“Nerve First” Approach
by David Fletcher, D.C., F.C.C.S.S.(C)
Dr. Fletcher is a 1980 graduate of Canadian Memorial Chiropractic College with a Fellowship in Chiropractic Sport Sciences. He trains and teaches thousands of chiropractors to interpret and communicate the power of chiropractic care, using CLA’s Insight scanning technologies. He continues to practice daily, while developing new strategies for coaching chiropractic offices towards excellence.
"Like most patients, I began seeing a chiropractor for some spinal pain and sports related injuries. This was in the early seventies, and my parents and I used chiropractic as one would use dentistry or medicine. A chiropractor was just another doctor you went to; in this case, for spinal care. Our family DC had little interest in teaching the "Big Idea" and would tell us to come back if it hurt. When I chose to become a chiropractor, I had no idea that chiropractic was a healing system based on vitalistic principles and the powerful science supporting it. That was until I heard Reggie Gold speak, off campus, of course. His signature lecture, ‘The Chemistry of Life’, struck me between the eyes. Here I was, already in a chiropractic school and I was being trained to heal people, not just spines! I was ecstatic! All we needed to do was tell the story often and properly."
And so the journey began that has led Dr. Fletcher around the world, teaching chiropractors that the hip bone is connected to the universe, because of the neurology that lies within. The American Chiropractor (TAC) caught up with this dynamic communicator in his office outside of Toronto, Ontario, Canada.
TAC: You’re a busy man with your speaking and coaching programs. Tell us what you have been doing to spread the message of chiropractic.
Fletcher: I do teach, train and coach chiropractic teams to excel; but what I still love to do is practice chiropractic. I call my office a "living laboratory" for developing new and innovative teaching and communication strategies. I think that this adds a relevancy to what I teach. I am always amazed at how a subtle shift in the message can be so powerful at getting that "Ah Ha" from the patient. Being in practice allows me to refine and simplify the message.
Helping someone through a pain or symptom crisis is honorable. At the spinal-mechanical level, we can assist a lot of people; but that is only the entry point for people to experience chiropractic. The real story of healing energy and potential lies in the connections of neurology within the spinal-neural-dural array. Our role is to show people how to care for this amazing system and coach them to live life fully. I practice and coach the benefits of an invitational approach which allows the doctor to become the trusted advisor, leading patients along their path to wellness.
TAC: Wellness seems to be the most popular message amongst chiropractors today. Tell us your thoughts on the link between wellness and spinal care.
Fletcher: Seven years ago, I was brought in to consult with an international health and safety board that was comprised of government and business leaders to whom I introduced this "bizarre" notion of wellness being included in corporate health programs.
They just couldn’t get their heads around this idea of something bigger than prevention; but they took a leap of faith and we created "The Wellness Way" at their annual convention. Eight thousand attendees got a glimpse of a new perspective in employee health. We used Chiropractic Leadership Alliance’s Insight Scanning technology to show how stress and nerve interference were present in almost everyone, whether they had back problems or not. This allowed us to show how stress was interfering in employee health and performance and, of course, tell how chiropractic was the natural starting point for a wellness program. The organizers were amazed at the interest and desire of business groups to learn about the natural management of stress in the workplace. Fast forward to the present and the Wellness Way is sponsored by all levels of government and big business. In these organizations, wellness is seen as a necessary message and funded protocol. Our challenge now, as chiropractors, is to bring the full message of healing and health forward and to be seen as relevant players in these programs. If we limit the story to back and neck care, we miss out on telling the wellness story, which mires us in the competitive spinal therapeutic marketplace. Our philosophy, science and the artistic brilliance of an adjustment, positions us perfectly as leaders of the wellness culture.
The link between Wellness and spinal care
really comes down to one word:certainty
TAC: So, if the time is right to see chiropractic breakout on the international health and wellness stage, what’s holding chiropractors back?
Fletcher: Well, it really comes down to one word: certainty. On a practical basis, I teach that you get paid at the level that you perform with certainty. If you are certain that you can manage acute care, you develop a terrific acute care practice. If you are certain that wellness lifestyles and lifelong chiropractic care are essential foundations for your community to thrive, then the sky is the limit for your practice.
Unfortunately, doubt and insecurity are rampant within the profession. If you can believe it, we see that the greatest uncertainty is around the role of the chiropractor. In seminars, we ask the question, "Are you acting as an over qualified physiotherapist, an under trained medical doctor or a perfectly capable chiropractor?" This is where coaching and mentorship is necessary. A capable coach can really help to teach the principles, while training congruent procedures. Most of all, a coach can mentor and unleash the hidden potential while refining the raw talent.
TAC: You mentioned earlier the importance of the nervous system in telling the chiropractic story. Tell us more about this.
Fletcher: I attained my Fellowship in the Sport Sciences in the mid 90’s. I wanted to learn more about performance and apply that to the chiropractic care I was delivering. What I came to respect and understand was the absolute importance of neural competency and efficiency. I started to investigate surface EMG as a reliable indicator of spinal nerve function and came across these two chiropractic pioneers named Patrick Gentempo Jr. and Christopher Kent of the Chiropractic Leadership Alliance. They had a terrific technology that included spinal range of motion, thermal scanning and the sEMG. I realized that this would be the perfect combination to show how the spine and nerve function were so intimately related and I immediately made this the hub of my practice.
TAC: How did you make this technology work for you?
Fletcher: Examinations, reporting, and even marketing were based upon the principle of identifying subluxations and tracking the changes with this technology. My practice changed dramatically and, years later, continues to thrive based on this principle. The most measurable change was in the retention of patients. A care plan was now relevant, as it addressed the issues that brought the patient in and laid the foundations for wellness and stress management. I developed a new practice paradigm known as the "20-80 practice." This is a reversal of a traditional practice where 80% of patients in a practice are there for the 2-4 months while only 20% stay a bit longer.
This traditional style of practice demands a tremendous effort to acquire new patients to replace those that leave. I teach and train my clients that the "20-80 method" takes a "Nerve First" approach to examining and reporting. Although we always recognize the necessity of spinal alignment and function, our first goal is to identify patterns of unmanaged stress affecting the nerve centers along the spine. By introducing how daily stress can eventually "stain" the nervous system, a care plan using neural scanning and spinal function allows the patient to be actively involved in their care and progress. This creates long term relationships and, hence, the "20-80 practice" where 80% of the patients are under wellness care and 20% aiming to get there.
Chiropractors are so lucky that they have aligned their careers with the Universal principles of healing and
TAC: How do you teach and train doctors to include this Nerve First approach in their practice?
Fletcher: I have become a leading authority on neural scan interpretation and the integration of scanning into a practice. Each year, I train hundreds of doctors how to interpret a full array of neural scans, including surface EMG, Thermal scanning, Inclinometry, Algometry and Heart Rate Variability. The real challenge is to ensure that a proper report is given by the doctor and I believe that is where my greatest skills shine through. Over the years in practice and while coaching doctors, I have developed powerful, yet simple, communication methods that take complex concepts and present them in practical and inspiring terms for the patient. A 7-10 minute Report of Findings really can connect the hip bone to the Universe!
I created the GAP Coaching program for doctors searching for that individualized training and mentoring. GAP stands for Greatness Action Plan. I believe that there is an untapped greatness in all of us that can be coaxed out and allowed to shine. Chiropractors are so lucky that they have aligned their careers with the Universal principles of healing and greatness. They are the perfect clients to coach with the GAP program.
TAC: What does Gapping mean in those contexts?
Fletcher: Besides the first meaning, we also use GAP as a communication and patient education concept. It’s a bit contrarian to the concept of "bridging the gap" and that’s what gives it an edge and gets people thinking outside the box. We teach the patient that GAP stands for General Adaptive Potential. It follows Selye’s work on stress and adaptation. In the nerve first approach, we teach the patients, very early in their care, the importance of identifying and modifying daily stress. Once we get them to understand the role that stress plays in their pain and health, we then introduce "widening the GAP." Gapping is the process of releasing the innate healing response while we collaborate with the patient to reduce the stress load that is narrowing the GAP.
TAC: What do you see as the practice of the future?
Fletcher: It’s hard to envision what chiropractic will look like in another 100 years but, in the next 5-10 years, I see a return to basic business fundamentals where a cash practice dominates. The rapid decline in insurance contributions is obvious and, as we all know, it’s a mess dealing with paperwork and receivables. To make a cash practice work, all systems have to be ultra efficient and cost managed: a simple fee schedule, convenient hours, simple care plans that allow restorative healing and, of course, an inspired doctor and team that are expecting a miracle with each adjustment.
We can learn a lot from the masters at cash-based, long-term care…the orthodontists. I have taken some of their finest practice strategies and adapted them to work in a wellness centered chiropractic office. Linking stress, wellness, lifestyle and structural integrity in an organized care plan allows us to widen the gap over months and, eventually, years of care.
I think it is also very wise to take the time to "know" your ideal patient. Chiropractic impacts everyone, but there are certain groups of people that we just resonate better with. Focus on these patient clusters and become passionate about adjusting this group’s perspective and behavior towards wellness.
The other side of the practice profitability equation is managing overhead. We coach and train our doctors in efficient procedures that inspire and educate at the same time. Imagine a 3 or 4-day workweek, high intensity, high profitability, cash dependent and low, low overhead. Lofty intentions delivered with a high degree of certainty, blended with compassionate care and brought by a doctor who respects his own health and well being, are the foundations for the future, successful practice.
TAC: What single piece of advice would you give a new practitioner?
Fletcher: Meet people. There’s an old adage that states, "The more people you meet and greet, the more you treat." When I started practice, I always had a stack of business cards in my pocket and handed them out to everyone I met. People, months and even years later, would remind me that I had passed along a card. In today’s technology based environment, meeting people can also be done via the internet. Joining networking sites, using Twitter, and sharing blogs allows you to meet a more diverse group of potential patients.
TAC: Thank you Dr. Fletcher for taking the time to share your story. Any last thoughts?
Fletcher: We are most powerful when we define our strengths and go for it! Above my desk is Aristotle’s quote," We are what we repeatedly do. Excellence, then, is not an act but a habit." Learning to be great and to act powerfully is a habit worth exploring.
You may contact Dr. Fletcher at
, by calling 1-905-831-9696, or visit www.docfletch.com