In the Rust Room with Dr. Pat Gentempo (video about chiropractor communication)

By Dr. Russ Rosen | Chiropractic Strategies

I’ve had the pleasure of knowing and working with Dr. Pat Gentempo for quite a while now. We got together to do his Rust Room video blog not too long ago – wanted to make sure that you had the opportunity to check it out. Just hit play and enjoy – it’s about half an hour in length but there’s some really cool things in here about chiropractor communication and helping patients “get” what we do!

Chiropractic Management Challenges: The One Year Mark for Patients

By Dr. Russ Rosen | Chiropractic issues

I had a great conversation with one of my one on one chiropractic coaching clients and thought you might enjoy hearing about it. We were discussing chiropractic management challenges and he said,

“I have implemented the procedures and have no problem getting people to finish their first year of care… but at the end of the first year many of them think they are done. What am I missing?”

The good news is this doc is clearly doing something right. When we first started working together, they used to have a tough time getting patients to stay for 12 – 15 visits. Now, the vast majority are staying for an entire year of care.

Obviously, the bad news is too many of them think they are done with care at the end of their first year.

This is a common problem.

There are a few ways to address it, though. I promise: if you implement these strategies very few of your patients will think they are done at the end of their first year and the majority of them will want to continue care at one level or another.

Key Pieces of the Puzzle

In our program we make sure:

In visit 1 we help them see that there is more often than not more than meets the eye. During our consultation we help them realize how it is affecting their lives and how they have had stress and that it is an accumulation of stress over time that can lead to subluxations and these types of HEALTH problems.

During the examination, our TTAT, and Whole Story, we help them fully understand that NOT ONLY do they have their chief complaint, but they also have other motor, sensory, and AUTONOMIC health challenges that they did not tell us about (i.e. they have headaches but they also have sinus issues. Or they have mid back pain but they also have digestive issues etc.) In essence they for the first time in their life see the IMPORTANCE of a HEALTHY functioning nervous system and they WANT to be free of subluxations.

When we effectively do our TTAT and Whole Story they usually say something like, “Wow! I had no idea!” This is a CRITICAL piece of the puzzle. If we are not doing a great job at this they will most likely not sign up for the first year of care.

In our ROF, we get extremely clear with them where they are and where they want to get to on the path to optimal health scale where -10 = near death, 0 = Comfortable but not FUNCTIONING at their optimum and +10 = not only FEELING great but also FUNCTIONING at their optimum.

Once they realize that they are maybe a -4 and they really want to get to optimal health or + 10 where not only are they feeling great but they are also functioning at their optimum, and we find out how long they think it will take to get there.

We then find out once they are at that level of health how long they would want to keep their nervous system functioning at its optimum and how long they want to stay at their optimal health. OBVIOUSLY most people say, “FOREVER!”

Again this is a huge piece of the puzzle in getting people to commit to long term care. It plants the seed that they will want to make chiropractic a part of their healthy lifestyle. In fact, when we give our recommendations we let them know how much care they most likely will need over their first chunk of time (could be 90 days, could be a year etc.) and we also let them know how much care they will most likely need once their nervous system is working at its optimum to KEEP their nervous system working at its optimum. I.e. if we believe it will take a year to get to optimal health, we would let them know that the following years they most likely would need X amount of care to keep their nervous system functioning at its optimum and we discuss why most people choose to do that.

During our Daily Interactions we MUST keep monitoring how they are doing and what is next for them. We do not want to cause “Old Spouse syndrome”. Remember we want to take them from IN-1 to IN-8 (innate) over a lifetime! So it is critical to keep meeting them where they are at in their healing process and keep helping them see and experience what is next as they continue to get healthier. We go into great detail about how to do this in our daily interaction module and it is one of the serious weak suits for most doctors!

Achilles’ Heel

Now comes the Achilles heel for most chiropractors: the re-evaluation and re-report. The fact is most doctors don’t do one or if they do it is terrible! These do not need to take long but they do need to be done right!

A few of the critical pieces of the re report are that:

  • We ALWAYS check back in to the -10 to +10 scale.
    • Where were they when they started?
    • Where are they now?
    • Do they still want to get to optimal health or are they happy just feeling better knowing that we have not gotten the nervous system at its best yet?
  • Now that they feel better how would they know they are still getting healthier?
  • What are their new health goals and how often do they feel they need to be in for care etc.? (Clearly we end up telling them what they need to get to the level of health they want to get to, but it is CRITICAL to find out what level of health they want to get to and how much care THEY think they need!)

Later in care when they are really doing great, feeling great, and their nervous system is really clear, we MUST ask the question,

“Now that your nervous system is functioning so well, and you feel so well, and you can leap tall buildings in a single bound (whatever they had hoped for), how long do you want to keep your nervous system functioning at its optimum and how much care do you feel you need, how many visits per month do you feel you need to keep it functioning at its optimum? What do YOU feel can cause more subluxations? With your present lifestyle how much care do you feel you need to keep your nervous system functioning at its optimum? Do you feel you want to make any changes in your lifestyle at this time and possibly need less care from me?”

We could spend an hour on that once concept. But needless to say most chiropractors do not do this, and this chiropractor that I was having a conversation with was not doing the daily interactions as good as they could and were not doing re reports the way we just discussed. This is why they were having the problems with people stopping care at the end of the first year.

Hope that helps, always love hearing your comments and we are always here to help!

Is your WHY big enough and does it really matter?

By Dr. Russ Rosen | Chiropractic issues

We’ve all heard the phrase, “When the “Why” is big enough the “How” becomes easy.”

Dr. Angie and I always talk about “Headspace” and “Procedure”. Regardless of who we are coaching and what we are discussing what inevitably it comes down to making sure that our head is in the right place and that we have the right procedures or systems to accomplish our goals.

In this article, I want to address why the “WHY” is so important.

Think about the things that you need to do as a chiropractor or as a business person that might cause you stress or anxiety.

  • Speaking in front of a group
  • Asking patients for referrals
  • Going out and introducing yourself to people
  • Seeing somebody out in public who you know could benefit from your care but being afraid to open a conversation
  • …and the list goes on.

In all counts, doctors ask Angie and I “HOW” to do these things. And we have answers. We have answers for everything. We can show you exactly how to do all of these things and have tried and true systems in place that we know absolutely work.

But if your head is in the not in the right place; if the “why” is not big enough then the procedure orthe system doesn’t work.

I was speaking with my dear friend Dr. Angus Pyke about how to help people understand why the, “WHY” is so important and he told me the story.

Imagine I asked you to walk across a 20 foot board that was one foot wide. Would you do it?  Most say that they would not have a problem walking across that board.

We then ask if you would walk across that board if it were a foot off the ground? Some say yes some say no. We then ask, what about if we gave you $100 to walk across that board 1 foot off the ground. Many more say yes. Still some say no.

We then ask what if we gave you $1000 to walk across that 20 foot board 1 foot off the ground. Again most people say yes.

We then ask what if we put that same board between two skyscrapers. Would you walk across that board now? The vast majority of the room says no. And a few thrill seekers say yes!

We then say what about for a $1000 would you do it? Again most say no. We then ask what about for $100,000 would you do it? We now start to get some interest and a few people raise their hands. We then say what if we gave you $1 million? And again a few more people raise their hand. We then say what about for $100 million, would you do it? And you can see people begin to wrestle with whether they would do it or not.

We then ask would you do it if your child was on the other and of that board and in the next few moments they would fall to their death unless you quickly got across the board to save them. Would you somehow make it across that board to save your child’s life?

Now I personally have asked this question in front of many groups of doctors and across-the-board most everyone says yes. And when I ask why would you do it the answer is the same. “I could not live with myself if I did not do it.”

I do have to tell you when I was in Ireland I asked this question and I saw a doctor looking a bit perplexed. So I asked him if he would walk across that board to save his child. He responded, “I have to be honest, I have five children and it really depends on which one you’re talking about!”

I always appreciated that doctor’s humor.

But I think from Dr. Angus Pyke’s story we really get the idea of how powerful the why can be. Most people really would not walk across that board even for a lot of money. Yet most people would run across that board to save their child’s life. That, my friends, is a big “WHY” and when the why is big enough it is amazing what can get done. Now I want you to add appropriate strategies systems and procedures to that big of a why and you can imagine how great things can be.

One of the things that Dr. Angie and I ask our doctors to do is to get your team on board. To make sure that you as a team have a big enough why.

We ask you to clarify what your mission is and we ask you to make sure that when you read this mission it brings tears to your eyes. My experience is if it does not bring tears to your eyes the why is not big enough.

So I’m asking you to do the same. I am asking you to touch your heart. I am asking you and your team to get a big enough why so that when you think about doing some of these difficult things such as asking for referrals or meeting someone in the public and speaking with them you literally are saying to yourself, “I cannot live with myself if I do not do this.”

So please imagine now that you are about to ask somebody for a referral, or get them to the health care class, or you meet someone in public and you need to speak with them to let them know that you may be able to help them. Feel how difficult that might be for you.

Now I want you to touch your heart. I want you to really get clear about what your mission is, why you are here on planet Earth, how powerful the work is that you do in the lives that you can save. I want you to get to the point that you have tears in your eyes. Now imagine speaking with that person. Do you see how different it would be?

We have systems in place for absolutely everything. We can teach you how to do all of these things. But you must connect your heart to a big enough why.

As always we’d love to hear from you and your thoughts about this blog.

What to do with Patients Who Just Want a Few Visits to Get Out of Pain

By Dr. Russ Rosen | Chiropractic issues , Chiropractic Strategies

I had a great conversation yesterday with a doctor in New Zealand and his three associates. One of the associates asked me this question that Angie and I hear all the time. She said, “I had a patient come in earlier this morning who said that they just want to get cracked a couple of times to get their neck feeling better.”

She asked me how I recommended handling these types of patients.

Has that ever happened to you?

In essence have you ever had patients tell you they just want to get out of pain as soon as possible and spend the least amount of money?

Of course the answer is yes.

I want you to realize that that is exactly what you want too! In all things we want to spend the least amount of money and get the biggest bang for our buck.

The question is how do we help people recognize the difference between getting “cracked” a few times and feeling better and truly resolving the underlying subluxations and keeping their nervous system functioning at its optimum for a lifetime?

This is the huge gap that we need to close.

Unfortunately we have shot ourselves in the foot and most people out there believe they chiropractors crack necks and backs to get rid of neck pain, back pain and headaches.

So it is our job as Optimal Health Chiropractors to find out what they REALLY want, in relationship to what we can REALLY do for them, and then simply show them how to have it.

Let me dive into that just a bit.

I have heard other management companies tell us to just find out what our patients want and give it to them. Just give them the one or two cracks, and they will become “crack addicts” and they will come back when they feel they need it.

Personally I could not disagree with that more.

I believe we need to find out what they really want in RELATIONSHIP to what we can REALLY do for them. I do not believe it is okay to just say to such a person, “Great lay down a crack your neck.”

Let me ask you this, if you went to a dentist and they found a cavity and you did not have pain in that tooth yet, would it be the doctor’s responsibility to let you know the truth about what’s going on with your tooth and the truth about what will happen over time with your tooth if you don’t get it taken care of?

Would the dentist use “patient scare tactics” with you? No! They would simply inform you about the truth and consequences of your condition and the choices that you have. They would not have a charge on what you chose to do, they would simply inform you but they would NOT just let it go and not tell you about what was going on with your tooth.

From my perspective we absolutely owe it to these people to help them understand the difference between what just “cracking your neck once or twice” will do for them versus helping resolved the underlying subluxations allowing their nervous system to function at its optimum for a lifetime. That is our job!

So how do we do it?

Okay I truly will get to that in just a moment but I need to ask you another question.

What is your philosophy around what you will do with these people once they understand the difference between feeling better and functioning at their optimum?

Assuming you got someone to understand that they could resolve their problems, get their nervous system functioning at its optimum, and have a better life. Or they could just choose to feel better now knowing that they haven’t resolved the underlying problems. And they fully understood this and said to you,

“Thank you. I fully understand the difference between the two. And I want you to just crack my neck a few times and get me feeling better.”

What would you do?

What is your philosophy?

Would you say to them that this is not what you do and refer them to someone else? Would you say fantastic I’m so happy that you understand the difference between the two and I’m happy to help you get feeling better now? This is a very important question for you to clarify how you want to practice. Personally I have done it both ways. And Angie and I coach chiropractors on doing it either way. The only important thing is that it is congruent with your philosophy.

Okay so how do we get somebody to this point? How do we get a patient who walks in and says “I just want my neck cracked a couple of times” to understand the difference between feeling better and functioning at their optimum?

Step one is to make it about them and not about you!

Don’t make them wrong. Don’t tell them that this is not what you do here. Do not tell them about DD Palmer and his dog fluffy. Simply meet them exactly where they are at and bring them to where you are.

I would follow our normal consultation examination process exactly as we lay it out in our communications modules link to website and just follow their lead. So if they just said that they wanted you to crack their neck so that their neck could feel better I would immediately start talking about their neck what’s going on with their neck and how it is affecting them in their life.

At this point they are absolutely happy to speak with you because you are not telling them what you will or will not do you are asking them about their problem. You’re asking them about their story which of course is the most interesting thing in the world to them.

Now that I know what is going on with them and what their greatest concerns are I’m going to get my hands on them. I would say something like, “Great let me get my hands on you and see what’s going on and see if this is something I can help you with. Sound fair?”

Again are they happy for you to touch their neck at this time? Of course they are! How could you possibly adjust them without getting your hands on them?

I would then start my touch tell ask and teach.

And as I was feeling for subluxations I would connect the dots between the subluxations that I found, their pain, their history, and of course their motor, sensory, and autonomic system exactly like I show you how to do in this video. 

If as I am palpating I find that there is more going on than meets the eye I will tell them so.

“Joe I have to tell you I believe that there is more than meets the eye. Not only do you have a subluxation right here that is most likely causing this neck pain, but odds are it is related to your dizziness and sinus problems. Not only do you have one here but it appears that you have one here to that very well could be connected to that elbow pain and sugar handling problems you’re having. Odds are if we were to do these tests with you (scans, x-rays etc.) we would most likely see these types of things going on. If that is what’s going on there really is a more serious underlying issue going on and it would be really good to know if that’s what’s going on with you are not. If it is odds are we want to get that taken care of and really get this functioning at its optimum so it doesn’t cause you problems in the future. If not one or two cracks will most likely get this thing not just feeling better but truly resolved the underlying issue. Do you mind if we go ahead and do these tests?”

If you have been through our communications program you understand that this is a normal process that we take everybody through.

The only difference is in this case we meet them with the concept that were happy to just “crack” their neck and get them feeling better. But during our consultation and examination if it is true that we find that there is more going on than we report that to them as any ethical doctor would do. Once we have done that we then give them the option of what they want to do from here.

At this point we would follow through with the rest of our examination and of course as per your protocol you would adjust them on the first visit or you would bring them back to the report of findings etc.

For the purposes of this blog I just wanted to help you get a better understanding of how to address these people and help them to recognize the truth about what was going on versus what they thought was going on when they came in. Remember it is all about closing that gap between what they think when they come in and what you know to be true.

Once you close that gap it becomes a simple process. Find out what they REALLY want in relationship to what you can REALLY do for them and then simply show them how to have it.

Hope that helps. Feel free to leave comments and questions.

Staff Suggestions for Improving PVA and More

By Dr. Russ Rosen | Chiropractic Care , Communications

Dr. Jake Smith in Spain asked his team to come up with ideas to help improve the retention or PVA. In essence how do we get patients to stick around longer so they can get amazing results?

This was their response in black and in red are the comments I made.

Do you or your team have anything you would like to add to this?

If so please put them in the comments section.

Tasks to improve PVA and overall numbers (1-27 my C.A.’s ideas/ 27- 38 are my ideas)

  1. If one of our patients has a business, try and use their services or purchase items from their businesses.
  2. Believe in what we do and never give up on our patients.  Never stop encouraging them to continue with care.
  3. Develop our Facebook page more
  4. If possible, reduce the frequency of care so that the patient does not “throw in the towel” due to economic problems.  (i.e.  I understand that you cannot come in 3 times a week, but due to your speedy recovery I believe we can go down to once a week and achieve your health related goals.)
  5. Do not classify new patients as “new patients” if we know that they will only be here for a few weeks or if they are already under maintenance care with another chiropractor and want to switch to us (this happens often as I used to work for another chiropractor in town six years ago.  Some people are just finding out that I am still here, and others are unhappy with his new associate so they seek me out.)  The intention is to have a more realistic appraisal of our PVA.
  6. Revamp our phone calls.  Our current system is that we call the patient 3 times.  If we do not get a response we stop calling.  If they are in the first phase of care we send them a letter within one month.  If they are beyond the first phase of care we send a letter within 3 months. Any ideas??? You can check out my system 4, module 1 REACTIVATIONS section. But for sure Listen to System 2 module 2 dive deep “Missed Appointments”
  7. Inform our clients about our facebook page and tell them they can receive important info about their health if they “like” us.  Maybe there is a way we can request they “like” us, via FB after we inform them??? Create a tribe (Listen to Tribes,system 4 dive deep section) and community! Regular internal series of talks goes a long way
  8. When I am the “runner” work harder to talk to the patient to figure out what their habits are, and how they could be affecting their progress.  (We could also find out positives as well.)
  9. Remember to ask patients for recommendations when they tell me how happy they are with chiropractic and their results.
  10. Insist more that patients schedule their appointments in blocks of 10-12.  Pre-paid plans should help with this (her words.) In Doc Handoff to CA use that scripting and form. Let them know up front that we will support them every step of the way but they need to do their part
  11. When a patient calls to tell us that they are quitting care, insist more that they do not quit careUse LAASR system 3 module 11. Find out why? See if there is anything we can do to fix or help? Get the doc to call and check in as he will be concerned.
  12. Develop blog and social networks more. Write articles in first person. This will bond them to us more and condition them to ask questions. Post more photos of seminars that I attend, the Barcelona College of Chiropractic (I sit on the board) meetings, events etc.  Posts outside of chiropractic such as nutrition and exercise to get more hits on Google.
  13. Post Big Idea video on website
  14. Post other video (don’t know name but I have it) shows split screen of same older man.  One is sick the other healthy.  Emphasizes quality of life.
  15. Once a year, hold a seminar for our patients (Saturday morning)  basically an advanced talk.  Also let patients share their experiences with others. Have the event catered. I did a few advanced talks a year. Biggest had 175 people. We can talk these down
  16. Create more handouts on how to improve habits.  We have on sleep.  We should make one about diet, exercise, mental health. See the ones I have system 3, module right after overview
  17. Encourage parents to bring their children.  Create a “Path to optimal health” for kids.  Make a game out of it.  Give them prizes along the way (we do a bit of this now)  Give them a medal when they reach maintenance care/optimal health. Go through system 4, module 4 no stress secrets to easy and instant referrals. And module 1, marketing, internal, family referral program. Brock did this and killed it
  18. Order gowns for kids
  19. Keep our patients engaged all year with nice touches and details such as:  Have a hot chocolate machine during Christmas, eggs for kids at Easter, Give out pens, t-shirts etc. with our name and logo to celebrate our anniversary. make it a fun place to come!
  20. Nice gift when patients reach 5 years 10 years etc. under care
  21. Give stretching exercises to everyone in first re-exam
  22. In second re-exam re-visit their worst habit and see if they have improved it tons we can do on this…
  23. Show them where they are on the path to optimal health keep talking about where they are, where they want to be and what they need to do to get there… and of course WHY they want to be there. Make sure we do meaningful re exams and re reports. Make sure the entire team utilizes the whole story brochure!
  24. Third re-exam.  If they have improved a bad habit, praise them. If not inspire them to do so.
  25. When patient achieves maintenance care (once a month) the whole team congratulates them and encourages them to continue care.
  26. After one year of maintenance care give them a bottle of nice olive oil (it is common to give bottles of wine but many people do not drink so we found oil is better and is more in congruence with health) to show them we still care and are here for them on their path to health.
  27. Force myself to ask everyone that accompanies a new patient to start care.  Sometimes I don’t do it because I think they can’t afford it or I feel like I failed to make a connection with them and they will say no. review no stress secrets to easy and instant referrals and learn HOW to ask for referrals
  28. Network more.  Take advantage of opportunities to meet new people.
  29. Improve Daily Interactions / Incorporate Path to Optimal Health.  Where do you think you are now? When patient wants to reduce care. And who do you know? And nail the TTAT Whole story brochure
  30. Keep refining first visit.  Get it locked in. and keep reviewing it forever!
  31. Schedule new patients better (i.e. so I am not rushed)if we are rushed or run behind people will put up with it until they are out of pain, but not after that
  32. Improve re-exams and health talk
  33. All of us need to watch Big Idea video and my health talk then critique them to make sure they are congruent and useful.
  34. Help patients more with their habits. Publish info in FB
  35. Start emailing patients once a month with useful info.  Encourage patients to “like” FB page.  This keeps us on their radar.
  36. Be more consistent with making calls to patient after first visit to see how it went. 100% of the time, First impressions!
  37. Be more consistent with keeping up with patients who dropped out of care for medical reasons (car accident, broken bones, in the hospital, surgery, heart attack etc.)
  38. Have an annual event that coincides with bank holidays something like a 4th of July BBQ.
  39. Testimonial week! System 4, module 1, internal, testimonials
  40. In essence,
    1. if we all do our job, if we do a great job, if we continue to improve people will stay, pay and refer!
    2. Get our patients to REALLY see the value of long term chiropractic care.
    3. Make sure everyone on the team understands how to use the TTAT brochure and discuss the whole story and make it personal with each patient.
    4. Make it about THEM vs. making about YOU or your “Numbers”.
    5. Love these people, give them a Red Carpet Experience, (see Red Carpet article in system 3, first contact process, CA Communications)
    6. Take the team through “Get the team to grow the practice” System 2 module 1. Get them philosophically on board and make sure they have regular quarterly objectives that you review in the brag session in your weekly meetings.
    7. Make sure your team has been to your talks and REALLY get the value of long term care.

Now obviously a lot of this feedback I gave Dr. Smith was referencing our 3 Pillars and 5 Systems content. If you don’t know what that is, take a look at this video introduction and start to learn about the program we have – it’s thorough, it’s constantly evolving, and it works.

Capitalizing on the Limited Scope of Other Chiropractors Near You

By Dr. Russ Rosen | Chiropractic Care , Chiropractic issues

I just had one of my coaching clients send me this email today.

“I had a new pt today from my talk. He’s a big guy, poor lifestyle in his early 30s. He told me he is afraid (brought to tears) he is not going to be around for his 9 week old son, in fact he wakes up everyday scared. He was there because of what I said at the talk at his office and he was crying out for help. It brought tears to me also. This guy gets the whole story and big picture and seems very motivated!

My dilemma is that he has been under chiro care for neck and back type symptoms which have cleared up, but his chiropractor never talked about the importance of clearing up the nerve interference and subluxations and made no mention of how important it is for this guy to live a reasonable lifestyle.  Again he was at the talk I gave the other day and of course I talked about how important the nervous system is and living a reasonable lifestyle and that’s why he came to see me. So his neck and back are feeling better however I tried to hint that his function will take longer. I would recommend more care not less, haven’t seen x-rays yet but scans especially HRV is not good. 

I suppose what I want to ask you, in a long winded way, is, is there anything different you would say or do, or really highlight? He told me he can be impatient and if things don’t happen quickly he moves on. This is a long term project in my view, I’m scared of what will happen to him if he doesn’t commit. He needs to understand the changes he wants to notice are ones that will probably take some time and a bit of patience will be needed.”

Have you ever run into this?

If you are out doing talks and really delivering the goods you will have a lot of people who GET IT and want what you have to offer. Many of them will have seen “limited scope” chiropractors who limit their scope of practice to neck and back pain. And these people will WANT more, they will want what you have to offer!

So how do we deal with a patient like this?

In our communications program we teach our doctors to find out what the patient REALLY wants in relationship to what we can REALLY do for them and then simply show them how to have it.

Let’s break that down a bit.

We must find out what our patients really want from us in relationship to what we can really do for them. The odds are we can do much more for these people by clearing up their nervous system and showing them a reasonable lifestyle than what they thought when they first came in to see us.

Most people come in thinking that we can only help them with their neck or back pain. But the truth of the matter is by correcting their nerve interference and helping them live a reasonable lifestyle they can most likely not only feel better and prevent problems in the future, but they can literally reverse the effects of the aging process and have a better life!

So in our consultation, examination and report of findings we have to help them realize the value of a healthy functioning nervous system and reasonable lifestyle and the present and future benefits to them. Again odds are this will be a much bigger picture than what they thought when they came in.

Therefore once we know what they really want in relationship to what we can really do for them we simply need to show them how to get it.

In this person’s case in our consultation we would help him get extremely clear about the “why” behind the “how”. In his case the “why” is because he wants to be around to see his child grow up. In essence he wants to live and he wants to be healthier.

Once we help pull this person out of the river in Egypt called “denial” then we have to be extremely clear and honest with him about what it will take to get the results that he wants. We must address the fact that he can be impatient and the reality is this will not serve him if he really wants to be here for his child.

In our offices, we look at a scale of -10 to 0 and zero to positive 10 where -10 is near death, 0 would be feeling good but not functioning at our optimum and 10 would be not just feeling great but truly functioning at our optimum.

Once you help this person recognize that they not only want to feel good but they want to actually be healthy, they want their nervous system functioning at its optimum and they realize that to do so not only will they need to be adjusted for a significant period of time to correct the present damage but they will also need to live a reasonable lifestyle so they are not re-creating the same types of health problems over and over again.

So you can see that regardless of the person who walks into your office we always do the same thing. We find out what they really want in relationship to what we can really do for them and then we simply show them how to have it.

As always, we are very interested in questions and comments.

Much love and aloha.

Chiropractic Management: When Patients Won’t Stop Talking

By Dr. Russ Rosen | Chiropractic issues

Patient communication is a vital part of chiropractic management. Knowing what to say, how to say it, and when to bring it up is a vital part of running a smooth operation.

With that being said…
Have you ever had a patient who just would not stop talking?

Have you ever had patients who just go on and on and on?

Have you had a new patient talk about every single ache and pain they have ever had, go on about every nook, cranny and orifice?

When you ask them when it started they say, “Well my great great grandmother came over on the Mayflower and SHE had low back pain!”

Do your regular patient visits going on and on with people talking about the weather, their beautician’s new puppies or the latest sporting event!?

This is such a challenge for so many of us! We don’t want to be rude but the truth is we must run on timewe hate it when we run behind and frankly these people can suck the life out of us!

Social Etiquette: Walking the Delicate Line

Doctors tell me all the time that they give it their best shot to get these people to SHUT UP and move on but they just don’t know how to do it without being rude. Often times, doctors will tell me that they just give up and sit there just letting their patient go on and on and they literally zone out, give up and know that they are just going to run late the rest of the day.

Is there a better way? Is there anything we can do to keep people on task and on time AND have them feel heard and well taken care of?

The answer is YES we can. Let me give you a few tips for patient communication.

#1: Doc, Don’t Do Your Own Pre-Consultation 

First of all: with a new patient, it really helps to have our CA do a pre-consultation. If our CA spends 10 to 15 minutes asking the right types of questions and responding in the right manner our patients can literally get “talked out” and feel heard so when we walk in we can get right to the bull’s-eye, spend much less time and our patients will have a tremendous experience.

#2: Summarize What You Know

During a chiropractic consultation, it is critical to let our patients know what our goal is for the day. We let them know that our main goal is to see if our patients are in the right place to get the care that they need. We let them know what will happen if we believe we can help and what will happen if we believe we cannot help.

If you will summarize what you know about the patient’s history from the pre-consultation or their history form and ask them what’s  going on and how can you help, you will find that many patients will not feel the need to reiterate all of the points that you just summarized for them.

Of course some of them, especially the real talkers, will just start right from the beginning and tell you everything all over again.

#3: Know What You’re Listening For

It is critical in your consultation that you are doing it by design. In essence, you must know exactlywhat you are listening for. We talk about listening for three different concepts. When you summarize what is going on and ask them to please tell you more, they will talk about one of three things.

  1. The first would be their diagnosis or lack of diagnosis. All you have to do is let them know that this is exactly what you’re going to do today. You’re going to try and figure out exactly what is going on and whether they are in the right place to get the care that they need.
  2. The second thing they may talk about is their pain. All you have to do is reach over and touch the area and go into your version of OPQRST of pain.
  3. The third and most common thing they will talk about is how it is affecting their life. We must dive deep into how it is affecting their work, home or play. After all, the truth is that nobody is there because of their pain! They are there because of loss or potential fear of loss and we must help them realize how it is affecting their life and what their greatest concerns are.

You will find if you are hitting the bull’s-eye’s and you are talking about what THEY want to talk about versus what YOU want to talk about you will get much better results in much less time.

#4: Write It Down

So what do we do with someone who is going on and on about something that we really don’t need to know about? There is really quite a bit to the subject but one thing that I would ask you to try would be to put your finger up right between your eyes and their eyes and say,

“Hold on one second – this is very important. Let me write this down.”

The odds are this wonderful talker will continue to go on and on. Now put your entire hand up as if you are saying stop and say,

“No really, please hold on.
This is very important and I need to get this down.”

This way they are not offended, you are not telling them to just shut up, instead you are letting them know how important they are and how important their story is. In fact it is so important that you need to write it down.

#5: Ask Closed Ended Questions

The next trick is to get control of the conversation by asking closed ended questions i.e., “Mary, can you point to where it hurts?” “Do you feel it more in the morning or the evening?”

More often than not, this can keep you and your talkative patient on track. The truth is sometimes they will not get the hint and they will continue to rattle on about things that you really do not need to know about.

#6: Let’s Not Waste Your Time

With these people, I find that this can work.

“Mary do you remember a few minutes ago I told you that our main goal was to see if you are in the right place to get the care that you need? Obviously you have so many things going on and the truth of the matter is if you have subluxations the odds are I can help and if you do not have subluxations there is nothing we can do. May I make a suggestion? Why don’t you come right over here and let me find out if you have these types of subluxations and whether or not we may be able to help you. With all that you have been through the last thing I want to do is waste your time.”

What About Regular Patient Visits?

Now what we do about our regular patient visits when our patients want to talk about the weather, sports or their beautician’s new puppies?

#1: Set Expectations at ROF

The first thing we must do is set the stage at the report of findings and let our patients know that we are NOT going to ask them for a laundry list of all their symptoms each and every visit. Instead we will ask them if there is anything new or different. If there is something new or different i.e. something is dramatically better or worse, they had an accident or a new health challenge has come up, then we must know about it. But the truth of the matter is they will notice there will be ups and downs throughout care and instead of wasting a lot of time talking about each and every symptom we are simply going to get right to it and not waste their entire day. We know that they are busy and have other things to do and we know exactly what we need to adjust when they come in.

#2: Be Careful What You Ask For

Then when our patients come in we do not make the mistake of saying, “How’s your neck today?” Or “How are you feeling today?” Instead we will do what we said we would do and ask if there is anything new or different. The truth is the first few times our patients may start to talk about all of their symptoms i.e. my neck is a little bit sore today.

Here is what will not work:

“Didn’t you listen to me the first time? I told you not to tell me about your symptoms, I told you to only tell me if there is something new or different, shut up and lay down!”

Again I do not feel that that is such a great practice building strategy.

#3: Be Hands On With Training

Instead simply touch the area and ask, “It is feeling a little bit sore right here? Right, so this is the area that we have been working on correct? Okay is there anything else new or different?”

You will see that in a very short period of time you can train your patients so they will really only tell you about things that are new or different. That will save a lot of time at the beginning talking about things that you already know!

For three years in my practice I let people know that we did not talk symptoms here in this office. I do not feel that this is a good or honoring strategy to grow a successful practice, so let me be the one to make this mistake and let you be the one to learn from it.

Focus on the Patient and Their Health

Now with these patients who have been cultivated correctly right from the beginning all we have to do is focus on them and their health each and every visit. If they do happen to mention something about the weather you can quickly comment on how beautiful the weather is and get right back to business. Lay your hands on their spine, tell them what you see going on, give them an adjustment, then give them a great coaching tip on the way out. We have a very specific four step process that will keep you and your patient right on track.

What About My Loyal Patients?

What do we do about our present patients who’ve been with us for many years and are used to talking about the weather and puppies?

In my experience, all we have to do is start to shorten our responses as I had just discussed above and get right to business. As long as you are focusing on them and their health you will find that that is really what they’re here for.

Yes, I do understand that you will have some patients who are really there more to just hang out with you. Often times the elderly – who no one else will listen to – will want to just sit and have a cup of tea with you and talk.

You must make a decision what you want to do with these people. You can either choose to spend time with them because you enjoy it (and of course you must let your team know so that they schedule appropriately). Or you must sit down and have a talk with them and let them know that although you love them and you love talking with them, the truth is you have found that you can give them much better quality care if you can just stay in the zone and focus on their health.

Yes I realize that this could be a difficult conversation but the truth of the matter is if you want to have the practice of your dreams you’re going to have to do some things that are uncomfortable.

Do you ever have a difficult time telling your patients the truth?

By Dr. Russ Rosen | Chiropractic Care , Chiropractic issues , Chiropractic Strategies

I was having a conversation with a doctor the other day who was having a challenge just telling the patients her truth.

She said that when it came to things like telling the patient how much care she thinks they really need or asking for referrals or a whole host of other things, she was really having a tough time.

The last thing she wanted her patients to think is that she is in it for the money.

Now the truth of the matter is this: I have had this same conversation with many doctors over the years. It may be about telling the patient what they need to get to a certain level of health, or asking for referrals. It may be telling the patient that if they really want this to resolve they will need to eat better, or deal with stress or get some exercise. It could be telling patients that if they don’t make certain changes like their frequency of care they really are not going to get the results that they want etc.

Now when it comes to different types of doctors it usually comes down to being more “Assertive” or “Non-Assertive”

In general, the “Assertives” may err on the side of overstating the seriousness of the patient’s problem, they may be prone to using “patient scare” tactics as they are “truly in the patient’s best interests.” They will often times use persuasion and high pressure sales techniques to get the patient to do what they want them to do, as they love the conquest.

The “Non-Assertives” may be seen as easy going, peaceful, unassuming, humble and even meek. Above all else these people want to be liked by other people and they want to be seen as a good, honest and truthful person. They are sensitive to rejection and combined with the desire to be liked; these people usually downplay the seriousness of their patient’s condition. They error on the side of telling the patient not to worry, that things are going to be ok. The doctor most often does not tell the patient the truth about how much care they need and how much it is going to cost. They are evasive and even cheery during the examination and R.O.F., the last thing they want is to use any of those “patient scare” tactics that many of the other doctors use.

If you are interested in a very detailed article on this subject, you can download it here. 

Regardless of which type of behavioral style you are the thing I have found works is to remember this single concept. Regardless of your behavioral style it is about THEM it is not about YOU!

We need to get out of our own way and just tell the truth and consequences of their choices. Patients are here because they want help. We owe it to them to them the Truth, the Whole Truth and Nothing But the Truth WITH ABSOLUTELY NO CHARGE!

As long as you remember that simple concept, and keep your patients best interests at heart you will be amazed at how much easier it is to tell them the truth in a way they can hear it.

As always hope that helps. Love to hear your thoughts.

I want you to go home and sleep on it.

By Dr. Russ Rosen | Chiropractic Care , Chiropractic Strategies , Communications

When coaching doctors through the report of findings process, we hear them say thing like

“I try to show them the care plan I would recommend and then tell them that I don’t want them to make a decision today. The last thing we want to do is pressure them to do anything. So we want you to go home and sleep on it and come back next time and let me know if you would like to do a program of care or just pay per visit for now.”

That all makes sense, doesn’t it? When I hear this kind of statement, I find that the doctor is in one of two categories: they are non-assertive and “roll over” when a patient pushes back (sometimes referred to as the O.K. Corral) or they’re tired of the high-pressure sales tactics that they’ve been told they HAVE to use. (By the way – the second category almost ALWAYS says that the high-pressure stuff has ruined their reputation and cut down on their referrals.)

Here is the problem with using the quote above: it is BS!

It is YOUR BS (or Belief System) causing you to do this. You have to ask yourself if it is really what is best for your patient and for you. I am going to suggest the answer is “no”. This mentality is in neither your patient’s best interests nor those of yourself and your practice.

From a behavioral psychology and communications perspective, there is a window of opportunity when people want to purchase what you have to offer. When you miss that window, you literally CAUSE them NOT to get the care that they need. (Ouch that hurts!)

Should every patient make their decision in the heat of the moment?

Of course not. There certainly is a time and a place, though. We teach doctors exactly when and how to do that. However, you can actually cause people NOT to get the care that they need and want by telling them to go home and think about it instead of giving them an opportunity to get the program they want when they want it or when that window is open!

The first thing we need to examine is why do doctors do this?

If you have been burned by doing some of those high-pressure scare care techniques then your first reaction will be to avoid them at all costs. If you are the non-assertive type of doctor, then this feels really good and very genuine.

In fact, these types of doctors reason that asking for a commitment to care during the report of findings will GUARANTEE that the potential patient thinks:

  1. I am trying to scam them.
  2. I am trying to pressure them.
  3. I am a salesman/woman trying to SELL them.
  4. I am a charlatan or huckster.
  5. I am just in it for the money.
  6. Blah, blah and yes… blah!!

Separate from the patient’s potential thoughts, most doctors just hate being rejected!

The S Word

Now I did specifically say “If I try to SELL them up front.”

I used the S word (sell) for a reason.

That is what these doctors tell themselves.

This is their BS or belief systems that keeps them from just giving those patients what they want and deserve.

No you are not trying to SELL them anything.

Is this a business? YES!

Business comes down to one thing. You have a problem, I have a solution. If my solution fixes your problem then we MAY be in business.

Are you providing a solution that they want to purchase? YES!

You cannot be successful in practice if you look at your services as things to sell to people that visit your office. You will fail.

The Key Difference

The way we teach doctors to do visit one and two is very simple. We want you to find out what your patients want in relationship to what you can REALLY do for them. After that, simply show them how to have it.

When someone comes to your office with a stiff neck, they may say that they want to get their neck “cracked” so that they feel better. By the way, many management companies (even the really expensive ones) will tell you to seize onto the “crack addicts” that come in because you can do something that they are asking for and you can do it over and over again to make a lot of money.

Instead of surrounding yourself with “crack addicts”, you should help clarify your patient’s real wants. In most cases, they REALLY want to get healthy, stay healthy and have the best life possible for a lifetime, but probably don’t understand that you can help them do that (yet).

When people truly understand the value of a healthy functioning nervous system and reasonable lifestyle, they are better equipped to voice their real wants. Once you have done that for them you then find out what they really want: do they want to just feel better knowing that they have not resolved the underlying subluxation and health issues, or do they want to feel better and resolve their underlying subluxations and health problems?

Our experience in hundreds of offices tells us that most people don’t just want to feel better, they want to resolve the underlying subluxations and address their health problems.

Once we help people clarify that they want to get healthy and stay healthy for a lifetime, then all we have to do is show them how they can have it with a real care plan.

A Real Care Plan

Once people understand this, they recognize that it is not going to be a quick fix. It will take more than a couple of quick cracks to resolve these underlying problems.

Imagine that you have taken a patient through this entire process and they really realize that they want to get healthy and stay healthy. You show them what they would need to do to get there. That patient says to you, “I am sick and tired of being sick and tired, I want to get healthy and stay healthy and I will do whatever it takes to get there.”

If you respond with “Great! I want you to go home and sleep on this. It’s a big decision.” Then you have most likely undermined your efforts and effectively pushed the patient out the door. All of your efforts to educate your patient goes away when they leave and go back into the rhythm of their daily life. If you aren’t comfortable asking for a commitment once your patient shows that they really get what you do, then you most likely have some headspace issues to resolve.

  • You need to learn how to get people to truly value their health and value your care.
  • You need them to understand the difference between what most other chiropractors, practitioners and medical doctors are offering them.
  • You need to be able to separate what you are offering from the other options they have.

If you need a hand with this, I encourage you to use the link below to learn about our unique program, called Headspace and Personal Growth, that has helped hundreds of chiropractors across the world to feel certain, better understand themselves, and approach their practice with the right mindset, mentality, and methodology. It can change your life.


Survey: are your patients referring?

By Dr. Russ Rosen | Chiropractic issues , Chiropractic Strategies , Communications

We all want patients who happily stay, pay, and refer. When new patients come to us, we want to make sure that they have a great experience so that they “get” what we do. We then move to ensure that they stay because we can’t restore them to optimal health if they don’t show up.

So when does that third part come into play? When do we figure out the right time to focus on “refer”?

This is a subject that is certainly up for debate. Head to a convention or a conference and bring it up during happy hour – you’ll hear lots of opinions and ideas. Which ones are right? Which ones are realistic? Most importantly: which ones actually work?


Sometimes, we need to step back and take a look at something that we so often forget to factor into the equation; the fact that YOUR practice is just that: YOURS.

So we’ll open this one up to the comments. When do you start asking your patients for referrals? How often do you do it? How well does that work? Leave us a note and we’ll publish the findings next week on our Facebook page.

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