Pay attention to patient waiting times

Waiting room in chiropractors officeThis is a speeded up world and the admonition to “take time and smell the roses” doesn’t apply when it comes to a health care practice. Patients often visit a chiropractor when faced with an acute problem like back pain. Later, after being educated about chiropractic as a lifetime wellness program, they may come in for regular adjustments without being spurred on by symptoms. But many new and current patients feel they need help right away and can’t or don’t want to wait days or even weeks to come in for their visit.

Waiting for an appointment isn’t a huge problem for the chiropractic profession – yet. There are indications that longer waiting periods may be in store. Some DCs are cutting back on the number of days or hours they see patients. Coupled with an increased demand for chiropractic services, this is creating a backlog for some doctors. It’s not uncommon for patients to have to wait up to a week (or more) to get an appointment, even for what they consider an “emergency.”

At this point, the situation is a far cry from what patients face when wanting to make a non-emergency appointment for a medical provider. A survey conducted earlier this year by the Massachusetts Medical Society found that the average wait for family medicine was 36 days, a week longer than in the 2010 survey. Wait times for some specialties in a few cities was as long as three months.

The outcry over this finding focused attention on the problem of getting appointments in a timely manner, and made all providers keenly aware of the public’s attitude toward what it considers overly long waiting periods.

In the past, some DC practices reserved one day a week for new patient appointments but that still leaves some people waiting six days to see the doctor – six days for them to “shop around” and find someone who can take them that day.

If at all possible, schedule new patients within two days of their call. Consider reserving an hour a day for new patients or “emergency” visits from regulars.

By showing patients you’re available to provide help when they need you, you’ll be making a great first impression and setting the tone for a long-term relationship. Yet, don’t get so eager to bring in new patients that you end up pushing existing patients to the side. One of the top complaints about health care practices is the amount of time patients have to sit in the waiting or exam room.

The normal waiting times for chiropractors rated on one major online doctor review site ranged from five to 30 minutes, but some extended to as much as an hour. Anything more than 15-20 minutes seemed to trigger complaints in some patients.

One patient posted this note: “Very slow! Every appointment I had to wait in the waiting room for at least 45 minutes. Staff needs to work on their people skills.”

Another stated: “This is a classic meat-market kind of chiropractor. Wait in the waiting room for 40 minutes past your appointment time to be put through the mill.”

Still another: “Appointments are dropped and patients are left waiting in the waiting room up to an hour after a scheduled appointment, that’s it … you’re dropped. Come back again soon??? I think not. And if you do get a table, you’ll have to wait some more.”

You get the picture. People aren’t going to put up with waiting an unduly long time to get an appointment and they don’t want to wait more than 20-30 minutes to see the doctor once they’re in the office. That’s not unreasonable. All patients – new and existing – are valuable to a practice and we need to show them the respect and consideration they deserve.

By now you don’t need any more proof of the importance of being “available” to patients. But I have to share with you one more story I read online. This situation – which is extremely rare – shows how bad things can get if you’re not careful in your office:

The patient, who posted her review on a major doctor-rating site, explained that she arrived early in order to fill out new patient paperwork, and then “proceeded to wait 30 minutes while the chiropractor saw patients who arrived after I did. I asked the receptionist how long I’d have to wait – and she assured me that I would be seen in five minutes. After I had been waiting for an hour, the chiropractor came out to the waiting room to see me. He told me that I completed my paperwork too quickly, and proceeded to blame the receptionist for my wait. I asked him if he would be able to see me immediately – and he said he needed to finish up with the patients he had. ALL of these patients arrived after me. He asked me if I could return 3 nights later. I explained that I was very upset and frustrated by being made to wait for (at this point) over an hour, and that I didn’t understand why patients who arrived after me would be see before me. He did not offer any explanation or apology, so I left. In pain, and with much frustration and dismay.”

If even one patient in your office experiences a problem like this and posts the story online, it can cost you dozens of other patients. Don’t let it get to this point. Monitor your waiting times and take time to smell the roses only after you see all our patients for the day!


Ask and you will receive (referrals)

Referrals in a chiropractic practiceIt’s an undisputed business law that word-of-mouth marketing is the most important ‘sales’ tool there is. Nothing convinces a potential customer, client, patient, or consumer to say “YES” to an offer better than a personal recommendation.

That’s why online review services like Angie’s List and social media sites like Facebook have become key marketing tools. It’s all about people telling other people how great (or crummy) a product or service is.

In health care private practices, word-of-mouth marketing most often takes the form of referrals from current patients. One patient gets good results and tells a friend, neighbor, co-worker or colleague. That person comes in, loves what you do, and tells others.

But referrals don’t just “happen.”

How many of your current patients are happy with the care they receive from you? Hopefully, all of them (or at least 80-90%).

How many have sent referrals to your office? Five percent? Ten percent?

If they’re pleased with you, why aren’t the rest sending referrals? It isn’t because they don’t know other people who could use some help with health and wellness issues. We’re all surrounded by people living at less that optimal wellness levels. If they’re not referring others to you, it’s probably because you haven’t asked them or made it easy for them to do it.

Instead of waiting around hoping your patients will send referrals your way, there are steps you can (and should) take to increase the referral rate.

Start out by being aware of statements patients make that offer you the perfect opportunity to ask for referrals. Respond positively, invite them to refer others, and give them the tools they need to take action.

Some examples:

Patient: “I wish I’d started getting adjustments years ago!”

Response: Many people tell me that. They’re always so thankful that somebody recommended chiropractic. It’d be great if people came in before their health problems reached the critical stage. I’ll bet you know a few people who should be coming in now, before things get really bad for them. Let me give you two gift certificates for a free evaluation. They expire in 30 days, so tell them to call for an appointment and I’ll get them in right away.

Patient: “It’s amazing how much healthier my kids have been since coming to you.”

Response: It’s such a shame how many parents still don’t realize chiropractic’s great for children. You probably know a few who never thought about bringing their kids in for adjustments. Tell you what, here are two gift certificates for a free evaluation. They expire in 30 days, so give them to a couple of your friends and tell them to call for an appointment. I’ll get their kids in right away.

Patient: “I don’t understand why my MD didn’t want me to see a chiropractor.”

Response: It’s hard to believe, I know, but many medical doctors still don’t understand what chiropractors do, and they don’t like to refer patients to us. People have to depend on their friends to learn about the benefits of regular adjustments. If you know anybody who might be in the same situation you were in, would you do them a favor and tell them about me? Here are two gift certificates for a free evaluation. They expire in 30 days, so have them call for an appointment and I’ll get them in right away.

It’s particularly important, when asking patients to refer others, that you provide them with the tools to make it easy for them to do so. A “gift certificate” or referral card offering a free evaluation is the standard tool, but don’t feel you have to limit it to that. Find other “incentives” for patients to refer friends, and for those friends to make an appointment.

For instance, subscribe to Integrative Outcome Measurements and make sure all patients receive IOM referral cards that contain your unique referral code. Using that code, people can go online and take a comprehensive wellness survey for free. They can find out their “IOM Wellness Score” and compare it to others who take the survey. People love taking tests and quizzes and matching their results to others. When they do, they are directed to your office for more information, detailed results, and (if you wish) a free evaluation. In this way, your patients are able to give their friends something fun and valuable rather than simply make a referral.

For more tips on how to increase referrals, be sure to read Dr. Noel Lloyd’s excellent article “7 tips for building a referral practice.”


Success comes through helping others

You established your office in a good location. You bought whatever equipment and supplies you might possibly need. You hired an efficient staff. You launched a terrific public relations campaign.

So what.

I don’t mean to sound sarcastic, but the fact is, none of that will guarantee your survival let alone your success. I’ve known successful DCs who’ve set up offices in remote areas, awful locations, and rundown neighborhoods. I’ve met many who had no equipment except a used table and their two hands; others who did all the front office tasks themselves when they didn’t have a spouse or parent to help them out. And what about the mega-successful chiropractors who never put an ad in the paper during their entire career?

If it isn’t the location, equipment, staff, or advertising, then what is the key to success? My theory is that it’s ATTITUDE. If you practice with an attitude of joy and service, how can you not succeed? I don’t mean “feel-good,” poor-but-happy success but financial prosperity, too. I’m talking about a great income to go along with the feeling of excitement you get welcoming the day instead of facing it with boredom – or worse, dread.

I’m hardly the first person to voice this belief in the power of attitude, which is a combination of what you think and how you feel. Books like “The Power of Positive Thinking,” by Norman Vincent Peale, “Think and Grow Rich” by Napoleon Hill, or “See You at the Top” by Zig Ziglar have been preaching that sermon for decades.

Most of these books, along with today’s top motivational experts, mention the importance of character traits like optimism, perseverance, friendliness, being a problem-solver, etc. But to me, the most important attribute is being service-oriented.

If you’re in chiropractic only for the money (don’t laugh, but chiropractic often makes the “top professions” list based on its high income potential)… or because you figured it would be an easy way to get the title “doctor”… or because it was what was expected of you, you’ll never max out your success level.

Even if you decided to become a chiropractor because you experienced the effectiveness of chiropractic first hand and were grateful to your own DC it’s not enough. You have to be in it to help others. Think of it like this. Patients aren’t going to come to you because chiropractic once helped you, or because your uncle was a DC and talked you into it. They’re going to come to you because YOU can help them and everything you do expresses your desire to provide that help.

If you’re not focusing on helping others or if you’ve lost confidence that you (or chiropractic) can help others, you need to get back on track. You need to undergo an intense attitude makeover. First step: read chiropractic motivation books and attend seminars like Cal Jam, New Beginnings, Parker Seminars, Jim Sigafoose’s seminars, Dynamic Essentials, or Sherman’s Lyceum.

Remember, your attitude doesn’t control you – you control your attitude. Without the right attitude, even the finest location, best equipment, greatest staff, and super ad campaigns aren’t going to result in success that truly satisfies and lasts. Yet, you can deliberately and systematically put yourself in the mindset needed to achieve real success. You’ll need to do it continually. Zig Ziglar put it this way: “People often say that motivation doesn’t last. Well, neither does bathing – that’s why we recommend it daily.”

No “so what” about it.


Asking for patient feedback

Not long ago, a chiropractor in the Midwest noticed that many of her regular patients weren’t showing up any longer. At first, she figured it was a seasonal thing (“It’s always hard to get patients to show up in winter…”). But when the weather improved, her PVA continued to decline.

When she was told about a couple of Internet “reviews” on, she was shocked. There, for the entire web world to see, were three scathing comments about her office, posted within the prior two months. One commented on the “nasty woman at the front desk,” and the other about the “lack of concern from the office staff.” The third one clinched it: “Used to be a great place to go. Now, the receptionist named (name deleted) makes me feel like I’m just bothering her.”

The doctor did some backtracking and realized that the sudden drop off in patients started about six weeks after she hired her new CA. She’d never paid too much attention to the CA, since the woman – who had worked as a CA in a chiropractic office in California – seemed to be extremely efficient at record keeping, billing, etc.

The doctor wondered who the patients were and why they didn’t talk with her about the problem. Then it dawned on her: she never asked.

In fact, during her entire career, she never really solicited feedback from patients about their experience in the office. Yes, she took before and after x-rays and made sure she tracked their outcomes so she could monitor their progress. She asked about their health issues, taught them about subluxations, and made sure they understood that chiropractic was wellness care. But she never asked them about their experience in the office. Were they satisfied with the care they were receiving? Were their phone calls answered or returned quickly? Were they made to feel welcome in the office? Did they think the waiting room was too cold, dirty, messy or noisy? Were the office staff members professional and friendly? Were the waiting times too long?

These questions are just as important to our practice as the standard “how are you feeling today?” But unless you ASK, patients usually won’t tell you. Instead, they’ll leave your office without a word of complaint, but never come back. Even worse, they’ll post their complaints on sites like Superpages, Healthgrades, RateMds or Angie’s List. In the past, a few comments from disgruntled patients might have gone unnoticed, but not today.

Research has shown that at least half of all patients now find their providers online and often check out one of the ratings websites to read “reviews” about the doctor., for instance, logs more than seven million hits each month, and who’s going to go to a DC with a rating of two stars?

The solution is to be pro-active: ask for patient feedback. Hand out a “quickcard,” a short patient satisfaction survey. The ones used in the VA system can be easily customized for your office. Patients can take the card home and mail it back anonymously, or provide their name for a call back if needed. You can go a step further and send random patients a confidential questionnaire in the mail asking about their most recent experience in your office. The Patient Satisfaction Survey prepared by the Department of Health and Human Services is a good example of the type of questions you can ask.

If you get a few complaints, act on them. If one person actually complains about something, chances are 10 others were annoyed by it but didn’t speak up.

Also, monitor online review sites and set up a Google search alert for your name and your office name. You’ll get an e-mail when content is posted that contains those names.

Nobody likes to get negative feedback, but it’s the best way to know how your patients feel – and improve their experiences in your office.

Is obesity part of YOUR office?

One of the major factors in health today is weight. Obesity affects more than 50 million adults and 16-33% of all children and adolescents. In just the last 40 years, the problem has increased by 300%. Chiropractors are increasingly being asked to address that issue in their patients, even if it’s simply providing health education.

Sadly, many chiropractic office staff members are overweight or obese, and there are even a number of DCs who fall into that category.

The problem is a common one in the medical field as well. A 2008 report in the Journal of the American Academy of Nurse Practitioners, pointed out that “even a casual examination shows that many nurses themselves are overweight or obese.” In fact, a study of a random selection of nurses and nurse practitioners from each of six geographic regions in the US found that 30% of respondents had an overweight body mass index (BMI), 18.7% an obese BMI, and 5.2% a morbidly obese BMI. In other words – almost 54% of the nurse respondents were overweight or obese.

That brings up an important consideration. Is it possible for an overweight or obese health care professional to be effective in promoting health practices, or educating patients about health, when they don’t provide an example for patients? Isn’t that like having a cigarette smoker teaching patients about the dangers of second-hand smoke?

I’m definitely NOT suggesting you fire a staff member for being overweight. CAs, receptionists, front and back end staffers can all be extremely competent and assets to a practice. Yet, we need to provide those staff members with the same level of health education, counseling and assistance we give our patients.

Not only will eliminating the obesity level of all team members help set a better example for patients, it’ll help improve the bottom line of office profits.

The Calorie Control Council (yes, there really is a council with that name!) came out with a report late last year that concluded: “A healthy staff is good for business… A recent study put the health care costs of obesity-related diseases at $147 billion per year, which can put a heavy price on employers covering paid sick leave and insurance policies.”

According to a 2010 MetLife survey, more than one-third of employers now offer wellness programs, up from just over a quarter in 2005. Among the larger employers – those with 500 or more employees — 61% now offer a wellness program.

Obviously, DCs are in an ideal situation to provide wellness programs to their employees. Just make sure your malpractice insurance policy covers free care you give to staffers.

The trend toward corporate wellness programs also opens the door for many chiropractors to market their services to local companies. Being a wellness professional has tremendous financial and health advantages over MDs, and approaching companies equipped with information on chiropractic’s impact on well being can be a first step in getting your foot into the corporate front door.

(As an aside, you might also look into subscribing to Integrative Outcome Measurements – it can be a powerful marketing tool. In addition to your services, you can offer all employees in a company a free Wellness Evaluation that can provide them with detailed information on their level of overall wellness and of four major components of health: physical, mental/emotional, stress and life enjoyment. It gives you the competitive edge over other DCs looking to work with a company).

Don’t let your website be held hostage

The importance of picking a web designer you can trust was made obvious this week when the Internet grapevine circulated the story about a chiropractic office that allegedly failed to pay the web designer who built its new site.

In a show of what even the designer admits is childish pique, the entire website was turned into a slam against the chiropractor and nasty accusations against him. Although the designer quickly removed the offensive site, the damage had already been done as the story (and the screenshot of the altered webpage) circulated around the web.

Such unprofessionalism may be rare, but it’s vital to remember that anyone who works on your site has access to your username and password and can wreak major havoc with your online presence if a problem arises. Be careful to provide such passwords ONLY to companies or individuals you know and never give them your primary host account and password.

One piece of important advice given by many web experts is that you should ALWAYS register your own domain name rather than assign someone else that task. That way, your domain name ( is never in jeopardy. Even if your website should get “taken hostage,” you can redirect your domain to another host account. This is very easy to do by using a reputable company (I usually use GoDaddy).

If you already have a domain name, double check to make sure that you’re the registered “owner” by going to and entering your domain name. If you aren’t listed as the owner, contact the person who is (probably the company you paid to register the name) and ask to have the account transferred to your name. If the company or individual refuses, you may be in for a battle or find yourself needing to pay an additional fee.

If you require an outside company to do your web design and programming, be sure you establish your own account with whatever hosting service you or your consultant decide on Again, I use GoDaddy since it’s inexpensive, easy to use, and has good customer service.

Once you set up your own account, you’ll receive an e-mail with your login information. Using the online dashboard, set up your administrative privileges and add your web company as a “user.” You can remove the company’s user designation when the work has been completed, and you’ll be left with total control over the account.

For more information, be sure to read the article “Avoid being held hostage by your Web designer” on last month’s Entrepreneur magazine blog.

For a blast of motivation

It’s inevitable that our enthusiasm will sag now and then, no matter how much we love what we’re doing. In private practice, as in any endeavor, there’ll be times when the steady stream of patients or projects keeps us busy, but not motivated or inspired.

I have two sure-fire ways to re-infuse your practice with a little excitement:

#1. READ inspiring books – from the Green Books to the latest motivational best sellers, there’s something for everyone. A few of my latest recommendations include:

Lessons From Everest: 7 Powerful Steps to the Top of Your World by Tim Warren, DC

Infinite Possibilities: The Art of Living Your Dreams by Mike Dooley

The Psychology of Achievement: Develop the Top Achiever’s Mindset by Brian Tracy (great as an audio CD for listening while you commute to the office)

#2. ATTEND a chiropractic event! Recently, the Parker Seminar in Las Vegas and the New Beginnings Chiropractic Weekend revved up hundreds of chiropractors and sent them back to their offices on fire with chiropractic! When you get a chance, visit the New Beginnings Facebook page and check out the fantastic gallery of historic chiropractic photographs like this one:

Although the speakers at these events are wonderful motivators, I think being around like-minded people is the key to catching the enthusiasm bug. You can’t possibly go back to your office in a dull mood after spending a weekend at one of these events.

The right metaphor can increase patient understanding

Ohio State University just released a study showing that the language doctors use with their patients can help determine whether these patients agree to participate in clinical trials testing new cancer treatments.

The same thing holds true with chiropractic and other wellness professions — using good metaphors can help explain everything from subluxations to chi energy and determine whether people decide to receive (or continue receiving) care.

The nervous system as water hose metaphor has been used for years.

In the study, doctors explained the concept of “randomization” to a group of 64 low-income, rural women over age 50 living in Appalachia. All of them watched a short video produced by the National Cancer Institute describing clinical trials. They then watched an additional video further explaining randomization, featuring a local doctor.

A third of the participants saw a video which explained randomization using simple language: “Randomization is a method used to ensure the research study is fair. It means that patients are assigned by chance to different treatment groups.”

For a second group, the video explained that randomization was like “a flip of the coin” determining whether they would be in the treatment or standard-care group. “The chance of getting heads is the same as getting tails,” the doctor said.

The third group saw a different video with a local doctor who explained randomization with a metaphor that it was “like determining the sex of a baby. The possibility of a boy is the same as the possibility of a girl.”

Some people didn’t need the “metaphor” video at all. They paid attention to the first video and understood the concept. But for others, the metaphors helped – in different ways.  The “flip of the coin” concept was a turnoff to most (the ‘winner-loser’ notion isn’t real smart when you’re talking about cancer treatment!) while for most of the women, the baby metaphor worked.

Using metaphors to explain concepts like subluxations, neurological functioning and symptoms (such as the well-used light bulb, train system or fire alarm) are all helpful, but we have to consider our “audience” when we choose which metaphor to use. While it may sound sexist to make assumptions about such things, using mechanical or sports metaphors are likely to have more impact on male patients and clients. Metaphors involving relationships and recipes are generally going to elicit more response among women.

As non-medical providers, wellness professionals also need to be careful about using metaphors that portray the body in an overly mechanistic manner. Neurolinguistic psychotherapists Penny Tompkins and James Lawley point out in an article titled The Mind, Metaphor and Health, that “Doctors [i.e., medical doctors] tended to use metaphors which assume the body is a machine (the urinary tract was the ‘waterworks’, bodies could be ‘repaired’, joints suffer ‘wear and tear’); illness is a puzzle (symptoms are ‘clues’ to ‘problems’ that have to be ‘solved’); and a doctor is a controller (they ‘administer’ medication to ‘manage’ symptoms and ‘control’ disease).”

Wellness professionals need to develop and use a new set of metaphors that stress the vitalistic nature of the body without pushing too far into the realm of religious rhetoric. It’s an interesting challenge but the right metaphors ultimately will help redefine health and educate patients.

No more resolutions!

Are you as bored with making New Year’s resolutions as I am? Every year we make our list, and although our intentions are good, most of us don’t make it past Feb. 1st before we lapse back into our old habits or patterns. It’s bad enough when this happens in our personal life (losing those last 10 pounds or spending more quality time with family are definitely resolutions we should keep). But when it happens in our professional life, it can mean financial disaster or burnout.

It’s some consolation to know we’re not alone. According to psychologist and neuroscientist Howard Rankin, founder of the American Brain Association, 80-90% of Americans don’t stick to their resolutions. Dr. Rankin, who’s been featured on The View, 20/20 and CNN, says he’s figured out why: “Most people try to do it through sheer willpower alone, and that won’t work. Without a more comprehensive strategy in place, you’re just setting yourself up for failure.”

I suppose that’s good news, since most of us have a willpower deficiency. But that doesn’t mean we just give up. “It’s entirely possible to create a better you in 2011,” Rankin confirms. “You simply have to be willing to really commit to these five steps. Lifestyle change isn’t a one-step fix…it’s a constant process. As I like to tell my clients, life is hard … and you need practice!”

So, in time for New Year’s Day, here are Rankin’s “Five Keys to Behavior Change”:

Step 1. Stoke Your Motivation. Most of us are in the habit of beating ourselves up if we lack motivation. Somehow, we think we’ve failed if we just can’t muster the energy to do a mall show or write a research report. But guess what? That’s normal. Motivation isn’t static; it ebbs and flows just like the tide. (Ever notice how you’re super-motivated at the outset of a personal change effort, but a week later you’ve run out of steam?) The key is to develop ways of keeping motivation at the forefront of your mind enough of the time to make a difference.

“Here’s where most people go wrong,” Rankin says. “They don’t realize that motivation is about emotion and passion — in other words, why you want to do something. They set goals — ‘I want to lose a few pounds’ — but have nothing in place to drive that behavior. The question is, why do you want to lose a few pounds? It’s the why that’s going to influence your actions. You might say, ‘I don’t want to have a stroke when I’m sixty like my dad did,’ or, ‘I want to live long enough to see my grandchildren graduate from college.’”

Rankin suggests coming up with a mantra that captures your why (for example, ‘Fit at Fifty, Free at Sixty’) and visualizing both what you don’t want (you eating junk food and having a heart attack) and what you do want (you exercising and enjoying an outing with your family). Yes, it’s okay to be negative! In most instances, he points out, it’s a fear of loss and negative consequences that kick-starts motivation the hardest.

Applying this to a chiropractic office, you can think about WHY you want to increase your patient volume. It may actually be so you can help more people live healthier lives … or it may be you want to retire at 50. Either way, focus on the WHY rather than on the numbers.

Step 2. Find a Way to Self-Monitor. A great deal of human behavior is done on autopilot — so if you want something to change, you’ll have to pay attention to your own behavior and experience. Otherwise, by the time you realize you’re going in the wrong direction, it’ll be too late. Yes, the concept is simple (in theory, anyway): Vigilance is associated with success. The more you’re aware of what you’re doing, the more you can control it.

“No matter what your resolution is, you have to find ways of monitoring yourself,” Rankin asserts. “Most people write down their behavior patterns, but you might just as effectively talk into a recorder. Not only does keeping a record help you pay attention to what you’re doing, it allows for subsequent analysis that will help you understand what prompts your behavior, and any patterns it might fall into.”

Since many people tend to self-monitor with diligence in the beginning but gradually become more and more lax, Rankin suggests recording every instance of a successful or unsuccessful behavior in the first week. Thereafter, pick one day a week for self-monitoring.

Step 3. Hone Your Self-Control Skills. While willpower goes only so far without good habits to bolster it, it’s still an important part of the lifestyle change equation. Self-control is a critical skill when changing a behavior and the good news is that it can be developed.

“There are two broad approaches to managing temptation,” Rankin explains. “The first is avoidance. But let’s face it — that’s not always possible. A better strategy is to confront your temptation and develop a controlled way to deal with it. As I’ve mentioned before, visualization is a valuable tool because it allows you to ‘practice’ your self-control without being exposed to real-life dangers and pitfalls. Essentially, on a daily basis you need to imagine yourself successfully resisting difficult situations.”

Step 4. Identify and Manage “Backsliding” Red Flags. You may have noticed: Your moods, outlooks, and attitudes tend to change almost constantly — and they play an important part in the decisions we make and the way we behave. Many people are more prone to make unhealthy decisions, give in to temptation, or otherwise “backslide” when they’re tired, stressed, or angry, to name a few common weak spots.

“Fortunately, knowledge is power,” Rankin assures. “When you are able to identify and anticipate things that typically cause you to slide into a self-destructive state, you’ll be much better equipped to handle them. For example, if you know that having to present at the quarterly meeting will cause you to stress-eat whatever’s in the breakroom for days beforehand, you can proactively practice other stress-management techniques, such as deep breathing exercises and, yes, visualization.”

To help you identify and then manage self-destructive states, ask yourself what moods, physical states (e.g., pain, fatigue), people, places, and times of day are associated with self-destructive states. Then brainstorm how you can manage them, how you can avoid them, and who can help you handle them effectively.

Step 5. Take a Hard Look at the “Other People” Factor. The fact is, others have a huge influence over our behavior, and since no one lives in a vacuum, you’ll have to factor in other people when going after your resolution-keeping goals. It’s important to realize that no matter what your preconceived opinions or decisions might be, your behavior will slowly but surely change to reflect that of the people you spend time around.

So, if you’re surrounded by CAs, associates or staffers who don’t share your goals, it’s time to re-evaluate if you’re in the right office (or if THEY are!)

“These five steps are the basics,” Rankin concludes. “They’ll give you the foundational tools you need to optimize your life in 2011. As you approach the New Year, think about how each step applies to you specifically, and how you can hardwire it into your day-to-day routine. This sort of strategizing doesn’t happen on the fly. You have to make time for yourself so that you can focus on your own needs — ideally, you should have one hour of ‘me time’ every day.

“It won’t be easy, but it will be effective. If you take one resolution at a time and build behavior change slowly, you’ll be amazed at how much healthier your life is when it’s time to celebrate the coming of 2012. Guaranteed!”

For more information on Rankin and his programs, visit

To help, do we need to diagnose first?

For years, chiropractors (as well as most other CAM providers) have debated the need — or even the wisdom — of diagnosing diseases before we adjust patients.

One contingent in the alternative health care field feels it’s important to make a differential diagnosis and put a name on the specific disease or condition presented.

The other contingent believes the aim of non-medical care is to help the human body achieve homeostasis so it can heal itself, and that for what we do (whether it’s adjust the spine to remove interference from the neurologic pathways or use acupuncture needles to balance chi) we don’t need to label the disease.

Apparently, even the medical profession is beginning to realize the wisdom of the latter approach. According to a new Johns Hopkins-led research study, slavishly following long-held guidelines for diagnosing the cause of arthritis-related back pain is resulting in excessive tests, delays in pain relief, and wasteful spending of as much as $10,000 per patient.

While arthritis is a common cause of back pain, experts say it’s difficult to diagnose precisely because of the poor correlation between a finding of arthritis on an X-ray or MRI and the degree of a patient’s back pain. That has routinely led to a series of temporary diagnostic nerve blocks to prove the arthritis connection before doctors will recommend radiofrequency denervation, which is a relatively safe, noninvasive procedure that interrupts nerve-pain signals from arthritic joints.

The new study, published in the August issue of the journal Anesthesiology, says the wiser course is to skip the diagnostic nerve blocks altogether and move straight to treatment when arthritis is the suspected cause of back pain.

“The whole way we’re doing this is wrong,” says study leader Steven P. Cohen, MD, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “If we just do the radiofrequency procedure first, we’re going to help more people and we’re going to save a lot of money. Our goal is to get people feeling better,” he says. “When you do two blocks, you may be wrongly weeding out many people who would actually benefit from radiofrequency denervation.”

I wonder how many times CAM providers “weed out” people because they feel they need to come up with a specific diagnosis before they can reach out and help that person. If they can’t label the condition, they send them to a medical doctor, who injects them with pain killers and far too often scares them into unnecessary surgery (usually with the best of intentions, but based on their limited understanding of wellness and the body’s innate ability to heal itself).

Dr. Cohen, who is also a colonel in the US Army Reserves and director of chronic pain research at Walter Reed Army Medical Center, says the idea to do without diagnostic blocks came from his experience treating active-duty soldiers who complain of debilitating back pain. Deployed military doctors are under time pressure because soldiers who can’t be sent back to their posts quickly are likely to be evacuated out of a war zone with the likelihood they won’t return.

In the civilian world, he says, patients also should be treated as quickly and safely as possible. Going straight to treatment typically means that those patients can also return to work and their normal lives in a shorter period of time.

I think that’s a good policy for chiropractors and other wellness providers to adapt. Go straight to “treatment” and help as many patients as possible lead healthier lives. Adjust their subluxations so they have an improved neurological function and musculoskeletal condition!

SOURCE: “Multicenter, Randomized, Comparative Cost-effectiveness Study Comparing 0, 1, and 2 Diagnostic Medial Branch (Facet Joint Nerve) Block Treatment Paradigms before Lumbar Facet Radiofrequency Denervation” by Steven Cohen, MD, et. al. Anesthesiology. 113(2):395-405, August 2010, doi: 10.1097/ALN.0b013e3181e33ae5. Online