This isn’t surprising since, behind the scenes, organized medicine continues to fight to restrict chiropractic to musculoskeletal “treatment” of chronic low-back pain in adults. While I’ve always opposed expanding the chiropractic scope of practice into medical areas, I’ve spent my career trying to make sure we have the legal right to provide care to ALL people, regardless of age or symptomology.

Since I view chiropractic as a holistic and neurologically based approach — one that allows the body to better address all health issues — I’m actually a “broad scope” proponent in the widest meaning of that term. Yes, I draw the line at any kind of medical procedures (i.e., drugs, surgery, differential full-body diagnosis, etc.) but I definitely don’t want chiropractic limited to the role of pain relief for back pain.

For those who feel we’re ready to join forces with the medical profession, I suggest a review of how the American Medical Association (AMA) and other elements of organized medicine continue to fight the expansion of all CAM approaches into what they see as their “turf.”

For instance, an article Amy Lynn Sorrel published in the Jan 25, 2010, issue of American Medical News noted with a touch of braggadocio that “in 2009, physicians fought a blitz of scope-of-practice expansions by other health professionals on legislative, legal and regulatory fronts. Organized medicine defeated attempts by naturopaths to seek licensure, prevented chiropractors from being able to perform invasive procedures and achieved further regulation of lay midwives. The efforts were among more than 300 scope-related bills the American Medical Association tracked last year.”

Sorrel added that “Physicians don’t expect the battles to let up, and with patient safety on the line, they are countering such efforts with some fresh tactics.”

Among their efforts will be to make it illegal for anyone but medical doctors to use the term “doctor,” establish state MD-dominated review panels to evaluate plans by non-medical health professionals to expand their practice, and mandate that non-medical doctors wear badges identifying their credentials. Let’s hope they aren’t suggesting badges with yellow stars.

Among the health professionals in the crosshairs for the AMA are nurses, podiatrists, naturopaths, optometrists, and — of course — chiropractors, all of whom appear to threaten the AMA.

A case in point was the Texas regulation that permitted DCs to perform manipulation under anesthesia and needle electromyography. Because of efforts by the AMA, the court overturned the Board’s decision and barred those procedures. The AMA and its allies also won a partial victory in Texas over whether the word “diagnose” could be used instead of “analyze, examine or evaluate” (which is permitted in the Texas Chiropractic Act). On Aug. 17, the court decided that DCs may “diagnose” — within limits. The final decision is up in the air and no one knows, at this time, exactly what it all means.

As I mentioned above, I disagree with some of the suggested scope expansions promoted by chiropractors, but it’s because they tend to make the profession more medically oriented rather than broaden their scope to include more people.

What I do know is that no matter what we see as chiropractic progress — whether it’s to become more ‘medical’ or, as I hope, to become less medical and address a full slate of neurological as well as musculoskeletal issues — we need to understand that organized medicine is NOT a friend of chiropractic or any other non-medical health approach.

As patients continue to join in the mass exodus away from allopathic medicine, the backlash against alternatives will continue and I strongly urge DCs to be careful when establishing “alliances” with medical professionals. Exceptions do exist and I know several MDs who are truly interested more in their patients’ well-being than they are in protecting their turf, but these ARE the exceptions, not the rule. Let’s move as far as possible away from the medical paradigm and allow them to stomp on their own grounds while we claim more fertile territories.

SOURCE: “Organized medicine pushes back on expansions of scope of practice” AMA News, Jan. 18. 2010.

"Laptop-itis" -- a growing problem

For years, chiropractors have been in the forefront of posture-related health care and have led the campaign to raise awareness of heavy backpacks that can distort the young student’s posture. Now, they’re seeing an increase in the number of young people with neck, shoulder, and back problems caused by hunching over a laptop computer.

“More and more patients, mostly young adults, are coming to chiropractic offices for upper back pain, and this is something doctors need to be aware of,” Terry A. Rondberg, DC, founder and CEO of the World Chiropractic Alliance noted recently. “The medical profession has dubbed it ‘laptop-itis,’ only half jokingly. They’ll be recommending pain pills and surgery for these kids. If chiropractors can help them first, with adjustments as well as education on posture, we may keep them from the surgeon’s knife.”

Because of the way the computers are designed, using a laptop almost inevitably leads to poor posture, noted Kevin Carneiro, DO, a doctor in the Department of Physical Medicine and Rehabilitation at the University of North Carolina at Chapel Hill School of Medicine, one of several medical institutions addressing the laptop issue.

The widespread use of laptops in schools (some colleges actually require students to purchase them) means an even greater problem in the future.

“Just as they did with backpacks, chiropractors can step up and become the number one resource for helping students avoid these postural problems, and care for those already showing symptoms,” Dr. Rondberg added.

Some tips to pass on to patients who use laptops:

• Position the laptop for the most neutral wrist posture you can achieve; avoid having to bend the hand or wrist at an unnatural angle.
• Position the laptop on a desk or work surface and tilt the screen so you can view it without having to bend your neck.
• Whenever possible, use a separate keyboard and mouse. There are small portable devices that can plug into a USB port.
• Get a lightweight laptop — and determine the “real” weight, with batteries, accessories, etc.
• Take short breaks every 20 minutes and do gentle stretching exercises such as shrugging your shoulders, bending your head from side to side, or other exercises recommended by your DC.
• Drink plenty of water to keep the discs in your back lubricated and healthy.
• Consider loading the StretchWare program on your computer; it will remind you when to stretch, and give you visual guidance on a variety of exercises.

SOURCES: The World Chiropractic Alliance; University of North Carolina at Chapel Hill School of Medicine

There’s no way to tell how many of these are being run by chiropractors and other natural health care practitioners, but Googling Chiropractor OR Chiropractic results in some 16 million hits. Add the word “blog” to your search words and you still get 1,810,000 results. Obviously, a lot of people are talking about chiropractic — and a lot of chiropractors are talking to people via the pages of a website or blog.

But can having a blog really attract new patients and build a more success practice?

Of course. ANYTHING you do that helps gets the chiropractic message out to people in your area, and gets your NAME in front of them, can increase patient volume and retention. If you stand on the street corner in a clown suit handing out business cards, eventually you’ll hand one to someone who’ll end up being a patient. If you print up 10,000 flyers and superglue them on every car windshield in the entire shopping mall parking lot, you’ll get a new patient or two out of it.

The question isn’t whether a particular marketing strategy will bring in new patients. It’s whether that marketing strategy is worth the time, money and effort it takes, and if the ultimate result will be more patients. The clown suit trick will get you a new patient — but probably lose you 20 current patients who see you and decide not to return. The superglue tactic will get you a new patient but it’ll be the most expensive patient you ever attracted (especially after you figure in the lawsuits for ruining people’s windshields).

Blogs CAN bring in new patients, because they give you an opportunity to put a human face on your office, to communicate regularly with both current and potential patients, to tell the chiropractic story (however you feel it should be told), show off new staff or equipment in a non-advertising manner, and position yourself as a caring and active member of your community.

Health care consumers are increasingly turning to the Internet for help in making their health decisions, including which practitioner to go to. It’s not the ONLY factor in their decision, but it’s a major one. According to the latest report from Manhattan Research — a health care market research company — the Internet now has far more influence over consumer health decisions and actions than traditional channels like print, TV, and radio (“Health Influence Mapping: Benchmarking the Influence of Various Sources on Consumer Health Actions,” Feb. 2010)

So, being on the Internet is almost a must today. But blogging is something different. It’s far more time consuming than many people realize, since content has to be added frequently (at least once a week). The content also has to be “fresh” and personal. And it has to be written carefully so that you don’t say something that will get you in trouble with your board. Sloppiness in spelling and grammar or even the formatting of your page can turn potential patients away. After all, if you aren’t careful about your own blog, will you be careful with their health?

You’ll also need to either turn the “comments” function off or monitor comments carefully. Robot spammers WILL get to your site within weeks of it going live and you need to make sure that your blog doesn’t get cluttered with crap.

You also have to make a long-term commitment to keeping the blog. If someone goes to your blog and it’s either no longer there or hasn’t been updated in several months, the natural assumption is that you’ve closed your office. Click. They’re on to the next hit on the list. Same thing if your site doesn’t load properly or if it’s hard to navigate. Click.

Luckily, blogs are pretty inexpensive and, with blogging software like WordPress, they’re far easier to use than “real” sites. (TIP: Host your blog on your own web hosting company. To be successful, you have to appear successful to the world and having a “freebie” blog on the wordpress or blogger.com servers looks amateurish to many.)

Before you begin, make sure you understand what’s really involved. If it’s something you might really enjoy doing (or have a talented staff member who can do it for you), it might be worth a try. Just don’t go into it thinking your blog will “go viral” and you’ll attract new patients by the hundreds.

He rightfully reminds us that we work hard to gain our patients’ trust and can expect them to ask about a variety of health and wellness services and products. The temptation is always to give them the least expensive options, but this isn’t always the best course of action.

“When asked, you should recommend what’s best for the patient, no matter the cost,” Dr. Breitenmoser advises. “There’s nothing wrong with recommending certain products, as long as you believe in them and know the company is a trusted name.”

These products can range from nutritional supplements, weight loss products, topical over-the-counter analgesics, and natural foods to orthopedic supplies, mattresses, pillows, backpacks, sports equipment, home gym and exercise equipment, or even ergonomic chairs!

You could, of course, refer them to the local pharmacy for their vitamins or the nearest Wal-Mart for the rest, but it could be helpful to patients if you would recommend or even sell high-quality items to them from your office.

In addition to helping your patients, this is also an ethical and low-cost way to increase your own revenue. As Erich notes: “Back-end marketing is extremely important for long-term practice growth and for the overall success of a sales and marketing venture… Back-end marketing is a very inexpensive form of marketing because the largest expense relating to marketing (new patient acquisition) has already been incurred or absorbed.” (Erich lists four specific reasons why you need back-end strategies, so be sure to read his complete article.)

The addition of multiple streams of income has become all but essential in most private practices today, and I’m not talking only about chiropractors. According to an article on the medical site, Physicians’ Practice: “As reimbursements fall and costs continue to climb, private practitioners across the country are adding an impressive selection of new products and services to their line-up — a direct attempt to diversify and enhance revenue streams. Some sell pharmaceuticals and prosthetic devices. Others offer physical therapy and smoking cessation clinics, along with inhouse elective procedures such as vasectomies, Botox injections, and laser hair removal.”

Thank goodness we don’t have to resort to doing that! But if we don’t help our patients find the health and wellness products that will help complement chiropractic care, they may end up at their MD’s office asking advice. So, take the initiative and give some thought to which products or services your patients would benefit from and consider implementing back-end marketing programs to provide those items.

As Erich succinctly puts it: “To be successful in chiropractic marketing in the long run, you MUST become adept at back-end marketing in your office.”

It looks very much how I envision the nervous system, with nerve impulses traveling from point to point within the body, carrying their own “cargo” of messages and instructions.

There are busy times and slow times, but the nerve centers never completely go dark.

Can you image the work air traffic controllers have in keeping all this coordinated and running smoothly? They redirect those yellow dots to reduce the risk of accidents.

To me, chiropractors and other wellness professionals who deal in the neurological functioning of the human body are like air traffic controllers. We don’t create the energy but we help it flow as it should and prevent “accidents” that occur when the energy flow is disrupted. Also, like air traffic controllers, we can’t always prevent accidents — pilot/patient “error” is still a factor.

At the risk of belaboring this analogy, there’s another thing we have common with air traffic controllers: we can suffer a great deal of stress because of our “calling.” We worry about our patients, income, profession, and families. We work long hours and battle insurance companies as well as those who favor a medical monopoly over health care. We even, at times, have to deal with bickering within our own professions and organizations.

But our work is so important that we can’t afford to allow ourselves to succumb to stress. We have to take time to care for ourselves, to rest and recharge our mental, physical, emotional and spiritual batteries.

If you’re feeling like an air traffic controller trying to juggle all the planes in that video, you need to back off and take time for yourself. If you don’t, you’re going to “crash.” Which will be more disruptive to your practice and your life: a few days off to relax, or a month off to recover?

The study, by the University of Illinois at Chicago and the VA Center for Management of Complex Chronic Care, was the largest ever to be conducted using actors presenting as patients in doctors’ offices.

“Physicians did quite well at following guidelines or standard approaches to care, but not so well at figuring out when those approaches were inappropriate because of a particular patient’s situation or life context,” said Dr. Saul Weiner, associate professor of medicine and pediatrics at UIC and staff physician at the Jesse Brown VA Medical Center, lead author.

Weiner said physicians need to understand why a patient is failing, for instance, to control their asthma, rather than just increase the dose of the drugs they prescribe. Specific issues — such as the lack of health insurance, the need for less costly treatment, or difficulty understanding or following instructions — must be recognized when making clinical decisions. Inattention to such issues leads to what are called “contextual errors” in patient care.

The study used actors trained to simulate real patients in 400 visits to a wide range of physician practices in Chicago and Milwaukee, including several VA sites. At each clinic, identities were created along with medical records and insurance information for the actor-patients. The doctors had all agreed to participate in the study but were not told which patients were actors.

Unlike real patients, the actors, or “unannounced standardized patients,” consistently adhered to a script, enabling researchers to make comparisons of physicians’ performance across the visits, said co-author Alan Schwartz, a methodologist and UIC associate professor of clinical decision-making.

Four case scenarios, each representing a common outpatient condition, were developed. Each case had four variants — uncomplicated, biomedically complex, contextually complex, or both biomedically and contextually complex.

The actors followed scripts that contained hints or “red flags” of significant issues which, if confirmed, would need to be addressed to avoid error. The actors always started with the same two red flags, but were randomly assigned to respond differently based on the variant.

For example, in a case involving a 42-year-old man concerned about worsening asthma, the actor mentioned both a biomedical red flag (coughing at night) and a contextual red flag (losing his job) that suggested acid reflux and loss of health insurance, respectively, as a key part of the problem.

The study looked at whether the physician picked up on the red flags and implemented an appropriate care plan for each of the case variants.

Not many did. For those patients where individualized care required modifying the “customary treatment,” only 22% of the doctors provided error-free care during a contextually complicated encounter, 28% during a biomedically complicated encounter.

When both contextually and biomedically complications were present, only 9% of the doctors made error-free medical decisions.

Even when no “complications” were present and doctors didn’t have to modify “customary practice,” only 73% provided error-free care.

“To date, measures of doctors’ performance have focused on situations where knowledge of the individual patient is ignored,” said Weiner. “Under those conditions, physicians did fairly well. But as soon as care required more than following an algorithm — finding out what’s really going on with a patient and acting on that information — only a minority of physicians got cases right.”

Interestingly, it didn’t even matter if the doctor spent time with the patient — they still got it wrong. “We expected that if physicians had more time with patients, they would be more likely to individualize care,” Weiner said. “But what we found was that among those visits where physicians did a great job identifying contextual issues and addressing them, they did not on average spend any more time with patients than the physicians who didn’t recognize contextual issues. That was surprising.”

The study found that physicians were more likely to respond to the biomedical rather than contextual red flags even when both were equally important to planning appropriate care. “We believe that reflects the way in which physicians are educated,” said Weiner. “The lesson here is that there has to be a dramatic change in the way we train physicians.”

The lesson we, as non-medical wellness providers, have to learn is that — unlike the allopathic paradigm — one size does NOT fit all. While it’s important to be aware of clinical guidelines and customary practice, we can’t so slavishly follow the guidelines that we overlook patients’ individual needs. Every person who enters our office is unique and we have to approach each encounter as a distinctive opportunity to provide care tailored made for that individual.

The drug industry is already beginning its back-to-school vaccine push, and once more chiropractors and other wellness professionals will be leading the campaign against mandatory vaccinations. You can help by learning the facts about vaccines (a good place to start is the National Vaccine Information Center and sharing that information with patients as well as community members (they have a number of excellent downloadable flyers).

Become aware of the exemptions allowed in your state for school children and protest the forced vaccination of children against their parents’ wishes. Many states are inserting “philosophical exemptions” that permit children to skip vaccines if their families have strong but not religious opposition to the drugs.

It’s also the time of year drug companies pump up their advertising for cold and flu medicines (every season is cold season to them!). In response, distribute information on the studies done on chiropractic and immune function (see the WCA position paper and the lengthy list of references supporting the claim that chiropractic can boost immune strength). Place a big poster with this quote in your waiting room:

“People who receive regular chiropractic adjustments have immune system competency that is 200% greater than those who don’t.” — Dr. Ron Pero, New York Preventative Medicine Institute and Environmental Health at NYU.

Chiropractors need to start a campaign to remind parents that health comes from INSIDE the body — not inside a bottle of pills.

And, of course, there’s the problem of backpacks, which seem to grow each year. I’ve seen kids wearing backpacks that would bring a longshoreman to his knees. The strain they put on back muscles, and the damage they can do to posture definitely involves the chiropractic profession.

CJ Mertz, DC, president of Full Potential Leadership, warned about this problem years ago: “The weight of their packs and the one-sidedness has led to an epidemic of adolescent back problems. The time has come for chiropractic to take the leadership position and save these children from a lifetime of suffering.”

There are a number of excellent resources online for information about backpack safety (such as Backpack Safety America and Posture Pro) where you can download research data. You might want to consider stocking some good backpacks to sell to your patients for their kids. Not only will you increase your revenue, but you’ll be going the extra mile to help protect the children’s health.

And don’t forget to use your local newspaper to spread the word about your efforts. Sending in an article, letter to the editor or press release helps educate the public AND position your office as a true “back to school” health resource. (search Google news for press releases by other chiropractic offices to give you some hints on how and what to write).

The kids may be going back to school soon, but we have to get back to work if we’re to help them get through the months ahead!

This is an important question because chiropractic isn’t just about getting sick people well. It goes far beyond the traditional ideas of health and actually has a powerful impact on the personal total well-being: physical, mental and emotional — all the elements that go into “performance.”

Parker College President Fabrizio Mancini gave the near-perfect answer when he stated: “One of the things that appeals to me about our profession is that it deals with function, which is a very similar word to performance. The reason why so many high executives, celebrities, and sports people use chiropractic is because they recognize that they do perform better. For the last 20 years, I always get adjusted before I give a speech. I never know in advance what I’m going to say and I believe I perform better when I’m adjusted. I get adjusted once or twice a week because of my travel experience and physical activities.”

It’s easy to sell “performance” to athletes because, in the chiropractic context, we tend to associate the word with some kind of physical feat. There’s even some research to support the benefits of chiropractic for athletes, such as the study published last year in the Journal of Chiropractic Medicine. Researchers studied 43 golfers and those who received chiropractic care hit their balls farther. In another study, 50 athletes were tested and the group that received chiropractic adjustments showed significant improvement in all 11 tests used to measure athletic ability, including agility, balance, kinesthetic perception, power, and reaction time. A study in the Feb. 2006 issue of the Journal of Manipulative and Physiological Therapy showed a significant improvement in quadriceps muscle strength in subjects receiving chiropractic care (good news for those athletes needing to lift large objects like opposing players).

Okay, so none of these studies are going to win the Nobel prize in medicine, but they confirm what we’ve seen in chiropractic offices for more than a century — chiropractic is great for both professional and weekend athletes.

But, as Dr. Mancini pointed out, athletes aren’t the only ones who “perform.” Executives have to hit a homerun at board meetings; mothers need to make a slam dunk every time the kids call for help; taxi drivers have to have the quick reflexes and stamina of an Indy 500 driver; computer operators require the concentration of a gymnast (and knowing how they hunch over their computers, most of them probably pull more muscles than a linebacker). Even giving a speech, as Dr. Mancini notes, is a performance that can be enhanced by chiropractic.

We can’t put a sign on our door saying we help improve public speaking skills, but in our patient and public education information we can make sure we explain that chiropractic does far beyond what we normally think of as “therapy” or “medicine” (despite the titles of our research journals). Nobody needs to be sick or in pain or exhibit a list of symptoms to be relieved. Healthy, active people who want to perform better in all aspects of their lives can benefit from chiropractic. You just have to make sure they know it!

Those percentages get eaten up very quickly, given the cost of the almost obligatory (though of questionable value) Yellow Page ads; print or broadcast media ads; promotional and marketing material including flyers, mailings, brochures, etc.; and the marketing of open houses, health fair booths, and other activities and events.

That helps explain why many wellness professionals turn to the internet. Look at some of the press releases posted by chiropractic offices online at 1888 Press Release and PR.com. They announce almost everything — changes in staff health, health lectures, new equipment or services, notable events, etc.

Press releases can (and probably should) be posted on press release distribution websites, but to take full advantage of free publicity, they should also be sent to newspapers in your area — along with high-quality photos showing your office in action or a professional portrait shot of the person highlighted in the release.

While press releases should be a primary part of your marketing campaign, you don’t want to submit material that sounds like an advertisement.

Examples:

“The Acme Chiropractic Clinic will hold a public educational forum this Sunday on how a balanced diet and chiropractic care affect your immune system and may help prevent colds and flu this season.” Here we have true press release material. It serves the purpose of publicizing your practice and offers a needed service as well.

Then there’s this: “Say well with Acme! This Sunday, the doctors at Acme Chiropractic Clinic will tell you all you need to know about how coming to us can boost your immune system — and keep you from getting colds and flu this season.” This belongs in an advertising section. An internet site where you pay to have your press release posted might accept it, but most print publication editors will reject it as being too promotional for editorial copy.

Also, be careful how you word your press release so it doesn’t violate any of your state’s regulations. Thankfully, chiropractors have fewer limitations on advertising than medical doctors do, but press releases could be classified as “marketing and advertising” by state boards, and be subject to the same restrictions.

You can write your own press releases if you have the time and talent. Still, it might be best to engage the services of a professional marketing company that can coordinate the releases as part of your overall message. If you decide to go that direction, be sure to choose one that’s thoroughly familiar with your particular health care approach. A company that really doesn’t understand what you do will obviously have difficulty trying to explaining it to the public.

For more information on writing press releases, see PRWeb and WikiHow.

In the past, I would’ve joined them in a good moan, lamenting my own financial losses and piling my worries on top of theirs.

Not any longer. I’m more and more convinced that this type of poverty talk is self-perpetuating. Call it the power of concentrated thinking, the law of attraction or whatever you want, the more we focus on lack and scarcity, the more we experience them.

The opposite is true as well. When we choose to think about abundance and success, we draw that to us.

There are many explanations for why this happens, and it may be as simple as the fact that our words and thoughts program our subconscious, which (even though we may not be aware of it) determines our actions. If we’re convinced that times are tough and our business is declining, we’ll most likely make decisions or take actions consistent with that belief. We’ll sabotage our own efforts without even realizing it.

Scientists have determined that the subconscious mind is 30,000 times more powerful than the conscious mind. The conscious mind works at slow speed, processes information at a mere 40 bits per second. Operating at 40 million bits/sec., the subconscious is a rocket booster in comparison.

Motivational guru Tony Robbins says that “All personal changes must take place at the subconscious level.” I extend that to professional changes as well. If we want success and wealth, we have to drill it down to our subconscious level that we can reach those goals. We have to replace our negative self-talk with positive reprogramming.

Personally, I couldn’t just jump from “woe is me, the economy’s rotten” to “I’m a magnet for money” in one leap. I had to take it a small step at a time. When I looked at things realistically, I had to acknowledge that many practitioners are hurting financially right now. But there are also doctors whose practices and businesses are actually growing and becoming more prosperous every day. The fact they’re doing it proves it can be done. So, it was logical to think that I could do it, too. One step closer to positive thinking.

Also, while it’s true that many patients are putting off needed care because they, too, are infected by the rampant poverty consciousness, despite the “recession” these same people are spending more on things like consumer electronics (up 12% this year over last year), chocolate (Hershey Co. profits in the first three months of 2009 surged 20%), wine (U.S. sales of California wines up 2% in 2009), and even gifts for their pets (an 11% increase according to an Animalfair.com readership study).

Whether they spend their money on health care or rhinestone-studded doggie collars is a matter of priority, not limitation. And if they’re not making health and wellness a priority, we share in the blame because we’re not educating them as well as we could.

Two steps closer to positive thinking.

Once I convinced my conscious mind of these two facts, I had to work on getting them embedded in my subconscious. That took repetition and vigilance. I constantly caught myself replaying the old tapes about the “hard times” we were in. Each time, I mentally “erased” that thought and replaced it with one of abundance and prosperity.

As my subconscious mind gradually accepted the new “reality,” my actions began aligning with that reality and I made decisions based on optimism rather than fear. It’s still a work in progress, but I’m seeing the results already.

Ask yourself whether you’re deriving any benefit from talking about how you can’t afford things, aren’t doing well, and are having a tough time in this bad economy. If you’re not, what would it cost you to try a more positive outlook for a while?