Most of you have heard of Daniel Amen, a psychiatrist really at the cutting edge of healthy thinking, healthy behavior and ways to access and treat behavioral conditions.  In one of his books he talked about the 18/40/60 rule.  I want to talk about that for a moment in the context of your life as a person leading others, as a person that is building a business, and your life as a person who is helping other people reach their potential.  And I want to discuss how the 18/40/60 rule can actually apply to your chiropractic practice in Part 2. 

So, let’s look at 18 years old.  Do you remember that time?  You were obsessed with what people thought about you, you worried about what your friends thought, you worried about what your teachers and coaches thought, you worried about what your friends thought about what you wore.  You worried about whether you were a cool kid or not or why you weren’t a cool kid.  You worried about whether or not you had the right bike, or the right car.  All those things were just in your brain causing mental RAM noise.  These anxiety riddled neuronal firings dominated your thoughts and through the process of synaptogenesis created lasting beliefs and behaviors.

And too often another’s opinion, their idea of you, becomes your idea of you. The bottom line is you just knew that everybody was thinking something about you and that it probably wasn’t good.

And then you turn 40.  And at 40 you kind of take the attitude that you really don’t care, I mean zero, underscore, you really don’t care what other people about you.  The truth is what you’ve done at that point is just sort of encapsulated all this rejection and maybe just put it into a place of re-action.  No matter what kind of career success you’ve had, what kind of status you have in the world, what kind of money you have, what kind of cars you have, that underlying feeling at that 40 says, “I really don’t care.”  The reality is that the 18 year old behavior really didn’t change, you just sort of walled it off and then, all of the sudden, this thing called aging occurs. 

This doesn’t have to be chronological though.  This can have life experiences and you could go through this a lot faster.  But the ideas here is that at 60 you have the epiphany that no one was really thinking about you that much in the first place. They didn’t really care about all those things that you obsessed about.  They didn’t really care about your profession, what you were doing, what you were thinking.  That wasn’t on their mind because they were thinking of what?  Themselves!  And they were thinking about how you were perceiving them. 

The epiphany is like a big breath.  Take a big breath and be 60 years old right now.  And if you’re 70 and you haven’t hit that point yet, hit the point with me.  Take a big breath and exhale as an affirmation that,  “Hey, other people don’t really care that much.”  What they care about is having authentic relationships with me.  So turn off your worries and your anxiety.  Did you know the archaic definition of inspiration means literally to breathe life into people?   I hope that we have inspired you to let it go.

About: DC Mentors provides chiropractic mentoring services to help chiropractors improve their business and personal lives.  We have elite one-to-one programs available or a complete online video training library available at www.dcm90.com.

I talked in the last blog about the March 2011 magazine, Consumer Reports.  This article, “What Doctors Wish There Patients Knew,” still gets my attention.  There is one piece in here about pain.  I know, I know, I know chiropractic is in the wellness business. I also know that many of your patients come in with complaints of not being well and sometimes that includes pain.  The idea here is that pain is really an entry point into a relationship with you, a mentoring, a healthcare concierges,  if you will. 

So, as a reminder, they took 660 primary physicians and over 49,000 consumer reports subscribers and surveyed them.  One of the things that came out here is the idea of effectiveness when it comes to taking care of and minimizing pain and minimizing disability.  What do patients think and what do doctors think? 

The highlight of this particular section said that the doctors are actually harder on themselves when it comes to judging whether or not their care plan and their recommendations and treatment have been effective in minimizing pain and disability for their patients.  The doctors are harder on themselves in judging their effectiveness than the patients were.  The numbers are pretty amazing.  37% of the physicians thought that they were very effective, that’s all.  And 60% of them thought they were somewhat effective. 

In contrast, when the patients were surveyed, 79% of the patients felt that their doctor helped minimize pain and discomfort.  Big disparity.  What’s to account for that? 

One idea is that a patient experiences their own condition, specific to them and them alone.  They have their point of reference, and maybe that of a family member or two, but for the most part the effectiveness is based on their scale, their direct response to the care. 

When it comes to the effectiveness the doctor looks at their entire career, not just the day, not just that person, but they look at their entire career.  If you have been in practice 15, 30 years or even 5 years, you get an accumulative database going of all the responses that you’ve ever had in all of the different patients you’ve ever had. That is how you see things.  The doctor sees this huge disparity.  It’s very easy to see why we’re kind of down on ourselves.  I want you to snap out of it. 

Check this out.  These were primary care physicians.  They were responding to things that Chiropractors take care of everyday.  While Chiropractic isn’t conditional, we take care of people because we have a philosophy, science and art to apply to human suffering.  The typical things that most doctors see, whether they are a primary care physician or a chiropractor, are things like Fibromyalgia, things like neck and back pain, things like chronic immune problems, whether that’s arthritic conditions or whatever, and, the big one here, headaches.  The conditions that are more chronic in nature create less of a patient satisfaction, of course.  And, of course, the doctors rating of that is also demonstrated.  Patients with these chronic conditions are more likely to complain about ineffective treatments.  I would imagine that our studies are showing that patients with neck and back pain and headaches are getting some great responses.  That Chiropractors treating Fibromyalgia are getting better results and better effectiveness and better patient compliance and satisfaction than the typical M.D., but . . . but let’s just not hang our hat here.  Let’s just step back and get an appreciation that we take care of sick people and that this is a long distance race.

I’m looking out through our windows here at DC Mentors’ offices and I am looking at Lake Tahoe and beyond as a metaphor for enduring purpose and passion. We want to eliminate needless suffering so we need to adjust enough people but we need to put things into perspective. We can’t help everyone or help everyone to the level we would like.  If we get stuck trying to be everything to everyone and we will never reach fulfillment. We must learn to say, “Next,” when appropriate and let go so that we can take care of the next patient and the next patient.  

You have to get better at your skill sets.  You have to get your soft skills together.  You have to get your ability to take your own emotional temperature and respond to the patients that aren’t getting well.  Some of them don’t. Yet you must remind yourself of the results you are getting as a whole so that you are motivated to continue to go in there day after day because it is the right thing for you and for them.

The idea here is that the higher marks for patient satisfaction, whether it’s in a physician’s office or a chiropractor’s office, are give to the doctor who explains and gives the patients S.M.A.R.T. goals (Specific, Measurable, Achievable, Realistic, in a Timeline) and then help those patients with chronic conditions,  letting them know when to return for care.  Now I know we are not symptom oriented but we are patient oriented, we’re patient-centered in that the patient’s experience with these chronic conditions has a threshold. 

Since we see a lot of patients with chronic pain we need to establish a baseline of care with realistic expectations and outcome assessments. Once the patient has reached those parameters we can teach them what that their personal threshold might be.

My wife, Cathy, just got back from the grocery store harvesting her accoutrements for a fine meal and while she was in the checkout line she picked up a magazine, “Consumer Reports.”   The title on the cover got my attention, “What doctors wish their patients knew.” Don’t you want your chiropractic patients to get this? 

The article is about patient compliance.  One of the things about studies we read, whether it’s from the AMA or from the Chiropractic genre and academia, is that sometime it misses exactly what’s going on in the mind of the consumer, the patient.  Sometimes our political groups and institutions more or less institutionalize and hardwire their own ideas and forget to talk to the consumer, the consumer of health care.  That is why I think it’s good to look at articles and magazines that the people are reading, your patients, your target market.  I could go on and on and bore you with studies about patient compliance in all kinds of other, more stringent, more academic findings, but let’s see what the people are saying. 

Consumer Reports took 660 primary care providers and 49,000 Consumer Reports subscribers and surveyed them.  One of the highlights they discovered was both doctors and the patients look at favorable interaction (cooperation, courtesy and professionalism) as something they value. 

The second thing that came up for the doctors was patient non-compliance with recommendations and treatment regimes.  They felt that non-compliance greatly interfered with the patient’s response.  That’s not unknown to us. 

For the patient, not knowing much about the doctor’s personality up front, before they went to meet and engage in a doctor-patient relationship, was a big part of compliance.  We at DC Mentors think that is mostly the responsibility of your chiropractic team and you, the chiropractor, to be able to adopt, adapt and read the patients that come in so that you are taking care of your half of the relationship.  It’s a huge part of patient-centered care. 

The other big point on non-compliance with the doctor’s recommendation is that 37% of the doctors surveyed said that it greatly interfered with their ability to help.  We might even think that percentage higher. 

An equally important  piece is to appreciate what the people, the consumers, the patients, said about compliance.  They said that it is hard, at times, to comply when it’s no longer just taking a pill.  Whether it’s a medical relationship with a patient or a chiropractic patient there are lifestyle changes that need to be made in order to accomplish a healthier, longer, more vital life.  So it’s not just us against them.  We need to appreciate that the self care chores we give patients, the exercise and dietary changes, they look at those as work.  We need to make them not such work. We need to get them to do incremental change in order to hit that tipping point. 

The other point of non-compliance is that people, many of them, are hopelessly disorganized, some of your patients are hopelessly disorganized.  I hope that’s not you.  And the other piece is quite simple, they don’t feel any better and we are all, all of us, in the feel good business. So if the person is not getting a response from the chores, not getting a response from your chiropractic adjustments, not getting a response from a change in lifestyle they’re likely to not comply. 

Another issue is they sometimes have adverse reactions.  Of course with medications we know the that the list of adverse reactions far exceeds the list of the things that you want to fix, but let’s look at chiropractic.   Sometimes adjustments make people sore, sometimes it puts them into a frightened mode.  Sometimes we go in there and just say, “I’m glad you hurt more.  That’s a sign you’re getting well.”  Well, it might not be a sign they want to hear, appreciate and understand.  They will need to hear your take on it in a more compassionate, empathetic outlook.  Not hand holding, but creating an understanding. 

We are in the business of getting results, so what can we do? We can investigate with our new people.  We can find out what we think they need, bare minimum, in a sense of getting, at least, from this point to this point.  Not from complete chaos and crisis to complete wellness, but how do we get incremental changes.  Not a bait and switch, but a step by step plan for them, something they know they can follow up on and get a certainty from you that if they do comply they will get a response.  So that is where we investigate, we inform and we influence.  We need to have our thoughts, our appreciation of health, healing and restoration, accepted and heard in a way that they can appreciate and understand.

When I was in Cabo at Christmas I was watching the surf and an analogy came to me.  A Chiropractor is, in a very real sense, a lifeguard at times.  We are sitting there looking out over the waves and we notice that there is someone playing and frolicking in the waves and there seems to be an undertow starting to carry them out, but they are doing well, no problem.  Then we see that the undertow has them, we grab our board and we jump in the water, paddling to their rescue.  When we pull them out of the wash, so to speak, it is not the right time to teach them about how to swim or to yell at them because they went out to far.  It’s the time to grab them, put them on the board ,do some first aid and get them to shore.

This is a whole different way to look at your relating of findings to a new patient.   We are not in the business of fixing boo-boo’s all the time and chasing pain and symptoms around, but what are we in the business of?  In my opinion, chiropractors do bring people in from the shore, give them at least another chance at their health and another perspective, a way of looking at what happens in a body when certain things are missing.  The patient doesn’t really care what kind of surfboard you have, in other words they don’t care about your chiropractic technique.  What they care about is that you are a master of it.  They really don’t care about technique but we make the board the big deal.  What they care about is if you make sense to them, can you help them.

Each of you have had days, weeks,  maybe even months, or some even a year or two where you can tell that your practice made a tipping point.  It tipped in the direction that you wanted it to go. 

A tipping point means that the small things added up to make a big difference.  You just don’t know what that accumulative effort is.  It  creates excitement and enthusiasm in your chiropractic practice.  A wave of new patients seems to come in when we are prepared and when we have been putting fertilizer into the practice for a while.  We’ve investigated, we’ve informed and we’ve influenced enough people that they are able to talk and tell the story of your chiropractic business in a way that sticks. 

One thing that greatly assists in the tipping point is the stickiness factor.  It’s  about your patients being able to communicate your message, in other words your description of what is occurring in their body, whether you call it a subluxation or a misalignment or neuroarticular dysfunction.  It’s really not what you say, it’s what they hear.  The stickiness factor is that your message sticks, it makes sense to the patients. 

In Lodi some of my patients were farmers and they understood when I said we are going to grease your zerks.  They understood by that description that we were going to help their spine move better.  Whatever that analogy is, it’s got to stick for that patient and they then take that contagion and become the messenger that talks to other people about what it is you do, how your chiropractic techs are interacting with them and what the feel of your practice is. 

When enough people get your sticky message that is in the context of their life, they tell your story to others and it begins to tip your practice in the direction you’ve been creating.  When you become a patient of another professional with a beginner’s mind, you will be surprised at the words that really stick for you when they explain what it is they do to you. 

Stickiness and creating enthusiasm,  that’s the tipping point.  And we want to be able to teach your chiropractic techs what that tipping point is so that they can, when they are in the grocery store or in Starbucks, relate the message of what they do with you in your practice.

A key piece to your Chiropractic report of findings is the simplicity of getting them to do one action toward getting well.  When we look at somebody, for instance, who’s 80 pounds overweight; we know they have knee pain, they have sciatica.  If we go in there and say, “I’m going to sign you up for the biggest loser, you’re going to work out 6 hours a day, you’re going to change your diet, you’re going to change your lifestyle, you’re going to start listening to motivational tapes all day, I’m going to adjust you and we are really going to get after this.”  If you do anything like that and expect results, you are really smoking chronic.  It’s not going to happen. 

You get the patient to make one shift.  The book, Influencer: The Power to Change Anything  is a great book for you to pick up.  This book really gets down to the heart of the matter, getting the patient to make one step.  That is the folly of most healthcare today, it’s trying to get the patient to make too many changes, too quickly and nothing really happens.  It is why people make New Year’s resolutions and don’t follow through because they bit this huge chunk off.  And they use nebulous words like, “I’m going to be healthier this year.”

A study in my home state of West Virginia got people to be “healthier” by simply switching them from drinking whole milk to 1% milk.  Now I agree with you, people don’t really digest cow’s milk, but that’s another topic.  The thing is all they did was shift from regular whole milk to 1% milk and the people got some traction in their lives.  It’s that simple on a relating your findings.  Get them to change one vital behavior.  They told these people in the study, “Look, if you shift from whole milk to 1% it’s like taking 15 pieces of bacon out of your diet.” 

You are changing a behavior.  That is your job.  If your practice is smaller than you want it to be then you are not doing your job.  I didn’t say sell, I didn’t sign them up for a free care and I didn’t say make some fiduciary incentives, buy 5 get one free, buy 2 get none, whatever.  It is really about influencing this human being. 

If you have a challenge with influencing look at the definition again.  It says to change a perspective.  I give the person a new idea, I give them a new strategy, I move them to a position where they can make a choice that is fairly easy.  

There are default mechanisms in their brains which say things like, I don’t have the money, I don’t have the time, I’ll only come if someone else is paying for it or I really don’t want to come for the rest of my life like my friend.  All those points are simply a lack of clarity and usually that is a result of your lack of clarity.  The patient is cloudy because you are cloudy.  You’re words are cloudy.  It doesn’t mean you have to perfect.  Look at the situation and discover what you can say or do that can influence the patient to see it in a different light.  And then you know you have done your best.

Everything is shaped by our fear of what we have. So even though we are not hitting our chiropractic practice success exactly like we want yet, everything that we do from this point is trying to protect what we already have.  You have a fairly good practice and now your chiropractic coaches are throwing all kind of different processes into it.  We are suggesting you think differently, we are strongly suggesting  that if you don’t change your actions you are going to get the same results.  And if you get the same darn results you are never going to change your belief systems around how successful you can be.  Most of the time our fear is, in a nutshell, the greatest stress we have.  It’s our lack of predictability in our world and our lack of control.  Let me say that again, fear is my lack of predictability and my lack of control. 

I am telling each of you that you have control over your business.  I am going to tell each of you that you can learn to predict what is going to happen when you do this, this, this and this.  And when you do it with a greater sense of urgency and when you make the changes in yourself that you need to make, it is predictable.  That is the promise to you.  There will be some circumstances that come up, staff will come, staff will go.  There will be changes in the economy, but your job is to make sure that your chiropractic business sustains itself through all of that. 

I hear fear everywhere, I also hear, “I know me.  I know what I’ve done in the past.  I get going and it doesn’t work so I think something is missing in me.”  If that voice is in your head, kill it.  There is nothing wrong with any of you.  There’s nothing missing in you.  There’s a different behavior that is going to take you to the next level, but there is nothing wrong with the way you are.  I don’t want to sing Kumbaya with you and hug you and hold you.  You have to get over the thought that you’re missing something, that successful people have something that you don’t have.  Does anybody believe me when I say that? 

Motivational speakers are up there trying to pump you up.  I am just trying to tell you, “Here’s the truth.”  It’s not what is missing in you, it’s that there are pieces missing in the way you have approached business.  You’ve approached as the technician, not the entrepreneur, or as the manager only but not the chiropractic entrepreneur.  It’s just the approach, nothing is wrong with you.  We all have issues and we will be working on those for the rest of our wonderful life on this planet.  But nothing is missing, there are pieces missing in your business approach.

What can I believe if I choose to believe?  This is part of your Self Direction score from your TriMetrix™ Coaching Report that DC Mentors Elite coaching clients get.   So go look at your Self Direction score and ask yourself, “What can I believe if I choose to believe?”   Can I choose to believe that whatever level I am at right now I am a rock star?  Can I choose to believe that?  Yes. 

The next question is, “What can I accomplish if I choose to enthusiastically take action over and over and over and over again?”  Remember, the word enthusiasm isn’t necessarily a Core  I enthusi-spasm.  Enthusiastic means I see something of a higher purpose in that.  The word enthusiasm means God within.  I see something so purposeful that I am going to embrace it every day and take action on it over and over and over and over again . . .  That means more than one day in a row. 

So the next question is, “What can I become if I choose to become?”  It’s your sense of purpose and your sense of self.  Is it a 500/week chiropractor?  Is my image of myself based on my numbers?  Or is my image of myself based on me saying I can always be better,  I just know that people can always enjoy another piece of me being better?  I know excellence is a lifestyle, it’s not a destination. 

Also as a take away, the economy will always have little ripples in it.  Yes, the world depends upon the economy and there may be this global organization that determines what goes up and down – you have control.  You don’t have a lack of control.  You may have a lack of discipline, but you don’t have a lack of control.  There is no lack of predictability.  So start somewhere in your practice and look at where you feel stressed out because you perceive that you can’t predict what is going to happen and take a peek at that.