249 Creating Engaging Treatment Plans

This week’s topic:  Are your patients engaged in your care recommendations? 

The KC CHIROpulse Podcast is designed for Chiropractic professionals ready to elevate their practice to new heights.  This week, the show is hosted by Kats Consultants’ coaches Dr Michael Perusich and Dr Troy Fox, seasoned experts in Chiropractic business management.  This podcast provides invaluable insights and actionable strategies to help you create a flourishing and sustainable Chiropractic business.

In this episode, we discuss:

• How your care recommendations may be causing patients to quit care 
• Why your doctor authority is important to patient compliance
• Why some doctors are damaging their long-term profits
• How your recommendations need to be clear and confident for patients to accept care
• …and so much more…

In each episode of KC CHIROpulse, we delve into crucial aspects of building a successful Chiropractic practice, covering topics such as establishing a strong foundation, adopting a patient-centric approach, mastering marketing techniques, achieving financial fitness, fostering effective team building and leadership, integrating technology and innovation, and navigating common challenges in the field.

Whether you're a seasoned chiropractor or just starting your practice, the KC CHIROpulse Podcast offers a wealth of knowledge and personalized practical advice to help you navigate the intricate world of Chiropractic business. Join us on this journey as we explore proven strategies, share success stories, and connect with industry experts to empower you in your pursuit of building a thriving Chiropractic practice.

Don't miss out on the latest insights and expert guidance. Subscribe now and unlock the secrets to taking your Chiropractic practice to the next level. Your success is our priority at Kats Chiropractic Business Advisors.

DISCLAIMER:  The information presented in this broadcast is for educational purposes only and is not intended to offer legal, investment, accounting, or medical advice, and represents the opinions of the speakers.  Seek the consultation of a professional for advice in those areas. And remember…your results using this information may be different than described.

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Transcript

249 Engaging Trx Plans

Why Plans Fail

[00:00:00] 

Dr. Michael Perusich: Doctors are your treatment plans creating good patient compliance? Hi everybody. Welcome to the KC ChiroPulse Podcast, brought to you by Kats Consultants in CHIRO Health, USA. We are your hosts. This is Dr. Troy Fox. And I'm Dr. Michael Perusich. Troy, we both know that the way you present a treatment plan to a patient, the way you structure a treatment plan, it's.

Gonna make you or break you, it's either gonna be profitable or not, or it's gonna create and or it's gonna create patient engagement or not. And where does it all start? 

Dr. Troy Fox: It all starts with you, the doctor, and a mindset. And I'm gonna talk a little bit about the mindset and then we can move forward from there.

Mindset and Leadership

Dr. Troy Fox: Here's our population in the United States, AKA in the world right now, but especially in the United States. We've been coddled. We're entitled. We have no direction in life. I'm just being honest. All right. We have no direction in life and we're waiting for somebody to tell us what to do, so doesn't matter what doctor we go to.

You [00:01:00] notice even when you go to your medical doctor nowadays, it used to be they would just see you and send you out the door, and it was kind of up to you to do whatever. Nowadays, we got follow up appointments for everything. We're following up and then we're following up with that follow up, and then we're gonna follow up with that.

Follow up with the lab. Then we're gonna follow up again. So what does that mean? It's a treatment schedule. They're just doing it a little more drawn out in a little different way. But in the truth of the situation is, is as patients, we want to be told what to do next. When patients come in that are compliant patients, you know what they say, doc?

You're the one with all the knowledge. Tell me what I need to do. Don't you love hearing that? That's what most patients are actually thinking. So that is what the mindset is, and you have to have that mindset when people walk through the door, even if they're a little bit barky and grouchy, it's amazing when you have a mindset that everybody wants and needs to be on a treatment schedule that matches their condition.

It's amazing how compliant patients are. That's my [00:02:00] thoughts at the beginning of this 

Dr. Michael Perusich: all day long. But yeah, you're absolutely right. You know today's consumer, they want problems solved. 

Dr. Troy Fox: Yep. 

Dr. Michael Perusich: They want problems solved and they want to go to somebody who's going to lead them down a path. Notice I said lead, who's gonna lead them down a path?

To solve a problem 

Dr. Troy Fox: Trem Rose path or what kind of path is that? Is that the high road or the low road? 

Dr. Michael Perusich: I think it's the path less traveled. 

Dr. Troy Fox: Yeah. I think you're right. 

Dr. Michael Perusich: Because what? 

Ditch PRN Scheduling

Dr. Michael Perusich: Because what do we see so much in this profession? We see doctors who have terrible retention issues. Patients are dropping out left and right and they're making treatment recommendations that are built around treatment plans that are.

Have a PRN schedule and that's just nails on a chalkboard to me. I don't care if you're in maintenance care or acute care, nobody's on PRN. 

Dr. Troy Fox: Yeah. 

Dr. Michael Perusich: Everybody should have a recommended course of action for their care 

Dr. Troy Fox: and unfortunately, what we've seen is, is, is that lifestyle [00:03:00] of pr. PRN type care also is, Hey, I'm calling my banker to let 'em know that I can't make my payment this month, and it's not because.

You're not milking enough outta your patients. I see some people, oh, that's not ethical to do this, that I, I, I hate when people throw that word around. 'cause quite frankly, there isn't anybody out there. I, I just had a PTA come into my practice this week for jaw pain. 

Immediately when I started talking about treatment schedule and I said, you know, as well as I do that it takes time and repetition to make change in the human body.

And she goes, absolutely. I wouldn't have it any other way. She goes, and I, I work that every day and so I'm like, why is it so hard for us to explain when PTs are doing it with their patients? Why is it that hard for you to explain to your patient that it takes time and repetition? That's pretty simple language to get people.

And if the patient says, well, I'll come to you until I start feeling better. Well, that's your choice. I mean, I can't change that. But quite [00:04:00] frankly, for us to get to the bottom of this condition may take longer than you just getting past your pain. Well, isn't that simple? 

Dr. Michael Perusich: Yeah. Yeah. Simple. 

Dr. Troy Fox: Simple. 

Dr. Michael Perusich: Yeah. 

Dr. Troy Fox: And then don't 

Dr. Michael Perusich: be 

Dr. Troy Fox: afraid when you make recommendations.

Do not go well. I think maybe this patient, Mike, you look like maybe. Your shirt's a little thread bare, and your nails aren't clean. It's a 

Dr. Michael Perusich: clean shirt. 

Dr. Troy Fox: I know, but it looks thread bare. No, I'm kidding. I look at the patient, I make an evaluation, but here's what's crazy. I had a doc say to me one time, yeah, I probably should pay put patients on more treatment schedules.

I always know like when they come in and they're in a brand new SUV and they just got their nails done, that they've got the money for care. But I just feel bad about charging 'em for Chiropractic care. 

Dr. Michael Perusich: Oh that is the most ridiculous comment ever. And you know what that 

Dr. Troy Fox: yeah, 

Dr. Michael Perusich: that, that leads into the secret ingredient that's missing.

And I'm gonna hold that right there. 'cause we ought to take a quick break and we're gonna come back and we're gonna talk [00:05:00] about the secret ingredient that is required secret sauce. Make your treatment plans your secret sauce to make treatment plans committable to patients. So we'll be right back.

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Doctor Authority Secret

Dr. Michael Perusich: Welcome back. We are talking about how to structure treatment plans so that patients want to commit to care, and I, I mentioned before the break that there's a secret sauce to it. You know what, I'm not gonna give it to you. [00:06:00] Oh, okay. Okay. All right. It's your doctor authority. It's your doctor authority. 

Dr. Troy Fox: Hey, didn't we just talk about that like last 

Dr. Michael Perusich: We did.

We did. So go back and listen to, 

Dr. Troy Fox: yeah. 

Dr. Michael Perusich: A, an episode of, of an episode back or two. I, I don't, I'm not sure which, but you've. You've gotta use your doctor authority. Okay. So we started off talking about patients want to have problems solved, they wanna be led. And when you come up to a patient and say, well, I don't know, come, come back when you feel like you need to, you know what that says to a patient?

It says, my doctor just quit me. Or it says, my doctor doesn't know enough about my condition that he doesn't know when I, he or she doesn't know when I should come back. 

Dr. Troy Fox: Right? 

Dr. Michael Perusich: And that wishy washiness is what's killing you.

In your practice all the time and you can't hang on to 'em, you're missing your secret sauce. 

Dr. Troy Fox: Yeah, so you don't develop the doctor authority. It kind of goes both ways. If you're not giving 'em recommendations, they're just like, this guy doesn't know what he's doing, or gal doesn't [00:07:00] know what they're doing.

But if you are making proper recommendations and patients are watching you regimentally go through care with the proper reexamination, you don't skip re-exams, you do you, you examine, you follow up, and you show the progress that's being made. If you're doing those things, guess what happens? You get awarded.

Doctor Authority. And now once that patient's, through a treatment schedule, and let's say we're, we're gonna move 'em to a maintenance schedule, that's also the same patient that comes to you and goes, Hey Doc I know this is way outside the scope of what you guys do, but like I'm getting this bariatric surgery, or I'm, I'm contemplating that and I wanted to ask your opinion on it first.

When you get to that point, you've got doctor authority. Yeah. Because they're asking you about things that they know are not in your scope, but they think. And they know that you're a very smart person that probably has some knowledge on that or can guide them in the right direction. That's when you've reached that pinnacle.

So treatment schedules, in my opinion, in a lot [00:08:00] of cases, push patients towards more doctor authority. 

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: Which is what you're looking forward to begin with. Isn't that fantastic? It's, it's like a fringe benefit. 

Dr. Michael Perusich: So ask yourself, why do you share, why do you shy away from making recommendations? 

That's why patients are coming to see you. And you know when, when we start having a lot of patients dropping out and, and we don't really know why, take a step back and look at your authority. Take a look at. Step back and take a look at how you're structuring your care plans and how you're delivering that report of findings.

Are you doing it with authority or are you given patients an opportunity to say, eh, I don't think you're the right doctor for me. 'cause they'll do it quick if you're not careful. 

Dr. Troy Fox: Yeah. If. And a lot of it is just based off of not, it's not even really your knowledge base. It's based off your confidence in the technique that you're gonna use or your honesty.

So like yesterday, I had somebody that would, that had a child that very young, had floppy baby syndrome, she'd had seizures. She's fainted, she's had concussions, [00:09:00] she's mildly autistic. I mean, you name it, she's got it wrong. We talked to her about and she came to me. She has another Chiropractor she's working with that is suggesting her, but they don't do any therapies.

She said, out of all these cool therapies you have in your office, by the way, that was a mailer that we sent out last month and everybody loved it and people have been calling us going, I didn't know you had all this stuff. So anyway, out of all these cool therapies that you have, based off of my daughter's conditions, what therapy would you recommend?

And I told her, I said, you know what? Your daughter has a very complex condition. I go, I would almost classify that as a dysautonomia condition because there's so many things going on. And I said. You know what? Let's look at some red light therapy to begin with. And I said, I don't know that I'm right about this.

And so I'm candidly open and honest with her, which is exact, 'cause sometimes you don't know the answer. There are other times when somebody comes in and they go, Hey, I got a little bit of swelling on my knee, and you're going, let's get some ultrasound on you right now. [00:10:00] Very confident in what you're doing, but also very honest and open is what creates that authority with those patients and they're willing to follow with through, with treatment plans.

Because like I do a lot of shockwave, some of you guys are doing shockwave and gals out there, and when you're doing it, do you tell patients a hundred percent guaranteed you're gonna get better? Absolutely. You don't tell 'em that, right? But you can give a percentage and go, Hey, we've had about an 85% success rate with shoulders in our practice now.

I want you to remember, I always tell people this, there are 15% that don't succeed. 

Dr. Michael Perusich: Yeah. 

Dr. Troy Fox: Remember that as we're setting you up today, I don't want you to go in going 85% means a hundred percent for me. Okay? I'm aware of that doc. I realize I could be on the 15%. I'm not gonna be upset with you if I'm not successful, but I'm gonna follow through with your recommendations and try to be successful.

I said that at a boy, at a girl. That's where, where we're at right now. So when you do treatment schedules the right way it gives you authority. But also drives the patient in the right direction [00:11:00] with a clear set of expectations. That's how you win with the treatment schedule. 

Dr. Michael Perusich: I was gonna say clarity.

Dr. Troy Fox: What do you say to add to that? Because clear set of expectations is, is where I'm going. 

Dr. Michael Perusich: Yep. Yep. You gotta have clarity added in there. You know, patients want, want to really understand how, how is this care going to help me? Is it going to solve my problem? And that's one of the things that I think we're missing is we get so focused on what we are doing as the doctor.

That we don't focus enough on the patient to really drill down on what do they want out of care? What are they looking for? What is their need? What is their problem that needs to be solved and we'll get stuck on pain. Or, you know, they, they've got a disc problem and we gotta fix that. Or they got hypolordosis and we gotta change that.

I doubt any patient ever came into your office saying, doc, I need you to fix my hypo lordosis. I just, I doubt it. 

Dr. Troy Fox: Right. 

Dr. Michael Perusich: They come in and they say, I've got back pain and it won't let me play golf the way I want, want to. So what's the [00:12:00] problem there? Well, the problem is I can't play golf. 

Dr. Troy Fox: Mm-hmm.

Dr. Michael Perusich: That's why I'm here. That's why I'm here. So we, we've gotta drill into. Make our treatment plan recommendations built around what that patient's problem is 'cause that's what they want you to solve. 

Dr. Troy Fox: And then they're gonna be shocked when you explain to 'em that the way that the facet joints set in the human spine, in the lumbar spine really don't allow a lot of rotation.

So it's probably not your lumbar spine causing the problem with your golf swing. To your thoracics or your pelvis, and they're gonna be blown away by that. Tell people what's really going on. Yeah. Quit telling. Oh, you've tweaked your low back. You know? So I, I love when patients come in that have, that have been to somebody that just tells 'em, oh, you twisted your tailbone.

Dr. Michael Perusich: Yeah. I loved it when patients had been somewhere else. 

Dr. Troy Fox: Yeah. 

Dr. Michael Perusich: And then came, and then came to me because I heard it every time. And I know you hear this too, Troy. Yeah. I, I've never had anybody explain it so well to me. 

Dr. Troy Fox: Be thorough and, and be honest, you didn't have a disc slip. Let me explain what a disc is.

It's a [00:13:00] water balloon with jello in it, with a meshed Turkey bag around it. You glue it to your hands. How easy is that to talk about a disc and folks, is that exactly what a disc is? Yep. Yeah. And how do annular fibers get tears in them? Well, one through accidents, but two through lack of motion, and they become choked of oxygen, flaky and fryable.

How hard is it to explain that to a patient? So there are really easy ways that we can talk about very complex things that happen in the human spine that make us absolute experts in a matter of moments. But you have to, but you have to practice those things. You have to get good at explaining things to patients in a way they understand.

And it doesn't take 15 minutes and you don't lose 'em in the weeds while you're doing it. 

Dr. Michael Perusich: Short, succinct, answer their problems. We gotta take another break, but we're talking about building care plans, airplanes and using your doctor authority to get patients engaged in care. So taking another quick break and we'll be right back.

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Clarity and Phases

Dr. Michael Perusich: All right, everybody, we are back. We're talking about using that doctor authority to, uh, get patients engaged in your care plan recommendations. But remember, you gotta make recommendations, so don't be afraid to make recommendations. Be the doctor. If a patient needs X number of visits, they need X number of adjustments, X number of therapies, x number of therapeutic exercises, whatever they need.

Make that recommendation. Don't shy away from it. You don't have to be cheap. Patients want you to be problem solvers. That means you have to be good and you have to have authority 

Dr. Troy Fox: and look at your long term. Do not, and, and here's a key mistake that people make. I'm gonna put you on a short treatment schedule, and then I'm gonna put you on another short treatment schedule, and then we get to the end.

Now we're gonna move you to maintenance and patients go What? What? 

Dr. Michael Perusich: Where did maintenance come from? 

Dr. Troy Fox: No, from day one I talked to you about what we're gonna do. There are three phases of care. [00:16:00] There's acute, acute rehabilitative and maintenance care. We're gonna talk about those three phases of care and how we're gonna get there.

And I'm gonna do it in a matter of 30 seconds. I don't sit there and, 'cause here's the thing, you can beat it into somebody long enough that they start going, this guy's talked to me about this so much and for so long that. It seems like maybe he's being a little pushy with it, so no, I'm just, boom, boom, boom.

Here's what it is. That all makes sense to you. Here's how we're gonna do it, and then here's the beauty. I don't have to spend a lot of time talking about maintenance care. I explain what it is, why we're gonna do it. Then I focus on your treatment schedule, because guess what, I've got time, every time you come through that door to talk about where we're headed and what maintenance care looks like and what your life looks like while you're in that commercial.

For whatever pharmaceutical drug it is. That's what we look like when we get to maintenance care. You're jumping, you're twirling in circles, going through a field of daisies when you get to maintenance care and they're like, oh my gosh, I want that. But no, you got time to talk to 'em every time when they come in so you don't have to beat maintenance care to death.

You introduce the [00:17:00] concept so that way they understand where you're headed it. That's like getting in a car and going, working on a family vacation. You go, where are we going? I don't know, but we're gonna stop in Columbus, Ohio first. Then we, then we go to Atlanta, Georgia. In reality, we're going to New York.

But nobody tells me until we get to Atlanta, Georgia. And then I'm, I'm ear, I'm irked at that point because I would've prepared and brought more snacks if I'd have known we were going to Columbus, Ohio, and then to Atlanta, Georgia, and then to New York. Right. I'm irked. We're your patient's gonna be irked if you don't tell 'em what the plan is and where, where you're going?

Absolutely. So tell 'em upfront and then reinforce that plan as you're going through care. 

Dr. Michael Perusich: And I'm just thinking about how much gas you use to try to get to New York by going all over the place but that's the reality that that's what you're doing when you're inefficient with your doctor authority.

Inefficient at building treatment plans and in inefficient at communicating your recommendations to patients. Yeah. You're all over the place and patients don't wanna make that trip with you. [00:18:00] 

Dr. Troy Fox: Nope. 

Dr. Michael Perusich: They just don't wanna make that trip with you. So if you're having issues with these kind of things, if your patients are dropping out, if they're not engaged in your care recommendations, if you're having trouble building good treatment plans that are profitable for your practice and good for your patients, go check us out at cat's consultants.com.

These are the kinds of things that we help doctors with every single day to help build great practices and have great, amazing patients. In their practices for a lifetime. Troy, anything to add? 

Dr. Troy Fox: You know, I don't toot our horns very often on most of the, most of the stuff that we do when we coach people, we just say it's common sense stuff.

But I will say when it comes to treatment schedules, patient dialogue and verbiage, that is understandable, but yet complex. I don't know that there are two guys other than you and I that really. Probably nailed it harder and still do from a standpoint of being able to do that. I feel like that's been a forte [00:19:00] in my practice.

I know it was a forte in your practice. 

Dr. Michael Perusich: Yep. 

Dr. Troy Fox: Same thing, like you said, you loved having patients come from another doc because you would explain things to 'em in a way they'd never heard before and in a way that they understood and it was very complex, but yet it was simple enough, they remembered it. I feel like you and I both do really well with that.

So this is a hot topic for us that we've loved, and you and I have had many napkin talks. In the afternoons. During, during True Story 

Dr. Michael Perusich: folks 

Dr. Troy Fox: time, we've written on napkins and wrote out things over the years and, you know, and we both wish we'd have saved all those napkins 'cause they were really cool, right?

But this has been a forte of ours for 30 years and, and I'm passionate about it. I love patient education. I think an educated patient makes a long-term patient that takes good care of their own health. So that's what I would add to the end of this. 

Dr. Michael Perusich: Awesome. All right everybody. Thanks for tuning into the KC ChiroPulse podcast.

I wanna thank Chiro Health USA, for being one of our sponsors. Troy, thanks for being here today, as [00:20:00] always. And uh, again, if you need help with anything, be sure to check us katsconsultants.com and be sure to like, and subscribe and tell everybody about the show. All right, I think we're out, Troy.

We'll see you 

Dr. Troy Fox: later.