardly match the vast knowledge and wisdom to which they’ve been exposed. Others seem to have no interest in seminars, turning out only for required continuing education programs.
There seems to be a disconnect between knowing and doing. (Which isn’t specifically a chiropractic problem!) It seems many seminars compound the problem by piling on still more things to “do” to make your practice successful. I’m guessing that a passive, sit-there-taking-notes-beside-your-staff-seminar is unlikely to produce the needed personal or practice breakthroughs.
I thought you’d enjoy last night’s interview. Reserve 22 minutes and take a listen. Turns out, that among other things, I’m the “next best thing to being a chiropractor.” Who knew?
Yesterday I spoke at the New Beginnings seminar in New Jersey. Since this philosophy weekend hosted by Dr. Jim Dubel began back in 1991, I’ve probably accepted the invitation to speak upwards to a dozen times. And while this time the feedback was generously positive, I left thinking that I didn’t give the talk I should have.
The 150 or so who attended represented the more philosophical faction of chiropractic in the tri-state area. They gather to be reminded of chiropractic principles and to rub shoulders with like-minded chiropractors and paraprofessionals. Instead of the “tough love” content I should have delivered, I took a safer path, squandering my 50-minute opportunity. Thus my regret.
While I briefly touched on some of these topics, here’s the outline of the talk I should have given:
The 1990 pages of the health care reform bill, referred to as "Affordable Health Care for America Act" (which is certain not to be affordable or offer true health care) is less than spellbinding reading. I’m guessing most legislation isn’t. This may be why our elected officials haven’t even read many bills recently signed into law.
I skimmed the document. The word “chiropractic” appears once (page 1645) alongside dozens of other practitioners who are defined as a “health profession” eligible for helping Indians and Urban Indians. Seems that the Secretary of Health and Human Services and the new Health Choices Commissioner have a lot of discretionary power. Among them is to establish a program to provide grants to eligible entities (pharmacists) to implement medication management services—that, oh by the way, include dietary supplements (page 1415).
I was delighted to see that wellness plans are included (page 62) but capped at no more than a token $150 per year. Huh? And alarmed that grants (page 1391) will be available to carry out demonstration programs designed to test the feasibility of using our nation’s elementary and secondary schools as so-called “voluntary” influenza vaccination centers. Hmmm.
The best way to get people to surrender their freedom for security is to create a climate of fear. Can’t help but wonder if the current H1N1 folly is somehow related to this overture to first hijack, and then control, what can and can’t be done in the name of health care. Granted, a lot can happen between now and the presidential signature. Let’s hope that exposing this monstrosity on the Internet will hasten its rejection.
I’ve mentioned my Dad and his cancer in previous postings, notably his diagnosis in The Symptom Sleight of Hand in June of 2008 and his cancer-free scan in Answered Prayers back in February. He passed away this past Wednesday evening with a vengeful return of the lymphoma that took down my Mom back in 1991.
Based on my previous postings it would easy to throw in an “I-told-you-so” and extol the virtues of proper diet and lifestyle, but when it’s your own flesh and blood, such an off-handed approach is inappropriate. And while I’m quick to attribute his additional 18 years to the chiropractic care I was able to convince him to avail himself of after Mom’s passing, who can be sure? Without a parallel universe (which Microsoft may be working on), I’m not sure you can automatically attribute his longer life to the two chiropractors who attended to him.
But I will.
I’m thankful that I was able to say my goodbyes and let my Dad know how much I loved and appreciated him for being the Dad he was. After meeting so many people who were not complete with a loved one when they died, especially a parent, if you find yourself in such a situation today, I hope you’ll attend to this matter immediately. If my plea causes you to take action, It would at least help me make more sense of Dad’s needless passing at such an early age.
If there’s someone in your life that needs forgiveness or an apology, will you forgive and apologize? Today? If some of your “I-love-yous” aren’t up to date, will you bring them current? You don’t want to miss out on this, I promise.
"I just get them well too fast," complained a chiropractor recently.
His struggling practice, or so he believed, was due to his considerable adjusting prowess that produced symptom-free patients so quickly that he didn’t have time to educate them about the value of nonsymptomatic chiropractic care.
I wasn’t convinced. Instead, I’m guessing he was taking the path of least resistance, showing up as a heroic doctor, fixing spines, reducing headaches, basking in the patient admiration and sabotaging any hope of communicating the benefits of periodic chiropractic checkups.
In other words, he was practicing chiropractic medicine.
Even with brilliant chiropractic marketing strategies, one of the things that distinguish busier chiropractic practices from those less so is the level of certainty exuded by the chiropractor. What makes this difficult to self-diagnose is that chiropractors with certainty issues either aren’t conscious of them or think they are successfully hiding them from patients.
Nice try. If you were that good of an actor, you’d be in Hollywood.
Besides being inauthentic, acting certain when you’re not is classic symptom treating. Better, is to actually be certain. That way, the nonverbal, insuppressible language of your body will send the messages patients want to receive. Then, your influence can mount, patients respond in ways that are more positive and your practice begins to fulfill its potential.
Consider some of these strategies for becoming more certain.
I pick up pennies when I see them lying on the sidewalk, in parking lots and elsewhere. Nickels. Dimes. Virtually any type of currency. Picked up a $20 while jogging one morning. I snagged a 200-peso note in Mexico last month that came in with the tide. I'm often ridiculed or laughed at for this, but I’ve probably acquired close to $100 over the years. It's not a living, but these gifts, in the form of free money, add up.
Do you bother picking up a penny? Consider the scripture that suggests that those who can be trusted with little can be trusted with much. Do you ignore pennies? Or is that beneath you? How about a quarter? Or does it have to be paper? What’s your threshold?
This came to mind after a recent conversation with a chiropractor who was feeling the economic pinch. Not everyone is. And while I don’t have a lot of data, I don’t think it’s necessarily the economy, geography, weather patterns, insurance companies or any of the other usual suspects. I think it has to do with pennies.
This is a great time to reinvent the way you deliver your patient reports. All too often a chiropractor’s report of findings becomes habitual, rote and repetitive. Like any other type of autopilot communication, it diminishes the impact of your words. Resolving to rethink the way you present your findings can introduce a new level of connection and patient influence.
The chiropractic report of findings I’ve witnessed or listened to as recordings almost always offer up too much information. What many chiropractors forget is that it’s often not what you say, it’s your enthusiasm, certainty, hope and emotional subtext that patients find convincing. Not the phases, millimeters and disc spacing.
Here are a couple of considerations (from a patient’s point of view) to keep in mind as you simplify, shorten and remove the sales overtures of your report of findings:
Had a great time presenting at the Indianapolis EPOC last night. (Thank you Drs. Nate and Cory Blume!) EPOC stands for EpiCenter Of Chiropractic. These are gatherings of chiropractors interested in advancing the philosophy of chiropractic, the success of chiropractors and the unity of the profession.
Sometime, either during or after my presentation, I was asked, “What separates those who are successful at spinal screenings from those who aren’t?”
Apparently, this question was prompted by my assertion that if a chiropractor doesn’t get out of his or her office and tell the chiropractic story to as many strangers as possible, he or she should only expect a meager number of new patients to show up, and those who do, mostly for headaches, backaches and neuromuscular-skeletal complaints.
“I think it depends on whether the chiropractor is conducting the outreach event as a sower or a reaper,” I answered.
If you’ve been seduced by the widespread belief among many chiropractors that your purpose is to adjust patients, you’ve reduced yourself from a human being to a human doing. A meat computer. A carbon-based pneumatic device.
Your purpose isn’t to adjust patients. More likely, adjusting patients helps advance your purpose.
True, delivering adjustments, the “doing” of chiropractic, can be performed as a mere physical maneuver; a linear, biomechanical intervention. And often is. Even devoid of the principles of chiropractic and the intent of reconnecting “man the physical with man the spiritual,” chiropractic can still deliver results appreciated by patients.
Those who write off chiropractic philosophy as weird, unscientific and the dated rantings of Palmer cultists, fail to see that the metaphysics of chiropractic have been largely hijacked by the Chopra’s, Weil’s, Dyer’s and similar multi-millionaires. What mechanists are left with is the spinal therapy of chiropractic medicine.
Apparently the “Tastes great!” “Less filling!” debate within chiropractic rages on, pitting the evidence-based-scientific-give-me-proof-med-heads against the anachronistic-paleochiropractic-subluxationophiles. (I didn’t make those up. They’re terms extracted from an actual email exchange between chiropractors!) Each points an accusatory finger at the other, assigning blame for what ails the profession, their practice or the sacred cow of “public perception” about chiropractic.
What’s so amusing, and at the same time tragic, is that neither party in this isometric, how-many-chiropractic-angels-can-fit-on-the-head-of-a-pin argument is capable of convincing the other. Neither can win. However, both can lose, if nothing more than the time wasted while having this self-indulgent exchange.
Actually, this debate has little to do with chiropractic.
Is it possible to rehabilitate and retrain the supporting muscles and soft tissues of the spine in patients over the age of 30 with the dozen visits or so doled out by an insurance company?
This means their symptoms are almost certain to resurface months or years after discontinuing their care. Usually from some new physical, emotional or chemical stressor. When it happens, will they return to your practice for follow up care? Or cozy up to the new chiropractor in town? Or give up on chiropractic all together?
It depends upon several issues that many chiropractors have overlooked.
“Hi, my name is Steven and I’m a patient pleaser.”
“Hi Steven.”
No, there isn’t a 12-Step Program for patient pleasers, but if there were, plenty of chiropractors would be attending. Apparently, when you choose a profession like chiropractic that doesn’t fit into the accepted mainstream model, you have two choices. Either dumb down chiropractic and round off the sharp edges to make it something more palatable, or morph yourself into something you think will get patients to like you. Both are common strategies that produce unhelpful and counterproductive results.
Perverting chiropractic or contorting your personality in the hopes of being more attractive, acceptable or influential is the ultimate sellout. Eventually it makes you feel dark inside. It requires massive amounts of energy to sustain and turns practice into a joyless routine of fixing spines and biting your tongue.
If you find yourself in one or both of these circumstances, you may find the following observations helpful.
You’ve probably heard that “England and America are two countries separated by the same language.” Apparently, add chiropractic to the mix and you have an even greater separation.
I mention this because on Monday, March 8, 2010 the General Chiropractic Council (GCC), the governmental body ostensibly created to “protect patients” (apparently from chiropractors) and “set standards” (apparently for chiropractors), released their new leaflet (brochure), “What can I expect when I see a chiropractor?”
Besides being a collector of chiropractic brochures going on 25 years, I’m keenly interested in what the GCC might have to say. Especially in light of the recent brouhaha regarding what is permissible for a chiropractor to publish on his or her practice website in the UK.
I quickly found two serious, yet common errors on the second page. And they weren’t merely typographical errors.
The ancient Greek Hippocrates handed down his classic admonition in the 4th century B.C., contained within the Hippocratic Corpus.
What you may not know is that these four words are absent in today’s version of the Hippocratic Oath medical schools administer to their graduates. And as a result, all types of medical mischief abound, from abortion, infanticide and doctor-assisted suicide to becoming the lapdogs for pharmaceutical companies peddling concoctions that routinely kill hundreds, probably thousands, worldwide every day.
So, we shouldn’t be surprised that chiropractic isn’t immune to the same pressures of cultural relativism, political correctness and the Cult of Scientism. This is borne out by the growing number of chiropractic influencers (I don’t know what else to call them. They’re not leaders.) who are embarrassed by the principles laid down a century ago establishing chiropractic as a separate, distinct and nonduplicative healing art, separate from the practice of medicine.
Just got back from The Conversation debrief in Denver. As usual, lots of interaction, a couple of tears, lots of laughs and an epiphany or two. Leading these conversations is one of the most difficult, enjoyable and emotionally rewarding things I get to do.
Each one is different. This time we seemed to explore the importance of clear, personal boundaries more than in past Debriefs. At first glance, this doesn’t seem like a topic that would help a chiropractor grow his or her practice, but it is. Probably, because most consulting and coaching programs focus on the “doing” of chiropractic. But you already know that doing what you used to do, doesn’t work.
If you’ve considered attending this intimate, 30-day program, watch the video and secure your seat at the table for the next Conversation closing on April 16 followed by the Denver Debrief on May 15-16. I guarantee it will be worth it. (Read what previous attendees have said.)
I remember my high school economics teacher telling us that if we were ever to fall asleep in class, and awaken, discovering that we had been asked a question that we didn’t hear, answering with “supply and demand” would likely be correct nine times out of ten.
This came to mind last week when I was speaking with a chiropractor who observed that many chiropractors already have their care plan designed for the next 100 new patients—whom they haven’t even met yet! You know the plan. Three times a week for the first four weeks, two times a week for the next four weeks, once a week for the next four weeks, etc.
Passionately repeating this mantra (as if it were handed down by D. D. Palmer himself), or neglecting the critical thinking necessary to see its obvious shortcomings, reveal a few of the underpinnings of struggling practices. Worse, if a patient were to ask, “Why three times a week?” the orchestra tunes up and the tap shoes come out.
Is the future of the chiropractic profession more likely assured by being an evidenced-based-treatment-for-skeletal-muscular-maladies-by-restoring-proper-spinal-biomechanics or by being a vitalistic-art-science-and-philosophy-addressing-whole-body-health-by-invoking-the-self-healing-qualities-imbued-living-things?
Which model best serves the patient, the chiropractor, the profession and the planet?
If you’ve had your head down, applying chiropractic principles to patients, trying to get paid by insurance companies and running a small business, you may not have had the time (or interest) to explore such questions. That’s understandable. But crunch time is coming and it’s important to know where you stand on this issue.
Is it just my own deafness, or is there a crushing silence about the impact of the health care reform bill on chiropractors that was recently pushed through Congress?
By now, you’d think that supporters of the legislation within chiropractic would be crowing from the rooftops about how the government “saved” chiropractic by extending chiropractic benefits to millions. Similarly, by now you’d think that detractors of this new burdensome entitlement would extol the benefits of being excluded from it, celebrating the freedom to practice true chiropractic without Uncle Sam looking over their shoulder.
I don’t normally cover this sort of thing, but a heads up from Dr. David Boyd brought this video to my attention. Might want to give some thought before you discard that old copy machine if you want to remain compliant with HIPAA regulations!
While you can protect the privacy of your patient’s private information by being more mindful of what happens to the digital copier in your office, who knows how information about you and I is being mishandled by larger businesses who turn in their leased copy machines for a new one every other year!
The number one chiropractic marketing strategy is to educate patients. Educated patients get well faster, ask better questions, have greater respect for their chiropractor and are more likely to refer others of the same ilk. After almost 30 years of being immersed in the patient education realm, this so obvious I feel a bit self-conscious even writing about it. Yet, most chiropractors rely on the least effective way of educating patients.
I’m NOT talking about which educational videos to use or what chiropractic brochures to hang on the wall! Those are convenient distractions that keep many chiropractors from a far more relevant and productive debate. The fact is, brochures, videos, health care classes and most of the other techniques or procedures for “educating” patients are merely forms of patient “teaching.” (Teaching is outside-in. Education is inside-out.)
After dedicating most of my adult life to patient communications, I only know of three ways to educate patients. Here they are, from least effective to most effective.
Seems like some chiropractors have taken their practice out of Drive and eased into Neutral. Neutral is where you can rev the engine, make a lot of noise, burn fuel—but not actually go anywhere. Perhaps that’s better than Park, but neither moves your practice forward.
In Dr. Seuss’ amazing book, Oh the Places You Will Go! he describes this as the waiting place:
“…for people just waiting.
Waiting for a train to go
or a bus to come, or a plane to go
or the mail to come or the rain to go
or the phone to ring, or the snow to snow
or waiting around for a Yes or No
or waiting for their hair to grow.
Everyone is just waiting.”
If you’ve had your head down helping patients, you may not be aware of a dangerous trend taking place in the United Kingdom. There, under the heavy hand of the General Chiropractic Council (GCC) regulatory body, many chiropractors are discovering that they cannot promote chiropractic for any health problem other than those proven by randomized clinical trials (RCT).
In other words, the fact that subluxated, colicky babies often respond to chiropractic care cannot be mentioned because there aren’t any RCTs of sufficient quality to “prove” that chiropractic care administered to infants with subluxations has any effect. So, ignore the countless personal experiences you and other chiropractors have had with subluxated bedwetters, asthma sufferers, those oppressed with PMS or other conditions. Ignore the firsthand evidence that you’ve experienced with your own eyes and hands. If there’s no RCT to support your experience, you’d better not be mentioning that to patients or posting it on your website!
Apparently, it’s this clarity, made possible by ignoring millions of cases, that makes so-called “evidenced based chiropractic” so safe and appealing.
A few minutes later your waiter returns with the bill for your meal. You kind of have an idea about how much dinner should cost, but, this time, you glance at the total before mindlessly handing him your credit card. Expecting something in the $89 range for the two of you, you’re shocked to see that the bill, before the tip, is $136.68.
You: “Excuse me, but there must be some kind of mistake.”
Waitperson: “I’m sorry sir, what seems to be the problem?”
You: “What’s this ‘Meal Equalization’ fee of $45?”
Waitperson: “Oh, that’s to help pay for the Surf ‘N Turf for Two and the Tiara Misu that the couple at the table next to you ordered.
You: “I don’t understand.”
Waitperson: “Didn’t you hear? Since good nutrition is a ‘right’ for every resident in the most affluent nation in the world, the government passed the Nutrition Reform Bill. The Meal Equalization fee is how we make it fair for everyone.”
Naturally, I believe that there is value in chiropractic patient education as well as chiropractic patient teaching. Education and teaching are the pairs of an afferent/efferent relationship. The purpose of these overtures is to give patients the appropriate meaning and context for your adjustments, the visit frequency you recommend and the expectations they can reasonably expect from their care.
Chiropractors do this every day. And based upon how it is done it can be more or less effective. Some chiropractors want a protocol that they can systematically implement that will consistently produce the patient enlightenment that these chiropractors desire. This linear, mechanistic approach doesn’t work, as many chiropractors have learned. When they make this realization, they respond in one of several ways. The most cynical abdicate their responsibility all together. Their practices degenerate into physical medicine pain relief centers. You can help a lot of people this way and it’s the perfect solution for chiropractors who prefer to avoid any form of conflict or confrontation. But is passes up a tremendous opportunity for creating significance.
If you see yourself as a true chiropracTOR and ascribe to the original orthodox principles of chiropracTIC you have a much more difficult assignment because…
Since I’ve had the same email address for 11 years, I get my share of spam. In fact, I bet I get more than my fair share of spam. Sure, it’s annoying, but since I have a delete button (and use www.spamarrest.com), I see it as merely the cost of being able to communicate electronically without licking a stamp or picking up the phone, all the while creating a permanent record of the communication in the process.
As a student of marketing, I’ve recently noticed a lot of spam with actual subject lines along this vain: “Large bone - more pleasure,” “Try and give her intense banging,” “Enter her all night,” “More drive for in-out sticking,” “Best manhood augmentors” and let’s not forget what is probably a classic among this type of drug marketer: “She likes it big.”
Hey, it’s revolting to me too. However, it’s a growing reality for anyone who uses the Internet. But here’s what clicked for me chiropractically from these subject lines…
The folks at the Council on Chiropractic Education are in the midst of revising the standards by which chiropractic colleges will be accredited come January 2012. As you’ve undoubtedly heard by now, student doctors are graduating atrociously undereducated and stricter guidelines are essential for the preservation of the profession.
I’m kidding of course.
However, that has to be the problem; after all, the purpose of The Council on Chiropractic Education (CCE) is “to promote academic excellence and to ensure the quality of chiropractic education.”
One might assume that the accreditation process needs some shoring up. Or the quality of chiropractic education is getting a bit rag-tag.
Neither is true. So, I fear something much more nefarious is in process. You be the judge.
On my last visit to the People’s Republic of New Jersey in April, I dropped in on the world headquarters of the Chiropractic Leadership Alliance to sit down for an On Purpose interview with Dr. Patrick Gentempo and Dr. Christopher Kent.
The only thing I know that can slow down time and even make it run backwards is attending the high school graduation ceremony of a distant relative. However, spending time with Pat and Chris has the exact opposite effect. This one-hour interview seemed to take no longer than 10-15 minutes!
They have granted me permission to post the interview here. If you’re not a subscriber to On Purpose become one. The three CDs that arrive each month will keep you up on the latest research affirming chiropractic, the latest political goings on plus a thought-provoking interview. Try a three-month subscription and see for yourself. True, there are chiropractic publications that arrive each month for free. But they simply prove the old adage that “You get what you pay for” and “There’s no such thing as a free lunch.” Enjoy. 65 minutes (To save to your computer, right click on the length link and choose Save Target As...)
I’ve been musing about the growing bifurcation of the chiropractic profession. I’ll just ask it out loud: Why are there chiropractors so ambitiously pursuing the elimination of subluxation and the addition of drugs to the profession of chiropractic?
At first, I thought it might be that these individuals are embarrassed that a “magnetic healer and fish monger” had authored the chiropractic profession. Or ashamed of the flamboyant and eccentric style of his son. Then, I imagined that perhaps this dissatisfaction with classic chiropractic was because it hampered the acceptance of some chiropractors into the medical health care country club.
While these may be factors, upon deeper reflection I’m wondering if something far more simple and obvious is actually at work here. In fact, the same thing that was present when I suggested to my Dad that he see a chiropractor while simultaneously receiving the ineffective chemotherapy he had chosen.
Many chiropractors appear to be scrambling these days, trying to find the money in chiropractic.
Is the money in some new gismo or spinal decompression? Is the money in a new adjunctive procedure such as cold laser? Is the money in a new service such as weight loss or nutritional counseling?
Peruse the ads in the pages of chiropractic periodicals or walk the gauntlet in the vendor area at chiropractic conventions and association gatherings and you may start to wonder. Seems like the increasingly shrill ads and exhibitor overtures have become more about profit and less about chiropractic care.
This begs the question. Is it possible to make a living these days, simply delivering quality chiropractic adjustments to people who want a natural approach to better health without drugs or surgery?
In case you weren’t at the Life Chiropractic College West Festival over the weekend, you may not know that Dr. Gerry Clum will be stepping down as president on January 28, 2011.
I received this tragic news within seconds of stepping on campus Friday morning where I was presenting “The Patient in Patient Education” talk as part of the annual festivities. When Dr. Clum told me about the announcement he had made just hours earlier, I was saddened. Many agree that he is amongst the brightest minds in chiropractic today and his absence will be sorely felt. His 30-year contribution at the helm of Life West, his involvement with CCE and the World Federation of Chiropractic has left a permanent mark on the chiropractic profession.
However, my outlook brightened when I learned that his successor would be long-time friend, Perfect Patients website client, New Zealand native and president of the New Zealand College of Chiropractic since 2003, Dr. Brian Kelly! This is great news for the students and faculty of Life West and for chiropractic in the Northern Hemisphere.
Best wishes to Dr. Clum. Thankfully he isn’t retiring, but seeking “…opportunities that will allow me to apply my strengths for the betterment of the profession.” When you’re at the top of your game it’s the perfect time to reinvent yourself. I did it in 1999 and it was the most difficult, painful, wonderful, rewarding, exciting thing I’ve ever done. I hope Dr. Clum will be similarly blessed.
This is the 500th entry in the Patient Media chiropractic blog since it began back in August 2006.
I’ve used this space to think aloud, share my latest conclusions about the doctor/patient relationship and harness the “wisdom of the crowd.” In fact, it has substituted as an outlet that would have formerly been self-published in another one of my chiropractic books for chiropractors.
If you click on the “Blog Archives” link at the top of the left column on the home page, you can see all 500 entries listed in chronological order with the most recent on top. It’s a lot of material. It represents weeks upon weeks of thinking and writing about patients and chiropractors.
Here are seven of my favorite chiropractic blog posts. Some of them have produced the greatest amount of feedback (which I love!) from readers. Others have not:
During the Q & A at the end of my speaking gig this past weekend, I became present to an issue that seems to constrain many chiropractors from experiencing the practice ease they deserve: worrying about what others will think about what they say or do.
This even prevents some chiropractors from telling the revolutionary truth about chiropractic. Combine this, with the temptation to show up as the heroic healer to get the adulation of patients, and you have a recipe for an underperforming practice. Worse, the chiropractor becomes the victim of insurance companies and a casualty of the cultural notions of why someone would see a chiropractor.
I think those who suffer from this arrested social development would be wise to take an inventory of their answers to three key questions.
You have a reputation. Just about everyone does. In your case, it influences the referral process, patient retention and many other nuances of your professional practice. In fact, the reputation of some chiropractors caused them to have a national or even international reputation, such as Clarence Gonstead, James Parker and others.
While some chiropractors worry that a lack of patient follow through may taint his or her reputation, there’s actually a far greater threat to your reputation. Because you actually have two reputations!
When most chiropractors think of their reputation, they think of their “real world” reputation. As in, “You should see my chiropractor. She’s great!” If you’re raising people from the dead, restoring eyesight and producing other miracles in your adjusting room, there’s no question your real world reputation will be positive and likely to spread far and wide. That’s great marketing!
Just be careful that you don’t neglect your other reputation.
Many of us use the beginning of the New Year as a prompt to abandon unhelpful habits or establish new ones. If you’re inclined to give up any sense of victimhood, whether at the hands of insurance carriers, the economy or the imagined competition down the street, this is a good time to do it.
I’m certain you already know a dozen or more things you could do, should do, have done but abandoned, that would most surely grow your practice. It’s rarely a lack of knowing what to do. Instead, what constrains most of us is the lack of desire, discipline or the willingness to take the emotional risks necessary to implement meaningful change.
Yet, many are seduced by the prospect that the solution is “out there.” That the answer can be purchased or acquired without the more difficult task of confronting ourselves. That there’s a shortcut or “secret,” that once obtained, will produce the circumstances we seek. This linear, mechanical notion of success is not only wrong, but distracts many from more productive actions that would actually yield results.
Instead of a new gadget, seminar or script, here are five things that are more likely to produce the imagined change we seek this time of the year:
As I consult with chiropractors, I’m increasingly hearing language that suggests many feel responsible for a patient’s recovery. Naturally, this will hobble attempts to grow a practice and help more people. Instead of explaining to patients that the purpose of chiropractic care is to revive their ability to self heal, these patients (and chiropractors) think that the adjustments are “treating” their headache, back pain or other named ache or pain. Overlook this critical distinction, and besides frustration and misunderstanding, you’ll find yourself emotionally drained by imagining yourself responsible for things that you are not able to respond—such as what a patient’s body does with the energy you add at opportune times and places along their spine.
“But Bill, you don’t understand,” I can almost hear you say, “If I don’t help them with their problem they’ll leave.”
Really? Is that true?
Those who believe this are probably chiropractors who fail to establish a clear boundary at the beginning of the budding relationship, outlining what they’re responsible for and what the patient is responsible for.
A common question I field coming from chiropractors, reacting to an increasingly deregulated practice environment and coming to grips with the tension faced by all small business owners is, “How much should I charge?”
The question reveals a profound misunderstanding of how business works, which is understandable, seeing that most chiropractors wanted a practice but find themselves in a small business, facing the same issues all other small businesses face—but hamstrung with little training (or real interest) in the nuances of pricing.
If you find yourself in this dilemma, you may find some of the follow observations helpful.
One of our deepest yearnings is to make meaning of our world and our circumstances. Most of us, especially in chiropractic, are constantly on the lookout for the underlying cause of just about everything. Or should be. “Why did that patient do that?” “Why are my numbers down?” “What accounts for this? Or that?” “How come?” “Why?”
And if we can’t determine the real cause, we’re quite resourceful in coming up with something to explain our circumstances. These are typically the economy, the weather, the time of the year and a handful of other convenient explanations. The problem is, other practices don’t seem to be similarly affected. Your December numbers suck. Their December numbers soar. Your summer numbers tank. Their summer numbers explode.
That’s the problem with our inclination to make meaning out of our circumstances. We’re often wrong. And when we are, but base our actions on the incorrect conclusions, we’re often worse off.
That’s because we imagine the real world is more real than the unseen world of the spirit.
It’s a common tale. For time, you’re so busy each day is a blur. You’re in the zone. You’re on top of the world, trusting your intuition; you’re practically a wizard. This is SWEET!
And then the numbers fall off. There are empty slots in the appointment book. There are disconcerting lulls between patients. There’s enough time to distract the front desk CA with questions about who’s next. Your confidence erodes. You have time to ruminate on what you should have said and should have done with that patient who didn’t show up for your report.
Welcome to the roller-coaster practice. One moment you’re giddy with confidence as everything you touch practically glows. The next thing you know you’re surfing the Internet, reading the chiropractic rags and wondering if anyone loves you.
What you do about this determines if this is a one-time anomaly or a lifetime sentence until you retire.
When Dr. John Hinwood of Australia’s Centre for Powerful Practices coaching program invited me to speak to his tribe via his monthly teleclass, I was quick to accept. It was only later that I learned that my half-hour contribution would be delivered at 3:30 AM Colorado time.
Still, I was able to deliver New Patient Metaphysics without too many fits and starts. In fact, I think it turned out valuable enough to post here.
Virtually all chiropractic practices are personality-driven small businesses. This begins to explain why a procedure, script or technology works for one chiropractor, but falls flat with another. While a cookie-cutter approach is often taught at practice management seminars, this overlooks the key distinction that success is always based on the “who” not the “do.”
This is also why chiropractic students who score well on tests and win the clinical awards often fail miserably in actual practice. Frequently, the introversion and analytical skills that make a good test taker, produce a “living-in-your-head” experience that patients find difficult to connect with or perceive as being aloof, judgmental or lacking confidence.
If you’re going to be successful connecting with and leading today’s patients, you’ll want to apply these five disciplines.
Not sure if it’s my age, my leanings towards introversion or my busy schedule, but I confess that I’m having a difficult time with Facebook. I sort of get Twitter, and enjoy the constraint of 140 characters, but when it comes to Facebook, I’m at a loss.
Perhaps it all starts with the word “friend.”
Four or five years ago when I first set up my Facebook account, I started getting friend requests. Which apparently is one of the objectives. And in the process, I noticed an interesting problem. I didn’t really “know” many of the people requesting to be my friend. Apparently they knew me, staring back at me from within a sea of faces all day at a speaking gig.
That’s when I made my first major mistake. Because I didn’t know that the meaning of “friend” had changed!
From time to time I encounter a chiropractor, usually a younger, more idealistic chiropractor, who has proclaimed that his objective; his purpose for being in practice is to create a “subluxation-free world.” I rarely hear this from more experienced chiropractors, tempered by the wisdom of many years in practice and having been trained at a time when chiropractic philosophy was still taught at chiropractic colleges.
I appreciate their passion and I’m thankful that they are so invested in a cause larger than themselves. However, in their zeal to change the world, chiropractors who make subluxations Public Enemy Number One, make three serious oversights:
1. You will not win by being against.
2. Subluxations are effects; symptoms.
3. Eliminating subluxations is the practice of medicine.
Care to join me on a quick exploration of each? Perhaps in the process greater clarity will emerge and an explanation for the current state of many chiropractic practices will be revealed.
Today’s chiropractic new patient is different. And an article in yesterday’s Wall Street Journal confirms it. The article was entitled 'Nearly Half of Americans Are ‘Financially Fragile.' The main takeaway? About half of the people in the US couldn’t come up with $2,000 within 30 days to fund an unexpected expense!
That’s probably no surprise if you practice in California, with an unemployment rate of almost 12% or in Michigan with its 10% rate. (Compared with a mere 3.3% in North Dakota.)
While there’s little you can do to reduce unemployment or help people in your community who have little financial margin to pay for an unplanned episode of back pain, there are at least two things you can do.
1. Market smarter. Grocery stores are still selling the more expensive organic vegetables and free-range chickens, bottle water and supplements to people who aren’t expecting to be reimbursed by their insurance company. Find out where people who value their health hang out in your community and start making connections. Meet the owner of the local health food store, Pilates studio and health clubs. You MUST get out of your office and become familiar, attractive and accessible to those who share the types of practice members you desire.
2. New phone skills. If your front desk assistant has the mindset of an order taker, you may be losing potential new patients on the telephone while you’re busy in the back adjusting. Can (or will) your CA go the extra mile to calm the fears (physical, emotional or financial) of apprehensive prospects who call? Can he or she offer simple, direct answers about fees? The old “May I take your name and number and have the doctor call you?” doesn’t work like it used to, since a more responsive chiropractor may be just a mouse click away.
Chiropractic has not fallen out of favor. Subluxations occur even more frequently in stressful economic downturns. And there are still plenty of people who value their health and want what you offer. But can they find you? And if they do, how many are getting past your receptionist?
Take an inventory of your practice-stabilizing, once-a-monther patients and you’ll discover that most of them have had two, three, four or more chiropractic episodes prior to embracing chiropractic as a long-term lifestyle adjunct. If this is true (research your own patients and see), then it takes a lot of pressure off trying to find the magical words or the seal-them-in-for-life procedures that so many chiropractors seem searching for.
But what about the chiropractor who thinks they somehow permanently “fix” patients? Even more concerning are patients who think they were “fixed” after a dozen or so visits with you? Have you created an "echo chamber" that has misled you into believing that you make permanent, lasting change because patients rarely return?
Here's how the perception gets started, and what you could do about it.
Many newer chiropractors seem to believe that merely outfitting an office in a highly-trafficked location, hanging up a sign and doing a great job is all that is needed to be successful. That may have been almost true in the 1980s when everyone had insurance with $100 deductibles. But today, that is merely the admission ticket into the arena of professional practice.
What so many chiropractors seem to overlook is that chiropractic is a personality-based small business. Naturally, if you don’t have one, it can be a handicap.
If you don’t tend to be outgoing, leaning toward the introverted side things and generally shun social settings in which you’ll encounter strangers, a busy, successful practice is more difficult to achieve. Not impossible, but difficult. Because patients see you “living in your head.” It can prompt one or more unhelpful patient perceptions that can thwart your practice.
Mortimer, who his friends called “Mort” or “Mo” and Lester, whose close friends were inclined to shortened to simply Les. While Mort and Les practiced about 100 miles apart, from time to time they would check in with each other on the telephone.
Here’s a recent conversation.
“Hey Mo,” asked Les. “How are your numbers doing?”
“Doing great,” replied Mo. “Naturally, I’m having to work a little harder, but the practice is doing well. How ‘bout you?”
“Not so well,” confessed Les. “The insurance companies are beating me up. The economy has patients on edge and frankly I’m having to dip into savings a little more than I’d like.”
“Yes, it’s definitely not business as usual,” observed Mo. “So, what are doing to turn things around?”
I’ve never been to a DE meeting (Dynamic Essentials), but when Dr. Brian Lieberman invited me to speak at the weekly Tuesday night Principled Chiropractic Conference Call, I was honored. Not sure how many chiropractic patients get the opportunity to share at a philosophical meeting like this, so I was on my best behavior, sharing the 12 things I believe about chiropractors and patients after these past 30 years as a patient and advocate.
My 41-minute session was recorded and I’ve included it here. (Click the square button). Or download it to your computer. (Right click on the link and choose Save Target As...)
The Band of Brothers is an apolitical organization that meets regularly to cultivate a passion for the principles of chiropractic. You might want to listen in some Tuesday evening at 9 p.m. EST. Simply call 213-289-0500 and enter the access code 6141535#.
I’m on the verge of doing something that I’ve never done before. I’m going to take a vacation.
That may not seem particularly earthshaking, but the so-called vacations that I’ve taken in the past have been largely working vacations. I toted along my laptop and used the new surroundings as an opportunity write and brainstorm. Perhaps more significantly, I’d use my Internet access to answer emails and generally keep an eye on things.
This time I’m cutting the cord. I’m going dark for 18 days. During those two and half weeks I intend to remain Internet-free. (I’m getting the shakes just thinking about it!)
Since 1994 or so when I got my first email account, I have been online. Oh, I might have dropped out of sight for a day or two while traveling to Australia or England, but never for two and a half weeks!
Cutting the cord and truly disengaging from “work” hasn’t been part of my experience. Partly, because I love what I do so much it’s hardly work. Yet, I realize that truly getting away from things can be beneficial. You know. The "All work and no play makes Jack a dull boy" thing.
Monday Morning Motivation will still go out like clockwork, patient education materials will still be recommended and shipped, chiropractic websites will still continue to attract new patients and educate established ones and chiropractic paperwork will still be personalized.
See you on the other side with renewed enthusiasm and probably some brand new ideas!
While there is a movement among some to drum out the special language of chiropractic, I for one believe that one of the things that distinguishes chiropractic from other disciplines is its unique language.
We're in the midst of creating a patient education poster, which will offer the definitions of seven key chiropractic terms: innate, ease, tone, stress, subluxation, adjustment and health.
Would you share with us how you explain these terms to patients? If so, use this simple, handy-dandy online form.
We’ll begin synthesizing the submissions July 15th. If you could share your ideas by then, countless chiropractors and their patients would be grateful.
I’m happy to report that I didn’t do much during my 18 days away from the telephone and email. Which, after all, was the point. And since I do so much travel, a “staycation” seemed the most appealing. So, I caught up on some yard work, read nine books, took two long walks (10 miles and 16 miles) and nursed my garden after being almost decimated by hail. I did spend a day in Denver catching up at my favorite spots, The Tattered Cover bookstore in LoDo, the Denver Art Museum and the Natural History Museum. Before that, spent five glorious days with James and Gina Milliron from Yakima, driving to the top of Pikes Peak (elevation 14,110 feet) with Marilyn. But the two and a half weeks were mostly about slowing down, being off the grid and simply “being.”
I deeply appreciate Leslyn, Kim, Wayne, Heather and all the others who kept everything “between the curbs” while I was gone, however, between the stress of getting ready and the stress of plowing through hundreds of emails, it looks like I still have a thing or two to learn about how to take a vacation!
Patient education helps create a common understanding, entice patients to attach new meanings to the experience of their body and embrace beliefs that more accurately reflect the reality of health and healing.
Some might argue that this is even more important than adjusting the patient. However, what makes effective patient education so difficult is that few patients begin chiropractic care with an interest in abandoning their current health care paradigm. Most see their problem as a back problem and dutifully consult a back doctor. You. End of story.
So, between the pressure to get paid by insurance carriers for treating mechanical back pain, and the resistance by most patients to abandon their current beliefs, it’s tempting to take the path of least resistance, devoting little energy to encouraging patients to abandon their germ-fearing, symptom-focused, drug-using notion of health.
With more than 30 years of playing a peripheral role in the chiropractic profession as a self-appointed “chiropractic advocate,” I get asked from time to time about what I’ve learned conducting 54 patient focus groups, in-office consultations and private consulting. Or why, over those 30 years, I have had nine different chiropractors.
While many seem to find my answers interesting, I think there is another dimension that is far more important that no one asks about. This quality affects the number of new patient referrals a chiropractor receives, plus it impacts patient retention, patient follow-through, reactivations and a host of other aspects of a “successful” (however you measure it) practice.
It’s not taught at chiropractic college. In fact, it is learned by the age of six or seven. In other words, it doesn’t matter what chiropractic college you graduated from, where you set up practice, whether you wear a white lab coat or what adjusting techniques you use. In fact, I’m going to share this essential quality with you in just moments, and if you lack it, it can take a sizable length of time to acquire it. Even if you know what it is.
The other day I made a list of some of the assumptions I’ve made. (It’s a helpful exercise you might want to try.) One such assumption is the idea that patient education is something that every chiropractor has a responsibility to do.
This exercise revealed a distinction I had overlooked. Odd, since I’ve committed the last 30 years of my life to exploring the many facets of the doctor/patient relationship. You’d think this would have shown up earlier. Guess that’s the danger of assumptions.
You may think this is a luxurious nuance to explore at a time when many chiropractors are finding the current practice environment challenging, however it may also provide a clue as to why.
If you try to educate patients in your practice, ask yourself this simple question: What are your motives for educating patients? In other words, why bother?
When the president or CEO of a major corporation has a bad day, distracted by a problem at home or is going through some other personal drama, it rarely affects the bottom line. In fact, depending on its size, larger businesses have enough momentum to endure months of this type of dysfunction. Not so in a personality-based small business such as your professional practice.
It prompts many chiropractic consultants to observe that their clients are “up when their practice is up and down when their practice is down.”
But they have it backwards. They’re confusing the symptom with the cause. More accurately, “when you’re up your practice is up and when you’re down, your practice is down.”
Are you up?
Mark Twain observed, “There are three kinds of lies: lies, damned lies and statistics.” Are your statistics a way of lying to yourself about the cause of an under performing practice?
When my dad was attempting to reverse his cancer, I remember having a dinner table conversation about the wisdom of including chiropractic care along with his choice of employing chemotherapy. Since he had benefited from chiropractic care in the past, I assumed that he would see its value and add it to his protocol. He did not.
“Adjustments just aren’t powerful enough to fight cancer,” he said matter-of-factly. “To beat cancer you need something far more powerful.”
Even though at the time I was 57, his parental tone suggested that the matter was settled and needed no further discussion. (Apparently, an intravenously administered poison designed to kill the cancer without killing him made far more sense than trusting the inborn wisdom of his body.)
As I chewed my food during the loud silence that followed, it occurred to me that this might be a common belief, especially among patients of chiropractors who present chiropractic as a bone-spine-muscle therapy rather than a nerve-whole-body-function resource.
Maybe the reason more and more chiropractors are not enjoying the fruits of a chiropractic practice is because they don’t have a chiropractic practice. They have a chiropractic medicine practice.
Not that they set out to water down the principles that attracted them to chiropractic in the first place. Instead, dozens of small nudges, expediencies and temptations along the way has brought them to a confusing place. As they see their practice volume erode they feel increasingly disoriented.
Instead of focusing on the real problem (a lack of clarity about their identity and purpose), they focus on convenient outside factors such as the economy, the weather, stingy insurance carriers and all the other usual suspects. As unseemly as this predicament is for the established chiropractor, it is even more pronounced for the newest batch of chiropractors who, because of the limited vision of their chiropractic college, emerge as over trained spinal therapists.
One of the self-appointed tasks I perform each week is to review the log that records the terms visitors enter into the search box in the upper right corner of every page on this site. My goal is to see what interests people, or as Google refers to it as “the database of intention,” and to update the keywords associated with each page so they will appropriately show up when searched on. (It’s actually easier to do than to describe!)
This week, the search phrase “how to be busy” caught my eye. The same visitor entered “increase numbers.”
Wow. Instead of entering “make a difference” or “change the world” it was a far simpler request.
Because constructing a castle from toothpicks will keep you busy. As will a jigsaw puzzle. Even watching television. (Probably the reason far too many people do it.)
Being busy is often confused with productivity, significance or even importance. As in, “I’m too busy, I can’t get to that right now.”
If you’d like to be busier by helping more people, the solution is simple.
"It’s the economy, stupid" was the catch phrase used by Bill Clinton’s political campaign preventing George H. W. Bush from enjoying a second term. A similar economic theme was used by Ronald Regan (“Are you better off today than you were four years ago?”) to unseat Jimmie Carter. I’m guessing the economy is likely to play a role in next year’s presidential election also.
Which begs the question. Has the recent economic developments caused your practice to take a downturn?
I had almost completed my four-hour speaking gig at the Missouri State Chiropractors Association Saturday night when the subject of the economy came up. Apparently, some in the room were of the belief that the economic downturn was responsible for the challenges they were facing in practice. That, combined with an earlier whining from a chiropractor who felt victimized by Medicare, prompted a rant that I’ll attempt to present more constructively and with greater self-control.
Spoiler alert: if you’re allergic to the truth or prefer being a self-righteous victim please don’t read any further.
It’s that time of year again. Actually it starts even before Halloween when store decorations featuring ghosts, goblins and witches are often fighting for attention from the Jingle Bells, Santa’s and nativity scenes.
This post isn’t about rising above political correctness to wish others “Merry Christmas!” This is about your practice and whether December is among its busiest month or slowest. Which is it?
If you think talking about the birth of the savior of the world is controversial, read on. Some may find the following observations about chiropractic in December even more contentious!
“I can always find something to bill an insurance company for…”
This is an all too common belief held by many chiropractors who are naive, lazy or inclined to steal. Naturally, this lack of integrity creates far more problems in the long run than it solves in the short term.
Chiropractors who see a patient’s insurance policy as some sort of entitlement are probably the worse abusers. Either they don’t know how insurance policies work, or do, and choose to blur the boundaries for their personal gain.
In case you didn’t know, the purpose of a health insurance policy is NOT to insure the patient’s health!
Five Arguments Against Adding Drugs to Chiropractic
Now that the dust has settled from the New Mexico attempt that would have allowed chiropractors to prescribe drugs and possibly perform surgery, it might be helpful to remind ourselves as to why this was, and is, such a bad idea. An idea that some, emboldened by last year’s close call in the Land of Enchantment, seem inclined to bring to other legislatures near you.
I’m guessing that when you see Minute Maid juice, you don’t think of apple juice. And when you think of BIC Pens you probably don’t imagine BIC pantyhose. (Yes, they tried that!) Or how about a Harley Davidson cake decorating kit? Or Lifesaver gum? Or Coca-Cola chap stick?
In marketing parlance these unsuccessful (and expensive) hallucinations are called line extensions. They rarely work. Yet a handful of chiropractors are trying to pull off something similar with the addition of drugs to the chiropractic scope of practice!
A fascinating theme has emerged among some of the more recent one-hour consultations I’ve been doing. The calls often begin with references to lower new patient numbers or some other aspect of their under-performing practice. But you and I know these are only symptoms.
Ironically, these same chiropractors a quick to point out to patients that they “don’t treat symptoms and instead correct the underlying cause of the problem.”
Chiropractors like addressing cause. I do too. Symptom treating is usually what governments, medical doctors and lawyers do.
The cause of an under-performing chiropractic practice is rarely the weather, the insurance companies, the economy or any of the other usual and convenient suspects.
Nope. It’s almost always the chiropractor.
But what is it about a chiropractor that produces the symptoms of an under-performing practice? That’s where it gets interesting.
The first chiropractic seminar I attended was in January of 1981 as I was doing research for what became the profession’s first patient education videos.
I still remember a huge insight from that three-day Renaissance seminar: the nervous system is the master system that controls and regulates every cell, tissue, organ and system of the body.
You know this. In fact you probably take it for granted. But trust me, most patients have never heard this essential, dot-connecting piece of information.
More troubling is the other takeaway I gleaned 31 years ago on the second floor of the Davenport Hotel in Spokane, Washington: the nervous system is responsible for our ability to adapt to the environment. Again. I know. Obvious. But rarely are patients presented with this simple physiological precept in a chiropractic practice.
The reason I bring this up is to ask this. Have you adapted your practice to chiropractic and its principles, or do you attempt to practice by making chiropractic adapt to you?
At yesterday’s seminar in Birmingham, England, we were discussing patient follow through and the frustration that one chiropractor was experiencing because patients seemed to ignore her recommendations. I assumed that not all patients ignored her recommendations, but maybe enough did that she thought it was her fault.
By the reaction of the audience, this is apparently a common annoyance in practice.
I’d heard this before. However, this time I used a metaphor. About dogs.
“I’m not particularly an animal lover,” I began. “However, I’ve noticed something about dogs that might be relevant here. Seems that dogs will love just about anyone unconditionally, especially if you feed them regularly. Apparently, this constant adoration and tail wagging is an attractive quality of dogs. But because you don’t have to do much to earn it and many dogs will even take a liking to total strangers, their indiscriminate appreciation diminishes its value. In other words, when someone or something will revere you so blindly and generously, you’ve confused puppy love with real love.”
If patients were dogs, I think you’d quickly tire of their obedience after a month or two. And if not, you might want to reflect on why you would want so much power over others.
I’m encountering more and more chiropractors in my one-hour consultations who are, or are on the verge of, burnout. Income is down. Savings are dwindling. Documentation is too much of a bother. Patients are problems rather than opportunities. The joy is gone.
With these and related circumstances, some chiropractors are questioning their career choice. Disguising their disdain for patients and their unhappiness in practice has become an increasingly difficult acting job. Many think they’re able to successfully hide their frustration and feelings of being trapped or stuck in a practice that produces less and less joy and satisfaction. (Take this burnout quiz.)
When I work with these chiropractors, many of them are surprised to learn what underlying emotion is producing their lethargic, take-me-out-of-my-misery pity party.
I trusted a hunch during my talk yesterday in Minneapolis and made the assertion that “...during the last four months, some of you in this room have actually contemplated what you could do other than practice chiropractic.”
After my talk was over, one of the chiropractors came up to me and asked, “How did you know?”
“Know what?” I asked having covered dozens of subjects during my talk.
“How did you know that some of us have considered alternatives to practicing chiropractic?”
“Just my intuition based on the vibe in the room. There seemed to be quite a few chiropractors who weren’t having fun. And if you’re not especially passionate about chiropractic, when circumstances get difficult it often prompts a look around for an easier way to make a living.”
“Well, that’s where I am,” he confessed. “Only trouble is, I’m stuck. There isn’t anything else I can do that would generate the income I used to make in chiropractic. And the problem is, even chiropractic isn’t producing the income I need to make, so I’m having to dip into savings.”
There. He had just said out loud what I suspected many chiropractors have been privately thinking.
I wasn’t sure how he was going to take my next observation, but I made it anyway.
“So, what do you know for sure,” I asked Gene who had arrived to clean our windows.
“What I know for sure is that I only have nine teeth,” he replied with toothless grin.
“Wow, that’s not very many teeth,” I observed stating the obvious. “What happened?”
“I’ve had two really bad dentists.”
“What a string of bad luck,” I commiserated.
I suppose there is the possibility that this 56-year old had had two “bad” dentists in a row who were inclined to pull his teeth, but the more I thought about it, it occurred to me that his answer was simply a cover up; a rationalization and justification.
I was struck by the hat she wore throughout the seminar while sitting in the second row on Saturday during my presentation at the New Zealand Chiropractic College Lyceum. She wore a different one on Sunday. We don’t see women wearing hats these days so I was intrigued who this chiropractor was. Naturally, I was surprised when she approached me after the seminar and invited me to join her and her husband for dinner at their home. Even more surprisingly, I accepted!
For about six hours each year the CIA headquarters in Virginia is opened to the families of employees. This is an opportunity for those unable to share their daily activities with their family to “show off” the hallways they walk, the security measures they must take each day and even the cafeteria they eat in.
On our recent trip to Washington, DC they seemed to be everywhere. In fact, I’d ridden tour buses in London, Barcelona and elsewhere. You don't have to worry about parking and you get a great overview of a city so you can get your bearings. Better yet, you can get on and off whenever you want. Some people choose to stay on for the entire circuit. Others get off with a moment's notice or at the slightest whim.
Generals are often accused of “fighting the last war” and this is true also for chiropractors. The strategies and tactics used when most patients had generous health insurance are no longer working. Conditions have changed. And if you don’t (or haven’t) changed along with them, you’ll become a casualty.
After my speaking gig at the UCA Autumn Conference in Birmingham, England this evening, I decided to leave the hotel for dinner at one of the dozens of restaurants surrounding the hotel. 
He was an older gentleman with a full head of strikingly white hair. The twinkle in his eyes revealed a deep understanding and wisdom. His energy and vitality disguised his 72 years. That he was still practicing was even more affirming. I had the good fortune of sitting next to Dr. Stephen Owens at a pre-convention dinner meeting Friday evening.
Many chiropractors have treated third party reimbursement like winning the lottery. And like the lottery, countless people who suddenly came into millions, lost it all.
As I spend more time and energy discussing the importance of patient financial education and the need to begin transitioning to a cash practice, there’s an important distinction that’s showing up. If you’re inclined to think that having a cash practice is about a new financial policy and telephone scripting to handle the “Are you on my list?” question, think again. Having a cash practice is about attracting cash paying patients.
In a magazine I was reading to pass the time before I could use my computer on the airplane after take-off, I ran across this ad for the Bellagio hotel in Las Vegas. It was the two-word headline that caught my eye: Superiority Complex.
On my most recent speaking gig, I and another speaker were invited to dinner by one of the attendees. As the dinner unfolded, I could tell I was dining with two chiropractors who take more of a short-term “
It’s Election Day in the United States and it’s the usual showdown between conservatives and liberals. Some would assert that the difference between the two parties is a matter of great importance. Others, who are more cynical, see the choice as merely two shades of beige and the lesser of two evils. 
Because of their Denver hub, I’ve been flying United Airlines for years, racking up over a million miles with them. Because of my loyalty, I’m practically guaranteed a seat in their Economy Plus section. This is an area of Coach in which the pitch between seats is 5” greater than Economy, allowing you to cross your legs and use a laptop without the passenger in front of you reclining their seat into your chest. So I was taken by the gate agent auctioning off seats in Economy Plus for $41 prior to boarding the plane this morning.
Our wonderful grandfather clock received service today. After 10 years of faithful service it needed some oil and attention. Mechanical (and non-mechanical) devices need an occasional tune-up. The symptoms? During the Westminster chimes, some of the notes were slurring. Not a serious problem, but one that portends future problems if ignored. So Tom showed up to do his voodoo. Towards the completion of his work, he called me downstairs to listen to his work. It sounded great.
In the popular book series, Rich Dad Poor Dad, author Robert T. Kiyosaki makes the distinction between assets and liabilities. Rich people invest in assets. Poor people spend their money on liabilities. 
I was speaking with a colleague this morning who, I suspect, is getting ready to change jobs. The reason I know that is because she complained about how she was being treated by her current employer. 
The end of third-party reimbursement is around the corner. It was a great run. There is little evidence that the erosion you’ve seen in the last couple of years will slow, much less reverse. If you don’t adapt, you’ll jeopardize your practice and your livelihood. 
One of the bright lights in chiropractic was extinguished over the weekend. Will Tickel, DC was one of my early inspirations. Perhaps our shared background in advertising and love of the English language brought us together. We would often exchange articles, thot pieces, as Will would say, in the hopes the other would either confirm our allegations and insights or provide clarity or direction for their improvement. 
It’s been a combination of pride and cringing embarrassment. What could produce such an emotional mixture? Posting each of the chapters from A Patient’s Point of View and My Report of Findings to this website over the last couple of days. (The drop-down menu under “Books” above.)
The earlier post about a new practitioner asking about advertising for pain relief versus advertising for wellness prompted several public and private posts. Seems this issue may deserve further exploration.
You got through December. Now most patients’ deductibles have reset and you’re waiting for March or April to get back into the new patient groove. 
Your practice has dwindled. New patients are practically nonexistent. You have a lot of free time on your hands. But you’re not making enough money to have a viable business. You probably graduated toward the top of your class, but the clinical honors and hopeful optimism you enjoyed back then have long been sucked out of you. It’s crunch time.
California is in the midst of grappling with escalating health care costs. Early rumblings suggest that the California legislature is coming precipitously close to taking a path that is unsustainable and will serve to make the problem worse.
Seems that chiropractors with the greatest number of “tools” on their belt (nutrition, emotional work, rehab, orthotics, etc.) can go through a stage in which they seem to shun patients who enter the practice lacking the interest in pursuing these “extracurricular” resources. 
Yesterday I had the pleasure to speaking to Dr. Mark Doerrfeld’s class at Palmer College in Davenport. The evening before, I spent an hour or so with the Masters Circle Club. Having never attended chiropractic college as a student, being on the campus of any chiropractic college is always a thrill for me. Spending time with students genuinely interested, who ask great questions, is among my favorite speaking gigs.
Thursday I completed a new, one-day program in New Jersey called the Cash Patient. I generally find East Coast seminar audiences generous and attentive, and the program in Saddle Brook was no exception. During this program, I tried to make the point that a cash practice is an effect, not a cause; a symptom of making the practice relevant and meaningful to patients willing to pay for their own care. Proclaiming that yours is a cash practice is often done out of frustration and is more about eliminating insurance hassles for you, rather than making the practice attractive to those who value their health enough to pay you, and if they have a policy, file the claims and wait to get reimbursed.
Is an adjustment commodity? That is, is an adjustment delivered by Doctor A the same as an adjustment delivered by Doctor B? You and I know that even if the same technique is employed, they can be two very different adjustments. It’s easy to forget this distinction because of the spell cast by third party reimbursement. Carriers have chosen to look past this difference (even though cash-paying patients don’t). To carriers, the full body diversified adjustment, the one-bone adjustment and the energy focused tonal adjustment are all the same. To a carrier, an adjustment is an adjustment is an adjustment. A commodity. It’s easier that way. This has created a huge problem for chiropractors coming out of the third party trance: “How much should I charge?”
As I was editing the previous entry about clutter, it occurred to me that most chiropractors probably don’t have a formal new patient lead generating system. Instead, most take a passive approach—like a spider, who spins its web and waits. This may produce the occasional meal for the spider, but it’s hardly a strategy for a thriving business. You could probably benefit from a formal lead generation system.
If you’re a bit disoriented because things that used to work don’t, you’re feeling a bit like Rip Van Winkle, waking up after a 20-year sleep. And while chiropractic principles haven’t changed, patients and the environment you practice in has. You’re dealing with a handful of issues that must be dealt with correctly or you’ll become the equivalent of the buggy whip manufacturer of 100 years ago: obsolete and irrelevant.
The argument continues whether humans are responsible for climate changes, or that we’re simply experiencing a cyclical “slipping and checking” due to changes in the output of the sun or some other natural phenomenon entirely out of our control. As I see people choose sides (or simply ignore the conflict), I can’t help but see the similarities with chiropractic. (Naturally, I see virtually everything as a chiropractic metaphor!) 
After speaking at the 
If you don’t have at least a few patients choosing not to begin chiropractic care at the conclusion of your consultation, you’re probably not casting your net wide enough. If your new patient lead generation system (do you have one?) produce prospects who all begin care, you may be playing it too safe. Without a rejection or two on a regular basis, it means people in your community are prequalifying themselves before showing up. This probably means your new patient numbers are down, and the ones showing up are largely those with neuromuscular-skeletal complaints. If you want a wellness practice; if you want to see more visceral complaints; if you want to see more miracles—you’ll want to create a larger opening to your practice.
One of the common themes of my most recent 
If attempting to serve two masters doesn't dissuade you from taking assignment, consider the multiple passages in the Book of Proverbs that warn of the dangers of co-signing on someone else’s loan. It got me to thinking. In some ways, isn’t this pretty much what taking assignment is?
When I wrote last week’s post (
The debate over whether to use the term subluxation or joint dysfunction, adjust or manipulate or care instead of treatment pales in comparison to a much larger conflict gathering on the horizon: national health care. More specifically, should chiropractic be included in any type of national health care plan, or should it remain outside whatever Congress and the next president concoct?
One more thing about the upcoming national health care scheme you may want to chew on as the election approaches and you develop your position. 
My parents had enough of a memory of the Great Depression to raise my brother and me to avoid any kind of waste. While we didn’t reuse aluminum foil, we were constantly urged to turn off lights, eat all the food on our plates and take care of things so they’d last. I’m reminded of this frugal approach as I see a growing number of chiropractors who think they can achieve prosperity by cutting costs. If you feel compelled to cut back, here are some suggestions:
“If I knew I'd live this long, I would have taken better care of myself.”
Income down? Then you need more new patients. Gapping holes in your schedule? Then you need more new patients. Stressed out about the future? Then you need more new patients. Are patients ignoring your recommendations? Then you need more new patients.
I just watched Sicko, the new film by Michael Moore. I’ve never been a fan of Michael Moore or his politics, but I have to admit I was taken by his documentary about “health” insurance in the United States. I already knew staggering medical bills were involved in most US bankruptcies—even people with insurance. While Mr. Moore’s conclusion seems to suggest that we socialize our health care system and model it after the Canadian, UK, French or even Cuban system, what we really have is a crisis in personal responsibility. However, he may be right about one thing. In France, and elsewhere, the government is afraid of the people. In the US, the people are afraid of the government. Which may be why nationalizing 1/7th of our GNP may not be such a good idea after all...
You may be feeling a bit apprehensive if you set up your practice with a greater emphasis on getting chiropractic patients than keeping patients. That’s okay. That’s where the money was back when third parties were picking up most of the tab. It didn’t make sense to squander valuable resources on anything other than what it would take to produce new patients. But now, years later, you have a burgeoning collection of brightly labeled file folders—but few cash-paying “once-a-monthers.” When you think about it, you had a “promotion,” not a sustainable practice. 
There are going to be a lot of sevens in the date tomorrow. I got to thinking, why does seven show up in so many religious references, folklore and fairy tales? Why is it considered a “lucky” number. Here are some interesting facts I found:
How do you overcome the tendency for chiropractic patients to discontinue care (or not even begin) if their insurance won’t pay for it?
Suggestion: You could consistently hand out brochures so patients could more easily tell others about chiropractic and your office.
I’ve been thinking about something I encountered a couple of Saturday mornings ago before a recent speaking gig in San Diego. I didn’t speak until after lunch, so I had the opportunity to take a self-guided tour of the aircraft carrier USS Midway. If you have the opportunity invest a couple of hours and take the tour.
The deeper I dig into what makes some chiropractors adored by their patients, the more I’m convinced that it’s who they are, rather than what they do. And while a lot of lip service is paid to “being,” I’m discovering that few are available for the introspection and self-examination required to “be” someone more attractive. Because like all healing, it requires going through, rather than around.
One of the ideas I’ve explored in these recent postings is my belief that it can take most patients many tries of starting care and stopping care before they “get” the lifestyle benefits of chiropractic. Having spent their entire lives steeped in the medical model of symptom treating, most patients aren’t about to embrace chiropractic after one spellbinding report of findings and incremental relief that comes over weeks or months. Then, because patients see how deeply you care, many feel guilt or shame when they discontinue care. This, combined with the fact that most chiropractors are unwilling to keep in touch with patients during the dormant phase before their eventual relapse, creates a voracious appetite for new patients. 
I get some revealing answers when I ask chiropractors, especially those still in chiropractic college, what they think an adjustment does. After a long, uncomfortable pause I can tell that they’re either not sure, have never thought about it or more likely, they’ve never actually had to put their own mental representation into words. Some, I suppose, are fearful that their working model of an adjustment might be amateurish or miss the mark completely. Yet, there is very little more important than being clear about what an adjustment is, what it does, what it doesn’t do and what your intention is when delivering one. Without clarity on this vital issue, you’ll resort to being a spine “fixer,” deluded into thinking you’re the one doing the healing! Many chiropractors have fallen into this trap. 
If you have any hope of making lasting change with patients beyond the relief of their most obvious symptoms (inviting a subsequent relapse) you must facilitate a patient’s belief change so they see chiropractic as a lifestyle decision, not just a short term diet for pain relief. I use the word facilitate because you don’t have the power to directly change anyone’s beliefs but your own. In the same way I cannot change your beliefs, you cannot change a patient’s. We can attempt to make a compelling case for what we think is a more enlightened perspective (as I’m trying to do here). And we can make it emotionally “safe” to abandon an old idea and embrace a new one. But like healing, it’s an inside job that you can’t do for someone else.
I applaud Greg Stanley for so eloquently expressing a growing tension felt by many practitioners in his recent Dynamic Chiropractic article “
Their mistake is thinking that it’s just one thing that stands in the way. 
According to David Seaman, MS, DC, DACBN in a recent article entitled, “
Last weekend I completed another Debrief for 
Apparently, the worst pejorative that can be hurled at those who consider chiropractic more than just a mechanical treatment for certain cases neck and pack pain is to call them a “chiroevangalist.” I think this is meant to be a derisive term, suggesting that the chiropractor is mentally deficient, unenlightened or plain stupid by “believing” in or putting stock in certain metaphysical or even whole body effects of the chiropractic adjustment. I guess the thinking goes something like this: if it’s not found in the “literature” (scripture) with the blessing of anointed and properly creditentialed “peers” (disciples), than the chiropractic “intervention” (sacrament) can’t produce the result (miracle) that is claimed. Any suggestion that chiropractic might help one’s general health, improve organic conditions or enhance the body’s healing ability is dismissed as old school dogma, irresponsible wishful thinking and well, unprofessional. 
Friday I had lunch with a nearby chiropractor who has been going through a rough patch. A divorce, staffing issues and a lack of new patients have created new, unfamiliar financial pressures. During our lunch, I heard three issues that seem to hold promise for his recovery. Whether he will have the courage to act upon them remains to be seen—after all, there is often a disconnect between knowing and doing.
It’s popular to assume that virtually any malady facing a chiropractic practice can be solved with simply an injection of new patients. Income down? Get more new patients. Mid-day down times? Get more new patients. Higher co-pays? Get more new patients. Higher gas prices? Get more new patients. Higher rent? Get more new patients. 
Let me first confess that I’m not much of a fan of so-called comedian Bill Maher. I find his sardonic style and political leanings difficult to swallow. However, this brief rant about 
I was inspired to write this posting after thinking about how I used to be. For years, I tried to say the right things and do the right things to be liked, appreciated and for the ultimate desire: to be admired by others. In fact, if the truth be told, I lived for others. I suspect this trap has ensnared others.
“It’d be a great business if it just weren’t for patients.”
I just got back from a speaking gig at a chiropractic college. I had the privilege of spending two hours with students who are about to complete their college studies and, with the end in sight, have a heightened interest in the implications of actually applying what they’re learning. 
I’m on vacation this week working on the next batch of Monday Morning Motivation broadcasts and some other cool projects. It occurred to me that life isn’t just digital (on or off, dead or alive) but shades of gray. Thankfully, because we subluxate rather than die when presented with certain amounts of stress, we each get to experience varying degrees of this thing called life.
There's been way too much energy applied to managing patients and way too little thought given to managing a patient's hope. Hope is an essential ingredient of the healing process that is often overlooked by those inclined to relish the technical aspect of when and where to adjust. Naturally, this reduces patients to mere spines, cases, insurance policies and practice volume statistics.
I was speaking with a doctor on the phone the other day who was lamenting about the state of his practice, recounting the different adjusting techniques he had employed over the years. More recently, his analytical bent had prompted him to pursue various postural and structural models of chiropractic. "But I was the busiest when my purpose was about finding and reducing subluxations," he confessed.
If your practice volume isn’t as great as you'd like, there's a good chance you’ve given considerable thought to how to turn things around. That search could send you down an unproductive rabbit trail to "causes" outside the four walls of the office and "causes" beyond the space between your ears. While it's convenient to blame the weather, the economy, the HMOs or the cheeseball advertising of other chiropractors, these are NEVER the real cause of slumping numbers. 
Things that are scarce are considered more precious than things that are found in abundance. Thus, gold is more precious than sand; diamonds more precious than glass. Is this why new patients are so precious? Because they seem scarce? 
Who awakens in the morning and proclaims, "Today, I want to be less significant. I want to be less important. I want to play a smaller role on the stage of life!"
With chiropractic critics ramping up their fear mongering campaign, this new research out of Canada should serve as a breath of fresh air. 
What a thrill to meet two people I have admired for some time yesterday. Both were speakers at the 
Astute marketers know that what a new product or service is named can have a profound effect on sales. It wasn’t “The Promise to America,” it was “The Contract With America.” It’s not called death insurance, but life insurance. Who would disagree with an estate tax? That’s why opponents call it the death tax. Instead of “unwanted” effects, they’re called “side” effects, as if they were a bonus or something.
We had the Denver Debrief for 
Marilyn’s an animal lover. Except for the animals you eat, I could take or leave them. And I’m sure the various cats and dogs who live in our house can detect my ambivalence. They tolerate me. I ignore them. 
I’ve asserted that sloppy language is a sign of sloppy thinking and sloppy thinking produces a sloppy practice (and life). Chiropractors sloppy with their own language are often unable to detect the subtle clues and nuances in a patient’s sloppy language. Language that not only predicts their behavior, but reveals their lack of commitment. 
Another example in the Sloppy Language Department is the chiropractors who say that they “treat” patients or go into the “treatment” room. Naturally, if you wish to treat patients, you’re free to do so. However, you might want to be mindful of what it means to deliver a treatment and what it means to the relationships you have with patients. Looking past the implication of this word choice may invite unwanted consequences.
I’m preparing my presentation for the Masters Circle New Patient seminar in Santa Clara later in March. This is a new talk and it addresses the topic of new patients in a way that I haven’t seen others touch. Anyway, while putting my PowerPoint together, I became present to a rarely mentioned bias I’ve noticed among chiropractors. From what I can see, there is a “pecking order” to the desirability of certain new patients!
I was interviewed this morning by a writer assigned by the ACA to explore the subject of cash practices. I think someone may have tipped off her editor that I had done some seminars about the cash practice in New Jersey and California and created a three-CD program for chiropractors called 
Sure, we were all told in elementary school that “there’s no such thing as a stupid question.” And it’s true, I think asking questions is the key to true patient education and understanding. But I think we can all agree that the question asked on many new patient admitting forms if not stupid, is at least ineffective. 
Tomorrow morning I’ll be reporting for jury duty. It’s been awhile since I’ve been called and I actually enjoy participating in the process. Unlike many, I’m looking forward to it. I’ll bring my laptop and do some overdue writing and use the time constructively. It’s been over 10 years since I was called, and on that occasion I was actually chosen to serve. 
When you report for jury duty in Douglas County, Colorado, after filling out more forms you watch… a video! It’s an orientation to get everyone up to speed, reduce apprehension, explain the players and what’s about to happen. This effectively imbued the jury pool with the proper mindset and respect for the proceedings. I couldn’t help but notice the similarities with visiting a chiropractor.
The trial ended yesterday. It involved stalking, breaking a restraining order, a childhood romance and the use of psychotropic drugs to control delusions. The defendant served as his own attorney, ostensibly so he could cross-examine the witness he had been illegally stalking!
Patients can’t ruin your reputation. Only you can do that.
After his warm hug, when you spend time with Dr. Fabrizio Mancini, the president of Parker College, you can’t help but emerge more positive and optimistic about chiropractic and the future of the profession. That was my experience today as I had the honor of being the featured speaker for this trimester’s all-school assembly.
I recently completed my 7th Conversation weekend debrief in Denver (The next 
Soon after beginning their professional training, student chiropractors lose touch with the patient’s point of view. The result, years later, is a highly-trained professional who has effectively lost touch with the people they desire to serve. And while this has created a career path for me, this all-too-common phenomenon has produced a cadre of chiropractors who are finding practice more difficult than it was even just a few years ago.
After a flurry of speaking gigs for several state associations it appears that many chiropractors are paying the price for years of patient coercion, manipulation and exploitation learned during the practice management era. At a time when insurance money was generous, at least compared with today, many chiropractors were urged to employ management tactics that were so abusive as to constrain the natural flow of referrals and reactivations; the foundation of a healthy practice.
Last week when I was in Spain, I became present to a subtle distinction that you might want to give some thought to. If my understanding is correct, it could significantly change what you do with every patient you adjust. Seems to me, becoming mindful of this observation could take the already excellent results you produce with most patients to an entirely new level. What could possibly be so revolutionary? A simple statement made by one of the speakers: “If you do the same thing, every time, with each patient there’s no art in your chiropractic.”
Have you mistreated patients for the last couple of decades, using manipulative techniques that were justified as “being for the patient’s own good.”
A popular advertising technique for automobile dealers is to entice customers by suggesting that their used car has more trade-in value than it actually does. As in, “Do whatever you have to do to push, pull or drag your car in, and drive away in a brand new car.” Apparently, this suggests that if you have some clunker that’s not even running, you have something that the dealership values that will help reduce the purchase price of a new car. 
I have a presentation coming up next week for the CORE Colorado group. I was discussing this speaking opportunity with a local chiropractor friend and asked if he had any ideas about what I should talk about in the hour or two that I’m going to have in front of a handful of Denver-area chiropractors. 
There’s a game I like to play with friends that I sometimes initiate during those moments of awkward silence after the catching up and small talk are complete. I call it This or That? It’s simple to play. You pose two choices in the form of a question. Let’s play.
While it appears Alberta is lawyering-up to be the battleground for the 
My dad has just been diagnosed with lymphoma. It’s the same thing my mom died of 17 years ago. 
I was talking with a chiropractor who was commiserating about the decreasing reimbursement that he was receiving from his patient’s insurance carriers. 
As I was thinking about why so many chiropractors have such brief encounters with patients, and thus an insatiable appetite for new patients, it occurred to me that it might not be caused entirely to the myopic, instant gratification viewpoint of patients. Or even the shortsighted vision of insurance companies. I’m increasingly suspicious that it may be partly due to the “story” the chiropractor is sharing with patients. 
Dr. Ross McDonald, who invited a number of us to come and speak at his third annual Edinburgh Lecture program, took all the speakers to dinner last Saturday evening. Sitting down to an incredible meal (that lasted four hours) with others who share the seminar “circuit” is one of the most enjoyable aspects of being a chiropractic gypsy. 
I was speaking to chiropractors in the England the Scotland last month, plus did a 
I’ve been making an assertion at my recent speaking gigs that, to date, no one has disputed. My claim? That the initial patient consultation is more important than the report of findings.
If Tiger Woods were a chiropractor, would he have a successful practice?
Regular readers may recall that from time to time I’ve leveled some harsh judgments about chiropractic colleges that seem more interested in tuition dollars and board examinations than producing gradates who can practice successfully. So along comes Life University, which has assembled an impressive curriculum entitled Principles of Practice and Business Management, designed to do just that. Moreover, imagine my delight when I was invited to participate in this program by delivering an 8-hour presentation to a group of students this past Saturday.
I’ve noticed that the chiropractic leadership in California is contemplating plans that could up the number of continuing education hours from 12 hours per year to 24. I’m sure there’s a good reason for this. But I can’t think of one.
Yesterday, I returned from spending 2½ days with one of my chiropractic heroes, Dr. Larry Markson, attending his new program called 
I’ve noticed an interesting shift in my seminar audiences when, during my initial introduction I review the five ways they can become offended by what I’m going to speak about. I’ll share these five ways in a bit. But why all the thin skins these days? Why does it seem so easy to offend others? Why have so many become so brittle?
Talked with a chiropractor who is going through a rough patch. He’s tried all the obvious things, such as reestablishing contact with his inactives, hiring the cheaper of the two recent new front desk CA candidates, putting his house on the market (bad timing on that one) and most recently, eliminating the monthly expense of the practice management coach that he’s had for the last seven years. These and similar strategies fall into the “save-yourself-into-success” category. 
If your candidate won, I’m sure that life is about to get better. If your candidate didn’t win, I’m sure life is about to get better, too. Yes, the sky will be bluer, the sun brighter and the TV news more upbeat. With the election behind us, there’s one less variable hanging in the balance. It was a convenient excuse for inaction, but it’s time to get your head back in the game.
One of the more common personas that many chiropractors seem inclined to assume, other than the “Fixer,” is that of the “Coach.” Apparently, so the thinking goes, showing up as the patient’s health care coach grants them the opportunity to employ whatever means necessary to “motivate” patients to do the right thing to regain and enhance their health. 
You probably get them too. “Double Your Practice in 60 Days!” and “Boot Camp for Marketing Dummies” and similar email subject lines. My first reaction has been derision. But then it occurred to me. These sorts of marketing overtures must actually work or they wouldn’t appear in my inbox. Somebody must be responding to them to prompt their continued presence in my inbox! Who?
To paraphrase Einstein, “Significant problems cannot be solved at the same level that created them.” Thus, when Wall Street expressed symptoms of an impending collapse, they sought relief from a higher level. Similarly, after the bumbling Detroit automobile manufacturers hit some black ice after years of running an uncompetitive business model, they have sought relief from the U.S. Treasury. Even American Express has expressed the need for help. Expect others to join the bandwagon.
Since it’s a human foible to look outside one’s self for the causation of our problems and challenges, it’s not surprising that many chiropractors look outside themselves and their practices for the cause of their underperforming businesses. 
Seems a week doesn’t pass that I’m not sent an email claiming the end of chiropractic. These epistles often use the eroding reimbursement from insurance companies as evidence that chiropractic is about to go the way of 8-track tapes and polyester leisure suits. 
For my last post of 2008, I’d like to explore a troubling telephone call I had recently from a practice management coach. You’d recognize his/her name, but this person’s identity isn’t important, since I’m suspecting that many in the practice/management/coaching/training/consulting space make similar suggestions. At least I make this assumption based on the state of the profession these days.
Those who follow this column know that for the last nine months my dad has been wrestling with lymphoma, the same thing that killed my mom back in 1991 and her brother soon after. Now, after eight infusions of poison (at an oncology center he jokingly referred to as The Cancer Shoppe) designed to kill the cancer without killing him, the report from his PET scan yesterday revealed… no presence of cancer. 
It appears that economic forces are conspiring to root out those in the chiropractic profession who are irrelevant, inauthentic or just misguided. Naturally, this is painful for those whose dreams of helping people by delivering chiropractic care are being called into question. The open market can be a strict disciplinarian. For many who have practiced the majority of their careers under the “price supports” offered by insurance carriers, today’s realities can be a rude, if not harsh wake up call.
Probably one of the most misleading movies used to inspire naïve chiropractors is the one with James Earl Jones and Kevin Costner who builds a baseball field in the middle of his Iowa cornfield. 
There are many practitioners whose practices are growing; having their best year ever. That may be hard to believe if you find yourself in the pit and feeling stuck. 
Before Y2K (remember that?) and before the dot com bubble burst (the other most recent economic downturn) the practice of chiropractic was different. Insurance reimbursement was on the decline, and phase two, known as the post-review audit hadn’t become so widespread. (One more reason to begin the process of 
From time to time, (last week was one of them) I learn of chiropractors who are suffering from cancer or some other serious disease. Or who die at some unreasonably young age. Sometimes it’s the spouse of the chiropractor who has been afflicted. Whether chiropractor or chiropractic spouse, both have usually been long time beneficiaries of chiropractic care. In other words, they received chiropractic care and surprisingly, got cancer. 
First there was Facebook. Then Plaxio. Linked In. And now Twitter. Will it ever end?
There’s a difference between what you believe and what patients believe. You may have noticed that. This discrepancy is what is used to justify the patient education overtures in most chiropractic practices. Granted, most so-called patient education is merely ineffective outside-in patient “teaching,” but the objective remains the same: cause patients to acquire a new meaning for their symptoms and the value of using chiropractic to address them.
The highways are still clogged. I still have to wait for a table at my favorite restaurant. And on Saturday mornings I can’t find a parking spot at the mall. Seems that all that the fear mongering of the media about the current economic climate is doing is forcing patients to clarify what’s most important to them. And by the looks of things, many chiropractors seem to have attracted people who don’t value their health that much. After all, if patients will only avail themselves of chiropractic care if a third party picks up the tab, it doesn’t say much for the priority they place on their health!
Disoriented? In a fog? Feeling lost? Inclined to freeze and do nothing?
From time to time, I encounter chiropractors who fear for the future of the profession of chiropractic. Ironically, these are often those who do not actually “profess” chiropractic.
On Monday, it will have been exactly 10 years since I conveyed my half interest in the old company to my business partner 
As I hear from chiropractors whom I have considered excellent examples of the profession, privately confess that their new patient numbers are down, I’ve become interested in the new patient aspect of practice. Frankly, I’ve avoided this. I’ve generally viewed new patient acquisition, beyond the internal referral process, as the seedy part of practice. The “tenderloin” of the profession. Traditionally, this has included everything from bent pens and free spinal exams to lightning-bolt adorned yellow page ads and heavy-handed recall scripting. 
Even though I no longer follow the media's interpretation of reality, even a quick glance, long enough to identify that the airport's monitors are tuned to CNN, reveals the latest fear mongering: swine flu. How delicious. On top of the financial "slipping and checking" that has infatuated the media, they can now fill the airwaves with something even scarier: an infectious disease. This is what advertising executives dream of, bent on reaching as many eyeballs as possible.
During some recent speaking gigs, and frequently during my telephone consultations, I will casually observe to chiropractors that your consultation is more important than your report of findings. I generally wait to see if I get any objections. I don’t. So either I’m onto something or my assertion is being dismissed as simply one more raving of a non-DC who doesn’t know what it’s like to actually practice chiropractic. It wouldn’t be the first time that such an accusation has been leveled.
This last week I became aware of two aspects of 
We Americans seem to enjoy importing things British. In fact, some of our most popular television programming originated in England, including Who Wants to Be a Millionaire, the Weakest Link and The Office.
Earlier today, I completed a one-hour telephone consultation with a chiropractor. The anger I’m feeling might be similar to what you’d feel when presented with a child suffering from vaccine damage or a patient who was maimed by a medical mistake.
Turns out my tantrum (
One of my guilty pleasures, being a radio guy, is to listen to one of the best interview shows on radio, 
Seeing the delays that our summer evening storms produce for flights leaving and landing in Denver, I opted to take an earlier flight out of Denver on Sunday. The original flight offered a mere one-hour layover in San Francisco to connect up with the once-a-day flight to Sydney and then on to Auckland, New Zealand for the first leg of my journey. My revised flight would give me a comfortable three-hour window to change planes in San Francisco.
After sleeping in to a luxurious 8:30 AM, I enjoyed the “free” breakfast included with my $49 room at the Grosvenor Best Western Hotel, just north of the San Francisco airport, compliments of United Airlines.
The flight from Honolulu to Auckland was about 9 hours. The plan was to sleep on this leg so I would be fresh for my Conversation Debrief scheduled to begin an hour and half after I arrived. Naturally, sleeping makes the flight considerably shorter. However, with the exception of about two hours of fitful sleep, most of the flight was spent attempting to get comfortable.
Today, Ngaire Cannon, my Australian distributor and I are off to Melbourne. The almost four-hour flight on Air New Zealand was on a gorgeous Boeing 777. We’ll be making a beeline for the new convention center and setting up the Cannon Communications trade stand for the Parker Seminar.
When I encounter something new that produces a “That’s interesting” response, and then come across it again a few days later, I’ve learned to pay attention and take such cues seriously. That’s what’s happened during the last week or so when I have heard two people suggest that at the consultation chiropractors should ask patients why they have chosen to seek the services of a chiropractor… now.
I’ve become present to the fact that the long plane flight from North America becomes a convenient excuse to avoid visiting Australia. I suppose that keeps some of the so-called “Ugly Americans” from showing up here. But Australia is worth the long flight. 
I’ve never lived in a large city. However, after three days in a downtown Sydney hotel, I can see the appeal. While nature is largely absent, save for some self-conscious parks, there is incredible access to just about anything you would want. My needs are sparse, so, being able to walk across the street from the hotel to buy some fruit and water from a vast underground grocery store, or duck into the adjacent Japanese restaurant for some fresh sushi, makes these outings quick and productive. Quite a bit different from living in rural Colorado.
Every time I get together with Steve Anson, my Perfect Patients business partner, it’s nonstop work. It’s not actually work, but it’s what we do to add value to the business. This unique collaboration has attracted 27 employees located on three continents who all contribute virtually.
It might surprise you to learn that the airport security in Bangalore, India is, well, over the top. 
Just had lunch with three Colorado Springs chiropractors. The original purpose of our meeting was to discuss potential meeting space for a monthly gathering of local chiropractors. 
I’ve been thinking about why certain procedures and policies that are recommended by practice consultants seem to work well for some chiropractors, but fail miserably for others.
As I was flying home after presenting New Patientology in Calgary last weekend, I reflected on my recent experiences speaking to chiropractic audiences. Why do chiropractors go to seminars? And what are they expecting from doing so?
Yesterday I spoke at the New Beginnings seminar in New Jersey. Since this philosophy weekend hosted by Dr. Jim Dubel began back in 1991, I’ve probably accepted the invitation to speak upwards to a dozen times. And while this time the feedback was generously positive, I left thinking that I didn’t give the talk I should have. 
The 1990 pages of the health care reform bill, referred to as "
I’ve mentioned my Dad and his cancer in previous postings, notably his diagnosis in 
"I just get them well too fast," complained a chiropractor recently.
Even with brilliant 
I pick up pennies when I see them lying on the sidewalk, in parking lots and elsewhere. Nickels. Dimes. Virtually any type of currency. Picked up a $20 while jogging one morning. I snagged a 200-peso note in Mexico last month that came in with the tide. I'm often ridiculed or laughed at for this, but I’ve probably acquired close to $100 over the years. It's not a living, but these gifts, in the form of free money, add up.
This is a great time to reinvent the way you deliver your patient reports. All too often a chiropractor’s report of findings becomes habitual, rote and repetitive. Like any other type of autopilot communication, it diminishes the 
Had a great time presenting at the Indianapolis EPOC last night. (Thank you Drs. Nate and Cory Blume!) EPOC stands for EpiCenter Of Chiropractic. These are gatherings of chiropractors interested in advancing the philosophy of chiropractic, the success of chiropractors and the unity of the profession. 
If you’ve been seduced by the widespread belief among many chiropractors that your purpose is to adjust patients, you’ve reduced yourself from a human being to a human doing. A meat computer. A carbon-based pneumatic device.
Apparently the “Tastes great!” “Less filling!” debate within chiropractic rages on, pitting the evidence-based-scientific-give-me-proof-med-heads against the anachronistic-paleochiropractic-subluxationophiles. (I didn’t make those up. They’re terms extracted from an actual email exchange between chiropractors!) Each points an accusatory finger at the other, assigning blame for what ails the profession, their practice or the sacred cow of “public perception” about chiropractic.
Is it possible to rehabilitate and retrain the supporting muscles and soft tissues of the spine in patients over the age of 30 with the dozen visits or so doled out by an insurance company? 
“Hi, my name is Steven and I’m a patient pleaser.”
You’ve probably heard that “England and America are two countries separated by the same language.” Apparently, add chiropractic to the mix and you have an even greater separation.
The ancient Greek Hippocrates handed down his classic admonition in the 4th century B.C., contained within the Hippocratic Corpus.
Just got back from 
I remember my high school economics teacher telling us that if we were ever to fall asleep in class, and awaken, discovering that we had been asked a question that we didn’t hear, answering with “supply and demand” would likely be correct nine times out of ten.
Is the future of the chiropractic profession more likely assured by being an evidenced-based-treatment-for-skeletal-muscular-maladies-by-restoring-proper-spinal-biomechanics or by being a vitalistic-art-science-and-philosophy-addressing-whole-body-health-by-invoking-the-self-healing-qualities-imbued-living-things?
Is it just my own deafness, or is there a crushing silence about the impact of the health care reform bill on chiropractors that was recently pushed through Congress?
The number one 
If you’ve had your head down helping patients, you may not be aware of a dangerous trend taking place in the United Kingdom. There, under the heavy hand of the General Chiropractic Council (GCC) regulatory body, many chiropractors are discovering that they cannot promote chiropractic for any health problem other than those proven by randomized clinical trials (RCT).
Last night at your favorite restaurant:
Naturally, I believe that there is value in chiropractic patient education as well as chiropractic patient teaching. Education and teaching are the pairs of an afferent/efferent relationship. The purpose of these overtures is to give patients the appropriate meaning and context for your adjustments, the visit frequency you recommend and the expectations they can reasonably expect from their care.
Since I’ve had the same email address for 11 years, I get my share of spam. In fact, I bet I get more than my fair share of spam. Sure, it’s annoying, but since I have a delete button (and use 
The folks at the Council on Chiropractic Education are in the midst of revising the standards by which chiropractic colleges will be accredited come January 2012. As you’ve undoubtedly heard by now, student doctors are graduating atrociously undereducated and stricter guidelines are essential for the preservation of the profession.
I’ve been musing about the growing bifurcation of the chiropractic profession. I’ll just ask it out loud: Why are there chiropractors so ambitiously pursuing the elimination of subluxation and the addition of drugs to the profession of chiropractic?
Many chiropractors appear to be scrambling these days, trying to find the money in chiropractic.
In case you weren’t at the 
However, my outlook brightened when I learned that his successor would be long-time friend, 
This is the 500th entry in the Patient Media chiropractic blog since it began back in August 2006. 
During the Q & A at the end of my speaking gig this past weekend, I became present to an issue that seems to constrain many chiropractors from experiencing the practice ease they deserve: worrying about what others will think about what they say or do.
You have a reputation. Just about everyone does. In your case, it influences the referral process, patient retention and many other nuances of your professional practice. In fact, the reputation of some chiropractors caused them to have a national or even international reputation, such as Clarence Gonstead, James Parker and others.
As I 
A common question I field coming from chiropractors, reacting to an increasingly deregulated practice environment and coming to grips with the tension faced by all small business owners is, “How much should I charge?”
One of our deepest yearnings is to make meaning of our world and our circumstances. Most of us, especially in chiropractic, are constantly on the lookout for the underlying cause of just about everything. Or should be. “Why did that patient do that?” “Why are my numbers down?” “What accounts for this? Or that?” “How come?” “Why?”
It’s a common tale. For time, you’re so busy each day is a blur. You’re in the zone. You’re on top of the world, trusting your intuition; you’re practically a wizard. This is SWEET!
Virtually all chiropractic practices are personality-driven small businesses. This begins to explain why a procedure, script or technology works for one chiropractor, but falls flat with another. While a cookie-cutter approach is often taught at practice management seminars, this overlooks the key distinction that success is always based on the “who” not the “do.”
Not sure if it’s my age, my leanings towards introversion or my busy schedule, but I confess that I’m having a difficult time with 
From time to time I encounter a chiropractor, usually a younger, more idealistic chiropractor, who has proclaimed that his objective; his purpose for being in practice is to create a “subluxation-free world.” I rarely hear this from more experienced chiropractors, tempered by the wisdom of many years in practice and having been trained at a time when chiropractic philosophy was still taught at chiropractic colleges. 
Take an inventory of your practice-stabilizing, once-a-monther patients and you’ll discover that most of them have had two, three, four or more chiropractic episodes prior to embracing chiropractic as a long-term lifestyle adjunct. If this is true (research your own patients and see), then it takes a lot of pressure off trying to find the magical words or the seal-them-in-for-life procedures that so many chiropractors seem searching for.
Many newer chiropractors seem to believe that merely outfitting an office in a highly-trafficked location, hanging up a sign and doing a great job is all that is needed to be successful. That may have been almost true in the 1980s when everyone had insurance with $100 deductibles. But today, that is merely the admission ticket into the arena of professional practice.
Once there were two chiropractors. 
I’m on the verge of doing something that I’ve never done before. I’m going to take a vacation. 
While there is a movement among some to drum out the special language of chiropractic, I for one believe that one of the things that distinguishes chiropractic from other disciplines is its unique language.
I’m happy to report that I didn’t do much during my 18 days away from the telephone and email. Which, after all, was the point. And since I do so much travel, a “staycation” seemed the most appealing. So, I caught up on some yard work, read nine books, took two long walks (10 miles and 16 miles) and nursed my garden after being almost decimated by hail. I did spend a day in Denver catching up at my favorite spots, The Tattered Cover bookstore in LoDo, the Denver Art Museum and the Natural History Museum. Before that, spent five glorious days with James and Gina Milliron from Yakima, driving to the top of Pikes Peak (elevation 14,110 feet) with Marilyn. But the two and a half weeks were mostly about slowing down, being off the grid and simply “being.”
Patient education helps create a common understanding, entice patients to attach new meanings to the experience of their body and embrace beliefs that more accurately reflect the reality of health and healing. 
With more than 30 years of playing a peripheral role in the chiropractic profession as a self-appointed “chiropractic advocate,” I get asked from time to time about what I’ve learned conducting 54 patient focus groups, in-office consultations and 
The other day I made a list of some of the assumptions I’ve made. (It’s a helpful exercise you might want to try.) One such assumption is the idea that patient education is something that every chiropractor has a responsibility to do. 
When the president or CEO of a major corporation has a bad day, distracted by a problem at home or is going through some other personal drama, it rarely affects the bottom line. In fact, depending on its size, larger businesses have enough momentum to endure months of this type of dysfunction. Not so in a personality-based small business such as your professional practice. 
When my dad was attempting to 
Maybe the reason more and more chiropractors are not enjoying the fruits of a chiropractic practice is because they don’t have a chiropractic practice. They have a chiropractic medicine practice. 
One of the self-appointed tasks I perform each week is to review the log that records the terms visitors enter into the search box in the upper right corner of every page on this site. My goal is to see what interests people, or as Google refers to it as “the database of intention,” and to update the keywords associated with each page so they will appropriately show up when searched on. (It’s actually easier to do than to describe!)
"It’s the economy, stupid" was the catch phrase used by Bill Clinton’s political campaign preventing George H. W. Bush from enjoying a second term. A similar economic theme was used by Ronald Regan (“Are you better off today than you were four years ago?”) to unseat Jimmie Carter. I’m guessing the economy is likely to play a role in next year’s presidential election also.
It’s that time of year again. Actually it starts even before Halloween when store decorations featuring ghosts, goblins and witches are often fighting for attention from the Jingle Bells, Santa’s and nativity scenes.
This is an all too common belief held by many chiropractors who are naive, lazy or inclined to steal. Naturally, this lack of integrity creates far more problems in the long run than it solves in the short term.
Now that the dust has settled from the New Mexico attempt that would have allowed chiropractors to prescribe drugs and possibly perform surgery, it might be helpful to remind ourselves as to why this was, and is, such a bad idea. An idea that some, emboldened by last year’s close call in the Land of Enchantment, seem inclined to bring to other legislatures near you.
A fascinating theme has emerged among some of the more recent 
The first chiropractic seminar I attended was in January of 1981 as I was doing research for what became the profession’s first patient education videos.
At yesterday’s seminar in Birmingham, England, we were discussing patient follow through and the frustration that one chiropractor was experiencing because patients seemed to ignore her recommendations. I assumed that not all patients ignored her recommendations, but maybe enough did that she thought it was her fault.
I’m encountering more and more chiropractors in my 
I trusted a hunch during my talk yesterday in Minneapolis and made the assertion that “...during the last four months, some of you in this room have actually contemplated what you could do other than practice chiropractic.”
“So, what do you know for sure,” I asked Gene who had arrived to clean our windows.