Back to Basics: Practice from Above Down, Inside Out
TECHNIQUE
William H. Koch
DC
As you know, the word “chiropractic” traces its origins to the Greek language and means “done by hand.” Chiropractors touch people. We use our hands to heal. Chiropractic healing is personal. The chiropractic profession was built by giving good care and getting great results quickly.
To grow as a profession and to gain acceptance and respect, chiropractors had to not only do well but also had to do better. We got to where we are by working harder, getting better results, and giving more personalized care. To get to where we are today, we had to dedicate ourselves to excellence.
Sometimes we need to remember our origins and what distinguishes us from the medics. We need to get back to the basics of chiropractic philosophy and practice. We need to practice as we heal — from above down, inside out.
If we concentrate on providing more personalized and effective patient-focused care, the chiropractic physician could become the preferred choice as the primary care doctor.
The world of health care is in transition. This is a time for us to sharpen our tools and regroup. It is an opportunity for us to come to the forefront. As overall health care becomes more impersonal, rationed, subject to the dictates of the “managed care” mentality, and governed by the economics of insurance companies rather than the needs of patients, chiropractic could become the preferred option for many people. If we concentrate on providing more personalized and effective patient-focused care, the chiropractic physician could become the preferred choice as the primary care doctor.
I am distressed by the trend in chiropractic to be focused on the numbers, rushing patients through their offices, trying to see as many as possible, rather than focusing on providing the best care for each patient, getting the best possible results. I am distressed by the trend toward building “big cases,” trying to get the most patient visits out of each “case.”
I do not practice that way. I am hoping to convince more chiropractors that they can have a more satisfying, successful, lasting practice by rejecting the numbers-based, insurance-based model and instead creating a patient-focused cash practice based on high quality, personalized care and excellent results. By focusing your time and energy on being the best, most skilled chiropractor, you can build your practice organically through referrals from happy patients. You can cut your overhead, limit the stress of wear and tear on your body, and improve your bottom line at the same time.
I have been in practice for over half a century and have had four very successful practices. I have always had referral-based cash practices. At almost 78 years old, I am still in practice and still love what I do.
I started my fourth practice at age 70 in Mount Dora, where I was completely new and unknown, with no history in the area. Word spread quickly. Personalized care and great results have always been my best advertisement.
The secret to my success has always been my focus on providing exceptional care. Exceptional, patient-focused care is what I want to encourage. I want to share and teach my personal approach to achieving that.
Our attention should be focused 100% on the patient during every visit.
Who am I to tell you, many of you have extensive experience in practice, how to consult, examine, and treat your patients? After all, you have done these things hundreds of times. You have done these things so many times it is routine — so routine, many of you could do them in your sleep.
That Is Exactly the Point
Often, the routine things we do every day become so routine that it is easy to overlook their significance, and we forget how important they are.
The procedures we repeat day after day, patient after patient, may be routine and mundane to us, but not to the patients.
For each patient, everything we do is important and significant. They come to us because they are in pain and often worried or even fearful about what is causing their distress. They are wondering if they can be helped, and if so, how long it will take and how much it will cost. For patients seeking our help, nothing is routine or mundane.
We Need to Start Doing the Ordinary, Basic Things in an Extraordinary Way
How we approach our patients is important. It is essential that we truly focus on each one as a unique individual and give them our focused attention and respect.
This is important each time we see them, but it is especially important during the initial visit, which is our introduction to each other. During that first visit, they will decide if they trust us, like us, are comfortable with the care they receive, and whether they will come back.
The first visit is the courtship phase of the doctor-patient relationship. For better or worse, it sets the stage and tone of that relationship, which is consummated in subsequent office visits. Like any relationship, it will cool and break up if encounters become perfunctory, lacking proper attention and the personal touch.
The courtship begins the minute a patient calls for that first appointment. Right away, they need to be made to feel like a VIP because they are. When they walk into our office for the first time, they should feel welcome and comfortable.
The time we spend with our patients is precious to them and should be to us as well. Our attention should be focused 100% on the patient during every visit. When our patients know that they are genuinely important to us because we treat them that way, we become equally important to them. And when we treat our patients in that manner, we will have very little trouble with patient retention.
From a practice-building perspective, a patient who feels their doctor really cares about them is much more likely to refer their friends and family to their “great doctor.” From a risk-management standpoint, a patient is much less likely to sue a doctor with whom they have this kind of rapport.
I believe in a single standard of care, whether it be the richest guy in your practice, some poor person you take care of pro bono, or a family member. The standard should be the same, and it should always be a standard of excellence. Always give the best that you can.
Why Back to Basics?
• We need to return to what made chiropractic great in the first place — personalized care and efficient results.
• Our practice should be patient-focused and results-driven.
• We should practice as we heal — from above down, inside out.
• Healing consciousness in our heads and hearts before we can heal with our hands.
The Importance of the First Visit
• Make the most of our only opportunity to make a good first impression.
• Lay the foundation for a good, long-term doctor-patient relationship.
• Everything we do, with every patient, every time, we need to treat as if it were our defining moment. That is especially true with that first visit.
The Initial Consultation
• Make every patient feel like a VIR
• Focus total attention on patient: condition, needs, worries, or fears.
• Five minutes of concentrated attention spent really listening to a patient is more valuable than hours of indifference.
• Encourage patients to relax and discuss all health concerns.
• Align the doctor’s goals to those of the patient. Clarify what the patient wants from their care.
The Initial Comprehensive Examination
• The lost art of a thorough, comprehensive examination needs to be rediscovered and revived.
• No treatment plan can be effective unless it is based on accurate, objective findings.
• No glossy patient-education program can possibly impress the patient like a thorough, interactive examination.
No treatment plan can be effective unless it is based on accurate, objective findings
The First Visit: You Only Get One Chance to Make a Good First Impression
The chiropractic consultation and examination process is unique in all the healing arts. Its importance, though, is surprisingly under appreciated.
The comprehensive consultation and examination process is a sterling opportunity for the doctor to become a “rock star.” I emphasize the word “comprehensive” because that is the only way to uncover the underlying cause of problems that otherwise might remain hidden. When the consultation, examination, and treatment focus on only the symptomatic complaint, it is likely that as much as 85% of the underlying cause will be missed.
During a comprehensive consultation and examination, the astute doctor can uncover important information, often discovering problems that the patient either did not know about, had forgotten, or thought were irrelevant.
It is important to develop the habit of looking beyond the obvious. It is fun and rewarding to be the sleuth who finds the missing pieces of the puzzle that the patient’s condition presents. This is especially true for cases where other practitioners have been unsuccessful. That makes you a superstar in your patient’s eyes and motivates them to talk about their great doctor and the exceptional care he or she provides.
The Initial Consultation
The initial consultation is much more important than we realize. Setting the right tone by making your first visit “patient-focused” is important. It is essential to start by taking a complete history and really listening during your initial consultation. We all need to learn to be better listeners. We need to be active listeners, meaning we need to hear their words, think about what they are telling us, and sometimes read between the lines. We need to learn to ask relevant questions and pay attention to the answers.
Too often, doctors think they already know what is going on with a patient and what the patient needs, and they are dismissive of what they often think of as “patient jabber.” They do not think the patient has anything useful to say, so the “jabber” just goes in one ear and out the other.
If a doctor really listens, he will frequently discover important clues that will help him uncover the most fundamental, underlying cause of the patient’s problem — and cause matters. We need to pick up on these clues and use them to help us provide the best level of care possible.
The Initial Examination
After taking a complete history and listening to the patient’s issues and concerns, it is time to begin a thorough and complete examination. Here, chiropractors can and should shine because they are better trained in the art and science of physical examination than most other physicians. And it is essential that we do it right.
However, to my dismay, I have found that too many chiropractors tend to shortcut here. The lost art of a thorough, comprehensive examination needs to be rediscovered and revived. No treatment plan can be effective unless it is based on accurate, objective findings.
Failure to do a thorough physical examination to analyze and correlate objective and subjective findings is the main reason for misdiagnosis and poor results. To me, such an examination is not only important, but it also is absolutely essential. How could I provide effective care without it?
I never adjust anyone without first doing a proper exam. An effective examination is meaningful to both doctor and patient. When I do my initial examination, the patient is fully engaged as an active participant in the process. An examination that actively engages the patient, in which the patient sees and feels the doctor’s findings, is more effective than the perfunctory exam consisting only of a quick palpation of the spine, range of motion check, and standard orthopedic and neurological tests.
This is not to deny the validity of those tests. I do them, but when done in the usual way, they lack the gut-level impact that patient participation elicits.
A vital tool I use to continuously engage my patients in the examination and post-treatment reexamination is the use of muscle testing. Standard examination procedures lack the functional component provided by muscle testing. With muscle testing, strengths and weaknesses are revealed are controlled exclusively by the patient. They feel their own weakness and are often surprised by it. They are even more surprised when a post-treatment muscle test proves to be dramatically stronger. This is clear evidence that something positive was accomplished by the treatment procedure.
An interactive examination that actively engages the patient is a very effective tool, serving multiple purposes. It allows me to confirm my findings, while the patient feels and acknowledges the muscle test results. An effective examination is meaningful to both doctor and patient.
As I do each of my exam procedures, I articulate my findings, either to my CA or to a recorder, allowing the patient to hear each finding. They may not understand what each test or finding means, but they do recognize that each has significance, and that I know what that significance is.
By verbally reporting the exam findings to the CA as the exam proceeds, the patient hears us attribute a name and affirmation of significance or importance to each positive sign and test. You would be amazed at how much most patients pay attention and remember. After all, it is all about them.
They are even more impressed when we quickly retest areas of weakness after treatment, and they find that what was weak is now strong. You would be surprised by how many patients recall results I have vocalized and remember the results when I retest. If you talk to them, and it is about them specifically, rather than generic patient education, they pay attention!
Such an interactive exam and vocalized reporting of findings further solidifies the doctor-patient relationship and the patient’s level of trust in the doctor and
the process. No glossy patient-education program can possibly impress the patient like the interactive examination. It is the best kind of “patient education” you can do.
The effectiveness of this approach to consultation and examination proves itself to me with every new patient I see. When patients experience care that is personalized and focused on them, it leaves an indelible positive impression. They quickly realize they are with a doctor who really cares about them. There is no better way to build patient loyalty and to engender the kind of enthusiasm that makes them want to tell everyone they know about the special doctor they discovered.
* Dr. Koch is a 1967 Cum Laude graduate of Palmer College of Chiropractic. He practiced in the Hamptons of Eastern Long Island, New York for 30 years and in the Bahamas for 15 years. Now, wanting to give back to the profession he offers courses on I_I "The Koch Protocols for Integrated, Advanced, Chiropractic Techniques." Simple, Effective, No Nonsense and Hands On. He may be reached on DrWilliamHKoch.com or by email [email protected].
