Making sure your patients get the news

What do YOUR patients read while they wait for you?

In the last few months, several important health stories have been reported, including news about Tylenol being linked to asthma in kids, the dangers of OTC weight loss drugs, the banning of flu shots in several countries, how antibiotics can destroy “good” bacteria for years, and why exercise programs shouldn’t be “do-it-yourself” projects.

All of this information is of importance to your patients – yet how many of you thought to print the stories and leave copies in the waiting room or include them in your newsletters?

While there are many excuses why doctors fail to do these things, ALL of the objections can be easily overcome. Here are a few of the reasons I hear most often:

1) I don’t want to violate copyright laws.

That’s a valid consideration, especially since most people are so protective of their “intellectual property.” And it DOES take time and skill to rewrite articles so you don’t violate copyright. One solution is to download the articles you find on sites like Health Watch, Wellness for Mind and Body, The Chiropractic Journal… even my personal blog, which contains a wide variety of health-related posts. All of these sites allow their copyrighted material to be reprinted and distributed freely. The only restriction is that you include a credit line (i.e., “reprinted from Health Watch”) along with the URL. You don’t have to do ANY rewriting. A quick cut and paste and the material is ready for you to use. This applies to your waiting room, newsletter, or e-mail communication. Take advantage of these health information sites and get the news out to all your patients!

2) “I don’t want to constantly be passing along bad news.”

Personally, I think it’s important patients know the dangers involved in medical procedures and drugs, but these sites contain a wide variety of articles including very positive news about research on natural approaches to health (everything from laughter to yoga!). It’s a good idea to share both the good and the bad … it’s part of the education process.

3) “I don’t want to appear anti-medical.”

Since many of the articles at the sites listed above are based on research published in medical journals, it can hardly be considered anti-medical. YOU aren’t pointing the finger of blame. You’re simply relaying warnings from the medical profession about medical risks.

4) “I don’t have the time”

If you don’t have time to educate your patients, you need to MAKE time. It’s an added service that not only helps patients lead healthier lives, but it’ll make your office stand out from the crowd. It says you go the extra mile for your patients, that you care enough about them to keep them up-to-date on health news. In the long run, it’ll increase retention and generate new patients. You have time for that, don’t you?

The information is available to you, but it’s up to you whether it stops at that point, or flows out to others.

Last chance to get your chiropractic postage stamps

Our profession has tried hard over the past decade to convince the US Postal Service to honor chiropractic with a stamp, the way it has for just about every mainstream medical field. But the proposals were rejected every time.

Finally, the World Chiropractic Alliance teamed with BARD Enterprises to design and produce first class post­age stamp “labels” that are accepted by the Postal Service as valid 44-cent stamps on all US mail. There are three distinct designs and all look fantastic — like mini billboards promoting chiropractic. Each sheet contains 20 44-cent first-class postage stamp labels.
Thousands of these stamps have been sold but now supplies are running low, and if you want them you have to act fast. Because of the increased costs, no more will be printed. Once these are gone, they’re gone.

Each sheet of 20 stamps is just $14.99  — that’s about $6 per sheet over face value!

Stamps can be ordered online at

These would be the perfect stamps to use on the holiday cards you’re sending to patients — talk about getting noticed! Plus, buy an extra sheet of each and frame them for display in your waiting room.

More people get health screenings when deductibles are waived

A study in the journal Health Services Research may give chiropractors and other wellness professionals an added incentive to offer free health screenings.Chiropractic screening

Researchers from the RAND Corporation found that people get health screenings if their insurance deductibles are waived; that is, when they don’t have to pay out of pocket for them.

The study analyzed preventive screening use among 44,106 people enrolled in preferred provider organizations, or PPOs. Over a six-year period, these plans initiated deductible-free coverage of four tests — lipid screening, mammography, fecal occult blood testing, and Pap smears — which reduced, but did not eliminate participants’ out-of-pocket costs. In general, these costs ranged from $10 to $30 per test.

The researchers found that people underwent screening more often after the tests became deductible-free, while rates were unchanged among a control group of more than 60,000 participants in plans whose coverage did not extend.

When they looked at the extended-coverage group more closely, the researchers found a significantly greater increase in screening among people in low-deductible than high-deductible plans.

The findings “open the door to examining the effect of deductible-free coverage on use of other preventive services, such as tobacco cessation and weight loss programs,” said M. Courtney Hughes, PhD, founder of Approach Health, LLC, an insurance consulting company.

Although it’s highly unlikely that insurance companies will waive deductibles for chiropractic screenings, DCs and other alternative practitioners can see from this study the advantage of making free wellness screenings available to the public. Often, the preliminary screening can provide enough information to create an interest in wellness or chiropractic care and reveal potential health issues that chiropractors could address.

SOURCE: “Coverage and preventive screening,” by Meeker D, et al. Health Service Research online, 2010.

One fifth of Americans have arthritis, survey shows

A report just released by the U.S. Centers for Disease Control and Prevention indicates that more than one fifth of all Americans have arthritis, and a million new cases are being diagnosed every year.

Chances are good that many of your patients come to you for the symptoms of arthritis, often after failing to get relief from medical treatment such as pain killers, anti-inflammatory drugs, or even surgery. They’re turning to you for something different … a drug-free way and non-invasive solution.

The way to help these people is to give them SOMETHING DIFFERENT — not just another medical treatment that provides temporary symptom relief, but a way they can help their bodies restore the proper condition of their bones and joints. By correcting subluxations, you can put them on the road to mending.

But you might also consider helping patients address some of the major factors contributing or causing their condition, which will allow them to maintain their adjustments longer as well.

According to most experts, obesity, smoking, and stress are three of the top contributors, as is advancing age. Nearly 30% of obese patients studied for the report had arthritis, and those who exercised less or smoked more were also more likely to have it. “Arthritis is a large and growing public health problem in the United States, resulting in costs of $128 billion annually, and continues to be the most common cause of disability,” the report noted. “With the aging population and continued high prevalence of obesity in the United States, the prevalence of arthritis is expected to increase significantly over the next 2 decades.”

Since the major contributory factors are all wellness and lifestyle issues, many chiropractors are taking a leading role in addressing them, through education and in-office services such as exercise training, weight and nutrition counseling, stress management and biofeedback, and smoking cessation programs. While these are not chiropractic itself, all can contribute to the wellness level of your patients and be valuable services to offer.

It’s also important to have in place a comprehensive wellness outcome measurement tool that can monitor the improvements resulting from your care.

While it’s important to educate patients that chiropractic is not a treatment or cure for arthritis or any other disease or condition, it’s equally vital to raise awareness that chiropractic is an holistic approach that can help all people increase their overall level of health and wellness. By putting into place specific educational programs for patients with arthritis, you can provide important services to them, and help your practice grow as it reaches out to the large portion of the population suffering from it.

SOURCE: “Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation — United States, 2007–2009,” Morbidity and Mortality Weekly Report (MMWR), Centers for Disease Control and Prevention, October 8, 2010.

Exercise isn’t a DIY project

Many chiropractors incorporate exercise training or rehab into their practice, but too often patients feel they can make exercise a “do-it-yourself” project without supervision by a trained wellness professional. If you come across patients like that, be sure to share this information with them.

Performance isn't just for athletesFlexcin International, the makers of Flexcin with CM8 joint nutrition supplement, says demand for its joint health supplements and creams have almost doubled this year for people experiencing discomfort from use of home fitness exercise videos and products that lead to injury and over-training.

The company press release noted that an estimated 75-100 million baby boomers are now being targeted for home fitness products but without adequate guidance, they are susceptible to injury.

“A growing percentage of these people are injuring themselves through improper technique and over-training with popular boot-camp style home workout videos,” the company warned.

Once you’ve given them the training they need, patients can often do the exercises at home if you feel they’re ready for that step. But they need to be cautioned that buying an exercise video or piece of home gym equipment isn’t the same as getting proper advice from their chiropractor!

Reminder: be sure to send reminders

A recent literature review published in the Cochrane database centered on how medical doctors could persuade more of their patients to get their annual flu shots, but the results may prove valuable to chiropractors as well.

The researchers focused in on three studies where participants received a letter, postcard or phone call personalized to his or her health status. The results were clear: reminding people to get their shots worked. “Personalized postcards or phone calls are effective,” the researchers concluded.

The results are similar to those received from a 2005 report, which found that “Reminding people to have vaccinations increased the number of people vaccinated, whether the people were due or overdue for vaccinations. The increases were observed in both children and adults for all types of vaccines, but not among urban adolescents in one study. Reminding people over the telephone, sending a letter or postcard, or speaking to them in person increased vaccinations. Providing numerous reminders was more effective than single reminders. Reminding people over the telephone was more effective than postcard or letter reminders, but reminders over the telephone may be expensive compared with alternative approaches. Reminders also worked whether it was from a private doctor’s office, a medical center, or a public health department clinic.”

Chiropractors can learn from this study and increase their “reminder” schedule, keeping in touch with patients who are overdue for a checkup or an adjustment. Although the schedule can include e-mails, I would suggest sending “snail mail” postcards and letters occasionally as well. This type of mail is actually less common today and has a more personal touch. Too many e-mails today are tagged as spam simply because they’re automated, and are far more easily missed or disposed of than an actual tangible item.

SOURCES: “Interventions to increase influenza vaccination rates of those 60 years and older in the community.” Cochrane Database of Systematic Reviews 2010, Issue 9. ABSTRACT

“Patient reminder and recall systems to improve immunization rates.” Cochrane Database of Systematic Reviews 2005, Issue 3. ABSTRACT

The ethics of giving people incentives to take personal responsibility for their health

One of the major problems the health care field faces is the unwillingness of many people to take personal responsibility for their own health. They make unwise behavioral decisions, prefer to look for “magic pills” to address health issues, and choose only those health care approaches that are paid for by insurance companies or other third-party payers.

Many suggestions have been made as to how to solve this problem and one of the most frequently discussed is to offer some kind of “incentive” for people to change their ways. But too many of those incentives end up rewarding people for having the bad habits to begin with, and penalizing the rest. Others seem to do the opposite and impose punitive measures on people who often make the wrong choices due to ignorance.

ACP logoIn recognition of this problem, the American College of Physicians (ACP) recently released a position paper concerning the ethics of using incentives to promote personal responsibility for health. In it, the ACP stressed that “programs designed to motivate behavior change should be part of a comprehensive strategy for well-being and prevention using evidence-based practice to develop nondiscriminatory programs that do not punish patients for unhealthy behaviors.”

ACP used the West Virginia Medicaid program — one of the early, controversial programs to use incentives — to highlight its positions. Programs that support the patient’s role in promoting positive health outcomes, ACP emphasizes in the paper, should be evidence-based and should focus on increasing access to strategies for prevention and treatment of disease; support patient autonomy and participation in decision making; consider variables influencing comprehension and learning; and respect cultural, religious, and socioeconomic conditions. ACP opposes the use of negative incentives that penalize patients for failing to meet stated goals by withholding or reducing benefits, or by increasing premiums for health insurance.

“Incentive programs should not discriminate against a class or category of people,” said Virginia Hood, MBBS, MPH, FACP, a co-author of the paper for ACP’s Ethics, Professionalism and Human Rights Committee. “Age, gender, race, ethnicity, and socioeconomic status should be carefully considered in designing, implementing, and interpreting results of social and behavioral interventions.”

One of the most interesting and important points the ACP made was that incentive programs should “support a patient’s right to refuse treatment without punitive consequences.” This should also be expanded to include a specific qualification that these programs should support the right to choose any licensed and qualified health and wellness approach, without punitive consequences. The role of chiropractic and other non-medical disciplines in prevention and wellness is well-documented, and if we are to encourage people to take responsibility for their own health, we must ensure they have the rights that go along with the responsibilities — and those rights must include access to non-invasive, drug-free alternatives.

SOURCE:Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond” American College of Physicians, Sept. 2010

Integrated doesn’t mean equal

In recent years, the “integrated practice” has been a hot topic. The idea of having medical doctors work side by side with chiropractors, acupuncturists, nutritionists, or other alternative health and wellness professionals is alluring. The problem, however, is that these integrated practices end up being dominated by the MDs, who reluctantly (if ever) dole out very limited access to non-medical practitioners.

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.

American Medical Association logoFor 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.

Chiropractors in perfect position to help with ‘laptop-itis’

Girl working on laptop

"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:

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

Blogging for patients

Right now, Technorati is tracking some 200 million active blogs on the ‘net (up from a mere 112 million in 2007). Some say the number worldwide is really closer to 400 million.

start your blog todayThere’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 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.