Now just imagine you are in the patient’s place.  The scans have something to do with my spine.  The doctor has used the words nerve and stress and I still have some type of back/neck pain.  What the heck do all these colors mean?  What is he/ she satisfied with?  How much longer do I have to come for this problem?

Can you really blame the patient who comes in for spinal related pain, gets told a bigger story about stress, health and wellness and then judges their improvements on their comfort rather than their test results?  Well, before we blame the patient or ourselves, let’s look at the dynamics of the relationship and how we can ensure its honesty.  If you are seriously setting goals that go beyond pain and structure, then the scans are an ideal method of tracking progress.  If you are using the scans to measure NMS integrity alone, then the frustrations will mount within both parties. The starting point for all care plans must be built upon truths and consequences.

Truth#1: the scans identify habits that have been created by the body’s best intentions to maximize it’s efficiencies in light of the subluxated state.  They do not necessarily point directly to the subluxation or the pain and inflammation that may be attendant to the symptoms a patient is feeling.  These habits are identifiable in a variety of neural processing states and NMS positions and motions.

Truth#2: Pain and symptom management are early stage identifiers that the body is responsive to your interventions, NOT that it has healed the subluxation.  Subluxated systems are ridiculously inefficient and protective.  Scanning detects the efficiencies that neural processor possesses and relates them in regional color patterns or scores them numerically against normative scales.

Truth#3: A chiropractic care plan must have goals that identify the needs of the patient, the desires of the practitioner and the reality of the situation.  There are consequences of a short sighted plan and limited adjustments.  If the neural processors are persistently distracted then the system is out of sync and requires a chiropractor’s intervention.  Do your adjustments stabilize the spine, reset the neural sequencing, arouse innate or all of the above? 

Truth #4:  A patient will follow your care plan for as long as they value the outcomes that you are certain of.  If you have developed a certainty that your care model unwinds the neural-dural tension and sets the tone for healing and potential, then the scans will reflect your excellent work.  If your method is focused on structural integrity with the HOPE that the neural system SHOULD release its old habits, then the scan progression can appear more variable. Certainty and specificity wins the day.

Truth #5: Information is free; advice is valuable and at times priceless.  I suggest that you be more certain than speaking in generalities.  Trust your greatness and give exacting advice.  Tell the patient how long you feel it will take to clear a scan or raise the NSFi.  Develop an outcome relationship with the patient.  That’s what they are aiming at.  The days of endless attendance because of the elusive holy grail called wellness, are over. Be a master of your outcomes and assure your integrity with proper communication and commitment on your part.  Celebrate the shifts in the scans as much or more than the improving comfort in the patient.

There are a gazillion more truths to explore in practice but these were the ones that resonated as I wrote this blog.  Send me a whole bunch more of your truths and we can discuss them in this blogosphere.  As Pat Gentempo reminds us, ”You are not alone.”

I’m not going to comment on the selection process in the colleges but the results are evident when the majority of candidates are kinesiology grads with a biomechanical background.  The challenge that faces all DC’s is defining what makes them and their offerings of chiropractic unique. There is certainly nothing that warrants chiropractic uniqueness in a better approach to core training.  For God’s sake lets all get over the distinction between fixation and subluxation.  What makes the chiropractic approach unique is that the “lesion” that emerges as a consequence of altered neural tone and a limitation in the expression of innate is a subluxation.  A component of the subluxation process is a vertebral reaction that may or may not exhibit a fixation in the biomechanics of a segment or two.  We all endure fixations either episodically or chronically.  It’s part of living in a gravity and motion dependent existence.  Remember the original definition presented by Palmer via Stevenson in 1927.  There were three necessities to claim the existence of a subluxation: loss of position and inevitably motion of 2 contiguous vertebra; an alteration and eventual closure of the IVF and most of all an interruption in the expression of the Innately tuned mental impulse. Well, 1 and perhaps 2 are associated with fixation but there must be a shift in neural-dural tone to qualify as a subluxation. 

If you remember my model of subluxation for patient orientation using the three layers concept, then it is so easy to understand that layers one and two associate with fixation while a persistent disturbance interfering with the communication along the 3^rd layer of neural-dural tone means that the person is no longer suffering from the limited biomechanics of a fixation but rather, they are developing devastating health issues related to the loss of vital communication. Subluxations are identified and adjusted by chiropractors and so that is what our role is within the community of healers and health care providers.  We are also incredibly capable of coaching and advising how to optimize the results while under adjustive care and to share and care for people to limit the potential to become subluxated. There is a lifetime of work to do in our communities let alone within the world.

Back to my patient…  I identified that indeed he was subluxated in several regions of his spinal core.  We reviewed his neural efficiency patterns and looked at the destructive changes to his spine. He was definitely fixated in many regions including his lumbo-sacral region. Undoubtedly the tissues in this region were generating tremendous pain and restrictions.  Joints and soft tissues hurt like hell when they are damaged and stressed out.  We identified his limitations in lifestyle management and we laid out a care plan that addressed his immediate issues and offered to care for him through the reorganization time frame encompassing recovery, restoration and finally, wellness care.  He was told that this was to be a collaborative effort for him to achieve the best results BUT if he chose to just use adjustments as a therapeutic approach, that was OK as well.  This thing called an adjustment works whether the patient is totally compliant with lifestyle modification or not.    In my years of parenting and “spine-parenting” I have learned it is wise to be creative in inspiring people to achieve results.  Guess what?  He is feeling better and healing at the same time.    If we were to look at his MRI and biomechanical parameters he would still be in trouble but his neural scans are shifting and easing.  He describes many wellness improvements such as clearer thinking, less night pain and spasticity, improved digestion and more mobility in the spine and he is happy!  It’s probably all a placebo because his structural metrix are all abnormal still.  I agree whole heartedly with the young DC that manipulation of this man’s lower spine is risky and non productive.

 If managing the deteriorative fixation was the goal of care, I suppose all that I would be left with is the surface approach to soft tissue and mobilization with movement.  As a chiropractor my eyes are on the subluxation and if there is a chance to adjust it, and why wouldn’t there be, then this man will improve and heal.  That’s the law of nature that is embedded in the philosophy and the principles, all 33 of them, of the chiropractic doctrine.  Of course there is limitation of matter but so long as there is a life spark and enough time, there is an opportunity to heal on many levels.

It’s just right to be and act as a chiropractor if you are going to call yourself one.  It’s a glorious and noble profession that has spent too much of its time trying to fit its philosophy and practice into the square hole dictated by medicine and chiropractic licensing boards. Be the artist that you know you are and stop defining the care you do as a modified physio approach.  Find the subluxations and adjust them.  There will be much more healing going on at that table and it won’t be limited to the person lying on it.

Happy New Year to all of you who read and respond to this blog. 2010 is already becoming a powerhouse of change. We have filled up the two coaching spots that were available and so my amazing assistant, Linda, has bribed me to open up two more.  You are welcome to call in and see if my communication training and my methods of practice development are right for you.  If not, I get a chance to meet more cool people from around the globe!  Be well and Be Great!

I remember having a conversation at a seminar with my dear friend Jim Sigafoose. He said it best when he was at his first Parker seminar as a lonely, underachieving DC.  When asked how he was doing in practice he would say, truthfully “I’m seeing 500!”  Although he was actually adjusting a fraction of those 500, he was “seeing” them.  He never lost the vision of where his practice would be one day. The rest is legendary.

When you awaken to start the next practice day, you have a choice as to how it will play out.  It will either drive you(nuts) or you will drive it.  Most DC’s chase a dream of more, more and more rather than realize that there are production limits to the system you have set up.  So often DC’s read about monster practices that can occur overnight with the right marketing etc..These are probably the same DC’s addicted to infomercials or MLM schemes.  The reality is that the practice you have is a perfect reflection of your level of clinical and management skills combined with entrepreneurial expertise.

I suggested that compression of the schedule was a good starting point.  Even if you are seeing a few patient visits in the hour or in the morning, schedule them all in the same slotted time frame.  This gives the perspective of a full practice; it creates a buzz of momentum in the flow and most of all it frees the day up for you to spend the time entrepeneuring. This simple cluster booking saves you the indignity of waiting for the one patient.  Remember that an efficient appointment book is scheduled horizontally and then vertically.  I created the ABC’s of staff responsibilities, where A stands for Appointment book management. I will review these ABC’s at a later date.

Once the cluster booking has been firmed up, it’s time to literally go to work.  Servicing the patient is the easy and straight forward stuff for us.  It’s the allocation of time and energy to be the CEO that needs to be learned and implemented.  I suggest that you agree to work at least 40 hr a week until your plate is full.  Not that hard a request.  If you do the math and allow for missed appointments and slow times you would only need to, at most, invest 27 hours in adjusting, examining and reporting time to see 250 pv/week.  That leaves a full 13 hours to be the CEO(Creative Exceptional Organizer)(DF’s acronym).  Sadly most DC’s see the 27 hours and book a play date instead of working their plan for the other 13.

I know this sounds pretty Dad and Mommish…put the nose to the grindstone but there is a reality of getting paid for the system that you create and manage. I once trained with a hedonistic coach who was all about maximal efficiency and minimal hours. My practice languished for some time until I reorged the schedule.  Let me just say from business experience, and I know billionaires who gladly put in 60 hour weeks; work should feel like play, so learn to love the business as much as you love adjusting.

 Interested in learning how to be great in practice and create your own Greatness Action Plan? Book a free consult time with docfletch.  Fill in the Mind the Gap info and send it through.  You can also just call Linda at 905 831 9696 and she’ll set aside 20 uninterrupted minutes to have a chance to chat about coaching and growing the practice.

The “holy” words within chiropractic are probably best found in the Green Books rather than Dynamic Chiropractic.  Whether you are in church or in practice you will have to decide which direction you want to focus on and what words and messages you will follow. This all important decision defines the intent and the principles that will guide your actions and communications.  

“I’m a chiropractor, who is a doctor, trained to release and adjust the tension that is being held in a person’s spine and nerves.  This turns on the power to heal while turning off stress and it’s all done without using drugs or expensive therapies.”

I just came up with this 7 second, elevator statement and it sums up some of the important distinctions that are unique to chiropractic.  Embedded in the dialogue are the key words:  doctor, release, adjust, spine, nerves, heal, power, stress, drugs and expensive.   Regardless of the way we speak or tell the story, the content and context of the words we use are expressing our intent.  In this dialogue I didn’t use the words back or neck care; specialist, pain, therapy, relief, muscle, joint, manipulation, strain sprain.  These are words that, when put together, represent a form of therapy and a therapeutic outcome.  Healing starts with therapeutic benefit and then opens up to potential.

Its so useful to examine our words as they confirm our intent.  This is one of the reasons that I have eschewed the use of scripts in practice management. Regurgitating another person’s intent is useless.  Learning the content of what is in the scripts and then reframing it to meet your message is valuable.  This is on e reason that I have developed templates to insert, in an appropriate order, your own words and your own message.  However or whatever we speak, it must be the truth to us.  I am driven by the message that resides in full view in our kitchen:  “Choose to be kind rather than being right.”  It sort of goes along the route of the Golden Rule.  What messages deliver kindness?  You can be direct and still be kind. You can disagree with a person’s opinion and position and still be kind. You can give a care plan based on the kindness of the truth rather than the righteousness of a practice management dictate.  

The root of the word trust is truth.  To be at peace in practice and in life, tell the truth as you understand it and the trust will build. It takes courage to be truthful but the words are in you.  Choose them wisely and you’ll sleep comfortably.

Docfletch trains doctors and their teams to use powerful and truthful words in practice.  His templates and dialogues have changed thousands of practices around the world.  Call today for a courtesy consult on how you can deliver the message that is inside of you. Join the Insight Academy and book a Mind the Gap session and get the New Year off on the right foot.

If we take this truism into the details of the practice then we need to ask ourselves the obvious questions: “What are we certain of ?”and “What and where are we fooling ourselves through inconsistencies and incongruencies? “  One question that I ask the attendees at my program is , “What is your product”.  Now of all the things that a business has to have nailed is the product along with the pricing and the delivery methods.  You wouldn’t believe what I hear.  I get health, vitality, change and wellness as answers.  This then narrows down to adjustments or care.  Generally the room goes very quiet as it becomes apparent that there is no consensus and the answers are asked rather than emphatically given.  The answer, as I see it, is none of the above.  With certainty, I can tell you that the product that a chiropractor sells is not an elusive or subjective  outcome.  Nor is it the adjustment alone.  It is the care plan.  This is the way health care and healing practices work. They create an avenue and a forum to develop a time-based relationship into which the doctor can add their extreme skills of  examining, analyzing adjusting, communicating, coaching, mentoring and being. 

Imagine how powerful and productive your practices could be if there was certainty in the communication of the care plan with every patient.  Imagine if every patient knew where they were going at all times in their care and were aware of their responsibilities.  The CA’s could be trained to be Care Plan specialists, dedicated to assisting the patient adhere to their plan rather than focusing on assisting the doctor.  Powerful practices run this way and the team gets paid at the level of the certainty that they project.

A case study in certainty can be found around the corner in any orthodontists office. These professionals are the very best at focusing on the outcomes  and having care plans that accomplish this.  Along the way they are certain that these results are going to be achieved and they get paid handsomely for this certainty. In fact, the client isn’t even told how often they need to be scheduled.  The intent is the successful outcome and the making of a new “smile”.  Damn, these guys are good!

Lets all take the next step in certainty development when it comes to the care plans.  Structure the care plan from exam to exam at the very least with goals that go as far as you are certain of the outcome you can achieve.  How cool would it be if the certainty of the outcome was based on the certainty of the value of clearing the scans. Imagine that the true goal was to observe neural clearing regardless how the patient felt and that the care plan reflected your expertise, like the orthodontist, on the momentum of the change.  Imagine that you could equate, without a doubt, that wellness was being acheived as the scans reflected the healing state and improved in their pattern. 

A solution to a lack of certainty is to dissect the care plan that you would love to deliver.  Write it out, step by step and fall in love with every bit of it.  Imagine and envision the scans and the healing  as the patient moves from a Release state to the Rebuilding phase.  How long and how frequent will you need to see the patient?  What are the outcomes you expect?  How will you communicate this each step of the way?  What media will you use?  What is the fee structure and the payment model?  How will you measure the success?  How does a patient grow into wellness?  How can they be trained?  Will they refer families and friends?  What do you do in the process?  Your staff’s role and duties?…These are the questions that develop certainty and I am certain that if you focus on removing the inconsistencies in your intent, actions and delivery, you will be repaid handsomely in so many ways.