34 minutes | Aug 31, 2018
Episode 13: Rocking Facebook for Your Practice with Teri Pfleger
Episode 13: Rocking Facebook for Your PracticeDownload your free Rocking Facebook for Your Practice Quick Tip Sheet to get your practice started and mastering Facebook TODAY. Download Rocking Facebook For Your Practice for FREE by clicking here. Welcome to Episode 13 of the ChiroPractice Pro Podcast. In today’s episode, we crush the subject of Facebook and Social Media Marketing. Our special guest today is Teri Pfleger, an absolute expert in getting your chiropractic practice found using Facebook. Here’s Teri’s Contact information: Website: http://www.socialmediamarketingtk.com Phone number: 586-703-3074 Facebook: https://www.facebook.com/ChiropracticSocialMediaMarketing/ We’ve had some great episodes so far on the ChiroPractice Pro Podcast, and this one is one of the best. You’re in for a real treat today as Teri and I get into pure marketing gold for you and your practice. Take advantage of our free download quick tip sheet entitled, Rocking Facebook for Your Practice. It’s an easy to use Facebook quick start guide that you can put into practice today. It’s based on the information Teri gave us during todays episode. And real quick, before we get started, at ChiroPractice Pro, we’ve gotten a lot of contacts from doctors and office staff that are just plain sick and tired of their EHR and office solution. If you’re ready to get started with an office solution that puts you first, call me toll free at 1-888-422-4476, or send me an email at firstname.lastname@example.org. I want to find out what your office needs, and let’s see if ChiroPractice Pro can get you the freedom you are looking for. Buckle your seatbelt, because this is going to be amazing! Here we go with Teri Pfleger on the ChiroPractice Pro Podcast: Outro: Teri, that was just straight amazing and you outdid yourself with the information you gave us. You are truly an expert in all things social media. We link to her site from our show notes at chiropracticepro.com/episode13. Make sure you head to chiropracticepro.com/episode13 and download your Rocking Facebook for Your Practice Quick Tip Sheet. It’s an easy to use Facebook quick start guide that you can put into practice today. Again that’s chiropracticepro.com/episode13. If you want to give me a call and discuss how you can get real freedom in your practice with a great EHR and office solution, my number is 1-888-422-4476 that’s 1-888-422-4476. Have a great week, and get out there and post some great, personal content to your Facebook page. You’re a great doc and you have a great practice, so let the world know about it. We’ll see you again next time right here at chiropracticepro.com.
54 minutes | Aug 1, 2018
Episode: Unbelievable Patient Results with Dr. David Rudnick
Episode 12: Get UNBELIEVABLE Patient ResultsDr. Rudnick provided us with his 10 most important tips to maximize unbelievable patient results, and we’ve assembled these in an easy to use, downloadable Quick Tip Sheet designed to create unbelievable results in your practice today. Click here to download your guide to UNBELIEVABLE patient results. Welcome to episode 12 of the ChiroPractice Pro Podcast. In todays episode we discuss how to build your practice around unbelievable results. Our special guest is Dr. David Rudnick, a specialist in strategies to maximize return to sport and return to work. Dr. Rudnick provided us with his 10 most important tips to maximize unbelievable patient results, and we’ve assembled these in an easy to use, downloadable Quick Tip Sheet designed to create unbelievable results in your practice today. Download your very own Guide to Unbelievable Patient Results at chiropracticepro.com/episode12 and that’s the number 12. If you’re sick and tired of your current EHR and you’re ready to switch to an EHR and office solution that will let you practice how you want to practice, send me a message at email@example.com, and I will personally listen to what you’re looking for, answer any questions you might have, and help you decide if ChiroPractice Pro is a right fit for you and your office. No pressure, just a great conversation. Again, send me a message at firstname.lastname@example.org. Let’s get started creating unbelievable results in your practice with Dr. David Rudnick, right now, on the ChiroPractice Pro Podcast: How amazing was that content. Thank you Dr. David Rudnick for joining us on the ChiroPractice Pro Podcast. I hope that you take one of these amazing tips and implement it today in your practice. My favorite is the follow up, and making sure to stay up on your patient’s future games, events, adventures and return to work. Dr. Rudnick uses a spreadsheet, but in ChiroPractice Pro, you could set up a separate schedule just for your follow-ups. If your follow up time is 1pm to 2pm, you could create a follow up schedule just for follow up calls. Then, you could schedule the patient for the future call during discharge, and then on the appointed day, you could call them. You could also create a schedule text or email reminder that lets them know you are going to call them at 1 pm that day so they’re ready for you when you call. This would also be a great time to let us help you create a customized note just for your telephone appointment so you properly document the call. All of the processes you just heard are part of the ChiroPractice Pro EHR and office solution and there is no extra fees for any of the processes we just discussed. It’s why we’re the best EHR and office solution on the market, with amazing customer service, all at a price you can afford. Send me an email at email@example.com, or call me at 1-800-297-0361 and let’s find out if ChiroPractice Pro is right for you and your office. Keep doing amazing things in your practice and communities and we’ll see you next time, right here at ChiroPracticePro.com
46 minutes | Jul 10, 2018
Episode 11: Advocating for Chiropractic As An Alternative to Opioids, A Life Mission
Episode 11: Changing The World Through Advocacy with Dr. Winn SamsWant to become an advocate to start advancing the causes that you find most important? Dr. Winn Sams shared these quick tips to get started advocating and you can download the Advocacy Quick Tip Sheet by clicking here: Changing the World through Advocacy, Quick Tip Sheet Welcome to episode 11 of the ChiroPractice Pro podcast. Today, we discuss how to get involved in advocacy with chiropractic advocate Winn Sams. Dr. Sams is heavily involved in advocating for chiropractic as an alternative to the opioid crisis. She speaks with legislators weekly and helps address local and national laws that help patients heal without the use of medication. Download our simple to use guide to get started advocating for chiropractic today. Go to chiropracticepro.com/episode11, and that’s the number 11 to download your free guide. Winn is also a client of ChiroPractice Pro. So if you’ve been wondering what it’s like to use ChiroPractice Pro, you’ll get some great information here. We’re pumped she’s here and we’re ready to get started with Dr. Winn Sams right now on the ChiroPractice Pro podcast. Dr. Winn Sams: “You were deployed at that time, weren’t you?” “I was, I was.” Dr. Winn Sams: “And so I asked him a really strange question (laughs), until this day I was like I got really weird, but I wanted to make sure that the money that I was paying was going to your family because I wanted to support them while you were gone or at least help.” “You’re right.” Dr. Winn Sams: “To know that my money was going to help was just really important to me. “ “Yeah, it was really a good deployment. It definitely made me had enough of the army as a soldier. Dr. Winn Sams: “I bet.” It was a weird time in the war because their kind of in a limbo because I think they wanted to wind it down. There were so many, there were a lot of bad people there still that were doing some pretty bad stuff and so I think the administration was conflicted and then that just kind a trickled down from there and so, I don’t know if people knew exactly how to act. “ Dr. Winn Sams: “Well, I’m glad you’re back safely.” “Me too. Thank you.” Dr. Winn Sams: “And you’re done, right? You’re not going back?” “They’re getting to, I don’t know if you know anything about medical and the DOD (Department of Defense), but they’re changing everything in this next year and they’ve got a new department that they set up this Public Defense Health Agency. Dr. Winn Sams: “Yeah.” Well each service is no longer going to be in-charge of its own health care. Medical command is going away. And it’s all falling under one centralized department that is going to be distributing health care. So everyone’s a little bit, especially the chiropractors, we’re not a hundred percent sure exactly what’s going to happen with the DHA and how they’re integrate to treat chiropractic into the health care. It’s dominated by physical therapists. They have no desire to seek chiropractic enhanced. They want to keep some small groups embedded in with the soldiers. And that’s where the army can hold on to some of their health care. So we submitted a proposal to the Sergeant General, me and a friend of mine who is an OT actually, and we’ve done a lot of work like at unit sites. The physical therapists like the idea, but they didn’t understand. I’m a diplomatic sport and so I love sports and I think that fits well with the army model. And so they just didn’t understand why a chiropractor would even be out of the team. So they asked me to send a proposal of why and what can a chiropractor offer without a physical therapists with the same training camp.” Dr. Winn Sams: “It just shows how people just don’t know. They don’t understand and I think that’s where we get really frustrated because I totally understand where you’re coming from. I do a lot of advocacy work and I get legislation pass that hopefully will help, not only chiropractic, but other non-drug modalities especially with the opium epidemic that’s where my focus is right now. All I’m doing is holding accountable what’s already been said. But PT is always included, I mean that’s just the, if you think of a non-drug modality as far as you’re an allopathic physician, PA or whatever, that is the go to. It’s like no other non-drug modalities exists beyond PT (laughs).” “Well, I think the things that I’ve seen at the hospital lately especially in PT because I ran my clinic when I was up in Washington. One of the things that I saw that stunned me, because these were really good PTs, what they did was dictated by the MD. And so I think that, one of the reasons why MDs like sending people to PTs, is they know they have absolute control of the PTs.” Dr. Sams: “Absolutely, and insurance covers it so they know they’re not saying okay, here’s something you could do, sorry, you have to pay for it and it’s very physical. I mean, it makes sense to them, it’s very physical. It clicks and ticks boxes in the head that makes sense. Anyway, I think things are changing. And I think people like you who, are like boots on the ground so to say, are awesome because you’re actually helping it change by doing it. (Cheering)” “If you come up with any, you hear with the legislation about chiropractic in the military, all the other thing too that we need desperately I think, is we need, we call them green suitors, so we need commissioned officers in the military which we don’t have because again they just drag their feet out even though congress has authorized it. They just keep coming up with excuses. But if we had a military component of chiropractic like actually commissioned officers, we would have someone to go to bat for us at the higher echelons which we don’t have right now. And I think if we want to see chiropractic take hold in the military, we have to start getting commissioned officers that can go to the Pentagon and start go in to bat for us. Dr. Sams: “When you say commissioned officer that’s a particular group of people?” “Well, there are three different types of soldiers: so you have here enlisted. Enlisted soldiers are noncommissioned. Commissioned means that you’re authority has been granted to you by the President. So basically, you are the President’s representative on the ground. You also have a lot of authority, but you also have a lot of responsibility. And you are in charge of a lot of different things. So, same with anything your liability also goes up. So you’re liable for those soldiers that you’re over. “ Dr. Sams: “Yeah, the system’s the system and that’s what done want to change right now…long way.” “And that’s why if you like him or you don’t like him, it doesn’t matter. But the President is one of the reasons why there’s so much animosity towards him, is because he thinks he contains the system. But you got a lot of people like just seeing it and I’m just a little component of the world of government, and I just see when we try to change something, even something simple, it’s just like it breaks people to set the breaks in nothing… Dr. Sams: “I understand, but I will say that it can happen. West Virginia passed the bill recently with language in it.” “Okay, very cool.” Dr. Sams: and did you heard about the West Virginia Bill? “I did not hear about it.” Dr. Sams: “Yeah. It was introduced by DO, at least he has some kind of familiar to you with… Did you know that chiropractor in the Savanah origin who is working with, I mean, he’s a chiropractor. I don’t know if he’s doing chiropractic for the group, but last time I talked with him was he was doing training. He’s an activator doc like me. Have you heard about anybody in the Savannah area?” “No.” Dr. Sams: Okay. I lost track of him. I only see him a couple of time. I see him in seminars. I think his family situation was a little dicey so I don’t know whatever happened. But maybe, he’s working within the ranks too to establish chiropractic within the system. “It’s difficult. The system is system.” Dr. Sams: “Even though they do an osteopathic manipulation and we do chiropractic have enough bridges to cross. But at least, again it ticks the boxes and goes oh, yeah, I kind of know what they’re talking about and then it works. It was a great team and now everyone wants to get on board, each day, chiropractic association wants to do their own. But I find the thing that really makes the difference is the heart and the intent because if you try to push something, it pushes back. If you’re in there like you are in your everyday: you go, you do your thing, you try to help educate… I mean your emo is not to change the system right off; your emo is just to provide care. Hopefully that catches on and people start to feel that people are changing. Something he’s doing is helping. It starts to like taking life on its own and then it’s not as much work. But pushing, in my experience, I was back with anything positive. Because it just initiates that push back, a tap or you got to stand up for something (laught)… So I have to go a different route. I mean contacting legislators. I just call until someone you’re hears me and who can get behind, because there’s plenty who don’t, or they refer it to the expert who really isn’t an expert. They like to call themselves that. But there’s always someone who likes this makes a lot of sense. You got you’re in. So I work with all 50 states, you’ll see things change. Georgia, I got a great legislator who will be bringing something next year. So maybe that will help effect the military. It probably won’t because this is about, probably it may, it’s about putting the choice back in the patient’s hand. So, if you’re a soldier, is the patient, I think it would be effective, I don’t know. Maybe something gets on the books that can be the next step.’ “Right, I like it.” Dr. Sams: “I’m up (laughs). I was like change in my next project, so I probably. I had trouble going to Washington, after that many, many times. I’ve never been to the Pentagon. But I’ve been many, many times, to all kinds of legislators’ offices and sat and talked. But I don’t want the talk; I want something to be done (laughs). That’s what everybody likes to do.” “They like talking to Washington.” Dr. Sams: “But thanks again for what you are doing, I think it’s so important. “ “So tell me a little about your clinic.” Dr. Sams: “Well, I’m very small. And I did that for a reason. I went back to school or to Chiropractic College later than most people. I had lots of careers before. My marriage was ending, I had three little babies, I was like, Okay, what am I supposed to do? This came up. I was like, no, I don’t believe in chiropractic. That was one of the reasons why I can understand why people have issues with it because I did too. When you live both sides it’s like I know exactly where they are. Anyway, after going through Chiropractic College, and being older, I just knew I wanted a certain kind of practice. I didn’t want a really busy chiropractic practice where I’m seen a hundred fifty people per day because I was still raising three children, three girls. So I had to have something flexible, where I can make enough for comfortable living, but also be a mom and a parent. So, I just never had gotten out of that mode. So my practice was very niche-type of oriented. And it gives me opportunities to do stuff like my advocacy work which is incredibly important to me, the freedom to have time to be on the phone and talk to people and get things going, that sort of thing and if necessary, go meet and talk with people like I’m going up to West Virginia in a couple of weeks to talk to the school nurses. Because one of my advocacy passions is heavy back packs and trying to address… and you guys, this would have been applied to you because of your heavy stuff that you carry around. But everybody talks about how to wear one, what to buy, blah, blah, blah… But I’m talking about it from the inside and so I’ve gathered tons of research and have gotten resolutions passed in probably ten states with more to come that require talking points. So that people could understand that there’s damage going on inside and even as an accountability measure, I ask the chiropractors to do school screenings within the schools. We know how to catch it early. So I totally understand that the rebut value there. But you can see, I just do a lot of different things because I love healing on a huge scale and I love chiropractic but that’s not all who I am so. My practice is bigger than just seeing people. If that answers your question.” “I’m just a little curious. Tell me about what you do for legislative work. How did you get involved in it and then where do you plan in going with it? And how does someone, if they want to get involved in helping with legislation, how do they do that?” Dr. Sams: “Well, one of my prior careers was being a paralegal. So I am very grateful that legal lingo doesn’t scare me and I can write it. That’s what I’ve done is put to together when I send to legislators information, I try to send as much as possible to make it easy for them. So that it’s done. I don’t know if everybody sees that gift, but I just want to put it together in a single packing. So what I do with the heavy back packs some would be opening legislation. I gather research and links. I kind of approached it not as a ‘Will you help me’ but ‘I am helping you. I got information that could help you.’ In that way, if I find the right people who can just go ‘Yeah, this makes sense,’ then we got that in way. Hopefully we draw stuff together. Many states just ‘take my stuff and we’ll do the right thing.’ Like for example today, I am contacting Delaware, they’re coming out with a bill that has my intention on it. I don’t know if they use my language. Some people have to do it themselves. You know, I do it differently. Because most people when you think of legislation, they’re in for the fight. They got to lobby for this. We got to fight for that. And then you feel like, people have to pay, I’m like, no, I’m not paying for anything. I don’t hire any lobbyist, No. It’s just that why do I have to prostitute my cause out. I don’t have to work with people like that. “ “You have the skills to do, which is you are fantastic.” Dr. Sams:“You know, what I have it’s no different with you Josh, because everything in our life, prepares us for what we are right now. That’s my belief. So everything that you are experiencing is perfect where you are right now. Everything I’m doing is perfect for where I am right now. You know, years ago when I wasn’t doing it, I had no idea. I had some inking like I need to be doing this for some reason. Okay (laughs), but you know if I haven’t gone into Chiropractic College, my oldest daughter wouldn’t have gone. So she’s a chiropractor. So you know, it’s just you don’t know how much good you’re doing until maybe later you get Wow! I’m so glad it happened that way.” “A couple of years ago, I submitted a patent and it was approved. But when I first submitted it, kind a like what you’re saying, I think to help young docs that might be interested in this. I had no clue how to submit a patent. If I don’t submit it, then my ideas is not going to be submitted in to law. And so, I figured it out there first. It was like what you were talking about.” Dr. Sams: “Somebody might take it. With West Virginia, they took all the credit. The chiropractic association said ‘Oh, this was our bill.’ And I’m like, ‘No it wasn’t’ (laughs). I don’t really need the kudos, but be honest you know. People are like that. It’s amazing. And I guess I’m naïve when it comes to that. Really, you could do that? Why would you do that? I had a part in it. I helped, but they said ‘this is our bill.’ I mean, act as smart. But even with what you came up with Parapro, that was exactly what I wanted, because I have spent ten thousand dollars. I think it was either 8 or 10 for a program that was hard drive.” “You’re on a local server, something of that nature.” Dr. Sams: “I was promised that it was flexible and I could adapt it because I’m an activator doctor. I don’t have the same approach as far as documentation. I mean yes, we all do oursothenotes pretty much the same, we’re supposed to because there are standards that we cover. But as far as what I document and what I do, and the listings that I use, are totally different: Versifier, gone standard, and any other tech therapies. So, I needed something flexible because once I bought that, and then in their mind, it was flexible. But in mine it wasn’t. I didn’t get my money back. So I was like, ‘okay, there has to be something that you’ll be willing to work with me, they can design what I need and that was you guys. And I didn’t get the point that was at the very beginning of all the certification, nobody knew where it was going. Nobody knew what rules were, and I was like, I don’t want the money, I just want some— “And now you look at it, it’s all dead anyways.” Dr. Sams: “It’s all dead anyways, but I think you guys offer and excellent product. It’s simple. It’s not fancy. I don’t want the bills—it’s like a car, you know, the more bills and muscles, the more things go wrong. I just want a way that I can document and flow. And the way it works, so, your brainchild, or whoever’s brainchild it was to offer this, and it’s affordable, it’s a great product I would imagine to, people at the school that needs something that is affordable to get started with. But that’s no different than me with the legislation. You saw what I need, and you were like, ‘Oh, ‘it seems like Peter is a great computer brains, so, the two of you guys go together are like—“ “And that was one of the things, the reason why I started it because I was trying to do an office in another location. And have to do on a gym because of sports. I just needed something that could travel with me. One of the things that I saw that just drove me crazy about chiropractic software, probably software AHR in general, but there was always a promise but then there was a hook. So we said, we’re just one month you feel, you like it, you don’t, you can leave at any second. Because I wanted to be able to afford it if I didn’t have, you know, if I wasn’t associated with it, I could still do this even as a single doc in a small office. I could make it work for me in my office. So that’s why we came up with this.” Dr. Sams: “It travels with you. It’s perfect at least for me. The legislation is no different. This is what this is leading to. I’m right brains, so I go woo, I’ll get there. But it’s all the same. So you see a need, and you’re like, we have something that can help build this need. And you start gathering information, data, research and links to work. Again, I think it’s very powerful if it’s already been defined for example, by congress. Hold them accountable. I know it seems like under that same, it’s like pie in the sky, but you can do that. You know, It’s like I’m holding the AMA, CDC, GEMA, Joint commission, WMA, all of them have said, for example, that non-pharmacological approaches need to be your first line of defense. Therefore —-, nobody does it. Just a quick dodge, last May I got a chance to go to Geneva, Switzerland, and speak at a person center conference about service that I started. Well, this is another thing. This is why I need more time that what I just practice (laughs) because I have lots of ideas. But I started a site / service called Least Invasive First. I did this because, one of my daughters, again, I saw a need for communication. You go look at it, it’s called leastevasivefirst.org. But she had a surgery that was not needed. Her gall bladder out which was not needed. I was sitting on the sideline, and I was like ‘hey you guys, she’s not showing the symptoms of a gall bladder issue. Give me a week, I’ll bring her back. If she’s not any better, and she was 18 at that time, she can couldn’t make a decision, she was in a lot of pain, and she was just like take it out. She wrote that, but the doctors totally overrode me. And in the hospital’s mission statement they say: ‘We work with the family, and blah, blah, blah…’ So I met with the CEO, who is a surgeon, and I was like, look you know, it is not in my scope of practice to tell you that you did malpractice, but I will tell you that you didn’t follow your mission statement, you didn’t give proper performance there. And that’s it, a big problem. They said ‘yeah, you’re right. We did.’ And then I said, ‘what are you going to do about it?’ Then they said, ‘we’ll take care of it.’ I was like, how can I know? And they just kind of screwed around the issue. And the CEO goes, ‘I don’t know how to say this, but if you don’t want ice cream, don’t come to an ice cream store.’ And I’m like, Oh God, get me out of here. I’m going to kill somebody! I got my car dashing. I was so freaking angry and I was like, why am I so angry? And you know, because he’s right. If you don’t want drugs or surgery, don’t come here. He goes, ‘by the way, I don’t believe in touchy feely stuff. They have a wellness program, that’s touchy feely. I guess that makes you lots of money, but he didn’t believe in it. So you see, here was, there has to be some way of communicating. So I started this site service: it’s a digital 24/7 service that you carry around with you and you can put your directives. What you want. What you need to do along with your red flag, medical information, but not all of it. I wouldn’t involve that, but it’s just a way you can upload forms, you can upload documents that will support them knowing how to do a better plan of care but not their standard of care. It is involving the patient. So anyway, in doing my marketing for Least Evasive First, I found out that nobody wanted it. I thought everybody’s going to be like ‘Everybody’s going to work with this. This is going to be great!” You probably know how that feels like? Nope. And I found out so many darker things about it that I was like, ‘this is amazing!’. Anyway, I got invited to share my research, my experience with this Geneva conference. And it was an all medical doctor conference. Two of my daughters with me, and by the way, if you haven’t been to Geneva though, it’s gorgeous. And these were doctors from all over the world that was put on by the World Health Organization. So during one of the presentations, by the World Health Organization, their representative said their definition of health between them. This is what we’ve been taught right? It’s not purely access of disease; this is health of the whole person. So after he got finished I raised my hand, asked a question, they literally, the people from WHO literally tried to skip me. I was going to say something… Because I was the only chiropractor invited. The audience goes, no, let the lady speak. I said, ‘look I’m so glad that you said, this definition of health because that’s the chiropractor, that’s what we’re taught. That’s what we believe and that’s what we practice. However, in the states, I’m not considered a real doctor and I’d like to know your opinion of where we got off track, because our health system right now is totally about illness and disease. And of course, they didn’t answer my question. It got people thinking, and I say all of this, just so you could know the legislation. If you can get people thinking that’s where you start. It’s not where you have to have everybody to agree with you. But you just have to find that one person that could hear you from where you’re coming from. You provide the documentation that’s already been defined. And it’s just isn’t being implemented. We need to hold this accountability for not being implemented. Then it takes the fight out of the game. And it’s just a matter of why aren’t we doing this. This is law and how come are we not implementing it? What’s the obstacle? It doesn’t matter who you are, we just need to work smarter and quit fighting.” “You mentioned the Joint Commission and those are the things they consider us physicians. But even in the hospital, we’re considered physicians, so they have to treat us like physicians. We’re still not given the respect of a physician. They will still be supervisors who are non-physicians. And the pay discrepancy is ridiculous compared to what they pay with physicians. I mean I still make a great living, so I’m not complaining about my living. But the discrepancy between a primary care doc and me, and even as a specialist, a certified specialist, is a lot.” Dr. Sams: “Maybe that’s where you go with it. It’s going in now. We are considered physicians. In Switzerland, chiropractors are in the same level as an MD, DO, I mean, they’re the same. I’d go practice in Switzerland if I could. But that’s where you get started. Okay, we are recognized as physicians but our pay grade doesn’t reflect that. The respect and honor, doesn’t reflect that. Again, it’s holding people accountable. Look, there are too many words that are flying around that have no physical ground. And that’s what people believe. And you know, people do this Josh, because they know they can. No one’s going to come and go ‘hey you’re not,’ and you may have to be the one. So that’s a lot of times we complain about. Well this isn’t happening. We’ll bring it then.” “Right.” Dr. Sams: “I’ll help you any way I can. The reason I did Least Evasive First and what I’m doing now isn’t for chiropractic. It’s for quality. It’s for a level plain field. I do not see allopathic medicine as being better or worse, it is just another modality. Period. But people, like I was talking about, with the people ‘oh, we got a doctor on our legislator,’ he’s our Opiod expert. No he’s not. If they were the experts, they would have existed in the first place.” “The same thing yesterday, I sat through a brief, the number one issue that people go to their primary care for and that they’re called profiles in the military, and the number one issues why they have those are muscular injuries. It’s been that way for the last a hundred and fifty years and probably longer for the military. And you know what, if you are in charge of a company, and you kept having the same problem for a hundred and fifty years, what would happen? You’d be fired. We still say, oh let’s just keep going with the same thing. Let’s not change the model because, the people that are in charge are still in charge. But they say that’s the definition of insanity. They keep on doing the same thing with the same result. And that’s what’s going on with our country right now. It’s a whole bunch of insanity because we still want to do the same stuff. All they do is prescribe OPx, so they keep on prescribing OPx. Dr. Sams: “You know what’s real to me is what’s in the physical. So like what you’ve been talking about, the words are, everything is on paper. This is the way it should be. But it’s not in the physical, so it’s not real. It sounds good, everybody’s like great. But it’s not real. Until it is being enacted, then it will be real. So it’s just a matter of bringing, first of all, I had to learn that they’re just people. Like my youngest daughter is starting on Broadway now. So you know, she’s gone from being dainty to a celebrity and everybody wants to be that. So we kind a give our power away to people that have what we don’t see what we have. So, legislators are celebrities and in people’s eyes, they’re just people. So if you can come across as ‘Hey, I’m a person too. You’re just a person.’ And you relay on a heart level and equal whether you start putting that into space. And so I would be glad to help you find somebody who could listen. And you know, just maybe start the wheels and motion. You would be the crucial part though because you’re the one who’s living it. I can get it started. But you would have to be the one really, because like I said, it’s more real to you than it is to me. I am not living it. I live in different ways. I certainly don’t get that respect and honor in my community or other people. Me and my patients, they respect and honor sometimes their MDs and their opinions more than my professional opinion. But that’s okay. But I hope that’s something that we can address. In addressing stuff like this, you know, just the baby steps, will start to ripple out. I’ll be glad to help. Just let me know when we’ll start.” “Can I ask you a couple of questions about ChiroPractice Pro? I’m sure you want to do something. What’s your favorite feature of ChiroPractice Pro?” Dr. Sams: “I would say the flexibility, because I helped design what my needs were. Then I’m included. Do you know what I’m saying? I would say it would be the flexibility; you are a part of designing your support and your documentation and what you need.” “And the customization may be for your practice.” Dr. Sams: “Yes.” “I like that, and how does it help with your productivity?” Dr. Sams: “Well, again, because I helped design, because it was part of the customization, I have more flow. It’s already built with the way that I worked. So I haven’t reinvented the wheel. I took it the way I practiced prior but just put it in a EHR format.’ “Have you told other people about ChiroPractice Pro?” Dr. Sams: “Uhuh. I’ve referred a couple of people and one actually signed up with you. Yeah, I do, because I think it’s awesome. Another is the ease in filing claims, because I don’t take insurance but I do have to file Medicare for people, I’m a non-par physician, so everybody pays me upfront but they get reimbursed. I still have to file for people who have little government card. So all I do is fill in the information, it’s populated, I just make sure that it’s accurate and I check it, make sure that I haven’t missed, my diagnosis codes are the same. And I send. It’s very easy.” “That’s nice. Good.” Dr. Sams: “All of my patients are on Medicare, so it makes very easy to do that. And so every Sunday is when I sit down and send my claims.” “How long does it take you to send those?” Dr. Sams: “Well, depending on how many patients I see that are on Medicare. I would say an average of two minutes.” “Okay, I like that.” Dr. Sams: “Yeah, it’s really, really easy. For me, if something works and it’s helping me in my life, I don’t need motivation to share. I’ll just share. You know, here you go. Here’s what works for me.” “You’ve given us some amazing gold today that people can really use, especially when they think about getting involved in their community, getting involved in the legislation. I think about what you said is very powerful.” Dr. Sams:“Well, thank you.” “What’s the best way especially with Least Evasive First, how are they going to get in touch with you about how do I get involved and do this advocacy or legislation? What’s the best way to get in touch with you?” Dr. Sams: “Well, you can provide my cell which is 828-817-4544. I would say the advocacy work though is not for everyone because again, it’s hard for us to get out of this victim mentality. Like we’ve been wronged, we’ve got to fight for our place. It’s not the way it needs to go. It’s more of, ‘hey, we’re all people, they believe this, I believe this. But my beliefs have been documented in and have been accounted for to they’re just not being implemented. It’s a different approach. If we come at it from a victim mentality, you would continue to be a victim. You’ve just given your power away. Does that make sense?” “Very much so.” Dr. Sams: “I’ll be glad to help in any way I can. We got to do some changing too. As chiropractors, we’re so used to being the victim, we’re not helping ourselves because we’re perpetuating being a victim still.” “Right.” Dr. Sams: “it’s not just doing advocacy work, getting things changed and they need to change. Everybody needs to change. We need to change in the sense of we know what we’ve been through. We know what type of education we’ve had. We know that grueling hours and exams and boards that we have to pass. We know that. So it’s time for us to stop acting like we’re valuable and what we offer is irreplaceable. So once we start doing that, it just going to automatically start changing things just the way it works. I’m sorry I just keep going on and on. I’m just so passionate about it Josh. It’s just like ugh (laughs).” “Winn, thank you so much for hanging out with me this morning. I appreciate it and I enjoyed talking with you and getting to meet you. And hopefully, we don’t live that far away. So if ever you going to come Atlanta, or if ever I come over that way, just make sure we get together. “ Dr. Sams: “Absolutely, I’ll go to Atlanta for my continuing end and I plan on coming to meet with the legislator and maybe you’d be a good person if you don’t mind going up to testify when the bill is dropped and is heard. But I’ll be there because it’s too clumsy for me not to be. So we’ll have a chance.” “That’ll be great!” Dr. Sams: “It has been great. Thank you for inviting me.” “It was fantastic, I enjoyed it. I loved talking with our different clients and I want to make this the best software because, for me, I loved it because it was my baby to start off with. Dr. Sams: “See that’s how it feels with me in the advocacy. It’s your baby; you want to see it live and thrive. And you keep advancing it and improving. So yeah, absolutely.” “And I love your feedback, so we’ll get something for that stuff going on. Thank you, Winn. Dr. Sams: “You are so welcome. Have a good day!” Talk to you soon, bye! Dr. Winn Sams is an inspiration and is doing a good work to help promote chiropractic in very high levels. Her dedication to making sure patients get the right care is incredibly admirable and I am grateful she took the time to share her story with us. If you like the way she’s using ChiroPractice Pro, and you want to check out what it can do for you, send me a message at firstname.lastname@example.org from our contact page on chiropracticepro.comford/contact. I hope you are inspired today to take action in your community, state and country to do something big for your profession. It takes a little each day, but if we bend together, we can do amazing things together. Thanks for joining us on the ChiroPractice Pro Podcast. We’ll see you next time, right here at chiropracticepro.com.
18 minutes | Jul 2, 2018
Episode 10: Increasing Income Through Standard Operating Procedures
Episode 10: Standard Operating ProceduresDownload your SOP Quick Tip Sheet to start increasing profits and providing incredible customer service in your office through Standard Operating Procedures. Click here to download your SOP Quick Tip Sheet. Welcome back to episode number ten of the ChiroPractice Pro Podcast. On today’s episode, we discuss standard operating procedures to maximize not only your patient care but also your business operations to increase your profits. Today’s guest is Peter Eldridge, the Head Software Engineer at Chiropractor’s Pro. Peter is an engineer, a pilot and has spent time in the military making him an expert on Standard Operating Procedures or SOPs. To find out more information about standard operating procedures and to download your quick tips to get started utilizing standard operating procedures in your practice, visit us at ChiroPracticePro/episode10 (that’s the number 10). Thanks again for joining us and let’s get started with Peter Eldridge right here at the Chiropractor’s Pro podcast. Alright Pete, welcome to ChiroPractice Pro podcast. Welcome back here on episode number one, now you’re on episode number ten. Thanks for joining us. Peter Eldridge: Thanks for having me. It’s good to be back. So one thing what we’re doing at the ChiroPractice Pro Podcast, since Pete is our Head Software Engineer at ChiroPractice Pro and Co-Founders, he’s going to be joining us every decade episode. So, 10, 20 and 30, he’s going to be here and we’re going to be talking about something new and how to integrate different ChiroPractice Pro into your practice. Today we’re going to talk about Standard operating procedures and Pete is a very good pilot. I’ve flown around the country with him and he does that very well. One of the big things that pilots have are Standard Operating Procedures. Pete does a little bit about being a pilot and the importance of a SOP or Standard Operating Procedures. Peter Eldridge: Sure. So, being a Pilot obviously is a big responsibility and you don’t want to take that responsibility lightly nor do you want to forget procedures or steps in any situation. As a pilot, there’s a procedure for everything that we do. From the minute we walk up to the airplane, there will be a checklist that says hey you need to check the wheels, the wings, the control services, the tail and operation of everything that you’re going to use before you even step into the airplane. We check the gas to make sure it does not have water in it. All of those lie on a checklist. Once you get into the plane, there’s a checklist to make sure you start the plane correctly. It’s delineated in the operating manual for the airplane. So I know when I get into the airplane, I’m going to have a checklist in front of me that says these are the steps that you need to go through to make sure that you’re operating the plane correctly. When you get into an emergency, there’s a checklist that tells that you need to establish this specific glideslope so that you have the most glide that you can if you lose your engine when you need to search for a spot to land. All of those are written down, study those and you have to know exactly what and when you’re doing that. If you forget, you always rely on that checklist to go back to. Thanks a lot. When we were employed direct at 2005, we worked on the ground with UAVs (Unmanned Aerial Vehicles) and one of the things we have to do is we had to say out loud every procedure in the manual. Every procedure on the checklist we went through it so it can be recorded just in case there was an incident. So I know even at higher airline level too hey have to say them out loud so they can record it. Peter Eldridge: Again, both of us were in the army, and you know as well as I do that there are standard operating procedures for everything that you do from how you wear your clothes to how you do your job. All of that is written down. So, no question about what you have to do and how to do it. And for a pilot, I know sometimes you have your regular procedures and those you can read through, and you kind of refer to it. But your emergency procedures are memorized right? Peter Eldridge: Yes. When something happens in the airplane, you have got to be able to react and you know exactly what to do if you lose an engine, if you can’t find the airfield your landing at, or if any type or emergency comes up, you always memorize those. You know exactly what to do if you stall the airplane. Those types of things you always have a type of procedure you can fall back on. You drill those when you’re training and it’s important to do that. We exercise those procedures so when we’re in that situation, we can react properly. How would you bring this around in a chiropractic office or any professional office and since I consider you an expert at Standard Operating Procedures, how would you bring that around to each day in a chiropractor’s office? Peter Eldridge: What’s important for a chiropractic office and things I seen in offices around the country that we’ve worked with is that there are some who can do it well and some don’t do it well. The people who are profitable or who are executing well usually have a procedure set up and in place so that when a patient makes contact with that office , when a new staff member comes on, staff member engages with a patient, when patient is leaving or coming into the office or contact outside of office… All of those things are important that you are drilled on that you know what you want, your interface with your patients to be, the more rehearsed, the more genuine that contact is with your patients is going to lead to better compliance, going to lead to a more profitable business, and when the patients and staff know what to expect then there’s not going to be any questions or I guess, any chaos in your office. You’re going to know for each thing what to do. Same thing we talked about emergencies. What happens? Are you prepared when you lose internet access? Do you know what you’re going to do? Do you know what to do when you lose electricity? If there is an emergency in your building: We’ve seen a lot of these school shootings and these type of things. If something like that would happen have you thought or talked about it? All of these things are important – to think and talk through and have a plan for it. And the other thing too as far as emergencies, those are big emergencies too, but what about if a patient has a heart attack or showing signs of stroke, do you have those in writing as well? I think that’s a big deal when it comes to malpractice. Did you have SOP and did you follow it once the incident occurred? If you could say: “This is my SOP when my patient had a heart-attack, we immediately called 911. We began CPR and then we had one person go upfront and we followed exactly our SOP. I think it would be very hard for someone to bring a law suit against you to make it stick. Peter Eldridge: You know, emergencies are one thing but what about everyday things? WE can talk through procedures that you should have when the initial contact of the patient. So when the patient calls you, do you have a procedure to get them engaged with your practice? For instance, do you take their name, phone number, email address and do you immediately follow it up with a welcome email? Do you invite them to go to your website where they can schedule their first appointment? Do you schedule the first appointment on the phone? Do you send them to your website to fill out their intake paper? So there’s procedure right there for initial contact. As we walk through this type of patient, we go like on an initial visit. New patient that comes in, what are your staff doing to welcome them in? Is everybody know exactly what they’re going to be doing when new patients walk in? Are they going to be filling out paperwork? Do you have a kiosk there where they are filling out the paperwork on the computer? Are you giving them information on other services that you have whether you’re doing massage, acupuncture or other things that you offer that is a great point to show them that you’re not just doing the chiropractic that you’re doing more than that. What about introducing them to supplies and different things you have that may be available to them? When a returning patient comes, you should have procedures in place for checking people in. When they first arrive, are you checking insurance? Make sure it is correct. Are you collecting their copay or on doing other things? Each stage of that contact with your patient, you should have a procedure for. I think one of the things too, as a Doc, is that you don’t have to be the only one that does or puts together an SOP. It may be your front desk office staff that’s already got their procedures in place that they do. What you can do is have them put those in writing. Have them put the SOP together. Then when you bring in another staff, because it’s their procedure, then you can go through it with them. And you can actually see what’s happening: any corrections, or like what you said before, maybe an upsell to a massage as well. This is a good chance for you to start bringing income. I think this is exactly what you’re saying. The buy in of your staff – that’s kind of what they did in the army with us- anytime we had to do something more than once, we were writing the SOP, some were routine of command, but we wanted to follow it to put it in place. Peter Eldridge: Yes. So we kind of talked about patient interaction. You should also have SOPs for your business. We do want to care for the patient, but there’s also the business side of chiropractic. I think a lot, especially new doctors, can fail because they’re not doing business correctly. I think it’s really important that you not only have that patient interaction procedures, but you also have business procedures on hand. You’re investing basically in three things: your product, system and people. If those three are operating correctly, then you’ll going to have to be successful. The system part of it is the procedure on how you’re doing your business. You want to make sure that every day, you’re checking to make sure you’ve gotten paid on your insurance claims. Maybe weekly you’re double checking that and making sure that your ARs are done. Every day you’re going to have procedures to do every week, weekly procedures, every month and every year. You’re going to look back and evaluate what you have done for the period of activity. Then you’re going to plan for the next activity. All those procedures should be written down and followed. So how can we take SOPs that we talked about what are some of the tools in Chiropractor’s pro that we can start utilizing to make these SOPs easy and easy to follow? Peter Eldridge: I think there are several different tools inside Chiropractor’s pro that can help on a schedule. We have spot on the schedule where you can push a button and send an email to every single person on the schedule for that day. We also have the reminder emails that go out every day or before everything – that’s part of a procedure that you have. That one’s automatic for you. Maybe at the end of the day, you want to send a thank you note to all your patients – you can do that with one click. So that’s the schedule. There are also individual spots on that where you can make notes for the patients. If you need to check something for the patient, maybe check their insurance, update something and even put a note on the schedule that will remind you that says hey, you need to do something with this patient. There are also notes for the day in general. If you want to plan a certain thing on Monday to check on a certain thing, you can put a note on every Monday, first Monday of the month, or whatever you need to do, you can put that right on the schedule. It will remind you to do that. So that’s the schedule. If we move on down to the Reports…. Reports are powerful in Chiropractor’s pro for this reason: Not only can you see what’s happening in your business. You can run a report on New Patients that you have over the last week, month or year. If you had a procedure after the first visit, a patient receives an email. And after the second visit, maybe they receive another email form you. Maybe after the third, fourth, etc. I did a letter for you thanking for their service. Your compliance rate is going to go up if you have that constant contact with them and if it seems organic to you, your business and patient. So implementing those procedures in there… Talking about reports, you can pull a report on New Patients, Specific CPT Code that you charged, or maybe you have something that is more special to you and when somebody does that, you want to make sure you thank them for it. All of these kinds of reports can be done weekly, monthly or yearly type of basis. The link from the reports to the communication area is what makes these reports so powerful. They are not just static reports; you can use those reports to push through communications area and have standard emails. Part of your Standard Operating Procedures through your practice is to have these emails in place. So you got a welcome email for your patient. You’ve got a first-visit email and other types of emails that I’m going to help you and your staff to keep those patients because there is compliant to what you’re doing here. What I like about that too, as a Doc, you think that through and I can make up an email that has the exercises that I’ve talked about first visit. Part of the SOP is to have a standard emails. You’ve got to have the welcome email, first-visit email, AR email and other compliance type of emails that are going to help you and your staffs keep those patients compliant to what they’re doing. The things what I like about that too, as a Doc, I can make up an email that has the exercises that I talked about at the first -visit. So on the first-visit, I always do control breathing with the patient. So I can have an email that I can send out to my new patient and say hey, this was what we talked about today in the office. If we automatically have their first name put in there so it looks like a personalized email for me. This is what we did. Here are the exercises. And here you can watch a video that you can link it to your website so the patient comes back to the website and checks that out. If for some reason, you want to have patients scheduling online, we can also make sure that we’re getting them an appointment set up. Peter Eldridge: So there are many different ways you can use that link between the reports and communication area. In the new system too, we also have text. So you can immediately text somebody, if you have or want to say “you know what, thank you for today” something like that. You can text somebody not directly from the program. All of those things will help you be more successful not only as a Doctor and Care provider, but also as a business person. That’s perfect. So that the way we use SOPs and Chiropractor pro. Pete thanks for joining us. Got anything last words that you want to leave for episode 10? Peter Eldridge: No. If you have any questions about how to establish procedures in your office or have any questions about any of the different features ChiroPractice Pro, then just let us know. You can send us or me a message at email@example.com you can head to our site at http://chiropracticepro.com/contact/. We’d love to talk with you and walk you through any of this information. Also along with this we’re doing a quick tip sheet on doing SOPs in your office, how to do this and examples if some. So Pete thanks again for joining us for Episode 10. We’ll see you back here at Episode 20.
5 minutes | Jun 18, 2018
Episode 9: Make Your SOAP Notes Great
Episode 9: Make Your SOAP Notes GreatDownload your SOAP Note Quick Tip Sheet and SOAP Example by clicking here. In this episode we’ve gone over how to make your SOAP notes great, and we wanted to give you an easy to use resource to go along with todays show. Let us know if you have any questions on this…we’d love to hear from you. If you want to get even more in-depth with SOAP notes, check out Episode 2 & 3 with Dr. Warren Jahn to dive deep on the intricacies of SOAP Notes. Welcome to the ChiroPractice Pro Office. My name is Dr. Joshua Eldridge and I’m your host for today’s training: Making Your SOAP Notes Great. As you know, there’re four parts to the SOAP note. Let’s just jump right into the subjective portion note. Remember if you’re using a problem list, have a different subjective, objective, and assessment note for every problem that the patient presents with. So if the patient presents with neck and low back pain, and they’re not related, there should be two separate subjective, objective, and assessments for each problem. The subjective portion of the note is what the patient tells you about the problem. We want to make sure that we get exact quotes from the patient in 2 to 3 sentence form to make sure what they say has been included in the note. Make sure what they say specifically pertains to their problem and not just general facts that they tell you about your day. It’s also important to make sure that you know any changes since the last visit. So if they’ve stopped having ridiculous pain in their left leg, this would be important to note. This objective is also the place that you want to add your outcome measurement tool scores like a Bournemouth questionnaire or a VAS. If you’re not using outcome measurement tools, these can be a great way to justify to insurance that you’re seeing real improvement with the treatment you’re providing. It also gives you a good tool to discharge the patient if they’re not improving. And lastly add in the section you’re aggravating factors and the relieving factors that you discussed in your initial exam or the latest re-exam. This can be added in from your previous note or the initial exam and do not need to be re-created each and every visit. Our next section is the objective portion of the soap note. Remember that the objective version is what you observe as the doctor. This is a place where we can know what has changed since last visit or what is change since the initial exam. Example if the range of motion has stayed the exact same for the lumbar spine then there’s no need to add this to the Objective portion of the note.
42 minutes | May 16, 2018
Episode 8: Getting Started in Personal Injury with Dr. Kent Choi
Episode 8: Getting Started in Personal InjuryWelcome to Episode 8 of the ChiroPractice Pro Podcast. Our free giveaway today is Getting Started in Personal Injury with these 5 easy and actionable steps. Click here to download and get started on your PI journey. Download 5 Easy Ways to Get Started in Personal Injury Today! In this episode, we discussed the Ichthus Injury Network that Dr. Kent Choi directs. You can find out more about his network here: https://www.ichthusinjurynetwork.com You can also call or text Dr. Kent Choi at 714-606-5330. He asked that you call so take advantage of this resource. Check out this flyer for his event in Atlanta on August 18 2018. Welcome to Episode 8 of the ChiroPractice Pro Podcast. On today’s episode, we discuss how to get started in personal injury, the best practices for personal injury, and some interesting components of personal injury that you may not have considered. Our special guest is Dr. Kent Choi, founder of Ichsthus Injury Network. Dr. Choi has spent many years developing resources designed to make personal injury leaders from chiropractors. His straightforward approach will help you understand PI better, and decide if Personal Injury is right for you. As our free gift to you, we’ve put together a special PDF download that will help you differentiate yourself from your peers starting today. Download the Personal Injury Quick Start Guide at chiropracticepro.com/episode8, that’s chiropracticepro.com/episode8, and that’s the number 8. In 2 minutes, you’ll have a actionable plan to put in place today. If you’ve been enjoying the ChiroPractice Pro Podcast, and you’ve gotten real value out of what we’ve provided, would you take 2 minutes today and share our podcast with a chiropractic friend of yours? We know that if you found value in our podcast, then they will too. Thank you for taking the time out of your busy day to share with your friends. Now, let’s get started with Dr. Kent Choi from ichthusinjurynetwork.com on the ChiroPractice Pro Podcast.
34 minutes | May 7, 2018
Episode 7: Owning Radiology with Dr. Cliff Tao, Chiropractic Radiologist
Episode 7: Owning Radiology with Dr. Cliff Tao, Chiropractic RadiologistIn today’s episode, we talk about utilizing a checklist for each x-ray series you take. We created this form here for your convenience and we hope it really helps to make your practice easy. Download your free Radiology Report Checklist by clicking here. Use one form per x-ray study and utilize for your Radiology Report just like Dr. Tao discusses in today’s episode. Radiology Report Example Dr. Tao was gracious enough to share his skills with us and read a hip x-ray for us and composed a report. High quality, precise, and meeting the legal standard just like all of his work. Find out more about Dr. Tao’s services at clifftaodcdacbr.com. Dr. Joshua Eldridge: Welcome back to episode 7 of the ChiroPractice Pro podcast. On today’s episode, we welcome Dr. Cliff Tao, a chiropractic board-certified radiologist to discuss the most important aspects of reading an X-ray and compiling a proper X-ray report. As our free gift to you, we’ve compiled an X-ray review checklist like Cliff talked about to make sure you review each X-ray you read with accuracy and the special detail your patients deserve. We suggest that you download this checklist and utilize it with every patient. This checklist can also be found in the ChiroPractice Pro system to help you compile a great report every time you use radiology. Also in our show notes, Cliff has presented an X-ray and provided the report for your education. This is exactly how he does it in his radiology practice. You can see the detail and care he takes with each read. You can find your free X-ray review checklist and the example radiology read in today’s show notes at chiropracticepro.com/episode7. Now, let’s get started with our special guest and my good friend, Dr. Ciff Tao. All right, Cliff, welcome to the ChiroPractice Pro podcast. I’m excited to have you. Just so everyone knows, Cliff and I went to school together back in the dark ages, I think. He got me into radiology. Cliff, welcome to the ChiroPractice Pro podcast. Dr. Cliff Tao: Thank you, Josh. I didn’t know I got you into radiology, so I apologize. Dr. Joshua Eldridge: Do you remember? I don’t even if you remember that was so long ago, but we used to go in the mornings to the clinic. That was my favorite part of the day I think. Dr. Cliff Tao: Oh, okay. Yeah, we did that a few times I think. Dr. Joshua Eldridge: Yeah, a few hundred maybe. Tell me about your journey becoming a chiropractor and then a radiologist? How did that all work and what got you started? Love to hear about it. Dr. Cliff Tao: All right, well I suppose I got a short answer and I got a long answer. Short answer is I was in college and I didn’t know what to do afterwards. One of my friends were on a chiropractic school, they got accepted, they’re good friends of mine. They were smart and I’d never even been to a chiropractor, but I checked one out in town. It was actually a little shady, but seemed like a nice guy and I said, well I’m gonna go to chiropractic school. So that’s the short answer. The long answer is I always had this fascination for the human body. I loved human anatomy especially musculoskeletal anatomy, and my dad is a medical radiologist. Although he didn’t really push me to go into medicine or healthcare, he was more about just do whatever makes you happy kind of guy. My mom was the one that wanted me to either be a doctor or a lawyer. There was that to deal with, but that’s why I went into kinesiology in college, so I could learn a little bit more about musculoskeletal anatomy. I was involved in sports. I played, I don’t know if you consider it a sport, but I know a lot of people don’t, but I played college badminton all four years. It is a pretty demanding sport. I loved the application of athletics to the human body and how we could optimize the performance. It seemed chiropractic was just a natural segue into it after kinesiology in college. So I got into chiropractic school. Even before I got in, I’d heard that there were specialties in chiropractic, but I thought you had to be really smart or you had to publish stuff to get into these residencies or postdoctoral, postgraduate training types of things. I mean you do have to have some minimal competency, but I don’t think you have to be that smart to do these things. I think you just have to love it, and I love radiology. I love the aspect of having just pictures to look at. Not that I’m not a social person, but I love the aspect where I didn’t have to talk to people all day. I was slightly burned in, this was between college and chiropractic school. I worked at a PI clinic. A motor vehicle accident clinic in Canada. I saw the business aspect of running a practice. The practice was pretty large. It had five or six locations in the Toronto area in Canada. I liked it from a business perspective, but I didn’t like it from a patient care perspective. That kind of turned me off from having to deal with patients and talk to them and treat them on a regular basis. Radiology was kind of a nice haven for me. I was a little bit away from direct patient care, but I could still have some input into what goes on, maybe not directly but some input into what goes on in the patient management spectrum. Plus, it makes me feel smart. I think you learn a couple extra things in the residency, and the goal really to help patients and help the doctor help the patient, but it gave me a little sense of accomplishment. I’m not that smart. I think I just really liked that aspect of it and the flexibility of working from different locations especially now with digital radiology was also a motivating factor as well. That’s the long story. Dr. Joshua Eldridge: I don’t want people to think that you’re not smart though, because it takes at least when I remember, to get into the residency to be a DACBR is very difficult and it’s very competitive. I think you’ve done a pretty amazing thing. I have the diplomate in sports, but I think the DACBR might be one step above that. Then us sports guys are just below you in the hierarchy of diplomates. Dr. Cliff Tao: I’ll go with that, yeah. Dr. Joshua Eldridge: I think you guys put a lot of work into that. I remember the residence at National as they were preparing to give their boards and how they had to present the cases. That was no joke with questions that they get. Dr. Cliff Tao: It’s pretty brutal. It’s been a little while for me now. I mean, how long has it been? I finished in 2003, so it’s been about 14 or 15 years, but the residencies were not that organized, so we didn’t even have regular testing and so it really was like a three-year long course and you get one big exam at the end. I remember our cramming session began the week before Christmas. It was 16 weeks of full-time studying, minimal family Christmas time and then the exam was like early April. It’s always like that. I don’t know why they won’t change it. I guess I’ve kind of forgotten about those pains. It was a little difficult, but I think it’s worth it. Dr. Joshua Eldridge: Yeah, I think you guys have definitely earned it. We were kind of talking offline. I just see the reports that you do compared to similar ones I see from a hospital, I just think they’re so much better. Before we get going into the meat of this, tell me about the most interesting or craziest case you’ve ever seen in radiology? Just off the top of your brain? Dr. Cliff Tao: Well kind of dovetailing in to what we’re talking offline. One of the craziest cases, I could probably pull up a picture here. You’re not gonna show a picture anyway. Imagine a lateral cervical and there’s no SP’s from C-3 to about C-6. The patient has DISH. Diffuse Idiopathic Skeletal Hyperostosis, and it’s obvious. There’s a big extra bone there anterior to the C-spine. There’s some nuchal bones, so you know, a couple ossifications back there. There’s Degenerative Disc Disease in the osteophytes that you’d normally expect from, I don’t remember how old the patient was, but probably in their 50’s or 60’s. This was a patient that went to a local hospital to get X-rays for some reason. The report came back from the medical radiologist. It was one line long, and it said multilevel degenerative disease, period, and that was it. Radiologically, it’s an easy diagnosis to make. Maybe from a medical standpoint, it doesn’t matter to them but as chiropractors, we’re gonna be palpating the SP’s and a laminin, stuff like that. We kind of need to know if those things are there or not. That’s a case I put in my presentation that I do regularly for CE and stuff like that. I always kind of say just because you sent your patient out for X-rays to professionals, I encourage everyone to at least look at the images and not to just rely on the report that you get. Dr. Joshua Eldridge: For sure. Getting into this. When we think about imaging, what should be the first thing that comes to mind before we make the clinical decision that imaging is necessary? When we make that decision when we’re in the room and we’re working with a patient, what should be our thought process before we image the patient? Dr. Cliff Tao: I don’t really get into that a lot. Part of the reason is I service a lot of different chiropractors. As you know, on one end of the spectrum, we have a very mainstream medically oriented chiropractors that just function like a medical physician, and then on the other end of things, I have my vitalistic or philosophically-oriented subluxation-based chiropractors who don’t have such strict criteria when deciding whether or not to order X-rays or other imaging. Just as a very broad generalization, I’ll say if you feel like having an X-ray is gonna help you treat the patient better, get the patient better, then go ahead, take the X-ray, or order the X-ray. I’m a little liberal in that sense. I don’t really follow the published guidelines or recommendations or anything like that. It’s probably not great. Sorry, I’m a little liberal in that case. I don’t care, or not that I don’t care, but it doesn’t matter to me what particular technique you use or how you treat them. I don’t know what’s out there. I’m kind of removed from that process. I just assume the chiropractor that I’m serving knows what he or she is doing and knows when it’s gonna be a good idea to take X-rays or not. Dr. Joshua Eldridge: All right, do you have any practice guidelines that you suggest to different practitioners if they ask? Is that something that you’ve looked at or not as much just because you’re more removed from that? Dr. Cliff Tao: Yeah, not as much. I try not to get into it. It seems like we almost need two sets of guidelines for the two opposite ends of our spectrum. On one end, we have the ACA, choose wisely which I think that recommendation was made without any radiologist consultation, so there’s that as well. Then we have the other and the spectrum, they have a set of guidelines too which of course are a little more liberal and a little more open-ended. I don’t really recommend either one, I guess if I were to, it would just be dependent on what type of practice this particular chiropractor has. Dr. Joshua Eldridge: I know in the hospital setting, they really don’t want us to do especially the lumbar spine X-rays. It’s something that they really push for us not to do unless there’s trauma or there’s some type of neurological deficit that we find in the exam, or trauma, neurological deficit or something that clinically we think that there’s an injury that’s occurred or some type of disease process going on that could potentially be causing the symptoms of the patient. And they have guidelines that say if you have a certain percentage, if you ordered let’s say 25%, then you’ve exceeded the guidelines and therefore should be looked at closer. Yeah, it’s a different situation because you’ve got a lot of accountants in the next two. There’s a lot of studies out there that say once you have the X-ray, is it gonna change your potential treatment. I guess that gets back into our job as more clinicians to decide that, and then just a thought. Dr. Cliff Tao: Part of the problem I think is that, I don’t know when it started, probably early 1900’s when they discovered that radiation was not that great for the body. We still hold on to that, and there’s still truth to that, but I think a lot of those studies have proved radiation was bad for high levels of radiation or even moderate levels of radiation. That we know is bad. I’m talking like the recent was at Fukushima, the nuclear plant in Japan. That’s super high amounts of radiation, but there’s been a lot of data that show what low levels amount of radiation will do. Low-level meaning from X-ray, CT scans. When you have no data, you can only really guess. I don’t know if it’s good, if it’s bad or if there’s no effect. I still think there should be some caution involved or let’s just be conservative and say hey let’s not just blast everybody with X-rays because we don’t know what it’s doing, could be good, could be bad, it could have no effect, but there should be some clinical or critical thinking involved before you plan to take an X-ray. Dr. Joshua Eldridge: I like that. That’s a good way to leave that one. I think that’s a good way to go. So just be smart. Once we’ve taken the X-ray, how do we make sure we’re not missing anything? So you got the X-ray, let’s just say a lumbar spine. We got a lumbar spine X-ray and it’s up here in front of us, either on our monitor or on the viewer, what process do we have to go through to make sure that as clinicians, we don’t miss anything? Dr. Cliff Tao: Well, I think it’s a good idea to have a checklist. The longer the checklist, the more thorough you are. I think everybody learned what I learned in school and what I learned in residency too were the ABCS, and that goes for spine and most other bone or musculoskeletal types of X-rays. Everybody knows A is for alignment, B for bone, C is for cartilage or joint spaces, and S is for soft tissues. That’s a good place to start, but then we have to realize there’s a little more under each letter. We could go further into it. Dr. Joshua Eldridge: Go for it. Tell us about alignment. Dr. Cliff Tao: Alignment, that’s probably the easiest one. Just making sure the bones line up on each view and then that’s kind of the reason why we got to have the right views first of all, and everyone knows this again, you got to have an AP and a lateral. Earlier before we started, I was saying I had a pediatric ankle fracture. I’ve seen a few of these where the fracture only shows up on one view especially in the ankle. It must be that it’s just more common, but I think it showed up on the lateral view, not on the A to P and not on the oblique view even. We got to have at least two or maybe even three more views to have a more thorough assessment. Alignment is make sure all the bones line up. B of course for bone and naturally, we think of bone density to start with. That in itself is as hard to evaluate because the X-ray is not really for looking at bone density, it’s more looking at the anatomy. We know we need at least 30% to 50% loss of bone density in order for us just to identify it on X-ray. It’s worse in the spine by the way, so that number 30% to 50% is average for all the bones in the body, but in the spine and in particular, the lumbar spine, I think that number’s 70% to 80%, so it’s actually pretty bad in the lumbar spine. We have to kind of keep that in the back of our mind. The other things that are under B are the shape of the bone, it’s the shape or the morphology of the bone, and does that look okay. Are there little osteophytes here and there, are there erosions, is there sclerosis for example when describing a fracture. This is more important if you’re communicating with the orthopedist or someone who’s in between the fracturing or they want to know the prognosis of the fracture. How close are the ends? Are they opposed, is there displacement, angulation, rotation? Is there a fragmentation? All these things are covered under B and in this specific example under if there’s a fracture. C is for cartilage or soft joint spaces. So you just think of for example, in the spine, the disc, there’s cartilaginous end plate or the annular fibers and then there’s the nucleus pulposus. You gotta look at those things, although we can’t really see them, but there’s ossification or calcification with them, we can comment on it as indirect relation to what we know is there. Of course, the disc spaces can be increased or decreased, of course, most commonly, they’re gonna be decreased much more commonly than increased. Then is there abnormal change in the joint space? So in the spine, is there a wedging one way or the other, laterally, medially, what-have-you. There’s other areas where there’s cartilage too. So the other joints, so like the hip joints and the lumbar spine, or the symphysis pubis, all those joints that have cartilage that really look like spaces, but they’re not. Then S, I feel like a lot of people just gloss over the S because we really don’t see soft tissues that well on an X-ray, but on a well exposed or X-ray that’s done with good technique, you can see quite a bit of soft tissues and you can get a lot of information from them. But we do of course have to realize that there’s a lot of stuff we don’t see on X-ray and there’s other stuff that we can use to evaluate the soft tissues, like a CT scan, ultrasound or an MRI, but just don’t forget to look at the soft tissues. Note any for example, common ones, atherosclerosis which everyone has seen in the abdominal aorta, but you can get that in the carotid sinuses in the neck, you can get in the upper vertebral arteries, you can get it in the ankle and the wrist which could indicate diabetes. That’s common in the soft tissue realm. How’s that? Dr. Joshua Eldridge: That’s good, and swelling too, maybe soft tissue? Did you hit that one? Dr. Cliff Tao: No, I didn’t mention it, but yeah that’s a good one too. Hard to see that directly, but easy to miss if you don’t look for it, but yeah we see that not infrequently for example in the knee, suprapatellar swelling or in the anterior wrist. Lot of times it’s just there’s a fat pad that looks a little deviated, some type of an indirect assessment of that. Dr. Joshua Eldridge: That’s really good, and I think that that’s a good review because people forget and they’re just out there looking at X-rays and they’re looking if they do Gonstead, they’re just drawn on it for their manipulations or whatever they’re doing, and then they forget about all the important stuff that might be in there as well. I like the checklist idea. That’s just like a pilot where people’s lives are a little bit more important, but making sure you go through that each time. Cliff, get into the how you write a report then. We’ve gone through the ABCS, and get into how you write a report on that? What’s the different components to report, what should be on there legally. From a legal standard, what do you need to have? Dr. Cliff Tao: Well, I think everyone knows this, but you gotta have the patient information at the get-go. So, patient name, date of birth, their gender, the date of the X-ray and of course, a date that you’re doing your report. I like to have a little bit of clinical indication in there, why you took the X-ray or maybe there’s something on the X-ray that looks a little funky to you. Also, sometimes, I like to put where the X-ray was taken if I know it’s not taken at the doctor’s office. In med-legal cases, sometimes it matters I think where the X-ray was done. For example, if the X-ray study was not great quality, who do you blame? The chiropractor or do you blame the Imaging Center? I think that matters too. Then you get into the meat of the X-ray report. Basically, there’s two sections in the meat, so there’s the findings section and there’s the impression or conclusion. In the findings section, generally speaking, this is just what we see. It’s kind of the nitty-gritty, do I see a white thing, do I see a dark thing, was it round, was it square? Is it pointy? That’s where you go to town on describing what you see. Actually even before we get there, or right before we get there, I like to look at X-rays twice. I think the first time you look at an X-ray should be without any biased information. You just kind of forget about what the patient is in for, whether they have pain or not, if you can forget about what they look like. All that stuff is all extra information to me. Just look at the image for what it is, just the image and that will force you to be a little more objective, I think, and it’ll force you to look at the whole image which you should be looking at anyway. Then, you got to kind of reinsert that information back in your brain, Oh, okay. They came in because they’ve had back pain for three years, and they fell 10 years ago or whatever. That should kind of focus you into a particular area and maybe it’ll change your report, maybe it won’t. A lot of times, it does. It takes a little bit longer I think to read an X-ray that way, but I think it’s a little more thorough and a little more objective that way. I do that and then you write it down, the nitty-gritty, what you see in the findings section. Then in the impression or the conclusions, that’s what you think of the findings. It’s what you think of what you just saw. Are they all normal things that you just saw, or is it degenerative disease? Is it spondylosis? Is it a fracture? And then kind of a subset of the conclusion or impression section is at least for me, recommendations. Are there further things you can do to figure this out? Do you need to take another X-ray view? Do you need to take the other side, or you need to get a CT scan or something? That’s where all that information goes. Then, of course, you have to sign the report at the end and I think that’s it. Dr. Joshua Eldridge: All right, nice. Then once you’re done with everything, how do you build it back into your clinical relevance with the patient? I know as a radiologist, you’re just kind of sending it back and you’re giving your two cents on it, but then what about if it’s your patient? How do you kind of build that all back into your treatment plan, and how do you present it to the patient? Dr. Cliff Tao: Well, I think you can do it a few different ways. One way is just to kind of show your patient the report. I think it probably depends on what’s on the report and what or how you perceive your patient to be. Do you really need to have your patients know every little detail about their X-rays, and is it gonna make that much of a difference? Those are things I think can be determined on a case-by-case basis. This is not a familiar scenario to me, so I think if it was me, I would wanna know. It takes more time obviously for the doc to kind of go through all these findings and hopefully they can sort out what’s relevant and what’s not relevant, and hopefully, the patient will have a little more confidence in treatment plan that the doctor’s proposing. Generally speaking, I use it to either refute or confirm your suspicions before the X-ray and maybe it’ll help you support your proposed treatment plan or management plan for the patient. Dr. Joshua Eldridge: I know that for me, whenever I have radiology on the patient, let’s say lumbar spine, or there’s some spondylosis on there, and I’m able to say that’ll change my diagnosis code from something like lower back pain to actual spondylosis. Now it also increases your medical decision making like we talked about in podcast 2 and 3 with Warren Jahn, but that’s part of your assessment too. It’s gonna increase your medical decision making that you’ve looked at this X-ray and now you’re giving them a diagnosis of spondylosis or spondylosis with radiculopathy. It changes that hierarchy of your diagnosis codes. That’s a big deal when you’re talking about reimbursement because you wanna make sure that you get paid for what you’re doing. If someone brings in their X-rays from a previous chiropractor and they were more let’s say, subluxation based and you took the time to read through the X-rays, and you see that there’s something abnormal that might be something as well to justify your treating the patient to a third party as well. Dr. Cliff Tao: Right, of course. Dr. Joshua Eldridge: Tell me about your services that you provide. How does that work? When I’m in my office and I take an X-ray, how does Dr. cliff get my information to read my X-rays? Dr. Cliff Tao: Well, it’s not that complicated. In my typical chiro that I serve, they have an X-ray in their office, they’re digital X-rays. There are several ways of getting the digital X-rays to me, so we set that up. It could be as easy as, soon as the X-ray is done on their end, they’re done taking the X-rays, they might have to hit one or two buttons and the X-ray gets sent over to me. It shows up on my computer within about 5 to 10 minutes, and I see it immediately. I can do it right away. Typically it takes us, meaning I also have a few associates here, or not here, but out there. It takes us about 24 to 48 hours to generate a formal report and get it back to you. Actually, some of my guys have it set up where they just want a more routine process. I think they have a higher volume maybe of X-rays so it’s worth it to them. They have it set up, so it actually doesn’t take them anytime to send me the X-ray. The computer knows as soon as the study is done, it gets automatically sent to me. That way, they don’t spend any time trying to figure out how to send the X-ray to me when to send it, which studies to send, it just gets done automatically. I have a few guys like that as well. Most of my guys are, they send on just a case by case basis. They see something weird, they’ll send it to me, or if it’s maybe a complex case, then they don’t get it. But it’s not that hard. Once you get it going, it’s an easy process to send the study over. Dr. Joshua Eldridge: Why would me as a chiropractor serving my city or my tribe here, why would I wanna send you my X-rays? What is the benefit to having a specialist look at my X-rays? Dr. Cliff Tao: Well, I mean you could look at it a few different ways. I think it’s better, you get a more accurate report off of the X-rays. I’m probably thinking more of an idealistic situation. If it was your eye and we went to just a medical doctor and they took X-rays in our office, when you want a specialist look at your X-rays rather than– We’re all trained to read X-rays, but I just happen to have a little more training and it’s what I do all day. I think it just gives a higher level of service and professionalism to your practice. It could help streamline things too. I think it’s hard when chiropractors in a busy practice, they’re taking X-rays and they’re reading them. You might read a lot of X-rays, but I’ll tell you, there’s a lot of different things that I see on X-rays and that I don’t see on X-rays that chiropractors don’t see, or do see and then I don’t see them. There’s over calls, there’s under calls. I’m talking ideal practice here, but we would like to try to minimize false negatives and minimize false positives. Then there’s special cases like med-legal cases. I think it always helps to get another chiropractor or another healthcare practitioner on the case. It just helps kind of spread the liability. I hate to say it, but it does spread the liability a little bit, but it also shows that we know what our limits are. When it comes to complicated X-ray that you have someone to send it to and do a more thorough job looking at it. Dr. Joshua Eldridge: Alright, that sounds good. I know you do a case online, you put a few up on Facebook every now and then and people should definitely check that out. What are the percentage in your experience that chiropractors that are doing their own X-rays are missing things? And use me for an example. I don’t mind. I got broad shoulders, so I can take it. But if I got 10 X-rays, how many of those am I missing something on? Dr. Cliff Tao: Oh, you know it’s very variable. I hate to say this, but for you, you probably wouldn’t miss a whole lot. It’d be probably less than one. Actually, it’d be probably more than one, but of the things that you miss, then you gotta look at does it really make a difference? Okay, so you missed a little osteophyte at L-1. Is that gonna make a difference? Probably not in your practice, but it might make a difference in someone else’s practice, so it’s hard to say. I do have some chiros that I think seem to miss on every single X-ray. I’m not gonna give any names, but I we’re all over the map. There’s some guys that do very well at reading X-rays, but they send me all their X-rays because they kind of know that there’s a lot of stuff that goes on that they don’t really see if they’re not trained or reading them on a regular basis. Then I have guys that send me stuff but almost on every image, I gotta make a special call to them or special email to them to make sure they saw something. Those happen frequently. I don’t really know exactly how it impacts the patient in the end, but I’d say at least maybe on average, maybe 20% would have a significant impact on how you’re gonna treat the patient. Dr. Joshua Eldridge: To me, that’s a big deal. 20%’s a big deal when it comes to treating a patient. That’s a lot to miss. Of those 20%, some of that could be like we just talked about in osteoma in the skull. Dr. Cliff Tao: Yeah. Dr. Joshua Eldridge: If you missed something like that, that could be the patient’s life at some point. Dr. Cliff Tao: Right, yeah. It’s not a best-case scenario that the chiropractor would be adequately trained to read all imaging, but it’s hard to be good in everything. There’s some guys out there that they’re really good with all that stuff, but I tell a lot of my chiros, hey, I don’t talk to your patients. You should be looking at the X-rays that you take, but maybe from a preliminary standpoint, and then you send it to me. You and I can talk about it but in the end, I should be doing that final analysis or final report on the X-rays. I hate to bring this into it, but from a med-legal standpoint, if you ever get subpoenaed for your records or whatever and you’re the last, why didn’t you just send this to a radiologist to read? There’s rarely a good answer for that, at least that I’ve seen. I think it’s good in the end. I know I’m kind of talking from an idealistic standpoint, but from a perfect scenario, we’d have a specialist doing everything, but we’re not in a perfect world. Dr. Joshua Eldridge: Right, so if people wanna find out more about your services, where do they go to find out more about your services? How can they get ahold of you? Dr. Cliff Tao: Oh, well they can go to my website. Should I give you the website? Dr. Joshua Eldridge: Yeah, go for it. Dr. Cliff Tao: Okay, it’s www.clifftaodcdacbr.com. Dr. Joshua Eldridge: Tao is T-A-O. Just so people know that. C-L-I-F-F T-A-O. Dr. Cliff Tao: Yes, same thing on Facebook. I’m pretty active on Facebook so you could search me with Cliff Tao, DC DACBR, and same thing on LinkedIn as well, or they can call me, 714-876-1126. I might not pick up the phone, but at least you can call me, and I’ll call you back eventually. Dr. Joshua Eldridge: Now, the other cool thing that you do, you do a really cool event that just happened last weekend. It’s an amazing ski trip that you do up at Mammoth Mountain each year. Tell us a little bit about what you do and what kind of time it is for those chiros that come out there. Dr. Cliff Tao: Alright, we’ve been doing it for about seven years now, just had it last weekend. It’s always at Mammoth Mountain. Obviously, Josh, I love to ski. That’s one of my passions, but so is chiropractic. They say you should work smarter, not harder so I’ve combined two of my passions for a two-in-one weekend where you can get continuing education and some great skiing in. What I do, I bring in a few speakers that I know, that do a good job. It’s kind of a mishmash all over the place. This past year, we had a great guy talking about documentation, another guy talking about personal injury, another guy talking about pediatric adjusting and a neurology guy, a neuro diplomate talking about his neuro exam and stuff like that. It’s kind of different guys and gals talking about their specialty within chiropractic. I try to keep it pretty formal on the CE, or not formal, but we’re dressed very informally because we’ve just gotten off the ski lifts or something, but we do have food there. It’s generally a pretty good time. Dr. Joshua Eldridge: That’s pretty cool. They find more information about that at your website as well? Dr. Cliff Tao: That’s on my website as well, yeah. Dr. Joshua Eldridge: Perfect. That’s something that I am very much looking forward to. I really wanna come out this next year and come to your event and hang out. The last time me and you skied together was in Michigan when you broke your fibula. Dr. Cliff Tao: Yes, boot top fracture. Dr. Joshua Eldridge: Yeah, I remember that one. Dr. Cliff Tao: I had no insurance by the way. Dr. Joshua Eldridge: Back in the day, huh? Dr. Cliff Tao: Yes, I have insurance now. Dr. Joshua Eldridge: Just in case it happens. Are you still doing the crazy stuff down the slopestyle? Are you coming down and hit the tabletops and all that kind of stuff? Dr. Cliff Tao: No, I don’t do those anymore, Josh. I’m a little too risky now, and I’m a little more fragile now. I stay off those things. I do get a little bit of air, but not much air these days. Yeah, I would love to have you come out and it’d be a great time. Yes, it’s fun times. A nice little venue and just a small group of guys. Usually, we have about 20 people, probably a little more next year maybe, but good skiing and you can learn a couple things, and hopefully get some CE in there too. Dr. Joshua Eldridge: Nice, well, Cliff, thanks for joining us on the ChiroPractice Pro podcast. I really enjoyed having you, and thanks for taking the time and sharing your knowledge about radiology. Dr. Cliff Tao: You’re very welcome, Josh. Thanks for having me. Dr. Joshua Eldridge: All right, you bet. Thank You, Cliff, for joining us on the ChiroPractice Pro podcast. Don’t forget to download your free X-ray review checklist and see the example X-ray read at chiropracticepro.com/episode7. We enjoyed having you on today’s episode, and we hope that you found real value with the podcast. If the ChiroPractice Pro podcast has helped you in your practice, take a moment and leave a review on iTunes and then share with another chiropractor that you respect. From our team here at ChiroPractice Pro, we want to say thank you in advance for doing this. Don’t forget that to be successful in practice, it’s all about the little things. Keep doing the little things each day to see big results. We’ll see you next time right here at chiropracticepro.com.
48 minutes | Apr 11, 2018
Episode 6: Owning Local Search Results with Dr. Derek Baron
Episode 6: Owning Local Search Results with Dr. Derek BaronToday’s Free Giveaway: Want to DOMINATE Google search results for your local area? Download 5 Ways to ROCK Local Search Results by clicking here. Follow the steps and see an improvement in local search and community image. You’re going to thoroughly enjoy today’s podcast and it will add enormous value to your practice. Enjoy! << Episode 5: Becoming A Sports Doctor We discussed a great article on voice search during the podcast and this can be found here: Voice Search: Is Your Practice Poised to Win or Lose? Dr. Baron also shared his personal email: firstname.lastname@example.org Make sure you straight away put your practice’s website here to download your report on what reviews you have online: PracticeReputationReport.com Dr. Baron has a site where he puts all of his new content: https://contentd4u.com/ And here are the websites that he discussed: TheDoctorsMarketingSource.com SportsAndRehabZone.com FiveStarPractices.com Dr. Joshua Eldridge: Welcome to episode 6 of the ChiroPractice Pro podcast. On today’s episode, we provide you with the best ways to dominate Google listings through reputation marketing and the local SEO search. Our special guest is Dr. Derek Baron from thedoctorsmarketingsource.com. In our podcast, Dr. Baron gave 5 things you can do today to dominate the search results when people in your community search for you. We’ve put these 5 resources and easy to use PDF downloads so you can implement these suggestions and start seeing results today. Download this free resource now at chiropracticepro.com/episode6. Chiropracticepro.com/episode6. These 5 tips are amazing and the rest of this podcast is pure gold. After doing this interview, I am convinced that this is a practice-changing podcast and it starts now with Dr. Derek Baron. Derek, welcome to the ChiroPractice Pro podcast. Thank you so much for joining us. Tell us about you, your journey into health services and chiropractic specifically, and then get into what you’re doing now. Dr. Derek Baron: Hey Josh, thank you very much for the opportunity to be here with you and your listeners. It’s always great to be able to spread a message to chiropractors and other healthcare practitioners. I’ll do the best I can to give you some great value. If you’re listening to this in practice or on the way in or out, hopefully, It’ll give you some good nuggets from here. Back into my journey into chiropractic, you could say is it truly started when I was a junior in high school and I was using chiropractic as a way to get out of football practice in the late fall and when the snow was hitting the ground way up in northern Wisconsin. I would see a great chiropractor, his name was Dr. Lupicas. I loved that when I would get my cervical spine adjusted, as soon as he would put his hand on my neck and I would hear that paper crinkle, I loved it. I would see chiropractors every once in a while. Then I went to school in Wisconsin, smaller state school called the University of Wisconsin–Eau Claire. I majored in biology and a minor in chemistry. I decided I had an option of maybe working at a zoo or seeing what else I could do. I went back home and I saw Dr. Lupicas, talked him a little bit more. He said, you know you should consider chiropractic. I looked at a couple of schools. I honestly didn’t visit a single school. I just went to National, applied, got in. That’s where I went. It was a great opportunity for me at National. At that time, it was National College of Chiropractic, now it’s National University of Health Sciences. They’re all great schools, but I’ll throw in a little bit there for the alum of National. When I was there, graduated, enjoyed it, met some great friends, some amazing professors of course. I had some really good opportunities. My first opportunity out of school was to work with a primary care physician in a medical setting. We were working a lot with cancer patients. We were using some microcurrent therapy to help them with the residual effects of cancer. We use this microcurrent therapy to heal them with prostate cancer, and to heal them with radical mastectomy. When I say heal, I should be careful with that. They have a lot of scarring tissue helping the wounds heal, it was amazing what it did. It just wasn’t my fit, it was less chiropractic than I wanted. My next opportunity was in the city of Chicago with an orthopedic surgeon. It was a great opportunity. I learned a lot, what not to do and a lot of what I should be doing when it comes to healthcare. It’s not against the medical profession, but for the way I wanted to practice which was a very active care model and give the patients a chance to go through a rehab protocol before they would have to go through surgery, we kind of wanted them in surgery before anything else. So, that didn’t work out well. At that point in time, I’d actually met my eventual wife who was a physical therapist and athletic trainer. We started having some conversations, got to become very good friends. Things developed from that point in time, so we moved back up into Wisconsin from downtown Chicago and started working with a couple other people in a rehab setting. Then, we decided to open her own practice back where we’re from in a small town in Wisconsin called Rhinelander, Wisconsin. It was called Integrity Sports Medicine. Loved it, I got to be a team physician for the high school and another school there. It was great, I earned my diplomate in chiropractic in sports and had a wonderful time. At that point in time, we had had our son. We wanted to make sure we were doing the right thing and having the right opportunities. We realized that maybe the opportunities were elsewhere. We moved to Florida for a bit and then back here to Illinois. That’s where we reside now. Dr. Joshua Eldridge: Great, and what do you do now? What path have you chosen now? Dr. Derek Baron: The last practice here in Illinois that I worked with was in a work comp PI practice and my emphasis was sports medicine. It didn’t work out as well as I would have wanted to, so during that point in time, I was starting to do some marketing for our practice as well as some other practices building websites, doing some online marketing consisting of maybe pay-per-click ads. That just slowly died away for me, the desire to be in that practice. I just didn’t care to start a whole new practice at that point in time. I started a digital marketing agency, it’s called the Doctors Marketing Source. I work with different types of physicians, but a lot mainly with chiropractors. We do everything across the board from website design and development to the important parts that everybody wants which is new patient lead generation with Facebook or with Google, and PPC, and content marketing, all the stuff that helps you or the chiropractor bring in their patients. Dr. Joshua Eldridge: Right, and one of the things you do is reputation management or as you said marketing. I find it very interesting, tell us about that about the reputation part of what you do and why it’s important and who needs to be doing it. Dr. Derek Baron: I’ll try and talk slow on this because I think it’s one of the most critical and most important things for any practice to deal with. But most people talk about reputation management. Management is a big portion of it, but I want people to also think about reputation marketing. The difference between the two is reputation management is typically when there’s a fire that’s out there and something needs to be put out. What that means is you have a negative review online, or a patient has said something to you or unfortunately, you’ve had some clients that they’ve had a DUI, so there’s something that’s put online that’s negative about you. That means if there’s a fire, so you’re in the hurry, hurry, what can you do to fix or correct it? With some of those, it’s very, very difficult. What marketing really brings to the table is instead of worrying about the fire every single day if you’re dripping something into a bucket by getting a new review as often as possible whether it’s written within the practice, whether it’s having a picture taken with your patient, whether it’s a child that you care for or whether it’s a senior or middle-aged people and you put it on your wall of fame in your office, it’s all a great thing to do. Your reputation is what precedes you, especially nowadays online. Every single time you’re getting these reviews, it’s important and it’s critical that you’re doing that for that one day that you may get a negative review and it will come. When we’re in practice, we know you can’t please everybody. If you’re struggling to please everybody as long as you’ve got some testimonials that are out their online reviews, it helps you battle against that. Dr. Joshua Eldridge: This kind of goes off of some of our questions, but I’ve seen online especially a lot of the younger docs, they’d take a lot of pictures with their patients. How does that work legally as far as what steps you as doctors to do to just make sure that they’re keeping hip in mind and that type of security for the patient? Dr. Derek Baron: Yeah, you bet. Great question Josh. Primarily, it’s just to get a release or a waiver form. It’s really important, especially if you’re working with athletes in the high school and/or collegiate and even professional athletes. They need to make sure that that passes the state regulation rights. If they’re a high school athlete and you do a video testimonial, you bring up is or her name and they’re promoting your practice, that can actually get that student athlete in trouble and actually potentially void their ability to participate in their sport. It’s just simple getting a patient confidentiality when they’re signing your HIPAA forms and right away, you can say we typically like to get a bunch of testimonials from our patients and sometimes it’s an image or a photo, and sometimes it’s a video. We’d like you to fill up this waiver, then it’s just asking their name, a small a little bit of information on there that’s really just going to hold you harmless, but let them understand that they’re ticking the box, yes, I’ll allow you to put this on your website, put it in videos, put it on your Facebook page, share it on Instagram, wherever you’d like. It’s just to cover yourself and more importantly to cover your patients, especially if they’re the athletes. Dr. Joshua Eldridge: Gotcha. This reputation management and marketing, how does this affect new patient acquisition? Dr. Derek Baron: Here’s how I try and tell people a lot to think about what’s happening nowadays. Mobile searches with your mobile device of course, tablets you can say, but your smartphones, 74% of searches for local businesses are done on a mobile device. People are actually trying to find out who they’re going to see or what they’re gonna get themselves into. The reason i s important for a chiropractor to have a good presence online is when somebody is searching for a chiropractor, so let’s just say you hire in the same town, Josh and my friend comes to see you, and you offer them great care, which I’m sure you do. And, I say, “You know what, I wanna go and see Dr. Josh, but I’m gonna do a little bit of research online.” So they’re gonna pull you up on their phone, they’re gonna pull you up on their computer at home. What are they gonna find? Are they gonna find that you have good placement online? Do you have good reviews online? Not just on Google which I think is the primary place, but Google is extremely important number one. Number two would be Facebook. Then there’s a bunch of other places that kind of follow in suit along with that. They wanna see number one are you able to be found? Number two, do you have good reviews that are out there for you, and are they consistent? In other words, if you could go to a doctor that you trust from a friend’s referral and you look online and they’ve had 22 reviews, but none for the last two years, it would make you question a little bit if you should actually go in and see them because of how our society is so social media savvy versus somebody that might have three or five reviews compared to the 22, but those are all in the last five consecutive months, or all in the last two months. They’re looking for somebody they can trust because you and I can tell each other whom and why they should come and see us, but they need to understand specifically that they couldn’t trust what somebody else has said that they’ve had good care at your office. Dr. Joshua Eldridge: Yeah, that’s fantastic. I like that. I think that what you’re getting at is just every little bit matters, so every day we need to be putting some energy towards this. Dr. Derek Baron: Yeah, the hardest part to do is ask for a review. That’s truly the hardest part. But I guarantee you when somebody comes in your office, and they’re so appreciative of the care that you do for them, you have to just do a simple ask and I always tell people, just think that you’ve got a little dinner bell in your head. As soon as somebody says after maybe a week or two weeks in care and they say, “You know what, doc? I can’t believe how great I’m feeling.” And it’s ding, ding, ding, ding ding. Okay, time to ask for a review. You would simply just ask them. “Hey Josh, would you mind if my office sent you an email that would ask for you to leave us a review online. Would that be okay with you?” And if you leave with just that question of would that be okay with you, it’s a very fine ask. You’re helping them, typically reciprocity will work and hopefully they’ll help you. That means you’ve got to ask a bunch of people, but every single patient that comes in that says they love you, you should be asking every single one of them to leave you a review. Now, if I can make one statement about that. Just be very careful of who you ask. You don’t always wanna ask everybody. You wanna make sure you’re asking the ones that you’re pretty certain would leave a positive review. Because there are sometimes practices just email all of their patients, even the ones that they haven’t seen for six months or six years to try and get a review when they realize that they’re not in the right position. Then that person’s like, “Well, they didn’t call me.” Then leave a review. As soon as that negative review is online, it’s there forever unless it breaks the Terms of Service and you can appeal that with Google or with Facebook, or any other services, but it’s 9 out of 10 times never gonna happen. Dr. Joshua Eldridge: Are there any legal issues to giving someone something, asking for a review? If you leave us a– because I know if you go to a restaurant, they might say, hey, if you leave us a 5-star review, we’ll give you 10% off your bill today. Can you say to a patient, “Hey, we’ve got this pillow or we’ve got this bottle of vitamins.” Is that allowed or is that something that’s frowned upon or just straight illegal? Dr. Derek Baron: It is illegal if you don’t offer it to every single patient. For instance, if you’re sitting in the room and you have a patient that’s in there that you know is gonna potentially leave you a good review. If you ask them and say, “Hey, Derek. If you don’t mind, if you leave a review on us online first, we’ll give you a pillow or we’ll give you a $10 Starbucks card. Then you go to the next room and you don’t offer that to that person, well they could turn you into the board, and the board would say hold on that’s not really following proper etiquette. If you wish of doing it, to put it in a polite way. The simple thing to do is you can put a fishbowl up in the front and say, please enter this month in for a drawing to get a TV, a gift card, whatever it may be. I honestly think that reviews are as important as buying a $300 television, and every month giving that away if you would get at least 10 people to leave you a review. That way, everybody has the opportunity. Now again, you could have somebody that has a negative situation that may leave that review. We’ve always heard that when you provide a great service, one person is going to give a review. When you provide poor service, 10 people will do that. Think of yourself in a restaurant, that’s unfortunately possible. You have to be very, very careful that you are selective in what you’re doing, but you can’t eliminate certain people and give it to others. They’re you’d have to consider are there certain softwares that can help online and generate some reviews for you. Dr. Joshua Eldridge: Right, and I know this was going away from the practice, but with my book on Amazon, Because She’s Worth It: A Nutritional Guide for Parents with Daughters, one of the things that we did was we offered whoever wanted to leave a review. We said if you really like the book, leave a 5-star review. If you thought it was horrible, then leave a 1-star review, but then we’ll send you a– it was a special gift. We put all the forms from the book in a PDF, or maybe we did a special video presentation just for them like a discussion on what we did. We had a lot of people leave reviews because there was a good gift, but they all enjoyed the book and left honest reviews. It’s kind of neat that there are ways that you can generate reviews and you can do it honestly, and also offer them something really great just to take an extra minute out of their time. Dr. Derek Baron: Yeah. That’s a great marketing avenue you went down with, Josh to do that for the book. It’s great. I’ve heard other people say if you leave us a review just like you did, giving them a gift away or you’ll be put on our special VIP list when the next item comes out, we’ll offer this for you. If you are offering tremendous value with the book and the video that you gave, or within practice. If you offer tremendous value of being the best chiropractic physician you can be, and offering the best services and when needed, refer out or having other ancillary services there, they can’t refuse that. They know you’re trying to help. You can’t fix everybody, maybe some great chiropractors out there that can, but it’s tough to make sure everybody is 100%, but you offer the best you can for them and they’ll follow suit and they’ll help you as well. Dr. Joshua Eldridge: All right. Any other positive ways that you can manage your reputation? Dr. Derek Baron: Yeah, I think the most important way is about getting video testimonials. It’s kind of hard, not a lot of people like to get on camera, but it’s really important that you do that. You could actually just ask your patients just to do it themselves and post it online, or you can literally, what I would tell you to do is take a selfie stick, put your phone on the end, have your patient sitting next to you. I know you can’t quite see what you’re doing, but you take that selfie stick and you kind of hold it up in the air. When they first see that coming across on YouTube or on your website or on Facebook, it’s one of those pattern interrupt they call it. As they look, it’s different from a high interview. You bring it from there, you kind of wave at the camera if you wish and then you bring it down and you just go through a couple of questions and say, “I just wanted to share with you another great patient testimonial from Jane here. She came in a few weeks ago. You know what, let me have you tell her the story.” And you just turn the camera a little bit so Jane could tell it. Then again, here’s what’s the best part is. When a patient comes in, I was just talking with a chiropractor that has a diplomate in pediatrics today. We all know as chiropractors, we believe we can help everybody. I believe that in our hearts, we can. We should be able to do the best we can. I can tell any patient that I can help you, but they know I’m in a sense trying to sell medicine on them. But when you have somebody giving you a video testimonial and somebody can read that and connect with them and say, I have that same problem. My husband, my wife, my son, my daughter, my mother has that problem, they know that it’s now– the fences are down, the border’s easier to get into it. It’s a lot easier for you to feel comfortable with that doctor. It’s building that know, like, trust factor. I think that’s one of the most important things you can do. Getting reviews online, but making sure you’re getting video testimonials. Dr. Joshua Eldridge: All right, that’s great. Now, how do we mess up our reputation management online or reputation marketing? How are some ways that we can mess it up, and things that we should really be staying away from? Dr. Derek Baron: First and foremost is if you’re not analyzing your online reputation, you’re gonna hurt yourself. Whether somebody leaves you a positive review or God forbid a negative review, you can get yourself in a lot of trouble. From a Google perspective, when somebody leaves review and it’s a 5-star review, and it’s great and it’s glowing. You see it and you read it, you give yourself a thumbs up like that and pat yourself on the back, you did a great job, but you don’t respond to that, you lose out on Google love, essentially. Google wants to give you some love and respect for responding to that. Now that also tells the patient that left you a review, it pats them on the back and knows that you appreciated what you did. Then tertiary what comes in is the people that are going through your Google feed or your Facebook feed and they see that you replied to that, they see that you take time, they see that you care, and they see that you’re interactive. That’s the type of doctor that they wanna see. You have to start interacting with your reviews, especially negative reviews. Everybody’s definitely afraid to respond to a negative review. The thing I tell people to do all the time is as soon as you can, in a sense, even if it wasn’t your fault because we never tend to think it’s our fault, you just accept it a little bit and do your best to take that response offline. What I mean by that is say, “Josh, I’m sorry that we didn’t meet or exceed the expectations like we have with others. If you don’t mind, give our office a call and make sure they put you through directly to me as soon as possible. I’d love to help rectify this situation. I hope to see you or talk to you soon.” So again, that comes back and says that you know that there was an issue, you’re trying to resolve it, you’re not arguing the point, you’re not pointing fingers that it was his or her fault. You’re maybe accepting some of the blame, but you wanna fix it. So it doesn’t get in this back-and-forth. Again, the most important is people are gonna come and read that negative review, they’re gonna see the reply and they’re gonna see you replied within a day or two, so you’re super active in it. It sees that you tried to fix the problem versus if you ignore it. If you haven’t yet when you’re at practice, go and check your practice on Yelp. Look at the negative reviews compared to the positive reviews. You’ll see people can give it a thumbs up, they can like it, think it’s cool, or think it’s funny. That’s what people lose out is that there are people reading those reviews, making a judgment upon if they’re going into your practice or not upon what somebody else said. Whether it was right or wrong, that’s what’s gonna happen. Dr. Joshua Eldridge: Now, you have an office that hasn’t been managing their reputation and they’ve kind of let things go, and they’ve got 1 or 2 stars on Google or Yelp, and they’re just really struggling. What can they do to get out of the gutter and get back into the game with Google? Because we know they’re gonna be hurting at 1 or 2 stars. How do we get them back to where they need to be? Dr. Derek Baron: It’s just to start asking. You start working yourself out of that hole. The only way you do it is by getting behind that terror barrier if you wish, and don’t be afraid to ask, and your staff has to ask, and your staff has to follow up. You don’t wanna be a pest about it, but you’ve got to start taking proactive action. The reason I say that is you have a limited amount of time in practice. Social media can be such a blessing or a curse nowadays for practice. If you remember a little over a year ago, there was a dentist in Minneapolis that was a big game hunter. People found out that he had killed a lion. People that were out of state, out of country went to his Yelp page and destroyed him. Now, animal rights or not, it had nothing to do with his practice, but it hurt him tremendously. Hopefully, there isn’t something that’s going to be there. But the only way you can do it is by starting to ask people to leave a review. At that point in time, when the doors are closed, you just ask, “You know Josh, we’re starting to build our online reputation. Would you mind if you could help us out?” And at that point in time, you could offer them something, or you offer everybody, I would just leave it at we’re starting to build and grow our online reputation. We haven’t done it for a while, we know it’s important. If we’ve helped you and you think that you could do us a favor, please feel free to leave a review online. If you leave a review on Google and you feel like copying and paste it over to Facebook, we’d love that too. Those are the things that you have to do. One thing I’ll mention about Yelp as well, Josh, is that most people say, “I’ve got 10 reviews on Yelp, but only one of them is showing.” Well, there’s something that’s called the power Yelper. In other words, you could put a sign up in your office that says are you a power Yelper? If you are, please come and talk to me. That means they’ve at least have 5 or more friends and they have left five or more reviews. Those are the reviews that will tend to stick and not get filtered in what’s called the sandbag. That’s a way in which if Yelp is an issue because unfortunately in their algorithm that they’ve been sued many times in one and says there’s no way that they don’t filter it for negative only, you’ll see negative reviews show up and you see the positive reviews hidden. Even the negative reviews that don’t have a bunch of friends or a bunch of other reviews. It’s a bad algorithm that’s out there and there’s class-action lawsuits. I don’t wanna get in trouble with Yelp myself, but there’s just too often that negative reviews show and positive reviews don’t. The best way to do that is either find power Yelpers, or if you have a great relationship with that patient, ask them to go and review McDonald’s, to review Burger King, to review their church, to review 5 or more places on Yelp, and then come back and review your office. That way, they’re starting to see that that’s somebody that Yelp says, hey there’s somebody that their value is important and we wanna reward them for this practice. Dr. Joshua Eldridge: I mentioned Amazon, you mentioned Google and Yelp. Where are the places that people need to be? Where is the most likely place that someone’s gonna find something about their reputation? Dr. Derek Baron: In the medical profession, Health Grade is the one that’s pretty big. You can ask people to leave a review on Health Grade. But most people don’t have the time to really look. The ones that are doing that may actually not be the patient you want in your office anyways, because they’re being so specific and peculiar that maybe that’s okay if they don’t come in. But number one is Google. If you’ve got a product like you number one of course Amazon. If it’s on eBay, you want reviews on eBay. But for a medical practice, number one, in my opinion, is Google because that’s what people have in their hand. It’s easiest to search that. Number two nowadays is Facebook. You need to increase your Facebook reviews that are there, and then it kind of goes down the line. Yelp is important. Again, most people don’t like to do it. If you don’t, that’s okay. But there are a bunch of places in which you can find out where you can leave them. I’ll kind of hit it too the way in which people can actually analyze their practice a little bit later here as we cover some of the 5 things that I think are important for people. I’ll show them where they can go and actually get a reputation report on their practice. In there, it’ll show them there are some of the locations where they can find out if they have reviews, they’ve got a listing or not. Dr. Joshua Eldridge: All right, fantastic. Now all of this I think, to me falls under a big heading of search engine optimization. So, SEO as well. A lot of people kind of think of it as, or the way it’s referred to in internet marketing. But can you explain what SEO is and can you explain in particular, local SEO, how that works? Dr. Derek Baron: Yeah, absolutely. The easiest way is to go to your computer or your mobile device and you can say find a chiropractor, or you type chiropractor near me, or depending on where you live. I live in Naperville, Illinois. You’d say chiropractor in Naperville, Illinois. The first thing from a local search perspective that pops up on a desktop computer is going to be a few ads. The same thing on a mobile device, you’re gonna get some Google ads that show up. The next thing is what’s called the map listing. For search engine optimization, SEO, local SEO shows up first. That’s the map that’s there on the top. If you’re in that pin drop section, meaning the A, B or C pin drop, you’re in a good place. Even Google is now starting to release where people can do Google pay-per-click ads and actually get their practice to show on top of the three listings that are there, so it’s actually four listings. You’re actually getting a little bit of a bonus if you’re doing Google PPC to get yourself in the map sections. The old-school SEO is what shows up underneath the maps. That’s in the organic search and that’s where your videos pop up. That’s where your blog posts pop up. That’s where if you’ve had newsletter articles or anything like that, that’s where it shows up. SEO is whatever you’re doing to get your practice found for chiropractor in Naperville. Back pain specialist Naperville, neck specialist Naperville, pediatric chiropractor Naperville. Whatever you’re doing that’s search engine optimization and how your website ties in. But it’s all about local search in the maps. That’s one of the most critical things, and that’s really where you wanna be found is when somebody is searching with their mobile device or their computer at home is when they search for chiropractor in Naperville, do you pull up in the maps. Dr. Joshua Eldridge: And that ties back into the reputation marketing because then you’re gonna see the stars and the reviews once they click on that pin drop, is that correct there or no? Dr. Derek Baron: Absolutely. It is one of the key factors, if not the top four key factors of helping your practice get found in the maps listings. It really starts with what’s called the NAP of the listing. So the name, the address, and the phone number. Your name of Integrity Sports Medicine should be written out the same way in Google as it is in Facebook as it is in Yelp and Bing and Yahoo and Citysearch and Insider Pages in Health Grades. Some people would say, they’ll list it on Google as Integrity Sports Medicine, then they’ll go to Yelp and list it as Integrity Sports Medicine, LLC. That takes Google and throws them into a hissy fit because they don’t really know what to understand that you say that you’re this practice here, but you’re calling yourself something different. So, the name, address, phone number is important. When it comes to address, if you’re ABC street, suite number 2, you want it say ABC street, suite number 2 whether it’s hashtag for the pound sign number 2 or ste or suite, you want it to be the same every single place. Then if you have the phone number, if you’ve changed phone numbers, you wanna go back into the directories and make sure they all match up. And then reputation is critical. The more reviews, because Google wants to do something good for you, believe it or not. Even though they sometimes have hurt practices in how SEO has changed. When somebody’s at home searching, they wanna provide the most relevant and the most up-to-date provider that’s there. The doctor that is located close to them, that has more reviews potentially, has a better name, address, phone number spread across the web, they wanna put them first before the ones that don’t have that. Dr. Joshua Eldridge: That makes a lot of sense. That’s good information. I know too, Google likes a site. The site that you’re pointing back to likes a site that has pertinent information about what you do and chiropractic and that people go and look at it and read it and spend a little time on your pages as well. Dr. Derek Baron: Exactly. Your website’s critical as an important part of it. Your Google my business page which is the page that allows you to see a review is to get your map listing there. You wanna open that up. If you don’t have it, just type Google my business, go on there and they’ll start you through a process of entering your practice in. As many photos as they let you add, put photos there. Make sure your hours of operations are filled in. Make sure that your services are put in there. Your number one service should be chiropractic or chiropractor. Then you wanna make sure you link your website. Your website has to have keywords that are linked there in the description, it’s called the meta description. The meta title, meta keywords. It’s not again as important of a factor as it used to be because content is more important, what’s on your website. So blogging is important, vlogging is important, all of that stuff. When somebody goes from Google to your website, you want them to stick. The best way to do that to get rewarded by Google is putting a video on your homepage of a hey welcome to our practice video. It’s the best way for them to– when Google says they clicked Integrity Sports Medicine, they went across to the website, they stuck on the page and they stayed there for more than 60 seconds and the best way to get them to stay there is if they watch a video. You’re playing into the game of Google. Dr. Joshua Eldridge: I like that. That’s great advice. One of the most common ways that people are searching now for offices and services like mediums, devices, voice, how are people looking for chiropractors or any provider? Dr. Derek Baron: Yeah, you bet. Most people, if they’re sitting at home, they’re watching television, so they’re gonna have their mobile device. Maybe they have their laptop or their tablet, but what’s really interesting, and Josh I’ll ask you, do you have an Amazon Alexa device, or you have a Google home device? Dr. Joshua Eldridge: I have the Alexa hooked up to my TV. Dr. Derek Baron: Okay, so you have it. What’s interesting, I just read an article out of TechCrunch site. I wrote a LinkedIn and a blogpost article specifically on this because it said Google has come out and said since October 19th of 2017, they have sold one Google home device every second, unbelievable. If you have one of those devices, you can ask Google on your home device different from your phone or you can ask Alexa. What was interesting is that when I asked Alexa three months ago, if she said I don’t have that information, but I’ll get it for you. So three months later when I saw that article, I asked and she pulled up four offices that were within a three-mile radius of me. That’s how fast voice is coming in. That’s why it’s important that people are using their mobile devices to make sure they are found online when they do a search in their office for it. They’re still searching on a computer. On their computer, they might be searching more for certain keywords like back pain or knee pain, shoulder pain, sports chiropractor, anything like that. They might be doing more keyword search. On the mobile device, it’s something they’re searching for it now. They wanna know where it is right now. We’re gonna link to that article too because I read it all the way through, and that was fantastic. I enjoyed that article. Dr. Derek Baron: Yeah, thank you TechCrunch is a great article. It was a great article and how I put some of the tips with a video in there how to improve it for yourself is good too. Dr. Joshua Eldridge: Right and something to ask too, your patients that come in, as doctors, we tend to attract a certain type of patient. Those are the patients that we see and you’d probably be surprised how many use Google or one of my coworkers, he uses Bing. That’s all he uses for sure. Dr. Derek Baron: Really? Dr. Joshua Eldridge: That’s exactly what I said. But I’ve also heard that some businesses, they’ll actually concentrate on Bing because they see a lot of good results from it. Just something to think about too, maybe just ask your patients. If they’re an older group, they may not be using Google as much, but if they’re a younger group, they’re gonna be using– they may not be on Google or Bing or any web site, they may just be straight at Facebook or Instagram. Dr. Derek Baron: Right, it’s a great point. Bing is hidden. There’s a lot of people that will do pay-per-click ads on Google and some will sign up on Yelp, and they hit one of the hidden tricks is to be on Bing because it’s not as expensive as the others, not as many people use it so you don’t have to pay for as many clicks. But there are a lot of people that are hidden in it. Dr. Joshua Eldridge: And it might be just some good traffic, but something to ask your patients. Dr. Derek Baron: It’s always good to have a broad reach across the board. One thing that’s important with reputation is we said a lot about Google and Facebook, but you actually do wanna get to reviews put on multiple different directory sites. Google will reward you more if you have a hundred reviews on Google, it likes it. But if you don’t have any and you have a competitor that is 50 on Google, and 50 on Bing, and 50 and Yelp, and 50 on Facebook, they’re going to favor them more than just all them loaded on one platform. Dr. Joshua Eldridge: Now, let’s go through a practical exercise. What I was hoping you could do is take us through 5 practical steps that a doctor could do today to increase their standing in SEO and maybe even with the reputation management. Dr. Derek Baron: Thanks for the question, Josh. I think the number one thing you can do is if you’re driving, please be careful listening to this podcast. But if you’re in the office or when you get back to the office, the number one thing you can do is sit either in one of your treatment rooms or in the very front reception office and pull out your iPhone and ask Siri, or pull out your Android device and ask Google the question, find a chiropractor near me. It’s the most important search you can do. Because what that’s gonna tell you is if somebody is close to your office, can you be found? When you talked about we attract certain patients that come to our office, if you are a lower back specialist, and you have decompression device, you do a lot of rehab, or if you work on extremities and you’ve got somebody that’s a runner, and they’ve got an ankle injury and they’re sitting two blocks away from your office but they’re new to the community. They do a search and they don’t find you, you just lost not only that patient, but every single patient they would have referred to you and those patients that would have been referred to you as well. The number one thing is grab your phone and ask Siri or Google, find a chiropractor near me. When you scroll through that, you’re gonna look at the maps listings. If you’re there, it’s important. If you’re not, that’s called a local SEO problem and we’ll address that in a second. So again, where do you compare? Are you in the maps? Are you one of those three people in the maps? Then the next thing you want to do is compare the number of reviews you have. So you asked, find a chiropractor near me. Your office pulls up, you’re in position C, so on the bottom of it. That could be from geographic reasons or the name, address, phone number across the directories may not all be correct. If you’re in position C and you’ve got three reviews, the office that’s across the street is in position B and they’ve got 10 reviews, and the office across a mile away has 27 reviews. I want you to think of what chiropractor would you go and see if you were new to the community? 27, 10 or 3? And some people will say, well I don’t think that’s a factor. I want you to think of it this way. If you have children, I want you to think of searching for a daycare center in your community. Would you send your child to a daycare center that had 3 reviews, 10 reviews, or 27 reviews? It makes it pretty simple. People are looking to see what others are saying about you, your staff and your care. It’s important that you have more reviews than your competitors. Number three on that was, I talked about this is a way for people to find out if they have name, address, phone numbers. If you go to a site, we can link up to this if that’s okay with you, Josh. It would be www.practicereputationreport.com. When you go there, all you have to do is you’ll start typing in the name of your practice. We use the Google API, so it should automatically pull up your practice. I would start typing Integrity Sports, and it knows locally where I’m at. And you can do it on a mobile device as well. You put that in, it’ll automatically pull up your phone number. Now, if it doesn’t pull up for you, that means that there’s a bit of local SEO confusion. Sometimes, you have Integrity Sports Medicine listed, and also you have Derek Baron DC listed. Google isn’t sure which one to pull up. It doesn’t mean that you’re not there, feel free to reach out to me or feel free to reach out to Josh and ask some questions about how you can find that out. But you literally just put in your name, address and that’s gonna go through about a minute of trying to search. It’s gonna pull up a form for you. It’ll tell you how your name is listed. It’ll tell you if you have the directories that are matching. It will go through the name, the address, and the phone number. And it will show you in red if any of them are not matching. If it’s Integrity Sports Medicine in Google, but in Bing it’s Integrity Sports Medicine, LLC, you can see right there, you need to go into Bing and change it to match Google. Number four would be simply to start asking for reviews. In the algorithm, Google wants again to reward the searcher with the best reviews that are out there. That’s done by you simply starting. Whether you’ve had a bunch of reviews in the past, you’ve had some negative experience, moving forward, there’s no better day than today to start asking. You can do contests like we talked about by putting in a drawing, whether it’s just a simple $10 gift card or a dinner for two out, something like that, or in the summertime, do a snow blower that’ll shock people like why are you giving a snow blower away in summer, that’s gonna bring all their attention to your practice, and other people are gonna wanna come in. There’s many different ways to do it, but you just have to start asking. Not only you, put your chiropractic assistant when he or she hears your patients say, gosh, I can’t believe how good I’m feeling. Like I said before, ding-ding-ding, that dinner bell goes off. You need to just start to ask them, and ask for the polite response. Then number 5, I talked a little bit about videos. But you’ve got to start asking your patients for reviews, but you need to start getting your phone out and make sure you are asking for video testimonials. Hand them the waiver form, and then you can even ask as you start getting those video testimonials, you wanna put them across all of your platforms. Now, real quick about shooting a video testimonial. I talked about putting in a selfie stick and taking it, that’s a great way. Make sure, you’re taking your phone if you’re gonna use that and put it in the horizontal position, not in the vertical up and down. You want it horizontal because that gives you full HD mode, and instead of having the black bars on the side, it may sound like it’s petty, but it’s really important for viewership. People like to see something and literally if they’re on a smart TV, they can watch your videos if they’re going through Facebook and they can do that. You would wanna upload that video natively. Natively means not putting it up on to YouTube and then taking the youtube link and posting it to Facebook. You wanna post that video to your YouTube channel. You wanna post that video to your Facebook page. You wanna post that video to your Instagram account. You wanna post that video to your LinkedIn page, and you wanna take that and then put it into hopefully you do a blog, or you do a monthly newsletter. I would load your newsletter with patient testimonials. Let’s say I came to your office, Josh, I brought my daughter for gymnastics, and she had an ankle injury and my wife who doesn’t like the chiropractor, she’s suffering from these symptoms in her hand and she doesn’t know why. And all sudden, I see that there’s a video testimonial of a 35-year-old woman that is suffering from arm discomfort and she says how she got results from you. The other mothers like okay, I thought he just worked with gymnasts, or I thought he only worked with this kind, so it’s a great way to bring people in by always being in front of them. And again, you hate to think about selling in chiropractic, but we really are. To take the selling off of our shoulders, we put it on our patients. If they’re happy, they’ll do a video testimonial for us. Dr. Joshua Eldridge: Yeah. I like that point too, and you get into the selling thing. I know there’s so many docs out there that just detest some of the ways that chiropractors get out there and try to manipulate patients. But this isn’t manipulating. You’re just putting out there the great stuff that you’re doing and people love to talk about it. They think it’s cool especially when you get a patient that gets to be on your YouTube channel that has 800,000 views, they go and brag to their friends and say, hey, I was on the YouTube channel that had almost a million views and they get excited about it. That’s something that I think is really cool. You’re really helping people out. At the same time, you’re getting some great promotions, it’s easy. Dr. Derek Baron: Yeah, it’s great. You have to think about if somebody’s in the grocery store and they’re in the freezer aisle and they’re gonna grab a pizza, and they run into their friend, and their friend is rubbing their neck. Oh, you’ve got to go and see Dr. Baron. He’s a great chiropractor. Here’s why you have to see him. So that person is already selling for you right there and then. You have to say okay, if they’re doing it for me on the street per se, why wouldn’t they do it for me now in a video? Then you feel uncomfortable, but if you don’t ask, you don’t know. A real quick thing about it, if you take one of a patient and you upload it to YouTube, you wanna make sure you send that patient a personalized email with a link to that video and ask them to watch it, like it, comment on it and share it. Google will reward you and so will YouTube of course, because Google owns YouTube. That will actually potentially get brought up on page one of Google of chiropractor Naperville. There’s a bunch of SEO factors that go with it. But the more people that look at it within the first three days that like it, share it, comment it, the better love Google gives to you. Dr. Joshua Eldridge: I know what you just said. A lot of it has to do with SEO factors, but sometimes if you just get it out there, Google will reward you and especially like you said when people like it. I have videos that I never thought– I think my page has has 700,000 views. I never thought I’d hit that. I just put on videos to help kids land properly. I didn’t think that it would ever turn into something like that. That’s just something that I just stuck it out there, and I didn’t know anything about SEO when I started, but people still go and watch some of those ones that I made 6 years ago. Dr. Derek Baron: It’s the value of what was there. That’s the critical part of this. You thought hey I’m just putting a video out, but the people that are watching it, it’s tremendous value and they may have shared it, liked it, commented. When you give something, we’re such a sedentary lifestyle now, unfortunately. People are looking for something that’s entertaining and they come across something for gymnastics and they see that, they’ll sit and watch it and you got rewarded for putting a great value out there, that’s fantastic. Dr. Joshua Eldridge: For sure, you’ve given amazing content to us and some gems for the chiropractors out there. Thank you so much for coming on the ChiroPractice Pro podcast. What are the services you provide and how can people get in touch with you because if I had an office right now, I’d be calling you tomorrow after this. Dr. Derek Baron: Thanks Josh, you’re a kind man. I appreciate it. Well, they can simply reach out to me via email, derek@thedoctorsmarketingsource and we can link that up so that will reach out to me specifically, my website thedoctorsmarketingsource. They can learn on it. If you are in the sports arena, I am putting together a podcast called the Sports and Rehab Zone. That’s the way people can reach out to me. Some of the things that we do, if you don’t know how to get Google reviews or Facebook reviews, we offer services and we have a system called 5-star practices. We have a system that can help automate the process, depending on what your software or platform is similar to yours. We’re trying to figure out a way to get the API’s to work together. Or if they’re using your software, it’s automatic. What I mean by that is right now, if we don’t have an API integration, not to get too technical, but the front office staff has to when they hear that dinner-bell go off, they have to enter the patient’s name, first name, last name, email address and cell phone number if you want, and it automatically goes into a system where we’re gonna email your patients and send out a text message. Then that link it’s gonna ask them for review. There’s a lot more, you can go to fivestarpractices.com to learn more about that system, so that’s important. Most doctors are into more new patients and rightfully so. We kind of take you through a step-by-step process. As you said before, finding your niche. If you really love seeing low back pain patients, why not market specifically to those using Facebook ads or Google PPC ads. We do lead generation for practices. We do some social content posting where we create social posts for your practice. It’s important that you’re consistently updating your Facebook page. The Facebook page algorithm has changed. They’re not going to reward people by showing that as much, but again, when they go to search for your practice and they find you on Google, they’re gonna go to Facebook, what do they find? If you haven’t made a post for the last 7 days or the last 7 months, they’re gonna question it. We help docs post twice a day, 7 days a week. We’re doing newsletters for practices and blog posting for practices and videos are really important too. It’s whatever we can do to help a practice number one, show up on Google, number two get reviews, and number three, bring more patients in. There are too many times I speak with chiropractors that struggle and it’s not a fun place to be in a practice that’s struggling. Whether you’re in California or Kalamazoo, Michigan, or Miami, Florida. Everybody should have the same ability to succeed. So much of this is transferred to the online world. If you’re not in the local SEO Google Maps section, you’re in a lot of trouble. Whatever we can do to help them get there. If anybody has questions and doesn’t want any of our services, please don’t hesitate to just reach out. I’m all about educational marketing. I’ll have this kind of a conversation with you and if I can show you a way to improve it, I’ll do my very best. Dr. Joshua Eldridge: All right, Derek. Thank you so much. Again, you’ve given us so much great information and I truly appreciate you coming on, so thank you. Dr. Derek Baron: You bet, Josh. Thank you so much, you have a wonderful day. Dr. Joshua Eldridge: All right, you too. Wow, that was an action-packed podcast, but the suggestions Dr. Derek Baron gave were so easy to follow and they’ll yield results today. Head over to chiropracticepro.com/episode6 right now and download the PDF that has 5 things you can do today to dominate the search results in your area. You can also find all the resources that Ddr. Baron listed throughout the podcast. Thank you for joining us on the ChiroPractice Pro podcast. Your assignment today is to start getting one new review each day. This will change how people see you in your community. My name is Dr. Joshua Eldridge and I have been your host on the ChiroPractice Pro podcast. Have a great day and keep doing all the little things that add up to big success. Thanks for joining us right here at chiropracticepro.com.
24 minutes | Apr 4, 2018
Episode 5: Becoming A Sports Chiropractor with Dr. T.J. Hagan
Becoming A Sports ChiroPractor with Dr. T.J. HaganIn this episode, T.J. Discussed 5 main points to become a great sports doctor. Download your free checklist here, follow along, and see amazing things happen in your sports practice. T.J. is one of the best authorities in sports med for chiropractors as he is the official chiropractor of both the Boston Red Sox, and the New England Patriots. Download my Getting Started in Sports Checklist by clicking here! Dr. Joshua Eldridge: Welcome to episode 5 of the ChiroPractice Pro podcast. Our podcast today will discuss how to get involved at a professional level with sports. We specifically discussed football and baseball, but the same principles would apply to dance, mixed martial arts, or other high-level performance athletes. Dr. TJ Hagan is our guest today, and he is a sports chiropractor for both the Boston Red Sox and the New England Patriots. TJ has extensive knowledge of the professional sports world. But remember, he didn’t start at the big leagues. He started in the trenches with local athletics and no pay. Because so many chiropractors wanna get started with sports, we’ve put together a checklist of how to get started in sports as a provider. This checklist is entitled, “5 Ways To Get Started in Sports.” Go to chiropracticepro.com/episode5 to download your free checklist. That’s chiropracticepro.com/episode5. Let’s get started with Dr. TJ Hagan, sports chiropractor for the Boston Red Sox and the New England Patriots. TJ, welcome and thanks for joining me. Tell me a little bit about your chiropractic journey. Dr. TJ Hagan: Thanks for having me, Josh. I’ll try to give you the short story and not keep you here all day. I guess you could always say I was always interested in science. Thought about becoming a surgeon for a little while there and steered away from that path after surgeries which was amazing, but it’s a lot for a patient, right? I kind of wanna work with people that were awake and not under anesthesia. Someone suggested chiropractic to me. I really didn’t know too much about the profession. I was never a patient growing up. It wasn’t a big thing in my family. I had the opportunity to shadow a couple of really great chiropractors that were helping people with their hands and getting really fast results with some good active people. That appealed to me. From there, I jumped right into chiropractic and ran with it. It’s been a great profession and a lot of fun. Hard work, but very fun. Dr. Joshua Eldridge: Out of school, where did you get started? What was your first job out of school? Dr. TJ Hagan: My first job was in a practice that actually dealt with a lot of athletes. I worked with a woman, Sheree Russell who was a PT, an ATC and a DC, so kind of a unique combo there. I learned a lot from her. We worked with some high school teams, and a woman’s professional football actually. She became an owner of a team which was really cool. That was kind of my first exposure working with athletes. From there, I moved full time into Cambridge, started working in another practice there which is where I am now. I’ve been there ever since. Dr. Joshua Eldridge: Yeah, and tell me a little bit about your sports journey. Dr. TJ Hagan: Well, there are a few random things. I was helping a friend out with men’s semi-pro football league which is interesting. I don’t know if you’ve worked with one of these leagues before. It’s a lot of guys with a lot of heart. They’re in their 20’s, 30’s and 40’s. They suit up and they play some real football. It’s interesting. Their physiques are not what they used to be in high school or college when they played, but they got all the heart. Dr. Joshua Eldridge: Yeah, I saw my first ACL injury at a semi-pro football. I think it was just a practice. Dr. TJ Hagan: So you’ve seen this before. It’s interesting, they really had no healthcare whatsoever, kind of scary. It was a funny thing, I showed up, there was an EMT there who was probably 16, that was it. These guys were playing a game Saturday night in stadium under the lights. The first thing, there was a quarterback with blown PCL. He’s got this brace on. They’re supposed to keep him stable. He goes in, he plays, he gets it really low, really hard, down the knee. His knee’s hanging on by a thread basically. And coach wants to put them back in. It was this classic scenario. Being a hero and we had to try to talk coach out of it. This is again with my first sports experience, right? Another player dislocated his finger. I may have put it back. Yeah, a lot of excitement within 30 minutes of football, it was a lot of fun. I think from there, I started working with women’s professional soccer with the Boston Breakers. The same group also cared for men’s indoor lacrosse, the Boston Blazers. Those are great, great groups to work with. Men’s lacrosse is really exciting, indoor version, I had never really seen before. I didn’t have much exposure to it. Those guys play really hard. It’s an action-packed game, a lot of fun to watch. A great group of players, great group of guys. Two of them played outdoor on our local team as well, Cannons, did a little work with those guys. Women’s professional soccer was great. We worked with them for a number of years. Their players are really dedicated, very, very talented. Dr. Joshua Eldridge: How did you get linked up with these teams? Dr. TJ Hagan: With that group, with the women’s professional soccer and with men’s lacrosse, we had a new orthopedist that came into town, a younger guy from upstate New York. Since he got here, I’d met with him just to learn more about his practice. Oddly enough, when the women’s professional soccer came into town, they were looking for an orthopedist. They weren’t necessarily looking for a chiropractor right away, but they were looking for an orthopedist. I can’t remember the connection there, but somehow we caught wind of this. I reached out to this orthopedist that I had met recently, told him about this opportunity and connected the two. From there, he’s building his healthcare team, he asked me to come on board. I helped out the team and then one team dovetailed into the other. It may have been soccer first, and then lacrosse second. Dr. Joshua Eldridge: That’s a great marketing lesson, I think for a lot of people is you help this guy out, he helped you out at the same time, that’s really cool. Dr. TJ Hagan: Absolutely, yeah it worked out really well. He kind of understood where we were coming from a networking basis where he is new to town. Usually, most orthopedic surgeons are pretty set with patients. They don’t really need to build a practice. This plain worked out there for them, everybody clearly understands what they do. But he was new and was building up his patient base. He understood where we were coming from. We’ve great relationship for a number of years after that. Dr. Joshua Eldridge: That’s brilliant. Then after that, gone on to some bigger teams. What was your next kind of step in this process? Dr. TJ Hagan: Sure, our practice has been affiliated with Harvard for a number of years because we’re right down the street. We’ve been their preferred chiropractic outreach for a long time. We started working closely with their sports medicine team a while back. They had a kind of a changing of the guard with their head trainer left and the new trainer came on board. We were able to set up a deal where you could provide care on-site at the University with this new trainer. He really thought that chiropractic was an important thing to have right there in their field house. In a similar scenario, to the other two teams that I worked with, the orthopedic group that worked with Harvard also cared for a number of teams including the Red Sox and Patriots. It was the Red Sox that had a massive overhaul of their sports medicine department. They were looking for a new chiropractor. They had appointed a physical therapist to go out and look for various positions to fill. I’m fairly certain that it was because of the affiliation I had with Harvard that they called on me and threw me into the pool of applicants. It’s interesting, we went through a number of interviews over the course of five days, just meeting with every one of their team doc’s, kind of rapid-fire. You get a call at 12, well, so and so can meet you at 3, can you be there? Then you’ve got to cancel patients which I always feel bad doing. Run over there and meet with doctor blah-blah-blah and go through that interview. Then the next day, I always had a suit my car ready to go. After multiple interviews, it worked out and it was a good fit. The Red Sox was the next team that I had started working with. Then a few years down the road, the Patriots had a need for someone to do soft tissue. That’s as you know is a big part of our practice. We went in and did interviews with those guys. Started working down there. It started out as like two mornings a week and then the need grew a little bit. 53 guys on their roster. There’s a lot of bodies down there and a lot that were in need, they get pretty banged up. That two hours came to be two days and then we’re down there I think five days a week now, half days. You know, half day clinics, but turned out to be a lot more time than we thought it was gonna be but it’s a lot of fun. Yeah, that’s sort of how it kind of grew together. I think affiliating with these groups was very, very helpful. It’s a small town. It’s Boston, there aren’t too many people that do what we do. If you’re known within one circle, then you become trusted. Your name gets thrown into the hat when there’s a need that pops up. Dr. Joshua Eldridge: When you go down to these clinics, what’s it like to be in the training room with the athletes, and what’s the dynamics that happens down there? Because I think that’s an interesting thing for a lot of chiropractors because they go from their normal life in the office where they’re the boss to maybe they’re part of the team now, hopefully. Dr. TJ Hagan: Yeah it’s interesting. You leave a place where you’re creating care plans, you’re doing maybe corrective exercise, soft tissue, using adjustments, you’re doing all sorts of things to help people get better, but when you go onto one of these teams, you’re filling a need, their need. You have to figure out what that is and what the best thing it is that you can offer. You’re not gonna be doing everything that you have in your repertoire. As I mentioned for the Patriots, they need us for mostly soft tissue. It’s kind of odd to go down and try to just wear that hat where you would prefer to make a diagnosis, you prefer to create a plan, but it’s really just a stripped-down model of care. You’re dependent on these other folks that are there which thankfully, the groups that I’ve worked with, they’re incredibly talented. You don’t really feel the need to try to do more because you know that they’ve got talented hands around them. It’s a great environment. There are a lot of multidisciplinary centers out there offering care and they claim to have meetings once a week to talk about patients. Maybe that happens, but I know a lot of them start out that way and then that really doesn’t happen down the road and it’s not true integrated care. But here, the PT is working on the table next to me and the athletic trainer is on the next table down. There’s open conversation. A patient may get dry needling right next to me and then get passed to my table as though it were an assembly line. We’re treating the same structures. You know, “What did you find?” “I found this.” “Okay, great let’s tap this.” We’ve always said it’d be great to recreate this for everyday folks, humans like you and I, that would be awesome. Dr. Joshua Eldridge: Absolutely. The neat thing about the Patriots is you guys have a common goal, right? And that’s to win a championship. I think when you keep that in mind, as a sports doc, it puts a lot of things in perspective. You don’t have to be the boss, you can be part of that team. Dr. TJ Hagan: Right, an environment as you’ve seen that you got to leave your ego at the door when you go in. So oftentimes in your office, you feel like you’re the only one that’s got to make it happen. But it really is, you’ve got your own team working on this team with that end goal of getting that championship or getting to that championship and it’s really an interesting environment. It doesn’t work for everybody. A lot of folks don’t wanna go in and just assume that everybody else is doing a good job. They wanna go in and they can’t take that hat off of being the overall manager, the director of care, which role we all play in our offices, right? Dr. Joshua Eldridge: Yeah, so in the training room, and you kind of alluded to it before, but do they ever come to you and just say, “Hey, I’m just curious about this patient. Is there something else that we could be doing that–” Do you guys have that conversation Dr. TJ Hagan: Which is great, yeah it definitely happens with folks that aren’t getting better as quickly. I’d say the same with the Red Sox as well. They do a great job of really talking openly about different patients, different patterns. You end up doing a little teaching in there as well which is great. A lot of chiropractors that I’ve run into, they want to hold dearly and covet the adjustment. We’re the only ones that can do it. That’s true, we’ve spent a lot of time mastering this technique. There’s a lot to it, it’s not easy, but there are other folks out there that can do it as well. Why not help them improve their skills instead of just trying to protect it and hold it guard like that. I’ve been a big proponent of that. It’s fun to go through a little bit of education. I’m getting educated at the same time by the techniques that they use, but there is a lot of open talk about, “This guy’s not progressing, what do you think, what patterns are you seeing, how has his presentation changed over the last four weeks?” A lot of times, it’s, “Here’s what I see, go take a look. Let’s see if it’s the same thing.” It happens in real time which is not like the next time you see him two weeks down the road, take a look at him, you let me know what you think. It’s great to have everything happen in the now. It makes for great care. Dr. Joshua Eldridge: Who’s the ultimate boss on the training room? Dr. TJ Hagan: Definitely the head athletic trainer. Most of the cases that I’ve seen. It’s a very underappreciated position across the board from most sports medicine departments. They’re definitely wearing the captain’s hat, they’re very good at it most often. Has that been your experience as well? Dr. Joshua Eldridge: Yeah, absolutely. I just went up to Life because that’s near us. They had the– trying to think of the name. It’s the Chiropractic Baseball Association, something? Dr. TJ Hagan: Yeah, I was supposed to be there. Dr. Joshua Eldridge: Oh, that would have been cool if you were to come. But it was head trainer from the Cubs who was there. He was a really cool guy. They had a couple good presentations. But the chiropractors mostly talked about their experience, they were talking to the students a lot. It was neat to see how they got into it, and it’s very similar to how you said. A lot of them just said they made that call or they stepped out and said, hey, I’ll try and see, but every single one of them said they had to be part of a team. None of them got to walk in there and say, hey I’m the boss because they would have just told them hit the road. They don’t need somebody like that. Dr. TJ Hagan: I’m sure you’ve seen it as well. I’ve seen it. The folks that have failed in that position. Usually, it’s trying to do too much and doing stuff that’s just way off the reservation. It’s one thing if you really are working with a core staff and you feel like you’ve got to step up and cover for them. In some of those smaller market teams that I’ve worked with, I end up doing a lot more just because really, I’d say there’s not enough bodies, not that there wasn’t– The head athletic trainer wasn’t talented but it may have been just him or just her. They have a lot of people to take care of, so they end up wearing a few hats and doing a little bit more. In those higher market teams, there’s so many people that are so talented. I think some folks just can’t grasp that. Dr. Joshua Eldridge: What advice would you give to a young doc that was coming up in the chiropractic and really wanted to get a part of sports? Because that’s where I was, but I didn’t really have anybody to reach out to. I didn’t know anybody, but I thought it would be cool if someone– what advice would you give to them, how they should get started? Dr. TJ Hagan: I do think a lot of it is who you know. I don’t wanna say it’s just who you know and not what you know. Knowing those people when the knee pops up, you’re there and staying fresh in their minds is really important. I would say to anyone that’s looking to get into sports is don’t be picky and selective. Don’t wait for the day for the major league baseball team, they will just to pick up the phone and reach out to you, right? Take whatever low-hanging fruit you can get, help out with that semi-pro football team that’s got nobody there. Help out with the local over 40 men’s league. You’ll really feel comfortable very quickly in that on-field experience or that locker room, that training room dynamic. You get pretty comfortable in that field and you get comfortable making those decisions and then working with whatever other healthcare members got around. I talked to some students and some newer chiropractors out there that they didn’t feel like it was worth their effort to go help out in some lower market team. I’m not gonna get paid for it, and I should be at the practice make money, but there’s a huge payout. They don’t wanna give up their weekends, my wife would tell you I spent many a Saturday night at whatever game or whatever practice there was. It was tough ,but it was definitely worthwhile at the end if you’re trusted in those smaller markets, then you can work your way up to the bigger market teams for sure. Dr. Joshua Eldridge: Like you said, people like to talk in sports. They tell each other about what they found works. Especially athletes, it’ll just go through like wildfire when one athlete is like, I feel great when this guy works on me. How does working with these professional sports teams now, the Red Sox and the Patriots, how does that affect your daily practice? How do you see a crossover? Dr. TJ Hagan: Yeah, I’d say it’s definitely challenging trying to run both. Working with athletes is always a passion of mine. It’s not incredibly lucrative. Thankfully they pay us, but it’s certainly not big breadwinner. Just trying to allocate enough time in the practice to work with the normal humans and enough time with these teams so that you can actually establish a relationship with the athletes and be there often enough that they can utilize your services, but not so often so that it kills your practice. I think we’re still learning that, but it’s a constant battle. If it we’re up to me, I’d be hanging out at Harvard a couple days a week just watching some practices and spend some time in the training room. But I’m not independently wealthy. We’ve had this sort of tailor that clinic over time and figure out, I can’t do two days there. I can do one day, put in a few more hours that day. Tweaking that a little bit has been challenging, but it’s definitely worthwhile. I think the patients really appreciate hearing about how we can integrate care there. I’m learning things every day in these different environments and then bringing that back there. I think they really value that times. They get a little frustrated when they can’t see you exactly when they wanna see you because you’re traveling with some team or whatnot, but they get over that when they really sense that value of the education that you, the practitioner is getting when you’re out on the field and traveling with these teams. Dr. Joshua Eldridge: Did the Patriots get you a ring last year? Dr. TJ Hagan: They did, they did yeah. It was great. It’s great to feel at least included in that and I really didn’t care if it was made of aluminum. I don’t think it is, it looks pretty shiny, but it’s great to get the nod there. The second year is with the Red Sox, we ended up getting one there as well. Little beginner’s luck there. Dr. Joshua Eldridge: When did you start working with the Patriots? Dr. TJ Hagan: That was two seasons ago. Dr. Joshua Eldridge: Okay, is that when they beat the Seahawks the first time? Dr. TJ Hagan: It was the spring after that big win. Dr. Joshua Eldridge: Okay, because that’s my team was the Seahawks, every time I think about you guys working with them, I’m like argh, but then I’m like well it’s all right. Cool any last words of advice that you got for docs that are interested in sports? I mean you’ve given some gems already, but anything else that you wanna leave with them? Dr. TJ Hagan: Well I just say meet everyone that you possibly can. A good number of us have a hard time going out and trying to advertise our services, but the big part of our networking is really trying to figure out and meet or trying to meet people for our patients as resources, places to refer to. We’re not necessarily going out and beating our drums saying you’ve got to send your people to us. We’re the only ones that can get them better. More so Josh, what do you do? What do you specialize in so that we can send our people to you and we end up applying that primary care doctor for neuromusculoskeletal conditions. They’re sending people out in many directions. The more you can get your name out there on that or in that way, I think is really helpful and knowing those people, it’s paid off huge for us. Dr. Joshua Eldridge: Very cool. Well TJ, thanks for joining us, that was perfect. I’m sure we’ll have you back on one day in the future and just talk about another championship or something like that. Dr. TJ Hagan: Anytime, man. Thanks for having me. Dr. Joshua Eldridge: All right, we’ll talk to my soon. Dr. TJ Hagan: Take care. Dr. Joshua Eldridge: Thank You, TJ for joining us on the ChiroPracticePro podcast. Your insights into sports are truly amazing. Don’t forget to download your free guide to getting started in sports and our show notes at chiropracticepro.com/episode5. That’s chiropracticepro.com/episode5. If you’re finding value in the ChiroPracticePro podcast, take a minute to leave a review on iTunes and then share with a friend. We’d very much appreciate that. On episode 6 of the ChiroPracticePro podcast, Dr. Derek Barron joins us to help your clinic dominate local Google search results. It is a must listen event. Until next time, thanks for being a part of our team right here at chiropracticepro.com.
27 minutes | Mar 27, 2018
Exams The Right Way with Dr. Gerard Bogin
Episode 4: Exams The Right Way with Dr. Gerard BoginAs our special gift, here’s Dr. Gerard Bogin’s exams for you to use in your practice. Click here to download the exams. We hope you find real value in these as we have over the past few years. Don’t forget that these exams are also available in the ChiroPractice Pro EMR and Office Solution. Click here to find out more. << Episode 3: SOAP Notes Dr. Joshua Eldridge: Welcome back to episode four of the ChiroPractice Pro podcast. On today’s episode, we propose a practical exam format with Dr. Gerard Bogin, diplomate of the American Chiropractic Board of Sports Physicians. He works for the group that provides chiropractic care for the PGA Tour and the Champions Tour. He also works with USA Archery, USA Fencing and has worked with USA Rowing. He is also a chiropractor to many professional extreme sporting events including both the Summer and Winter Dew Tour. His easy-to-use format when followed will make sure you reach the legal standard every time you do an exam. Today’s show notes can be found at chiropracticepro.com/episode4. We’ve put together this exam format in an easy to use PDF download including upper extremity, lower extremity, and torso. Dr. Bogin was extremely generous in sharing his exam format with us. As with all of our customized exams, we have this exam format available in the ChiroPractice Pro EMR and office solutions system. Give a warm welcome to my good friend, Dr. Gerard Bogin. Alright, Gerard, welcome to the ChiroPractice Pro podcast. This is my good buddy Gerard. We’ve been friends for a few years now. He actually was instrumental in helping me get my diplomate. Gerard, welcome and thanks for joining me. Dr. Gerard Bogin: Thanks for having me, Josh. Dr. Joshua Eldridge: Tell me about your journey into healthcare and chiropractic. Dr. Gerard Bogin: My mother worked at a chiropractor’s office growing up, and I had a lot of issues with asthma. I spent a lot of quality time at Dr. Gregory’s office. As I got into college, I was looking for something to do with my life, it seemed like a pretty neat way to make a living. We just kind of follow along the path there and just kept working at it, and guess that’s where we are now. Yeah, pretty much goes back to Dr. Gregory and some pretty bad asthma attack. Dr. Joshua Eldridge: What do you do in the industry now? Tell us the cool stuff you do. Dr. Gerard Bogin: Sure. I’m very fortunate I had the opportunity to sort of surge towards sports medicine, sports chiropractic a couple years back. It was partly intentional, partly fortunate. I started pursuing all the things that you needed to be to be a successful sports chiropractor. Diplomates and additional certifications, and little by little, I started having the opportunity to kind of travel with different groups. These days, when I’m at home, I work for a large practice. Couple days a week, I see my own patients who tend to be athletes, and then a couple days a week, I see the other practice patients which gives me the opportunity to travel. Now, these days, I get to travel with a group that provides chiropractic services for the PGA Tour and for the Champions Tour, that’s kind of a neat experience. I also travel, I’m a qualified healthcare provider, meaning I’m a sports chiropractor. I travel with USA Fencing, and I also do some traveling with USA Archers. When some of the senior national squads travel overseas, I get the opportunity to go with them, so I’m very fortunate with that. A lot of people don’t get to do that, and I really enjoy it. Dr. Joshua Eldridge: Also USA rowing, you’ve done some work with them as well. Dr. Gerard Bogin: Yes, I have, I had the chance, I had the opportunity to work with women’s rowing at the Olympic Training Center before in London, and spent three months out there and getting them ready. That was a great experience. Dr. Joshua Eldridge: That’s very cool. Sometimes, when I think about growing up, I think about the stuff that you’re doing, it just sounds like such a great experience and kind of what I wanna do as we get going. You got great stories and you’ve been all over the world doing really cool stuff. Dr. Gerard Bogin: Yeah, I’ve been very, very fortunate. Dr. Joshua Eldridge: The other thing. I kind of alluded to it earlier. When I was taking my diplomate exam, I hung out with Gerard and he set up mock exams for me to go through. One of the things that he did was he had a format for exams. That’s what I wanna get into today with you Gerard, is talk about this exam format that you’ve developed. Tell me a little bit about this, how you came up with it, and what you call it. Dr. Gerard Bogin: Sure. I can’t actually take credit for it, Josh, it was when I was taking classes for my sports diplomate. One of the instructors, gosh, I can’t recall who now. One of the instructors was going over basic exams and couple different things. The way he introduced it to the class was basically that it was the legal minimum to be considered an exam was to hit all these different categories. It didn’t sort of sink in at the time, because it seems like stuff everything that we would normally do anyway. But when you’re out on the field, or when you’re at a sporting event, it’s a very different experience from when you’re in your office. When you’re in your office, you have paperwork, you have everything set exactly how you like it, you just have to do it, you don’t have to really think. When you’re on the field, and someone runs up to you and their leg’s pointing the wrong way, things kind of get hectic fast. You tend to skip over parts, which isn’t really ideal when you think about in terms of a legal minimum. When I was studying for my test, what I did was, I condensed that doc’s information into an acronym that I call VIP NORO. Each letter is a category that lets you fulfill a basic standard for an exam. Dr. Joshua Eldridge: What are some of the expectations for the exam from your standpoint? As a diplomate, why are they so important? Dr. Gerard Bogin: There’s two ways to look at it, right? The basic way to look at it is the expectations for an exam is to get an answer to whatever the problem is at hand. Usually, athletes are presenting with something, your job is to find out what that is and what the next proper step is. The other side, the legal side, liability side is that truth is, you don’t get everything 100% correct. You need to hit legal minimums, a bare minimum for an exam. The way it was presented to me is if you cover each one of these categories in exam, you might not get the right answer, but you performed the bare minimum to fulfill your legal obligation. Dr. Joshua Eldridge: Gotcha. Do you think this is important, a format like this just for diplomates, or do you think it throughout the chiropractic healthcare? Dr. Gerard Bogin: Yeah, during the course, this was not presented as a diplomate specific requirement. This is basic legal requirement. Again, in your office, it’s easy because you just follow the paperwork. In the field, and you’ve been there, we worked in half-pipes together, and we worked on cold mountain when it’s negative 30 degrees. You know what? You don’t feel like taking a blood pressure or a pulse, but you know what, you don’t know what’s going on underneath that ski jacket, either. It’s important to have something to rely on, that you can count on when things are kind of going south quickly. That’s what this was designed to do. As long as you covered each letter, you’re gonna get a correct answer, and you’re gonna be protected, and the athlete’s gonna be protected. Dr. Joshua Eldridge: Great, let’s go through each one of these, of our acronym of VIP NORO. What we’re looking for, and what we could consider normal, and what you document. Starting off with vitals. Dr. Gerard Bogin: Okay. I’m just gonna prep this discussion with the fact that each category, each letter has an acronym to itself too. I know you love more military stuff. Each one has an acronym too. I’ll go down the list, and then I’ll give you each acronym, how about that? Dr. Joshua Eldridge: Sounds perfect. Dr. Gerard Bogin: Alright, so vitals. Vitals is easy, height, weight, blood pressure and pulse. That’s considered bare minimum for an exam. That one’s easy. Inspection, is visually inspecting the area of complaint whether if that’s a shoulder or knee, up the leg, the back, whatever it is. For that, I use the acronym ADD HAS which sounds kind of crazy, but it makes sense, I promise, because it’s easy to remember. ADD HAS means the way I view it is the problem sides should look similar to the non-problem side. As long as they match, you’re probably gonna be okay. But if not, you’re looking for the ADD HAS stands for A is asymmetry, D is deformity, D is discoloration, H is hypertrophy, anything like that. A is for atrophy, scars, swelling and other. As long as you go down that list, and you don’t notice any of those, you’re probably gonna be okay. Dr. Joshua Eldridge: I like it. It’s too easy. Dr. Gerard Bogin: Yeah, for the next piece, for palpation. For that, I use MAG+. Palpation is anything you can feel that might be going wrong. If it’s a fracture, chances are that’s gonna be pretty evident, and there’s gonna be so much screaming as you’re palpating or touching. MAG+ stands for Muscles, Attachments, Growth plates and other. Especially in younger athletes where you’re gonna have sometimes it’s hard, they’re more flexible, it’s hard to find something going on. Those are the areas you wanna test, especially with the younger athlete, you wanna make sure you palpate growth plates because that’s where they tend to have a lot of problems. Palpation is MAG+. All right, then N stands for neurovascular which I break down to ABCs and MRS. All right, for neurovascular, A was for arterial, means peripheral pulses, got to make sure blood’s still go to whatever’s distal. B was for Babinski or Hoffmann’s, which is upper motor neuron lesion reflexes. Then C was cerebellar, because you never know what you’re gonna see out on the field, or even in your office. For cerebellar I always use Romberg. MRS is your classic muscle testing, reflex and sensory. Everyone knows that one, that was easy. The one I did add, which I’m not even sure was in the original course was other, which I think was one of the ones that surprised me when I took the course, because maybe I never really thought of it this way, but truthfully whenever you’re dealing with a chief complaint in a certain region or joint, you really do need to test the joint or region above and a joint or region below, especially with younger athletes, because they do have certain things where you can have a hip issue that’s presenting as knee pain, or different things like that. That’s just a reminder that hey, just because they’re laying, their grabbing their knee, doesn’t mean they also didn’t hurt their hip or their ankle. Dr. Joshua Eldridge: One of the things that you always told me is do a quick VIP NORO with the other two. Let’s say you’ve got a knee complaint, when you go to the hip, you’re doing a quick inspection, palpation, neurovascular, range of motion or a special test. Dr. Gerard Bogin: Exactly, and then next is range of motion which everybody knows how to do, your classic range of motion that everyone learned in school or whatever the chief complaint is. The last one is orthopedic or special test which is, of course, everybody love to study and learn all the names, and all the specific tests which I guess nowadays everyone’s showing that don’t really work that as well as we were taught in school but just have to do it. Dr. Joshua Eldridge: Right, and even now, they’ve even talked a lot about instead of coming up with these fancy names after somebody, the Gerard test or the Josh test, it’s more descriptive of what you’re doing. Dr. Gerard Bogin: Which is the way it should be. However, I would totally be behind the Josh test, just so you know. Dr. Joshua Eldridge: Going back through, we got vitals, inspection, palpation, neurovascular, other, range of motion, orthopedic, or special test. Dr. Gerard Bogin: That’s it, VIP NORO. Dr. Joshua Eldridge: It’s pretty versatile, this format. What body regions do you apply it to? In your daily practice, how does it look? Dr. Gerard Bogin: Actually, you know what, it’s whatever the region or chief complaint is, I apply VIP NORO. If it’s a cervical spine, if it’s a shoulder, whatever it is, I think if you hit those categories, you’ve done a pretty thorough exam, you’re gonna have a pretty good idea what’s going on. Dr. Joshua Eldridge: How do you link it? Do you use SFMA through your practice as well? Dr. Gerard Bogin: Yes, I do. Dr. Joshua Eldridge: Okay, how do you link it through that? Dr. Gerard Bogin: It’s more like an additional add-on. Not that it’s not important, but SFMA gets more important with the level of athlete you’re dealing with. It is important that everyone I see gets some functional testing, but I don’t consider it part of the core VIP NORO because it’s an additional add-on, it’s not a legal minimum, how’s that? Dr. Joshua Eldridge: Right, and I’ll add it in on range of motion. I’ll go through all the rest, and then I’ll add it in as my range of motion, and then look for the area, if there might be an area that’s causing the issue, the actual area of pain. That way, I know to go there and look after. That’s one thing I do. Dr. Gerard Bogin: Actually, I kind of do that too because what I’ll do is if I’m doing range of motion, I will go through a full body weight bearing range of motion. I do mix in some of the SFMA. But you’re right, because I’m looking for where the problem might be coming from. Dr. Joshua Eldridge: Right. Dr. Gerard Bogin: But that’s also different from like if you have someone presenting with more of a gradual onset issue versus someone laying in front of you on the half-pipe that just bit it. Dr. Joshua Eldridge: Absolutely. Dr. Gerard Bogin: How tight their hips are when their ankle’s bent the wrong way. Dr. Joshua Eldridge: Make them do a squat. Dr. Gerard Bogin: That’s right. I need to see a we’re just gonna lift your leg here for a second. Dr. Joshua Eldridge: When you’re linking these together with your history, talk to me a little bit about that. How you link it, how do you think they interact? What’s your kind of flow maybe? Dr. Gerard Bogin: That’s a great question. To me, I think the history is the most important part of any exam. That’s where you’re getting a feel for what’s going on, how long it’s going on and what kind of patient is. To me, I think VIP NORO it stops me from skipping ahead. I tend to take pretty long histories because again, I think they’re the most important part. Generally, you always thought you should have a good idea what you think’s going on by the end of the history, but sometimes I think as we’re busy in practice, or in the field or whatever you’re doing, you tend to think okay, well this has to be such and such. Let me just confirm it and we’ll move on. To me, VIP NORO makes me go through the steps to avoid skipping ahead. Does that make sense? Dr. Joshua Eldridge: Absolutely. Dr. Gerard Bogin: What’s on the air brakes for my enthusiasm for my chief complaint. Dr. Joshua Eldridge: When I’m getting excited and I’m like working ahead, I always have Gerard’s voice in my head like, “Hey, VIP NORO. Get back to it, get back to the basics.” Dr. Gerard Bogin: Yeah, that’s how I look at it too, it’s the basics. It prevents you from making mistakes. Dr. Joshua Eldridge: Absolutely, and how do you work this into your documentation? What does your documentation look like when you get through this? Dr. Gerard Bogin: Sure, actually, if you imagine a SOAP note for a regular treatment, subjective objective assessment. My exam is actually just blocks all the way down to VIP NORO. Vitals and then like I said, I have the different acronyms under each category. Inspection, I just have a whole list, ADD HAS, and then I make any notes in there. It actually is my exam. Dr. Joshua Eldridge: In my system, when I work outside of the hospital, when I’m doing the work with my athletes, I have it set up in my system just like that. It makes it really nice for me as I’ve applied the VIP NORO to my documentation, so it makes it easy. Dr. Gerard Bogin: You know what, it travels pretty well. Dr. Joshua Eldridge: It does. Even you’ve had some quick tip sheets that you shared with me. I still take them with me when I go, and especially one of the habits that Gerard taught me was when you’re on the plane traveling to an event, they take your notes and go through it and refresh everything you do. That’s part of my refresher packet. Dr. Gerard Bogin: I still do that every time. Dr. Joshua Eldridge: You’ve given me a lot of great habits that hopefully we can share with other people. I think too, part of it was when you were helping me prepare for my diplomate exam, you grilled me pretty good. It was good information and it’s just stuck with me. Hopefully, we can pass this on to people, so they can have some of the things that they can do. We’ve kind of went over this before, but just tell us again why you think it’s so important for a thorough exam. Just hit some of those key points that you hit before. Dr. Gerard Bogin: I think a thorough exam prevents you from overlooking some less obvious problems which could be a real complication. I mean, everything in your office is generally controlled. The chances of having a problem are a lot less. But in the field, no one says you have to have just one problem, right? You could have a knee injury with an internal bleed. You came over onto somebody and they’re grabbing their knee, and they said they twisted wrong and they’re pointing to the outsides. All right well, ligamentous injury or something along the line. If you don’t take the time and check the distal pulse, you might not realize, there’s a torn artery inside, too. What could have been just a quick life-saving trip to the hospital, now gets delayed and now there’s some real complications. I think a thorough exam helps you avoid overlooking things. Dr. Joshua Eldridge: Do you mind if we do a practical exam? We’re gonna put you on the spot, no big deal. We’re at a basketball game, and we have a FOOSH injury and let’s just say an AC joint injury. Walk us through even if we bring them over the bench and you’re on the sideline, how would you go through this exam with this person? Dr. Gerard Bogin: Since it’s a traumatic injury, first I’m just gonna check your basic EMT things. We’re gonna go through some A&O X3, did he also hit his head? Is he alert, oriented X3, just clear out any problems there, You don’t know why did he fall, did he get hit and then fall, what’s going on? That’s one of the things the exam does for you is it kind of steers you away from just isolating on a certain problem. Say he’s alert X3, no problems, you know, PERRLA, everything’s checking out neurologically. Okay, he’s pointing to the spot, if you wanna follow the exam, now I don’t have a technical question. Are you and I officially there, or did we jump onto health? Dr. Joshua Eldridge: We’re officially there. Dr. Gerard Bogin: We’re officially there, all right. That means I know that I’m gonna be able to do a couple things back in the locker room in a few minutes. I might do sort of a more cursory timeline exam, but I’m still gonna follow VIP NORO. I’m gonna get the vitals eventually, I might not just get them right there on the bench because of what’s going on. I would inspect it and chances are if it’s an AC separation, we’re gonna see a bump, he’s gonna be pointing right to where it hurt. But inspection, one of the important things that I was always taught was amazing how many people don’t visualize the actual area with skin. They’ll just assume what’s going on underneath the shirt. I was always taught you have to get down and you have to visualize the actual joint, or whatever’s going on. Basketball should be a big deal because they wear a basketball jersey. Inspection, I’m gonna look for all the things we talked about. Asymmetry, we’re gonna see a difference side to side, deformity, we’re gonna see an elevated AC joint, discoloration, we might start to see some swelling. Hypertrophy, we’re probably gonna see a little bit of that by now, and then probably a little bit of swelling going on. Then palpation, I’m gonna palpate a little bit. What I’m gonna do is it’s pretty obvious to what might be going on, but I’m gonna palpate that, but then I’m gonna start working my way north and south from there. I’m gonna palpate up, any of the musculature up to the cervical spine, although we’re gonna hold that off for other, but I’m just gonna palpate up. I’m gonna palpate down. I’m gonna check out what else might be going in the shoulder. Neurovascular, okay so now, we have a good idea what might be going on. Now I’m gonna check the distal pulse just to make sure that there’s still blood going where it needs to. We’re gonna do Hoffmann’s just to make sure that when there is a fall, there’s not an upper motor neuron lesion or something more serious near the spine, and then Bromberg’s fast. We already have an idea because we sort of gave him a bench side neuro test, so I have a pretty good idea that those are gonna be okay. Then we go to range of motion, we’re gonna be really careful because we suspect what might be going on. I’m gonna probably just walk him through some real simple stuff. I’m just gonna do whatever I can to the point of tolerance just to see what we have. But most likely, I’m gonna be really careful because it’s traumatic and we don’t wanna make anything worse. Then we’re gonna go to other. That’s where you avoid missing something else that might have happened. Now, I’m gonna do a quick range of motion, a couple of tests in the cervical spine, and then probably down on the elbow too, maybe even the wrist, because it was a FOOSH, right? You don’t wanna miss a possible fracture that he hasn’t even really kind of noticed yet in the wrist because he fell on it. We might even expand that out a little bit further. Then range of motion we already talked about and then orthopedic special tests, I mean there’s gonna be some more of those that are probably gonna confirm what we’re thinking, If I’ve already felt a deformity and we have a pretty good idea what’s going on, I’m probably just gonna do some confirmatory test just to make sure. I’m gonna try not to piss him off too much because we’re probably gonna have to go get this athlete to the ortho and get some bracing, at least probably go to the hospital and get some x-rays. Dr. Joshua Eldridge: Alright, and once you get up in the cervical spine, how in-depth do you get there? What would you do for your quick VIP NORO there? Dr. Gerard Bogin: Same thing, it’s a little harder to do other in the lower extremity because the distance is greater but the shoulder’s so close because it’s the upper quarter. You’ve already pretty much visualized the cervical spine, but maybe I’m gonna take a closer look, make sure there’s no bruising developing, no swelling anything like that, that’s inspection. Palpation, I’m actually gonna feel in there. I’m gonna see if there’s any tenderness, any difference side to side, we’re just gonna work our way down, make sure we’re not missing anything from the fall. Then we’re gonna do some range of motions. The cervical range of motion really shouldn’t affect the injury site, so I gotta be pretty thorough about that. I’m just gonna check through and make sure a young athlete like that as long as there’s nothing going on should have a pretty full range of motion cervical spine. Dr. Joshua Eldridge: A quick example of some of this stuff was I was treating at a gymnastics meet and a girl went off the floor, overshot her landing. She came over the table with her coach and coach was like, “Yeah, she just kind of slid off the floor. Her shoulder hurts.” First thing I did was I took her vitals and her blood pressure was just crazy high, and her pulse was high. I’m like “What happened when you went off the floor?” She’s like, “I don’t know, I don’t remember.” So then we got into it a little bit more, and then it came out that she had a concussion. Her vitals, after they went high, they just started to tank. There were actually EMTs at the meet. We did a seated to standing to backboard stabilization of the cervical spine. It was really cool. I’ve never done it before. She was sitting in a chair, so we stabilized her head and neck. As we were doing that, the fire department was coming in. That’s who ran the paramedics and the other EMTs. They were actually impressed with what we did. Once her vitals started tanking again, then we backboarded her and they transferred her. Dr. Gerard Bogin: Did you put the collar on while she was in the chair? Dr. Joshua Eldridge: We did. When it was in the chair, from there, we stabilized and stood her up and then we laid her back onto the backboard. It was like a standing to straight to laying down on the backboard. Those EMTs were high-speed, they’re great people. Dr. Gerard Bogin: Yeah, EMTs are great. They don’t fool around. They’ve got a protocol and they follow it. Dr. Joshua Eldridge: Yes, and that was one of the best meets that I worked at with EMTs, because they were like, hey that’s a sprained ankle. We don’t know what to do with it. We’re gonna put it in a boot and put them in the ambulance and that’s not necessary, you take care of that and then we had two or three actually where we had to call fire department to come in that meet, but they were great people. Dr. Gerard Bogin: How many transports do you average at a gymnastics meet? Dr. Joshua Eldridge: That one was rare. I don’t know if it was the time of the year or what the problem was, but that one seemed to be more often we’d have three or four almost every time on that meet. Usually, even on big meets, I was out at one in Las Vegas that had 5,000 athletes come. I think we had two where we called the EMTs to actually come in the ambulance. One girl, she was an elite girl. She went to a double back, so she did two backflips off a tumbling pass and landed off the floor, it was carpet, but it sat right on cement. She landed on that. I think we had to call the EMTs for her just because it was such a serious bilateral calcaneal fracture. Just for her comfort, we did that. The other one was an awkward one where a girl had fallen and hit her head. She was just acting very unusual, so we called EMTs and they got there. As soon as the EMTs got there, she hopped off the table and was like, “There’s nothing wrong with me, there’s nothing wrong with me.” That was the weirdest encounter that I’d had up to that point with an athlete. Dr. Gerard Bogin: I’ve had a couple of those. It’s amazing what change of attitude someone in a uniform will make, right? Dr. Joshua Eldridge: Yeah, and the problem was, she started to hyperventilate and she wasn’t able to calm down. But then once they got there, her parents were not happy, to say the least. Dr. Gerard Bogin: At you or at her? Dr. Joshua Eldridge: No, at her. They were very upset at her just because of the way she was acting. Dr. Gerard Bogin: That’s really strange. You know what, getting back to our basketball example which is actually perfect because again you and I, we’re at the game. We’re watching the athlete, so we have a good idea what’s going on. It’s not like we walked up onto a trauma. In the example, I would have gone through that bench side and I would have determined if it was an emergency case that had to be rushed off or something that was gonna be treated in-house, in which case then I would take them back to the locker room, then I would be a little more thorough where I would take the vitals. I would go through everything a little bit more as opposed to just the bench side where you had to determine if it was gonna be a transport or not. That’s what VIP NORO does because I wouldn’t let that athlete leave my care until I had all those categories still. I might not have gone in the exact order because of the situation, but I definitely would have gotten, and technically you would normally take them every 15 minutes. If it was a transport, we would go back to locker room and I would be taking them in every 15 minutes until the EMT showed up. Dr. Joshua Eldridge: Well, that’s pretty cool, Gerard. I think that’s pretty solid what we got. Dr. Gerard Bogin: We did okay, Josh? Dr. Joshua Eldridge: Yeah, I think so. Thanks for joining us. Any last thoughts you wanna leave with us? Dr. Gerard Bogin: No, I wish I did. I wish I had some original thoughts, but pretty much everything I’ve got is from somebody else that I just condensed to my own need. You gotta kind of thank everyone that went before you. Dr. Joshua Eldridge: And just like that, I got it from Gerard. He’s been instrumental in just helping me develop those protocols that I use today and even out on the field and with athletes. Every time I talk to him, it’s amazing because it just gets me back to the basics, and that’s so important for us as docs is to get back to the basics and don’t forget these things every day. Dr. Gerard Bogin: I agree, basics are important. Dr. Joshua Eldridge: Yes, do you have a place where people can get in touch with you, or do you have any social media for anything you do? Dr. Gerard Bogin: You mock me, Josh. I do not have any social media Josh, but I do have all my contact infos on my website, athletesonlyperformancetherapies.com. Anyone wants to get ahold of me or any of you doc’s who want this information, I’m always happy to share, by all means, shoot me an email, I’ll give you whatever we have. Dr. Joshua Eldridge: All right, thanks Gerard for joining us. Dr. Gerard Bogin: All right, Josh. Dr. Joshua Eldridge: Getting your exam right is important to make sure you properly diagnose your patients and reach the legal standard for exam completion. Dr. Gerard Bogin laid out an easy-to-use format with the acronym VIP NORO. We’ve created a resource of three exams, upper extremity, lower extremity and torso that you can download at chiropracticepro.com/episode4. Again, that’s chiropracticepro.com/episode4. Thank you again for joining us. My name is Dr. Joshua Eldridge, and I’ve been your host for this episode of the ChiroPractice Pro podcast. We’re looking forward to seeing you next time right here. Have a great day and enjoy being a leader in your practice and in your community.