Healthcare

Big Ideas On Marketing Evidence-Based Practices (Part Two)

CF 099: Big Ideas On Marketing Evidence-Based Practices (Part Two)

Today, you’re going to hear Part Two of our two-part series about marketing. Specifically, marketing an evidence-based chiropractic practice. How do you do it and do it right?

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. We’re not the stuffy, high-brow kind of research. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. 

If you haven’t yet I have a few things you should do, like our facebook page, and go to our Store link at chiropracticforward.com and check out the goods. That’s it. Not bad right?

You have shimmied into Episode #99 and I hope you’re enjoying the Marketing series. 

Now, if you missed last week’s episode, it was Part I of this marketing an evidence-informed practice series. Stop now and go back and listen to Part I first. Then come back here and devour Part II. 

Because….make no mistake…..we’re serving it up hot and fresh here people. 

On a personal note, nothing special is going on around the office or in my work life balance. It’s just been business as usual. We’ve had a bit of a fall off from the Summer but it’s still busier than this time last year and we’re staying busy busy busy. 

So, nothing of signifigance to report here but, before we get too deep, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

OK….now, back to Part II of our marketing series. We covered some general marketing thoughts and we covered internal marketing last week. We were just about to get into External Marketing and the idea of the first big three means of external marketing which can be thought of as shotgun marketing. 

So, let’s pick back up where we left off last week. Here we go. 

#2 External Marketing

Now, let’s move on to External Marketing. This is the traditional marketing we think of. Things like:

  • TV
  • Radio
  • Billboards

Let’s talk about those three first. We can call that shotgun marketing because you are hitting random people with random pebbles. You can’t laser focus marketing with a cannonball this way. You can only hope that someone that would be interested in you happens to see your message. Some will. Most probably won’t. 

Don’t worry if you’ve fallen for some of this crap. I spent $19k one year to have the front page corner of the yellow pages. Now, that was years ago when everyone actually used the yellow pages but, trust me, I’ve done stupid crap too. 

Back to TV, no matter how smooth the sales reps are, more and more are unplugging. They’re using streaming services like Netflix or Amazon. Disney and Apple are jumping in with both feet too so sooner rather than later, I think the majority will not see a message on traditional TV. 

Same goes for radio. Hello, every heard of Sirius radio? Or, if you’re like me, I’m listening to a podcast as soon as I get in my truck to go anywhere. I don’t even listen to traditional radio anymore. If you do, I think you’re quickly becoming the minority. 

Billboards may make sense if you’re right off the highway and it leads people to your front door. Otherwise, I think it’s probably mostly a waste of money. Don’t get too tied up in whether or not you see your face or your name up on a big board or up on TV. It’s not real. It didn’t happen organically because you’re awesome. You put it there with your money. And you may have just wasted that money. 

Shotgun marketing can make sense but only after all of the base coat has been painted and now you’re just going for exposure and saturation of the market. I really don’t care what the sales reps say and how many graphs they show you. Those are manipulated to take your money. 

Another negative about shotgun marketing is that it is hard to track. Marketing needs to be traced and tracked. Either through computerized means or on a simple spreadsheet. Better believe I know where every single new patient comes from, who to thank, and where my bread and butter lies. 

Unless you’re really tracking well, many times you won’t know if someone comes in from a billboard, TV, or radio. Sometimes they’ll tell you straight up but sometimes they just don’t remember. 

But what about other means of external marketing?

What about things like:

  • BNI
  • Chamber of Commerce
  • Charity and philanthropy. 
  • Social Media
  • Sponsoring teams and events
  • If you want to do personal injury, wouldn’t you figure out how to attract and market that demographic?
  • If you wanted more pain patients, where do they hang out? Where do they go? Wouldn’t you want to figure out how and who to market for those people?
  • Direct mail – yes, it can still work and you can target it like a laser
  • Brochures
  • Marketing representative
  • Creating authority – talks, appearances, book, podcast, content creation, etc…

I have so much on external marketing. The options are endless and we could talk about them for ever. I’ve tried them all. Trust me. 

Something I forgot to mention in the beginning is the fact that marketing is always changing. It’s not a set it and forget it endeavor. You have to be on it all of the time. Yellow Pages anyone? Hello….Bueller. 

#3 Who You Are

As I said before I add this third one because we are in a personal business. You’re not a big brand like Coca Cola. Coca Cola doesn’t have a face. It doesn’t have a name behind the brand. While some would argue that it does, in the context I mean it in, Coca Cola does not have a personality and it damn sure doesn’t have a relationship with it’s drinkers. 

You could say that #3 really has more to do with internal marketing but I think it’s a cross-over thing. Who you are, your vibe, how you carry yourself….that all goes into making your business what it is and makes your reputation what it is. 

For a smaller community, this is even more vital. For a city, still vital. You are attracting people or you are repelling them. It’s not very often that you have not effect or neutral effect on people. Right? Do you ever leave a conversation or a personal encounter with someone with absolutely zero feel about it? You get the point. 

So, what if you spent on average $150 per each new patient that gets on your schedule? There are some pretty good stats you can keep on this stuff. What if you invested $150, they come to your door, you’re having a bad day, rush through their exam, are a bit of a jerk about them doing exactly what you recommend, and then maybe there’s a snafu at the front desk when they pay out because you were too lazy to get the staff trained appropriately?

You may have made the $150 back up but you’re probably not going to profit on that patient because of YOU. Your vibe was crap. You didn’t want to be there. You didn’t want that patient there. You didn’t train your front desk right. And now YOU probably won’t have another visit with that patient. 

What if you are at an event, you woke up that morning and stepped in dog crap, and that just set the tone for the day. Now you’re at this event you don’t really feel like being at and everyone can tell. Mr. Sourpuss chiropractor over there sucking on a whiskey sour with his sour face. 

These are dumb simple little examples but who you are, how you are able to talk and communicate to people, and communicate what you do can make all of the difference in the world. If you’re positive, energetic, smart, and capable…..Boom. The battle is won. 

Eyore from Winnie The Poo on the other hand gets no patients. Only your mom is coming to see you. #66 in town, #1 in mama’s heart. 

More than personality though, you MUST be a real person. Don’t pretend. Don’t sell. Patients smell that garbage a mile away. Be AUTHENTIC. That’s a key concept in marketing. 

It’s the stuff you learned in kindergarten. Treat others the way you want to be treated. Honesty, ethics, forthright, stand up, and gentlemanly or lady like. Professional. These are so important. What about loving? Of course. You better love your patients and you better love your staff. 

Our practices are made up of lots of relationships and if you aren’t interested in people and relationship building, I’m afraid no amount of marketing will make it OK or will make you succeed. No amount of money. 

When you’re providing quality care with responsible recommendations, and you salt and pepper that delicious brew with a little love and personality, you got a winning recipe on your hands. I like cajun food so I add even more personality to my spicey brew!!

Boom snap pow!

I mentioned this earlier but, I think the biggest key to anything business related is keeping and tracking stats effectively. Do you know the exact number of new patients you got last month from Google or Facebook or Instagram or from referrals from your existing patients? Do you know how many new patients you got from your own staff referring people to you?

Do you know your PVA? Do you know how much you make per patient encounter on average and how much it costs you in marketing dollars to get a new patient in your doors? Do you know what your average profit per patient visit is each month or what it averages over the course of the year?

If you can’t answer these questions, you have to figure out how to answer them and you need to do it yesterday if you get my drift. 

These numbers and metrics aren’t only important to your marketing efforts. They’re important to your business in general. How can you possibly know your return on investment for anything you do in your business? It sounds crazy to say it, right? For so many of us, record keeping and stats are just second nature. But, I wasn’t always there. I had no idea where I’d been and not a clue where I was going.

I was like a drunk pin balling off of the walls trying to get somewhere and falling down every so often. 

I’m not just trying to relate to you on some level. That’s real talk. I was on an island for so many years. No colleagues to bounce ideas off of or to ask for help. No association involvement, no network. No real continuing education. I came late to the party. But, with knowing I was coming late to the party, I jumped in with both feet, man. 

Gimme the bottle of tequila, the bottle of vodka, and throw in some fireball on top of that. Let’s get there as fast as possible. 

That’s what I did with being a chiropractor. 

Now, as far as the stats keeping, I’m working on a solution for those of you that might be interested in getting some help with keeping stats. Something that will make it easy and fast. Yes, it’ll have a monthly cost but it won’t be ridiculous and you can only pay for what you think you need. Different levels…that type of deal. But, it’s in the works and I’ll let you know more about it when we get it up and running. You numbers nerds will love it. 

Some other random thoughts and musings:

  • Having something to talk about is always important. Especially on social media. If you’re talking, people are typically listening. Even when you think they aren’t
  • Make sure your website is doing what it’s supposed to do for you. IF you can’t do it, hire it out. It really is that important. 
  • IF you can learn YouTube videos, learn it and do it. Even if you think you suck on screen. It’s important. 
  • Eliminate the risk. Do what you can to remove any and all obstacles to coming to see you. Is your insurance staff making the payment process a little bumpy? Fix it. Are people wanting to fill out paper work online but you don’t have that? Fix it. Does the majority of your population want to come in from 5-6 and you’re closed at 5? Fix it. Not for just one or two people but if the majority needs that time block, give it to them. Just remove the obstacles. 
  • Be the expert that you are and be the expert everywhere your market will allow you to be the expert. Clubs, associations, boards, etc…
  • The secret to referrals is the difference between satisfaction and enthusiasm. 

Things NOT to do pretty please for the love of all that’s holy. 

  • Do not put your office and profits above your patients for any reason ever. 
  • Do not scare patients into care. It’s rude and it’s unethical
  • Do not use curve correction as a reason to manipulate patients into setting up 70 visits. It’s rude, it’s borderline unethical, it makes all of us look bad, your actions really do reflect on the rest of us, and there’s no good, non-biased research backing the notion that curve correction matters at all. 
  • Don’t do dinner with the doctor unless you truly are simply trying to build authority in your community. If you are using them as bait and switches where you get someone in for a $29 initial treatment and then scare the crap out of them to make them sign a contract for $3500 over the course of a year, then YOU are the problem with this profession. 
  • Oh yeah, contracts between doctors and patients do not belong in healthcare. It’s embarrassing. Please stop if you do it and never start if you don’t. 

Just be honest, ethical, put the patient first, behave in a manner that would make the chiropractor next door be proud to be a chiropractor, and take care of your patients by following industry standards for treatment. Keep learning and expanding your knowledge. Be the smartest in your town. The more real, research-backed education you get the better you’ll understand things in the profession and the better you’ll understand how to carry yourself. CCSP, Diplomates, etc. 

Basically, have a moral compass which sums it up.  

So, there’s the quick form of a marketing seminar.  We could spend an hour on each one of these little nuances to marketing and could go on and on and on. 

Again, if any of you want me to put together a more robust marketing talk and have me present it for your group or association, let me know and we can see how we can make it work. 

If you have any questions or ideas, shoot me an email at dr.williams@chiropracticforward.com

I hope you’ve enjoyed my marketing talk. I literally sat down and just started typing. Yes, I’m sure I didn’t cover everything as thoroughly as you’d like but, if you’re really paying attention, I gave you some good solid cement to build a base out of. 

Key Takeaways

  • Have a USP
  • Have a marketing meeting regularly
  • Set goals
  • Be honest, ethical, loving, authentic, and don’t sell people
  • Don’t push people and scare care is crap care. 
  • If it takes you 100 visits to help someone, you could get better at what you do
  • Internal marketing means as much as external marketing which means as much as who you are and how you communicate and carry yourself. 
  • Track EVERYTHING

Store

I will hopefully have something in place to help you track metrics soon enough. Also Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic vs. High Impact Chronic Pain, Coordinated Care/Medicaid, DACO to DIANM

CF 097: w/ Dr. James Lehman (Pt. 2) – National Scope, Chronic Pain vs. High Impact Chronic Pain , Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. This is Part Two of the interview. If you are just now joining us and did not get to hear Part One, make sure you do so. When Dr. Lehman speaks, you don’t want to miss a word. We’re going to cover topics like implementing a national scope of practice, chronic pain vs. high impact chronic pain, and topics like should a chiropractor own rural healthcare clinics and chiropractors working in coordinated care and medicaid integrated settings. 

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. We’re not the stuffy, high-brow kind of research. It’s like we’re talking about research over beers. Which is NOT like talking about research in a classroom or an institution of some sort. Accessible research if you will. I could be more professional but I’m not. 

Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  If you haven’t yet I have a few things you should do, like our facebook page, join our private facebook group and interact, and then go review our podcast on iTunes. We have a youtube channel and twitter too but those are the main things. 

You have collapsed into Episode #97

I always do a little update on my personal practice and life in the trenches. In the real world if you will. Instead of that, I want to say that last week, I was scrolling through my Facebook page and Dr. Lehman and I are friends on Facebook. 

I noticed a picture he posted laying in a hospital bed watching his beloved St. Louis Cardinals play on TV. 

It turns out that just last week, Dr. Lehman suffered a myocardial infarction. I normally wouldn’t mention this but, I figure if it’s posted on Facebook by the man himself, he’s OK with it. 

Anyway, the main reason I mention it is to ask you all to say a prayer for Dr. Lehman if you are the praying kind, which I most certainly am. If you are not, then please send some positive vibes, energy, or thoughts his way through the ether. Whatever it is, let’s give it to him because Dr. Lehman certainly has given us chiropractors a lot. 

Dr. Lehman, from what I can tell through Facebook and text, Dr. Lehman is doing well and on the mend. From me to Dr. Lehman, you have my prayers and thoughts and please get well my friend. 

Now, before we dive into this interview that we did a couple of weeks ago with Dr. Lehman, we have to pay the bills. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there.  Chronic pain is a huge topic that really can be it’s own year long topic of chiropractic forward podcasts. Chronic pain affects a huge number of patients.

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg
This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM

Today we’re going to be talking with Dr. James Lehman. Yes, THE Dr. James Lehman and we are fortunate to have him with us. The experience and the common sense Dr. Lehman brings to the table is immense and I can’t wait to dive into it today. We’re going to talk about national scope

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #96

Now if you missed last week’s episode on chiropractic and opioids, on anti-inflammatory diets, and on screen time for kiddos…. make sure you don’t miss that info. Go back and listen. I think there were some good information there within so make sure you’re up to date and not falling behind the rest. 

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We can’t get started without mentioning the sponsor of the show, 

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Introduction of Dr. James Lehman

Now, let’s go ahead and get on with the reason we’re all here. Before we speak with Dr. James Lehman, I want to go through a little background information on him for you so you are well aware of who he is and where he is coming from. 

Dr. James Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education (HSPED). 

Dr. James Lehman completed his MBA at the University of New Mexico and a doctorate in chiropractic medicine at the Logan College of Chiropractic in St. Louis, Missouri.

Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. We could go on and on. 

Welcome to the show Dr. James Lehman, it’s an honor to have you on the Chiropractic Forward Podcast this week. 

Let’s start with the topic that immediately impacts me. I have been telling our listeners for a year or more that I’m going through the DACO program. DACO stands for the Diplomate of the Academy of Chiropractic Orthopedists. Very recently, as in just a few weeks ago, I received notice that the designation has changed to DIANM which stands for the Diplomate of the International Academy of Neuromusculoskeletal Medicine. 

What was the impetus for the change and what all went in to making the decision, deciding on the name, and then moving forward with the decision?

You wrote an article recently that Dynamic Chiropractic published in their September 2019 issue. The title of it was “What Is Chiropractic? We Need A National Practice Act.” We are in a profession that seems to me to bristle at the idea of standardization. How has this article been recieved or is it still a bit too early to tell?

In the article, you say, “Limited Medicare and Medicaid scopes of reimbursement and individual state scope-of-practice restrictions reduce access to chiropractic wervices for patients in pain.” Can you explain how you think limited scopes reduce access and how a broader scope can help us? And how broad of a scope do you advocate for?

I would assume a national scope would be something the ACA would be in the driver’s seat for, which is something you mention in the article as well. Is this something the ACA is looking at? Other than resistance within our own profession, what hurdles would you see in the way of a national scope?

You say it’s not impossible to accomplish and offer 6 essential charactieristics which include:

  1. Chiropractic Physician designation. 
  2. The scope being determined by Doctoral and Post-Doctoral education, trainng and experience 
  3. Full management, referral and prescription authority commensurate with contemporary chiropractic education for patient examination, differential diagnosis, working diagnosis, and health assessment
  4. Full evaulation and management, referral and prescription authority commensurate with contemporary chiropractic education for the care and treatment of neuromusculskeletal and other health conditions or issues. 
  5. Full authority for the delivery of information, advice, recommendations and counseling regarding general health matters, wellness, and health optimization. 
  6. Full authority and adaptable requirements fo the management and training of health care teams and the participation in collaborative or integrative health care groups. 

When I read through that list, does anything jump out at you as being particularly radical or provocative to some chiropractors?

In your article, you include a section titled “Modernization of Medicare and Medicaid Coverage” which will lead us nicely into one of the main topics of our episode today. In this section you mention how Article 2706 of the Affordable Care Act is supposed to prevent discrimination against chiropractors but, for whatever reason, it hasn’t. I’ve been hollering about this through my position with the Texas Chiropractic Association for years. You talk about this a little in the article but…..why do you think nobody is forcing 2706 down people’s throats and what would it take to take a stand against insurance companies with 2706 as the basis?

OK, coordinated care and Medicaid: a topic you are very knowledgeable. In fact, we have discussed the integration of chiropractors into the FQHC’s around the nation. FQHC, for those that don’t know means Federally Qualified Health Centers. One of our former podcast guests is Dr. Kris Anderson from North Dakota who just happens to be the first in his state to work in an FQHC. 

Can you tell us more about coordinated care and Medicaid and the initiative to get chiropractic care integrated more into that setting?

Alright, last on our list of things we must talk about is the topic you have done a ton of work on. I remember one of the DACO classes I had with you as the instructor. In the class, I recall you mentioning that we as a profession do not diagnose chronic pain syndrome nearly enough. It’s a big problem, and one I’ve become more and more engaged in through the DACO program, so let’s dive into the topic of Chronic Pain Syndrome vs. High Impact Chronic Pain. 

I’m just going to turn it over to you on this. The way I want to start is for you to just tell us what you think we as a profession need to know and we can take it from there. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Healthcare Of Old – Days Gone By

CF 090: Healthcare Of Old – Days Gone By

Today we’re going to talk about how healthcare has changed – gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion. 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #90

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago.

But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there. 

And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89

Item #1

I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now. 

Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to. 

The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:

  • Health management organizations
  • Managed care and 
  • The insurance exchange

Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation. 

I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact. 

But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them. 

Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own. 

Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies. 

Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!!  He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days. 

He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!! 

In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way. 

Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased? 

Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do. 

Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all. 

He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough. 

He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles. 

This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first. 

He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice. 

He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason. 

While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly. 

It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”

Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper. 

I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes. 

Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is. 

We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way. 

Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?

We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells? 

Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again. 

It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe. 

And to that I’d say, welcome to my world friend. Welcome to my world. 

But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain. 

Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery. 

When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia – cauda equina- type stuff, or a progressive neural deficits. 

So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?

Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average. 

Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own. 

Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000. 

Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely. 

Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years. 

If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy. 

Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well. 

Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing. 

That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that. 

And that’s the way I see it today. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Weiss M (2019). “The old days of medicine are gone.” Medpage Today – KevinMD.com.

Closing Patients – Helpful or Destructive?

CF 088: Closing Patients – Helpful or Destructive?

Today we’re going to talk about what closing patients in chiropractic is, we’ll talk about where it comes from, and we’ll talk about if it’s a positive or a negative. Plenty here to be provocative I must admit. Listen up and then make up your own mind. 

But first, here’s that oh how sweet it is bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #88

No research today. Only Opinion. I didn’t even include any sponsors in this episode because it might be seen as controversial to an extent and, if there’s some sort of uproar, I don’t want them in the crossfire. Now….

I believe the business of being trusted and an authority of sorts is to be objective. Regular listeners have heard me talk about the medical realm and failed surgeries, etc. I state over and over that I am a chiropractic advocate. 

I am an advocate. Just listen to all 87 previous episodes and you will clearly see where I stand on the big stuff. BUT, if we do not have the ability or the honesty to police our own, then we’ll never be able to pull out of red-headed step-child status. 

We will forever be ridiculed and mocked. And that’s because the bad apples spoil the whole basket. 

It’s been a while since I’ve been able to just do a brain dump on a certain topic. I think the last time I did that was back when I talked about religion being brought into chiropractic.

I’ve been seeing more and more terminology like this lately and it’s time to address it and meet it head on. 

Let’s get something perfectly straight here: I’m about to piss some people off. Let’s also be clear on the fact that I’m already pissed off so I don’t give a damn if I do. I have been for a while. It’s been stewing and simmering and, after a while, it’s time to talk about it. 

Hell that’s the whole point of having a podcast. Promote what I agree with and find value in and spotlight cockroaches when I identify them. Having a platform to sound off on has been so cathartic. You have no idea. It helps in so many ways. It’s probably why I don’t have to go to therapy. 

As I have said, I am seeing the term ‘closing patients’ more and more and you know what? I’m mostly seeing it from wannabe gurus that aren’t even freaking chiropractors!!! They are trained at spouting their horns and touting their skills but never bought in enough to actually be a chiropractor. No, they just prey on chiropractors. 

Does that register? Closing patients! They’re fine with the term closing and the idea because it’s not their profession, their profession is marketing, so what the hell do they care if they trash the profession and whatever reputation we have scratched out? As long as they continue to fool well-meaning chiropractors into paying them, they don’t give one single damn what it takes.

As I said, the real unfortunate thing is that they go around jazzing up actual real chiropractors to the point that now many chiropractor actually think closing patients is a good and an acceptable idea.

Here’s the thing: it’s black and white. There’s good and there’s evil. There’s right and there’s wrong. Closing patients is straight up 100% wrong. And in my opinion, borderline evil.

I posted on our private Chiropractic Forward Facebook group the other day asking for opinions on closing patients. Good, bad, pros, cons, etc.… I value our tribe and their wisdom.

For a more general opinion, I asked in the Chiropractic Facebook group. That’s what it’s called…..just Chiropractic. You’ll find birds of all feathers in there so I figured I’d get some crazy answers and some in the middle answers. 

I really didn’t though. It seems that most, if not all, were essentially against the idea of closing patients.

Here’s what I got. Some that I highly respect say that if you’re NOT giving good solid recommendations and the telling them what it costs, then you’re not doing your job. 

One colleague wrote that patients want a doctor. Not a friend. Damn straight.

On this, all of us absolutely agree. 

Although a report of findings and recommendations and a financial talk could be viewed as closing patients,  that’s not necessarily what I mean when I refer to closing patietns. Not in my mind anyway. 

Being a doctor certainly comes with the responsibility of telling patients what you think is wrong, what you think they should do to fix it, and how much that would cost. That’s just being an ethical professional regardless of what business we are working in. 

I’m talking about manipulation of information and manipulation of emotions to get a desired effect that benefits the practice more than it benefits the patient. That’s what I’m talking about.

There was a reason I never really got down a good report of findings. It’s because I never felt comfortable with it. It never felt right because it wasn’t me. So I just went to what felt right. That doesn’t mean those of you that are good at a report of finding are doing something bad. I’m referring to a closing patients sort of ROF that I was once force fed. That’s what I’m talking about. 

What felt right was telling patients what I think, what I recommend, asking them if they have questions, and then getting started. It’s pretty damn simple honestly and I have more patients and business than I can handle. 

To tell me that my only way to succeed is to learn tactics and manipulation, we just have to disagree. Our values are not in alignment. Adjust that won’t you? 

I heard one guru say that our job is to identify or uncover what the patient’s pain is keeping them from doing or accomplishing and then leveraging that information against them by focusing on that shortfall in order to make a sale. To get a desired outcome.

Really? That’s what my job is? Are you sure? Because I thought it was to give my patients the very best recommendations that I can based on education and experience and then be there to help and guide them regardless. All these years and I was getting it wrong. All I needed was this 20 something person to help me get it right. Insert eye roll. 

When closing patients in chiropractic, he says we NEED to be focused on it. For example, if a patient comes to us with back pain, that’s not what we need to focus and work them over about. No….we should be working them over about what the back pain keeps them from doing…..THAT’s what they really care about so THAT’S what we pounce on like a grizzly on a salmon.

So, uncovering the ‘pain point’ of a patient just isn’t something I think smart, capable, educated doctors should be concerning themselves with. It’s called morals and ethics. 

They act like being unethical builds the fat wallets so that the fat wallets can further chiropractic. So…..I don’t want that kind of chiropractic being furthered. At all. Not a millimeter. Ever. I want it to die and go away never to be heard from again. 

A previous guest on our podcast, Dr. David Graber up in New Jersey is literally one of the smartest people I know and he had this to say about it, 

“When the Chiropractic profession started relying on business and sales techniques for practice building they did use approaches to ” close the sale” of care to patients. 

It’s a transaction- based approach with a winner and a loser. It’s positioned the doctor-patient relationship as a competition or Confrontation. This became especially prominent with long-term care and prepayments plans.

The alternative is open the relationship rather than close the sale, because there’s nothing to sell. A report of findings now is exactly that, a report of findings and options given. Respect for the patient’s autonomy in decision-making and service over sales. It’s becoming a partner not a competitor with our patients.”

He’s so damned smart. I wish I could have the eloquence to put things the way he does. He makes it look easy. 

What he’s talking about is being patient-centered, not doctor-centered. That’s really the whole point of the whole damn episode I think. Being a partner with our patients is being patient-centered. Not dominating them through whatever means necessary.

If you think some chiropractors’ shenanigans aren’t making it online? You’re crazy. People are posting it everywhere. Names, dates, events, quoting the doctors word for word. Things don’t happen in a vaccuum anymore in the year 2019. 

Here are a couple of stories I found on the interwebs while researching this episode about closing patients. 

This first one is an experience a woman had when she visited the chiropractor. Luckily, she didn’t swear off chiropractors completely after the experience but who could have blamed her if she did?

She preframed this sucker as a cautionary tale to all those who are easily persuaded by emotional sales pitches. She went to a fair and got on one of those spine check doohickeys that checks balance from one side to the other and high shoulders and all that crap. 

The lady told he she was carrying 9 more pounds of weight on one side of the body than the other and her head is 2 inches too far forward and one shoulder is higher causing her head to tilt the other way to compensate. 

All of the sudden, a care-free girl out shopping at the town fair who stopped to have her spine checked for a little fun change-up in her daily routines is thinking, “Oh damn…this sounds awful.”

No worries though, the chiro office offered her a $20 preliminary screening at the center to include 2 x-rays, a spinal exam, a foot screening….the whole shubang, for $20. Awesome. Way to value your services random chiropractor screening at a town fair that has nothing to do with health.

Luckily for this lady, her husband smelled a skunk.  

She went to the appointment, paper work, intial intake with the staff, and then the chiropractor arrives. She asked if she could do a few more exams of the spine. Following this exam, she said in a grave voice that she has some serious concerns about the neck and spine. 

IN FACT, she would like to take two more x-rays than scheduled in order to check out a few other things. She reassured me that I wouldn’t need to pay for these x-rays — they would just send the bill to my insurance, and if insurance wouldn’t cover it, they would eat the cost. 

The patient thought WOW, they must really care about the well-being of their patients to take this financial risk! 

Then, sent home with a follow-up appointment scheduled. Not before the chiro reminder her how urgent it is for her to come back and get treatment started as soon as possible. Makes me want to pull what is left of my hair out of my head. 

She left that first appointment sincerely afraid that there was something seriously wrong that only chiropractic was able to fix. She was leaving that first appointment basically in tears. She didn’t sleep at all that night. She was thinking, “What if I lay with my hnead at the wrong angle….would that make her neck even more crooked?”

Follow up appointment, seated in an education room when whe underwent a lesson in the philosophy of chiropractic. They told her that by the time we feel pain, our bodies are down to 40% health which means that if we feel healthy, we really aren’t. Holy guacamole. Crap fire and just save the damn matches won’t you?

All of our illnesses come down to subluxation which only chiropractic has the answer for, blah blah blah.

Then the x-rays. These are her exact words, “First we looked at the before and after x-rays of people whose lives and health were transformed at the Wellness Center. 

Next we compared *healthy* spines (people who have regular readjustments) with *unhealthy* spines (people who just don’t care about their health and don’t want to live past 65). 

Finally, we looked at the x-rays of a few tragic people who did not get the treatment they needed and whose spines were COMPLETELY COMPACTED. Dr. Amy then asked if I was ready to go look at my films — and I responded by bursting into tears.

She goes on, “When I saw my x-rays, my first thought was, “Wow, it’s not as bad as I thought! My spine doesn’t look like a 70-year-old!” But still lurking was the shadow of what might be — the ghost of future spines, if you will — if I didn’t pursue a full chiropractic treatment plan. 

Dr. Amy and I talked through my x-rays, and I learned that my spine is only at stage one degeneration (something they NEVER see in a 28-year-old!) — in other words, still terrible, but treatable. 

By this time she was fully convinced that 

  1. I needed chiropractic care, 
  2. it should start right away, 
  3. this Wellness Center should be the one to offer this care, and 
  4. it would save my life.

Guess what she got….you just guess! That’s right, she got a 12-week treatment plan, 3 visits a week for the low low basement bargain price of $2,800. 

The office, because they’re so giving and kind and genuinely caring offered her an 18-month payment plan at $140/month. For treatment she didn’t even need in the first damn place!!

Remember, even if you don’t hurt, you’re still sick? Good Lord jumpin’ jehovah. The lady told the doc that she needed to run it by her hubs before signing a contract. Like a contract belongs in healthcare in the first place but whatever. It’s outlawed now. At least in Texas. 

Anyway, the doc told her to come back the next day with her husband so that he could get a free screening with x-rays as well. Lol. These people. The hubs wasn’t buying it. She couldn’t believer her husband wasn’t more concerned that she was 28 years old and already had stage I degeneration of her spine!

He talked her down, she went and finally did some of her own research, and realized she had took a big swig of the snake oil. 

Yes, of course chiropractic could have helped her with her neck that had been a bit sore recently. Yes, a chiropractor’s office was exactly where she belonged. But no, not in an office like that where she was manipulated emotionally and almost financially. 

Here’s a lovely ditty about one of those beloved ‘free dinners with the doc.” Ugh. That’s a whole different episode, isn’t it?

Anyway, here’s what happened. the first thing is that the flyer advertising all but hid the fact that a chiropractor was the presenter. 

Quoted in this article was Robert Puleo of the California Board of Chiropractic Examiners. He said, ““It reeks of snake oil. There are some chiropractors out there who want to make a buck any way they can.” And: “The chiropractor holding such seminars tries to sign people up for months of office visits that can cost thousands of dollars.”

Ummm….yes. Exactly. You think chiropractors keep buying dinner because they’re nice people? Hell no. They’re trying to scare people into a close and a sale. 

The attendee to the dinner mentioned in the article said it consisted of four parts:

  1. Trust building – that’s where the presenter talks about their education and why they’re super double awesome and should be trusted. Can I just say that I immediately do not trust someone giving a free meal to prospective targets? I just don’t. Regardless of education. 
  2. Medicine bashing – This is where they talk about the inefficiency and poor quality of the US healthcare system. You all know the dance. I know that waltz myself. I can tell you all kinds of numbers and frame out the inefficiencies in a bunch of different ways. When it’s there, it’s there and I don’t mind that dance because they don’t mind bashing on chiropractors all of the time. 
  3. The product being sold – he was selling some laser therapy for neuropathy. The same stuff I believe that I just saw where an LA doc was on TV being accused of selling stuff that doesn’t work. Guess what? That dude was selling at a free dinner as well. I just never wanted to be a salesman. I just wanted to be a doctor and help people. Maybe I’m crazy. 
  4. Recommending consultations – Basically come see me at the office for $29 so I can sell you on thousands. Whne the attendee asked how much the laser service costs, he was told, “Oh, the doctor sets that amount.” So…..you can’t just tell me the cost? And…is there a dual fee schedule? Like, the doctor sets different costs? Because it it’s not a dual fee schedule, then the price is already set and, in that case, you should be able to simply tell me the price. Right?

I guess being upfront, transparent, and honest doesn’t quite fit into the dessert menu does it?

Last thing I’ll touch on is the RELIGIOUS ROF – For a more extensive exploration of this, listen to episode #61 of this podcast. It covers it at length but, in short, I’m a Christian so let’s not think I’m an atheist bashing on Christians. That would be a biased discussion wouldn’t it?

This is a non-biased discussion about it so settle down fellow Christians. 

Here is a script from a management company that uses or used a person’s faith against them to close a sale, ““Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

You can’t make it up and, as a Christian, I find it dissappointing to say the very least that a fellow Christian would think this sort of manipulation and sales tactics is permissable in any way, shape, form, or fashion. 

It’s just awful. All for the sake of closing a sale. Are we really that desperate? Obviously some at least think they are and maybe there’s no other way to make money. 

You want to know how to build a company? How to build trust in a brand? I’ll share it right here. Instead of the religious manipulation script I just read, say this:

“Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

See how simple it is?

Look, we all want to get rich while we help change the lives of our patients. But where does the switch happen where it’s OK to work patients to the point of emotional breakdown just so that they’ll sign up for countless visits over the course of a year or more? How does that switch go from being a new doc excited to work with the population into a manipulative street corner huckster schooled in the art of emotional manipulation? 

How does that moral compass get swapped approximately 180 degrees to the point that money is more important than superior patient care? And….reputation. I would argue that your reputation absolutely precedes you. Especially the smaller the town or area that you practice. 

One of my very respected colleagues, Dr. Gregg Friedman, who also happens to be a nationally known speaker, shared this thought with me when I asked about closing, “Closing a patient” looks like a sales technique and makes me want to puke. It does not create a positive image of chiropractic in the minds of the public we strive to serve. Just my opinion.” Spot on, nailed it. 

There are about 45 chiropractors in my area give or take. I know how about 80% of them practice because patients tell me. I’ll bet about 80% of those chiropractors know how I practice. For better or worse. I say worse because they only see my failures and I only see theirs. BUT….we still have a general idea of who the chiros in our area are, how they practice, and if they’re reputable. 

Basically, would you send you brother, sister, or mom to them? How about your child? If you’d send your family member to yourself, maybe you’re in a good spot. I can’t answer that. If you have systems set in place that manipulate information, manipulate a patient’s emotions, and manipulate words to make the practice a lot of money……and you’d still send you kid to that…..we need to talk. 

Let’s dive in a little bit more. Now, those of you that use this, and firmly believe in it, are going to be pissed right now. 

“Who the hell is this guy, what make him think he can question this or that, blah blah blah?”. I’ll tell you who I am. Nobody particularly special is who I am. In many ways I’m no smarter than the people that use some of this stuff. In some ways I am. 

I’m a bit of a research nerd – a dude with what I like to hope is an EDUCATED opinion and I’m a dude with an opinion that just happens to have figured out how to record and air podcasts, build a crowd, and talk about his opinions. That’s all. If you don’t like my opinion, go get your own podcast and crowd, go figure that out and talk about what’s important to you. 

There are already lots of them out there. Go call your company something like Chiro Closers, hustling chiros, chiro shrimp, or cervical correction academy specialist association or whatever the hell you can come up with that gets attention, or sounds important. Hell, I have half a mind to buy the domain www.chiroclosersareus.com and just have a landing page that says, 

“Hey, welcome…I’m not selling you anything. I just want you to know that closing people in healthcare is not patient-centered, it’s not quality care, it’s not being the doctor that you are, and you can be just as successful if you be the doctor, diagnose well, make good responsible recommendations for care, be a partner with your patient in their recovery, be sincere, really really care about them, and then be there however they decide they want to use you.”

Bam….secret to success nugget. 

Right there. If you didn’t listen or zoned off, rewind that about 15 seconds. You don’t have to buy it packaged up a million different ways from wannabe gurus. It’s really so so simple folks.

Back to the point: One of the most common reasons for big money, long-term plans I hear from patients when we’re talking about their previous chiropractor was that they saw an x-ray of their neck and it was straight. And to get that curve back, it was going to take 65 visits over 14 months at a cost of $4,500 (I’m making those numbers up but you get the point). All to get that curve back. 

Now, can we be honest a sec? You can go tell me to jump in the river. You can tell me I’m only about treating pain..and you’d have a fair point… You can call me a medipractor. You can call me whatever names you like but be serious, thoughtful, and maybe even non-philosophical for a minute. 

I believe, and my experience suggests, that a straighter curve is a consequence of simply being alive for a whole bunch of years. I believe that not having a curve when a patient is 50 years old is NOT going to impact their lives so much that they need to pay me as much as a surgical co-pay would be for surgery? What if I improve the curve a few degrees? Is it really that big of a deal that made that big of a difference?

The ONLY research I’ve seen on straight necks that made much sense was more recent. We covered it here on the podcast. It said it may lead to some degeneration of I believe it was C6/7 but, overall, impact of it was minimal. 

Other research you may have seen on this may come from other gurus that have conducted their own research. 

How nice is it to be able to say you conduct your own research, not have it peer reviewed or published in any respected journals, and then say it backs up your method so that people buy your products? That’s nice. Funny how that stuff works right? And so convenient. 

THAT’S what I mean by manipulating information. 

Let’s re-visit the title of this episode. Just repeat it a time or two. Closing patients. Let’s add a couple of words. Closing patients on care.

For me, that’s an oxymoron. If you care, are you going to manipulate patients with words and emotions? The correct answer is hell no you’re not.

Put yourself in the patient’s place real quick. 

Do you, in a healthcare setting, EVER wish to be closed? Other than an incision of course…. as my good friend Dr. Tyce Hergert in Southlake, TX says. Lol. 

The answer is no. At least I sure as hell don’t want to be closed. Not under the fear of losing my ability to function 30 years in the future. Not under a fear like that that no research I’ve ever seen can back up. 

As mentioned above, you want to be told what is wrong, you want to know how to fix it, and you want to know how much that costs. You might be interested in any other treatment options as well. You might want to know if you could just undergo a trial period of treatment first to see how you respond to care before deciding on anything else.

ALL OF THOSE should be on the table and your patient should know that, at the end of the day, your job is to be the doctor and give them your best recommendations while also understanding that you are there to help them to the best of your ability regardless of what they decide. 

Again, we should be our patients’ partners, not their boss, not dominating them, not running the show regardless. 

In the end, remember the three pillars of a patient-centered, evidence-informed practice. They are of course, 1) the best external evidence, 2) individual clinical expertise, and 3) get this…..pay attention….patient values and expectations. 

Not the doctors values and expectations. 

Key Takeaways: be a partner with your patients. Do not be a domineering, street corner snake oil salesman. Please. Those that do this give all of us a bad reputation. I have gone through the DACO diplomate program. Countless chiropractors around the globe highly educate themselves and take great pride in the results they can get for their patients. 

When you go about business like we’ve been discussing here, you discredit all of us almost immediately in the minds of those patients. Who then turn around and tell their family and friends and then go and post it on their blogs or tell a TV reporter about it who then tells everyone in the world in one way or another. 

Cut your crap. Enough is enough. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

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Player FM Link

https://player.fm/series/2291021

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

The Evidence For Some Surgeries, Searching for How We Help, and Opioid vs. Non-Opioid

CF 078: The Evidence For Low Back Surgery, Searching for How We Help, and Opioid vs. Non-Opioid

Today we’re going to talk about evidence for low back surgery, we’ll talk about if spinal manipulative therapy is partyly in the brain, opioid information for back, hip, or knee osteoarthritis….what does the research say?

But first, cool like a velvet Elvis, here’s that bumper music

Chiropractic evidence-based products

Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have flip flopped into Episode #78

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

I should have in my first order of the decompression brochures in in just a few days. These dudes are going to look great. I’ll put some pics in the show notes and in the email we send out once a week to our email list. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Personal Happenings

I’ve been asked to emcee the Texas Chiropractic Association’s President’s Gala which will be during the ChiroTexpo event in Dallas, TX on June 8th. 

I’m trying to figure out if I need to be making fun of everyone I introduce or not. Maybe I should trip them? You know we chiropractors….some of us can’t take a joke right? We’ll see how it goes. Most of the guys and gals in the TCA are pretty good with having fun. 

I always heard that people don’t join state associations because they think they’re made up of a bunch of old white dudes sitting around bitching. 

Well, not at the TCA, people. We have young people and certainly not all white. That doesn’t happen in Texas these days. We are a pretty mixed state in regard to ethnicity. We are also mixed in respect to gender. Several smart and highly capable women are either on the board or in a position of influence. Heck, we have a female going through the executive chairs starting in June. I’m excited to hear her ideas and see where we go under her direction. This girl is making it happen. She has young ones too. Nothing slows her down it seems. 

Let’s get to the topics today. 

Item #1

The first item we’re talking about is called “Randomised trial support for orthopaedic surgical procedures” authored by Hyeung Lim, Sam Adie, Justine Naylor, and Ian Harris(Lim HC 2014) and published in Plos One in June 13, 2014. 

This is an interesting one because we think that the surgical procedures we undergo have been fully validated. Fully vetted. Hell, you wouldn’t lay someone open unless it’s been researched and proven beyond a doubt to fix the issue would you? One would think so…..but…..let’s dive in a bit. 

Why They Did It

The authors wanted to investigate the proportion of orthopedic procedures supported by evidence from randomized controlled trials. Trials that compared surgical procedures to non-surgical alternatives. 

How They Did It

  • Orthopedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked
  • Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures
  • A risk of bias analysis was conducted for included studies using the Cochrane Collaboration’s Risk of Bias tool
  • 9,392 orthopedic procedures were performed across the index period

What They Found

Of the 83 RCTs, 23% were classified as supportive of operative intervention.23%. Twenty three percent were supportive of operative intervention. 

Only 37% of the total volume of procedures were supported by at least one RCT showing surgery to be superior to a non-operative alternative. ONLY 37% y’all. 

19.6% of the total volume of procedures were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative.

Sounds crazy right? 

Of the most common orthopedic surgical interventions….the most common…..of those surgeries, less than 20% of them had a low risk of bias randomized controlled trial backing them up. 

I have some problems with cussing in my personal life but I’m determined to keep this show mostly PG-13 but man. 

That’s just shocking. Cutting people open with no better evidence than that. 

One word – two syllables. Day-um. 

The Conclusion was “The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.” 

Good Lord I hope the other areas of medicince have more scientific support. 

What procedures are we talking about? Let’s be fair, we’re mostly spine people and the majority of the procedures their taling about here have nothing to do with the back. They’re talking about things like:

  • Knees
  • Hips
  • Intrnal fixation of proximal or shaft fracture of the femur
  • Ankle fracture fixation
  • Shoulder arthroscopy
  • Arthroscopy of the ankle…….no studies at all. Lol

It’s just crazy to think about. If we’re talking about evidence-based practice, is this it? 20% of our profession is about half crazy I think. Well, that’s about the same number of procedures they do that only have one RCT with low bias risk. 

Is it evidence-informed? I don’t know. That still sound awfully low to even consider it evidence-informed. 

I don’t know all of the answers and I don’t pretend to. Do what you do, but…..why they hell do they question spinal manipulation and say we have weak evidence to perform it? What? Stupid. 

Makes me want to cuss in Spanish.

Item #2

This one is just building on what we understand about what a manipulation does. It doesn’t answer any questions definitively but it does lay more groundwork for the future. 

It’s called “Spinal manipulation therapy: is it all about the brain? A current reveiew of the nurophysiological effects of manipulation.” It is authored by Gile Gyer, Jimmy Michael (never trust a guy with two first names. Especially if he’s left handed), Jame INklebarger, and Jaya Tedla. Published in the Journal of Integrative Medicine in May of 2019(Gyer G 2019). 

Hot stuff coming up

Why They Did It

While spinal manipulation has become more and more accepted after being more and more validated by research, the fact remains that we still don’t know exactly HOW it works and according to my interview with Dr. Christine Goertz in Episode 67, we are far away from having that satisfaction. The authors say there are certainly biomechanical and neurophysiological reasons for it’s effectiveness, 

The paper says, “Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.”

“The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.” The nerual plastic changes part of that is really fascinating. It was once thought that the brain is the brain and we just start chipping away at brain cells as we age and go stupid stuff. Lol. 

They’re finding out that the brain changes. It can be trained. It can be built sort of like a muscle but in a neural sense. It’s fascinating. But that’s a different episode all together. 

I don’t have access to this full paper but, the point is, they’re trying to find out HOW we are effective through spinal manipulation and they recommend we plan for long-term follow up studies to help us determine the clinical significance of the neural responses that happen from spinal manipulation. 

Pretty interesting stuff there. 

Item #3

Last one for this week. It’s called “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” It was authored by Dr. Erin Krebs, MD et. al(Krebs E 2018). and published in JAMA on March 6 of 2018 so a little over a year ago. 

The question to answer here was, “For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?”

How They Did It

They had 240 patients and found that the use of opioid vs. nonopioid medication did not result in significantly better pain-related function over 12 months. But they may have gotten some folks addicted in on the way to the conclusion. Lol. 

Basically, this study says stay away from opioids for moderate to severe chronic back pain or hip and knee osteoarthritis. the official conclusions was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Boom. Pop. Pow.

I feel like I’m preaching to the choir here but you never know who listens. 

Speaking of that, Dr. David Graber shared with me that after his episodes with us, he got an email all the way from Switzerland from a chiropractor that was pretty jazzed by his comments and thoughts and Dr. Graber wanted me to know that we are indeed reaching folks and influencing on some level. 

I can’t tell you how incredibly satisfying that is. Every now and then, I get a little bit of encouraging feedback but honestly, not enough. You never know what the reach is. Are you enjoying the show? Are you listening regularly? Send me an email at dr.williams@chiropracticforward.com and let me know. I love to hear from you guys. I really do. 

Not only is it inspirational like filling up your gas tank…..but feedback can help me direct the show in a direction that I know you guys are interested in or focused on. Feed back only helps me learn more and get better so send me an email won’t you?

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Krebs E (2018). “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial.” JAMA 319(9): 872-882.
  • Lim HC, A. S., Naylor JM, Harris IA (2014). “Randomised Trial Support for Orthopaedic Surgical Procedures.” PLoS One 9(6).

Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain

CF 072: Kids Need A Rest, Chiropractic In Europe, & Exercise For Chronic Pain.

Today we’re going to talk about a surgeon that says let kids slow down, the shape of chiropractic in Europe, how exercise affects chronic pain.       

But first, here’s that bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #72

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

F4CP

We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

Let’s talk a bit about the DACO program

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

“Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less” by Dennis Manoloff of the The Plain Dealer(Manoloff D 2013). It was posted back in February of 2013 so a little old but has been making the rounds here lately in the private groups and with several colleagues. And it’s right up our alley when you consider we are also trying to keep kids out of surgery. 

Some highlights are when Dr. Andrews says they have worried for too long about patching people up rather than preventing the injury in the first place. Amen brothers and sisters. 

When asked why kids are getting hurt more and more these days, he says there are really two factors. One being that kids specialize too much now and what he calls professionalism. 

Specialization means kids are just playing one sport these days instead of being well-rounded athletes with a wide array of different activities and skills. When they’re only doing one thing and they’re doing it over and over and over…..well, that’s a recipe for surgery due to overuse.

He says ‘professionalism’ is taking these young kids that are 12 or 13 and working them like they are professional athletes with year-round training and activity. 

Advice he would give parents that can help us guide our conversations with patients and parents was 

  1. Use proper mechanics in any sport.
  2. Don’t play year round. Their kiddo needs at least two months off each year to recover from a specific sport. Ideally, 3-4 months. 

Basically, sometimes we have to look at mom and dad and say, cut it out or a surgeon will be cutting something out. 

I just made that up but you can use it if you like it. You don’t even have to give me credit for it unless you make money from it. Lol. 

Alright, Item #2, comin’ through.

Before the DACO course, chronic pain (while it should have been) was not on my radar at ALL as far as something I was interested in and something I wanted to learn to solve. It sure it now though and this next paper fits right in. 

It’s called “Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain” by Anne Polaski, Amy Phelps, Matthew Kosted, and more(Polaski A 2019). It was published in January 2019 and I’ve cited it in the show notes. 

Why They Did It

As more and more studies are showing the effects of exercise as a first-line treatment for “nearly all forms of chronic pain,” things like dosing for different treatment modalities has not been explored just yet. 

What They Found

As you can deduce from the title, this was a meta-analysis. 

They say in the abstract, “increasing the frequency of exercise sessions per week is most likely to have a positive effect on chronic pain patients.”

In the end, as is always a part of the conclusion, more research is needed but there is a modest effect. 

Item #3

This one was in BMC Chiropractic & Manual Therapies in April of 2019. Hot stuff….comin up! It’s called “The shape of chiropractic in Europe: a corss-setional survey of chiropractor’s beliefs and practice(Gislason H 2019).” It was written by Halldor Gislason, Jari Salminen, Linn Sandhaugen, and other names I refuse to attempt at this time. 

Why They Did It

Considering the ongoing split in the profession, the authors were looking to report an adherence to unorthodox descriptiions of chiropractic and the types of chiropractic practice in Europe. 

How They Did It

They sent out an online survey amongst European chiropractors in 2017. They sent it out through social media and through the different membership associations. 

What They Found

  • They got back 1,322 responses back representing about 17.2% fo the profession. 
  • The responses were boiled down to fit into 2 different groups of practices. 
  • The two groups were categorized as orthodox and unorthodox. 
  • The orthodox group made up 80% of practitioners
  • The unorthodox group made up 20% 

Some Key Differences

  • 23% of the unorthodox chiropractors x-rayed over 50% of their new patients while the orthodox chiropractors x-rayed only 5% of theirs. 
  • The amount of unorthodox chiropractors seeing over 150 visits per week was more than double the amount seen by the orthodox chiropractor. 
  • Then, of course, there’s info demonstrating how unorthodox hates vaccines while orthodox chiros are fine with them. 

Wrap Up

They concluded by saying, “in parallel with other research, this survey suggests that key practice characteristics in contravention of national radiation guidelines or opposition to evidence based public health policy are significantly more associated with non-orthodox chiropractic paradigms.”

Now, what does that mean exactly? Well, for those of us on the evidence-informed end of the spectrum, it means that we are in concert with 80% of the profession in Canada and in Europe. From what I recall, about 80% of the profession in America is either evidence-informed or somewhere in the middle. Basically, agnostic. 

It’s not my place to argue if subluxation is a real thing or is not a real thing because I believe people define it differently. My opinion, not research because there is none to my knowledge….but my opinion is that if one defines a subluxation as something that can be removed thus fixing cancer, infections, and things like that…..well, my opinion is that that definition puts you in the unorthodox category and puts you in the 20%. 

That’s my opinion anyway and that’s worth diddly squat in the unorthodox community so, take as you may. 

We can also discuss the x-rays. I honestly have no problems with initial x-rays. I realize that flies in the face of a lot of newer guidelines but I believe that we get gut feelings that don’t fit into the definition of a ‘red flag’ per se. You damn well better get x-rays on those deals. 

I’d also say, if you have a history of x-raying every single patient that comes through the doors, that’s also putting you in the 20% that is defined as unorthodox and it’s also meaning that you’re considered an outlier. 

Outliers MUST keep an eye out if you have contracts with insurance companies. If you’re going to be an outlier, you’d best be a cash practice. Whether it be right or wrong in your opinion, insurance companies do NOT like outliers and unorthodox practitioners. And, honestly, who can blame them?

If I’m writing a bunch of checks and I have 80% of the profession over here mostly following guidelines, seeing people a reasonable amount of visits, I’m going to be cool with that 80%. If I have 20% of guys and girls over here seeing people 100 times per year when they have absolutely zero pain and taking repeated x-rays through the year, well…..if I’m writing those checks, I’m going to have a problem with that 20% at least 100% of the time. 

Do whatever you’re going to do but you should give at least SOME consideration to what I’m saying. 

Chiropractic evidence-based products
Integrating Chiropractors
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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg


The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Gislason H, S. J., Sandhaugen L, (2019). “The shape of chiropractic in Europe: a cross sectional survey of chiropractor’s beliefs and practice.” BMC Chiro Man Ther 27(16).

Manoloff D (2013). “Noted surgeon Dr. James Andrews wants your young athlete to stay healthy by playing less.” The Plain Dealer.

Polaski A, P. A., Kostek M, (2019). “Exercise-induced hypoalgesia: A meta-analysis of exercise dosing for the treatment of chronic pain.” PLoS One.

w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

Part of that is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. 

Website

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger


CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

iTunes

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Player FM Link

https://player.fm/series/2291021

Stitcher:

https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

TuneIn

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

CF 052: Chiropractic Forward Podcast Year One Review

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 060: Medical Marketing & Integration Care Expectations

CF 060: Medical Marketing & Integration Care Expectations

Today we’re going to talk about medical marketing scoundrels and about what the multidisciplinary world expects of us chiropractors. 

But first, here’s that ‘goes down so smooth’ bumper music

Integrating Chiropractors

And we’re back. .Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  We are honored you’re spending some time with us and we hope we give some entertainment and some value in return. 

Introduction

You have disco’ed your way into Episode #60 just like John Travolta in Saturday Night Live. Kids, go Google that. It was cool back then. You could walk down the street in a Staying Alive strut man. Travolta was the bee’s knees back then wasn’t he? From Mr. Kotter, to Grease, to Staying Alive. Then turned kookoo wacko on everyone. He got so open-minded that his brain fell out and went splat. 

Let’s talk a bit about the diplomate of the Academy of chiropractic orthopedists quickly. That’s also known as the DACO program that I’m currently going through. I’ve officially hit the halfway point for the online hours and only have one class left for the live hours which I’ll get in less than a month down in Austin. Basically, out of 300 hours, I have about 125 left and have just been serious about this thing since October. Recent classes have been A Neurological Approach to Scoliosis, and the Neck and a Sense of Well-Being. 

I feel like it’s scooting fairly quickly at this point. It’s funny to watch my staff when I’m performing an exam these days. They’re familiar with the way I do exams and have done them for years. Just about every week, including this week, I’m adding or taking away from what I normally do. They don’t really know how to handle it. Lol. These classes really do change what you do almost immediately. 

If I can help you get started and rocking and rolling on your DACO, shoot me an email at dr.williams@chiropracticforward.com and I’ll be glad to point you in the right direction. 

New Year

How’s your new year starting? By the time this episode goes live, we’ll have been in it for a little over a month. I have to say that I’m confused this year. This is typically our slowest time of year. But, it’s going a little crazy this year for whatever reason. I have literally had 35 new patients in the last two weeks. It’s all I can do to get this podcast written each week, to be honest, but I’m committed. 

I actually had to come in on a Saturday to record the last episode because I just didn’t have the time available during the week to get it done. I’m not trying to brag. I think if you have a good staff, which I do, and you have them spaced appropriately, which I do, you can make your way through them while giving them the best care possible. Especially when you’re using post-graduate educations like the DACO to guide your exam and diagnosis. 

Crazy Busy

And, 35 new patients for my practice looks different than it may in a lot of clinics. I don’t see how many times we can run them through the doors. I don’t convince them their lives are at stake if they don’t see me 50 times this year. 

I used ChiroUp for all of my patients which I highly recommend. An additional $150/month seems like a lot. I know. But this programs is worth even more than that and they’re not paying me anything at all to say that. One of the things it does is track your patients through follow up emails. 

That’s how I know my case average, which is the number of times I typically see a person, stands at around 8 times while their national average stands at about 7 times. 

I know that my average improvement rating is 79.43% for ALL cases and that included everything from cervical radiculopathy and lumbar stenosis to cervicogenic headache and greater trochanteric bursitis. Their national average for improvement is 71.8% so I’m doing good there. If I’m getting 80% of my patients well, I’m happy. 

They have also tracked me at having a 98.6% likely to refer from my patients. Meaning, our patients are 98% happy to refer us to their family and friends and that makes me feel warm and fuzzy inside. I’d still like to know what I can do to make that other 1.4% happy but I think some people cannot be made happy at all. 

Even if you get them well and gave them free ice cream. They’d still gripe because the ice cream didn’t have chocolate syrup on it. You know those people. You know who I’m talking about, don’t you?

Anyway, the point was….I hope your 2019 has started off like my 2019. If it sustains, I’m going to have to get me some help in here! Including a nurse practitioner. Ahhhhh, the day I finally make that leap I may have a few hundred beers. Lol. 

Paper #1

The first item of research I want to get to is on medical marketing. Why do we care what the medical field is doing for marketing? Well, because they’re the main stakeholders in healthcare and it’s important to know what they’re doing. Either we can copy it or we can go 180 degrees from it depending on what we’re talking about. 

This paper we’ll talk about was in the Journal of the American Medical Association also known as JAMA on January 1, 2019, so it’s hot off of the press. It is called “Medical Marketing in the United States, 1997-2016” and was written by Lisa Schwartz, MD and Steven Woloshin, MD[1].  Please remember, if you’d like to see the paper, the methods, and that good hulabaloo….I always cite the papers at the end of the show notes over at chiropracticforward.com. This show is episode 60 just so’s you’s knows. 

Why They Did It

They wanted to answer the question, “How has the marketing of prescription drugs, disease awareness, health services, and laboratory tests in the United States changed from 1997 through 2016?” I think that’s a great question. 

Let’s find out, shall we? I say hell yes we shall!

As far as medical marketing goes, they say, “From 1997 through 2016, medical marketing expanded substantially, and spending increased from $17.7 to $29.9 billion, with direct-to-consumer advertising for prescription drugs and health services accounting for the most rapid growth, and pharmaceutical marketing to health professionals accounting for most promotional spending.”

Let’s dial down into that just a bit. 

As you are probably already guessing because you see this trash on TV every time you turn it on but the most rapid, crazy increase in medical marketing advertising was in the direct-to-consumer advertising. It went from $2.1 billion in 1997, which was 11.9% of the total marketing….it went from $2.1 billion all the way up to $9.6 billion and now, marketing meds directly to the consumer now make up 32% of the total spending. I say NOW….that was 2016’s numbers. Probably worse now.

They broke it down even further and highlighted the prescriptions that are marketed directly. The drugs you need a prescription for ….ads for them went from $1.3 billion in ’97 which was 79,000 ads, all the way up to $6 billion dollars and 663,000 ads in 2016. 

All I have to say here is, “Dayum.”

Then, I’m not done yet….hold my beer and watch this….Lol. That’s what I feel like here. Then, they say that medical marketing straight to healthcare providers like the MDs, DOs, etc….that marketing went up from $15.6 billion to 20.3 billion in 2016 but here’s what’s crazy when you think about it, folks, $13.5 billion of that was for free samples….OK, whatever. Then $979 million went to payments to physicians for speaking fees, meals, and things like that that were related to specific products. So they paid almost a billion damn dollars to MDs to go around medical marketing & touting their drugs.  

It’s insane. You cannot tell me no way no how that with that much money in the hopper, that we don’t have some nefarious skunky smelly dirty crap snaking around and messing with people for the worse. You can’t convince me of it and I’m not a conspiracy guy either. 

Like, when they say we didn’t land on the moon, it was shot in a studio in Hollywood? Yeah, they need a kick in the nuggets. Really? The Earth is flat? Are you sure? I’ve seen a lot of pics from outers space and round is what I’m getting people!! 

You see what I mean here but I also know people and I know what greed does to people. It’s insane, honestly. 

Pharmaceutical Commercials

Let’s talk about those medical marketing commercials for a minute. Let’s make up a name that sounds a little like a prescription. How about Killyametrix? Yeah, sounds good. OK, here’s how it usually goes, “Have you been having a hard time getting into your life? Are you just tired? No energy, no drive, no ambition anymore? Wouldn’t you like to have more energy? You’re too young for this. Killyametrix has been shown to increase energy and get patients back to enjoying their lives quicker and faster than any medication in the history of man that was ever made. There are some side effects. You’ll want to talk to your doctor if you experience any of the following symptoms: gout, liver failure, tumors coming out of your eyeballs, if your foot falls right off in mid-stride, high blood pressure, going cross-eyed, bleeding from the ears and fingernails, if your hair curls, if all of your hair falls out, or if your knee cap pops right off as you sit down and shoots straight across the room knocking someone out. Other than those issues, it’s a great drug. Try Killyametrix. Ask your doctor about Killyametrix and if it might be right for you.”

Here’s the deal, when I was growing up, did you realize whiskey, bourbon, scotch, …..the hard stuff…..it was never advertised on TV because they knew it was damaging to the population so why promote it nationally. I believe it was actually illegal to advertise the hard stuff but I’m not 100% on that. 

But, now, or at least in 2016, it’s OK to advertise prescription drugs straight to the consumer to the tune of 663,000 ads at a cost of $6 billion dollars. It’s lunacy. 

How about you go to your doctor with no preconceived idea of what’s wrong with you and he or she plays doctor, figures out what’s going on with you, and the DOCTOR, the actual doctor, decides what medication you need if any at all. 

Why don’t we try that crap out in America for a change? 

If I were an MD or DO, I’d be livid every time I saw one of those stupid commercials on TV. Hell, I’m a DC and I’m livid when I see them. 

Make me a crazy person. Makes me want to go live in a rubber room for a couple of weeks to decompress.

Paper #2

Let’s get to the last thing here. This one is called “Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study” by Zacariah Shannon, et. al[2]. published in BMC Complementary and Alternative Medicine in December 2018. 

Why They Did It

They say that few studies exist on what the expectations of chiropractic care really are within a multidisciplinary setting so they wanted to add to the literature on this topic. 

What They Found

They found that expectations for the chiropractic program in this study were mostly positive. Good news. The idea of the patients making progress was the overriding theme for the group. They expected the addition of chiropractic to help patients progress by improving pain management and physical functioning. 

In addition, they also expected indirect effects of chiropractic on healthcare integration. Things like increasing the patient participation in other providers’ treatments which would lead to improved care for the patient across the board. 

I wonder if those other providers were or will be helping increase the chiropractor’s load as well? That’s a good question to ask. 

Wrap It Up

They summed it up by saying, “Stakeholders expected the addition of chiropractic care to a rehabilitation specialty hospital to benefit patients through pain management and functional improvements leading to whole person healing. They also expected chiropractic to benefit the healthcare team by facilitating other therapies in pursuit of the hospital mission, that is, moving patients towards discharge.”

Not bad, not bad. It’s a helluva lot better than we had going on for us before the opioid crisis. I’ll give them that. I think the only part of this I really don’t like is their expectation of the chiropractor helping feed the rest of them while, in my biased opinion, they should be feeding the chiropractor first in an effort to keep people off of meds. 

Their stated goals are pain management and physical function. Well…that’s sort of right in our wheelhouse so why wouldn’t we be getting those first? I think the stakeholders have been fed quite enough. They’re fat as hell and slobbering. 

Bring the evidence-informed chiropractors in and watch your patients shine with happiness, leave amazing reviews, and go out and tell your city about all of the good things your clinic is doing. 

If they get the right evidence-based chiropractor in there, that’s the way I see it playing out because the research we covered several weeks ago shows us that chiropractors have the highest patient outcome satisfaction when compared to MD and DO’s, in fact, we wipe the floor with those people in regard to musculoskeletal issues. Not only that but we beat out the PTs as well on outcome measures. 

But we should feed them, right? They should be thankful to have us. 

Integrating Chiropractors The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out.

Connect

We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Bibliography

1. Schwartz L, W.S., Medical Marketing in the United States, 1997-2016. JAMA, 2019. 321(1): p. 80-96.

2. Shannon Z, S.S., , Gosselin D, Vining R,, Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study. BMC Comp Altern Med, 2018. 18(316).

 

https://www.chiropracticforward.com/cf-025-vets-with-low-back-pain-usual-care-chiropractic-vs-usual-care-alone/

https://www.chiropracticforward.com/cf-032-how-evidence-based-chiropractic-can-help-save-the-day/

 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain