#56 - Medical Collaboration for the Private Practice DC with Dr. Alex Frantzis, Part 2

WEBVTT
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Factor spelled FA k t R stands
for Functional and Kinetic treatment with rehabilitation.
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Over the past decade, this unique
approach to treating pain and dysfunction has been
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utilized by healthcare providers on six continents, serving as a framework that guides clinical
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decision making and patient visits around the
globe on a daily basis. With this
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podcast, our goal is simple to
bring the best and brightest in clinical education
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to the forefront and empower practitioners with
cutting edge, evidence based content that improves
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patient outcomes and inspires healthcare providers to
continually evolve their approach to treatment. In
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each episode, we will feature a
training or interview with some of the top
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minds and help care in a short
format that is easy to digest, with
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actionable information that you can implement into
practice right away. Let's get started.
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I'm your host, Jessica Riddle.
Welcome and thank you for listening. Today
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we wrap up our two part training
on medical collaboration for the private practice Chiropractor
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with doctor Alex Francis. In part
one, we got to know the medical
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model and how medical referrals work.
We discussed best practices and approaching medical providers
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for co management of cases and chatted
about the importance of addressing mental help as
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a component of chronic pain and pain
management. In today's episode, we discuss
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the easiest way to effectively communicate with
medical providers and the best tools to build
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professional relationships with multiple providers in your
local area. And who better to speak
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on this topic than doctor Alex Francis, a board certified chiropractic orthopedes who owned
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several integrated health centers throughout northeast Ohio. A two thousand and eight graduate of
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Logan University, doctor Francis began his
first multidisciplinary clinic soon after graduation, growing
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to three locations and employing a team
of providers including a board certified orthopedic surgeon,
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general practice medical doctor, physicians,
assistants, physical therapists, and massage
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therapists. In twenty thirteen, he
became staff privileged with a local hospital in
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Cleveland and has operated an established office
in the hospital since two seventeen, working
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with specialty teams such as primary care, general surgery, vascular surgery, and
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pedietry. Most recently, doctor Francis
has expanded to integration with an urgent care
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facility offering chiropractic care as part of
their model managing neuromuscular skeletal conditions alongside various
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other healthcare specialists. This two part
training is going to provide you actionable depths
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that you can take to begin establishing
relationships with medical providers in your area.
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It will also give some guidelines and
best practices for overcoming misconceptions on what it
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is that you do, and of
course, establishing yourself as a trusted partner
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on your patient's healthcare steam. Let's
get started. So that's kind of it.
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So let's talk about co managinge care. This is a good topic that
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I always talk to students about,
and I know we got a few students
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soon. I'm hoping more students watch
it. Co managine care. God,
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I don't know how many times I
see it. Where I talked to two
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different providers. I talked to myrathpedic
surgeons, where I talk to my primmer
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at care and they tell me the
story about how they send something to a
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cairo for low back pain and the
Cairo ended up telling the patient don't take
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your diabetic medication. You can treat
your hypertension off your meds. Just do
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these exercises and get fit and all
this stuff, and it's so so aggravating
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to me. It's so I mean, I want. It almost keeps me
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up at night when I hear these
stories from providers. We get referrals,
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Caros getting referrals from these primary cares, from these orthopedic surgeons, and they're
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going off some tangent and treating something
that they really shouldn't be treating. So
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never attempt to treat something outside near
muscular n MSK. Now where we are
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trained knowing gigu stuff. We're trained
knowing cardiac stuff and lung stuff, and
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yes we are trained in that,
but by no means are we specialist.
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And it's funny because I equate us
to primary care. Like going back to
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my talk with doctor Person a couple
of months ago, he always tells me
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every time I say, he goes, you guys are better than primary care
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because you refer and you guys understand
like not all of us, but we
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understand that our relationships with our patients
are huge, and we have a close
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bottom of our patients because we touch
our patients, we see our patients stormy
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other basis, we build a bottom
with our patients, and most primaries don't
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and that builds a trust with our
providers and makes us portal entry primary care.
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Whatever you want to say, but
I'm not treating any cardiac issues.
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Somebody has a five not coming in
my office. I mean, I understand
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it, I get it, but
I'm not delving into it. Yes,
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diabetes, can you help manage it
with exercise and diet? One hundred percent.
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Should you tell miss Smith to get
off or met forming for it?
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Absolutely not, okay, So never
go outside with the with the provider referring
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provider is going to ask you to
treat, don't do it. If they've
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sent you for low back pain,
if there's a shoulder issue, that's fine,
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keep them in the loop, do
it. But if they have hypertension
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and they have diabetes and they got
cardiac issues, don't just don't. Okay,
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keep it in mind as you're treating
your patient, keep it in mind
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that it might affect how your tasing
response to treatment. But don't start treating
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that, okay. Co manage that
with other providers, co manager of the
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cardiologist, comanager with the primary care, co manager with the general surgeon.
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One percent. But don't don't.
Don't take the reins on that instruct a
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patient to stop stop seeing their primary
care or getting off their medication. I
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feel like I shouldn't have to say
that, but I have to say that
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because I see it too many times
where that that's a common occurrence. Never
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talk about medication that's outside of her
scope in all fifty states. Never talk
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about getting off meds. That's getting
you in a whole world of hurt and
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problems that completely outside your scope.
Don't even think about that. If you
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feel like there's some kind of over
medication, or there's an issue that maybe
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Miss Smiths seeing multiple providers and getting
the same kind of a medication, or
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there's some issue there, I would
bring that up to the primary care.
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But like, hey, I noticed
Miss Smith's on this, this and this.
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Did you know about this? That's
something you're concerned about, But you
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leave it at that. Don't take
them off medication. Always let the professional
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taking off medication. Obviously, I'm
a poll a patient out of there for
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away from the provider if a patient, if a provider refers to a patient,
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don't try to steal the patient.
It's just it's not polite. Like
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I don't know what else to say
that that to keep it simple, stay
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in your lane, like Kurvitt says, here to coust zero dollars to stay
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in your land. In mind your
business, do what you're good at.
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Stick to the normal scale skeletal anything
else, be aware of it, Understand
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how it's going to hinder your care, and co manage it. So the
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first part of this presentation, I
spent a lot of time talking about referring
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patients game refer to you, But
what about using your patient base as a
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referral source. I learned early on
a practice we make the best normal scale
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providers. I'm going to tell you
right now. And I sent this link
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to an orthopedic surgeon friend of mine, and I'm like, you gotta watch
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this. I'm doing this at two
o'clock today. Watch this, and I'm
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hoping he's gonna watch this, and
I'm gonna say this knowing he's gonna watch
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it. When it comes to normal
scale skeleton, there are no providers better.
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And I include orthopedic surgeons in them. And what I mean by that
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is orthopedic surgeons are great. And
if you find a northopedic surgeons a great
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surgeon, you you stick with them. All good, all good orthopedic surgeons
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will only do surgery when they think
what they're gonna do is going to help
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the patient. When conservative has failed, and most importantly, when surgery is
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not an option, and there's a
lot of time surgeries in an option.
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And that's why I say we're better
nermal scale Skeleton because we're not just one
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trick ponies. We're not going to
just cut somebody in and that's not what
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we're doing. We can provide them
better care in a holistic, non surgical
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way, non drug way to help
actually fix hundred lying problems without having a
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cut of patient. And that's what
I mean. We're better than doctor balk
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if you're going to see this neuromuscular
skeletal conditions. That being said, when
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it's surgical, the surgeon is going
to get it. And that's what the
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surgeon wants to to see too.
They want it when the conservatives failed,
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they want they want to know.
When it's surgical, that's they're ready to
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roll. But we're not so great
at other issues. Yes we're training cardiac
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issues, Yes we all took GIGU
classes and all this stuff, but we're
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not great at them. So don't
delve into them when you do your intake.
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When you talk to your patient,
always ask about coromabilities. Are a
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diabetic hyd pretension? Always have them
filled in the even though we don't do
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medicine and we may not know the
medication. I have it when medicine are
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taking and what are you taking it
for? Okay? So diabetes that can
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affect stuff, heart, cans that
can affect normal scale scalpel, high coasterial
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can affect that staton. Drug use
can all affect what we can do.
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So asking about comorbidities, even without
thinking about referrals or co management, they
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should be part of your routine anyways, so that you know that how their
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health is going to affect the treatment
and you're providing. Always ask if they
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have a primary care provider. Please
do, I'll go through the medalist I
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have on my intake forms. Who's
your primary care? More importantly for those
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comorbidities, if there's a condition there
that's going to affect your treatment, over
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how they're going to respond to your
treatment, and you want to make sure
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that's being actively co managed. Do
you want to make sure that mister Smith
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who's a diabetic is getting regular checkup
or his hypertensive, he's seeing his primary
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a regular basis and making sure that's
controlled. If it's not, okay,
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we have to be made aware of
that. So ask about a primary care.
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If they have a primary care that
they see at a regular basis,
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you know what three letter approach?
Send them letters. Hey, you know
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what doctor Smith, mister Jones has
been seeing me. He came from the
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low back man. Just want to
keep you in the loop. This is
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what I'm doing, This is what
I'm seeing them for, this is what
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I'm planning to do with them.
I also told them that there's any issues
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that I can't handle, there's a
problem for changes to reach out to you.
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Okay, three letters, initial,
revolve final. They didn't refer the
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patient to you. But you're not
using your patient base to make a relationship
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with a primary care that they may
you may not have a relationship with.
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Again, the more you do that, your name gets out there. It
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also shows common courtesy. And the
reason I like that is I see mister
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Smith, I get his little back
better, back pain better. He sees
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his primary In six months, primary
goes through the final says, hey,
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you saw doctor Francis for your low
back. How's that going. Oh,
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it's wonderful. It opens a door
for that patient to sing your praises and
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to be like, he was wonderful. He managed my condition. I got
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better in the six visits. It
was a miracle. Whatever wording they want
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to use, the primary is now
aware of that. And you know what,
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that primary may never refer that patient
to you, but you know what,
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guess what they're gonna do now next
time the little back pain after mister
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Smith, it's whoever the next patient
is with low back pain. Hey,
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you know what, mister Smith,
I just saw this. Patients said it
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was wonderful. Give them a try. It builds a relationship. Using your
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patient base to build a referral network
of providers is a wonderful tool that we
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can use. Again, it's simple, and I'm going to say this,
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I don't spend any money on marketing. My marketing is zero and it has
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been for a long time, initially
to build patient base and build my patient
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base, yes, but now it's
a self referring system. My patients that
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I get are urgent care patients that
are referred from the urgent care from the
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priders I work with Orthopedic surgic referrals
Hospital referrals and my pre existing patients.
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I said, I spend nothing on
marketing. My marketing budget more often than
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not for these places is literally zero. And I still do some minor marketing
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on where I have an associate.
Yes, but for the most part,
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my marketing budget is actually zero.
And I between me and myself, I
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see about one hundred and fifty patient
business a week. Can I see about
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twenty five to thirty patients a week
at the origin care, I'm seeing now
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thirty patients every time I'm here.
Hospitals about twenty twenty five. So I
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see patients. But I built my
referral network based on using my patient base
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and using a referrals to coming in
to generate more a bigger patient base.
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When you ask if they have a
primary care, if they don't have a
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primary care, it's a perfect opportunity
to build journey to use your network to
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get those primary care. So I
one of my good friends, a piece
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of physicians assistant, he's been in
my office. He see patients in my
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office. I work with them an
urgent care works from at the hospital when
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they're hypertension and they have to say
a primary care. In two years and
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a lot of people don't I use
my MIC. I got a patient here,
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this is the situation. Do you
mind, no problem? They got
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digestive, they have ibs, they
need a scope. This is stuff I'm
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not doing. I'll take care of
little back. You do the rest,
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and it builds that network. So
by co managing with other providers, it's
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going to help facilitate helping your patients
in a holistic way. You're not going
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to treat diabetes. You can help
manage it, but their diabetes is now
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in check. Your patients are going
to love you for it, and you're
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thinking about them. You're not just
thinking about their low back pain. You're
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thinking about their overall health and they
love. Keeping in mind, your specialty
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is no muscular skeleton. Okay,
that is your specialty. Stay in your
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specialty. Once it goes outside of
that specialist box, you need to be
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referred. Primary care is not dealing
with a fIF. Primary care is sending
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a fIF to cardiology. You should
be in that same mentality. You refer
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patients when you need and when it's
appropriate. Okay, I'm not saying refer
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every patient for an MRI, for
imaging, for expensive testing, but when
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it's appropriate. You need to do
it. When it's in the patient's best
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interests and their health is on the
line here, you need to do it.
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That is what we should be doing
for all our patients. Yes,
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we're great with MSK, but if
they have IBS or they have prons disease
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that's being not managed. You're doing
them a disservice by just dreaming a low
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back pain. So keep that in
mind when approaching medical providers. These are
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the things I want you to look
for. I want you to understand that
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when you're thinking about your network,
when you're trying to build your network,
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you can't be going And I use
this example. I got lucky with the
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hospital I worked as a small hospital. It's considered a middle meetings hospital in
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Cleveland, and Cleveland's got the cleanmand
clinic. So you want to make sure
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that the providers you're approaching, you
need to understand most of them are institutionalized.
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And what I mean by that is
they're usually affiliate with the hospital.
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Usually the bigger hospital systems employ a
lot of providers that are taught to keep
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it in the family. So primary
care there back pain has to go to
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the hospital's PT department. Okay,
so those are harder nuts to crack,
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and that's a harder network to build. So when you're trying to build in
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a medical refral network, you want
to work for solo practitioners providers that are
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not necessarily part of big hospital systems. They usually have more freedom. So
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you need to do your homework about
these people first. If you're gonna approach
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primary care down the street, you
got to do some homework for that by
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understanding how they're structured. Also,
you also understand how you can kind of
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facility and help complement what they're doing. So try providing providers and smaller hospital
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settings. There's not a lot of
primary cares are independent still, but those
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are great providers to work with,
okay, because they're not tied to hospital
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system. They're driven. And then
understand there's always a risk if you send
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somebody somebody, Yeah, they might
get stolen, they may not come back
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to you, and they may not
to refer something back. That's okay because
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as you go through that and you
deal with more providers, there are going
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to be providers that can send patient
back and that's how you build your network.
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So you definitely want to do your
homework and Understand who you're approaching and
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kind of where they're coming from before
you make the introduction. Okay, so
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do your homework. You need to
do your homework about who you approach.
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Understand how factors of how long they've
been in practice, specialty, patient demographics,
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their location, hospital group, and
all those things. Try finding providers
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will work with you, not to
be I don't want to throw stereotypes out
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there, because I definitely don't think
this, but in my reputation, medical
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doctors are with the school thirty forty
years ago tend to not be the most
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chiro friendly, Okay, not as
open minded. They're set in their ways
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now. That being said. Ductor
Purse, who I mentioned multiple times before.
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Ductor Purse graduated medical school back in
the seventies. He's a general surgeon,
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you know what, but he's very
open. He was very open to
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chiropractic. He loves our practical loves
the right kind of fit. But he
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also knows there's some cairos out there
that aren't necessarily evidence based, so you've
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got to kind of be aware.
Usually your practitioners, recent graduates, they
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tend to have more well rounded understanding
of what we do and those are typically
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easier people to approach. But again, understanding you do your homework when they
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graduated, what's their specialty? Are
they hospital? Based on all that,
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So you really want to do your
homework before approaching these providers. If you're
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00:16:26.360 --> 00:16:30.559
listening to this podcast and you've yet
to attend a Factor Rehab Live course,
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00:16:30.960 --> 00:16:34.000
I have a special offer just for
you. See, I realize that sometimes
249
00:16:34.039 --> 00:16:38.000
you need to kick the tires a
bit to learn more about a course before
250
00:16:38.039 --> 00:16:44.559
you register, especially one that offers
a certification track. So I've developed a
251
00:16:44.600 --> 00:16:48.399
special offer just for those of you
who are interested in learning what this Factor
252
00:16:48.480 --> 00:16:52.360
thing is all about. See,
We've put together a free one hour webinar
253
00:16:52.480 --> 00:16:56.279
to introduce the concept of having a
systematic approach to rehab. In this one
254
00:16:56.320 --> 00:17:00.679
hour online course, our director of
Education, Todd Riddle, will show you
255
00:17:00.720 --> 00:17:07.480
how implementing a system for patient treatment
can improve patient outcomes, streamline your operations,
256
00:17:07.000 --> 00:17:11.440
grow your profitability, and help you
to build a practice that you absolutely
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00:17:11.519 --> 00:17:17.920
love. You'll also hear from doctor
Riddle's personal experience in using the Factor Rehab
258
00:17:18.000 --> 00:17:22.039
system, both with elite athletes as
well as the everyday patient just looking to
259
00:17:22.079 --> 00:17:26.240
move and feel their best It's a
great first step to learn more about FACTOR
260
00:17:26.279 --> 00:17:32.960
certification and how FACTOR could impact your
patient care. And to sweeten the deal,
261
00:17:33.000 --> 00:17:37.839
we're offering CE credit for completing this
online training absolutely free. Yes you
262
00:17:37.960 --> 00:17:42.720
heard that correctly, free ce so
CE credit is available in a number of
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00:17:42.880 --> 00:17:48.920
US states for chiropractors, as well
as for massage therapists, athletic trainers,
264
00:17:48.000 --> 00:17:53.240
and physical therapists. To learn more
and get your free CE while learning more
265
00:17:53.279 --> 00:17:59.200
about how FACTOR can impact your patient
care, visit the free Factor webinar link
266
00:17:59.279 --> 00:18:03.880
in our show notes. Now back
to the show. All right, So,
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one of the questions I see is
do you need a records release assigned
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in order to contact patients PCP due
to hip up? So I always ask
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a question verbally to my patients,
is it okay if I reach out to
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your primary care providers? Typically the
response that I get is and the way
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I explained to my patients is,
hey, you know what, if it's
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okay with you, I'd like to
reach out to them. And the approach
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really is, I want to reach
out to them. I want to keep
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them the loop I want them to
have so the next time you follow up,
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I want them to have the whole
picture of what's been going on since
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the last time you saw them.
So I want to reach out to your
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doctor because I want them to know
what's going on with you, and I
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don't want you just if you're not
seeing another five months. I don't want
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you to have to remember, oh, yeah, by the way, back
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in May, I saw doctor Francis
four times. I'll reach out to them
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nothing that we're doing, kind of
approach them so that way next time you
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see them, they know what happened
over the last few months. They don't
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have to remember that. And ninety
nine point nine percent of actually one hundred
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percent of time, they're like,
yeah, I should ahead and send a
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letter. You don't. As long
as you have some kind of permission.
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You can have them signed like a
little hipA compliant I'm going to release.
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But also remember you're not necessarily divulging
any real health information, like you're hey,
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a low back pain, but you
should definitely get some kind of consent
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from the patient. It doesn't have
to be a full hippo release. Could
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be like I had a little form
drawn up of if it's okay with you,
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I'm going to reach out to your
primary and they'll sign it situation.
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But that's that's something definitely that week
go. And that's a good question.
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I have another question here, So
a lot of discussion is happening right now
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within the healthcare community about the psychosocial
aspect of care. Do you find that
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it's been important for you in practice
to also have a relationship with mental health
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professionals for those patients you encounter that
have pain that is being exacerbated by some
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things going on in their life outside
of the physical. So I do have
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being part of the hospital, I
have psychologists and psychiatrists available, and I
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have and usually what I'll do with
those is usually I'll make a direct referral.
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A lot of the times what I'll
do is I'll refer back to the
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primary or it's one of my physicians
assistants about like, hey, we're dealing
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with the low back this aspect of
it, but I think there's a mental
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component. I think there's something else
going on. I think we have to
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address this other issue. The good
thing is most primary care providers are comfortable
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enough to start the process on the
mental health, whether it's giving them a
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low dose of anti anxiety matter,
depression matter, something like that, and
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if they're not comfortable, they know
to refer accordingly. So I definitely implement
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that the whole psychological approach, especially
my chronic pain patients. Then I definitely
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keep I'm not apponent medicine obviously because
of what we do, but I also
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understand the importance of that, so
I'll definitely refer back to one of my
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psychologists that I have kind of in
my back pocket, but like, hey,
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I also have a nurse pectitioner at
the hospital that I work very closely
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with. She's part of an integrative
health department and they do a lot of
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chronic pain and they have a psychologist
psychiatrist they do the mental health aspects.
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So I'll kick it back to them. But I one hundred percent believe,
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especially when I'm dealing with a condition
that it's not responding as well as I
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was expecting, and I feel like
there's some kind of psychological component, I
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would definitely refer back to psychologists or
primary care and like listen, I'll deal
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with the Moscow sclepel, I'll deal
with the actual physical problem, but I
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definitely think there's a psychological component,
and I'll have the conversation with my patient
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if I feel like it's a chronic
pain issue, even if before I start
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care on my initial consultation, but
like, you know what, this is
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what I can do for you physically, but you've been in pain for so
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long that mentally it's going to take
a toll on you. Like you've been
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in pain going on for so long. I tell this little like smart ass
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comment where I'll be like miss Smith, if I was in your shoes and
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I've been suffering with this for six
months, a year, or two years,
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five years, whatever the case is, if you came into my office
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and you're all happy to go lucky
and you thought this is the greatest day
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in the world, I would think
there's something wrong with you like that.
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That's not normal what you're going through. I found in practice, you've had
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this going for so long. I
think there's another aspect we have their address,
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Like I'll deal with the physical,
but you've been dealing with this for
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so long, and there's a mental
aspect that we have to approach, and
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then I'll make the appropriate referral.
Again, depending on where the patient came
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from it was one of my primary
care patients, I would send it back
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there and then what I would do
is. I would also include a psychiatrist
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psychologist because I like to do a
cute stuff. I get to keep paying
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under control. But there's always a
mental aspect to it, and you have
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to really gauge on our initial console
because it goes back to the barriers you're
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going to face as a provider like
you, I expect my patients to be
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objectively measurably better after six visits because
in my clinical experience, what I've done
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for these conditions has shown this kind
of response. Now there's always complicated factors,
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but it doesn't go bat physical.
There's also that mental aspect that as
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practitioners we have to be aware of. So definitely building that psychologist, psychiatrists,
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primary care mental health is incredibly imperative
for what we do. And because
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early on a practice like I'd been
doing these with patients and something at better
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and I'm doing the same thing and
like this patient isn't getting better, and
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I felt like a terrible practitioner and
it became frustrating for me. And then
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I realized I started doing the pain
management part or understanding the psychology of pain,
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that psychosocial stuff. I'm like,
wait, a sect, there's more
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than I can't help with that.
I need to address and once I implemented
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that, especially with my chronic paint
patients, and made a role the difference.
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So definitely, the psychosocial is a
huge part of what we do.
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Absolutely someone else was asking, when
initially trying to kind of get your foot
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in the door and start a relationship
with a medical provider, do you find
357
00:23:19.279 --> 00:23:23.000
it best to start with a phone
call, an email or stop by the
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office in person, like what is
kind of commonly accepted within medical So here's
359
00:23:29.680 --> 00:23:33.319
the deal. There is no right
approach. A lot of it has to
360
00:23:33.400 --> 00:23:36.400
go with your comfort too. Is
I'm an outgoing personality. I have a
361
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type of personality. My wife made
the joke when I first met my wife's
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00:23:40.279 --> 00:23:41.960
family was at a funeral, and
like, I met all of them and
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I was, for lack of a
better term, a life of a party.
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But it doesn't fit well for everybody, It really doesn't. So you
365
00:23:48.559 --> 00:23:52.559
have to find works for you.
If you're a very timid person, if
366
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you're a very shy person, that
first step might be an email or a
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call or something along those lines.
I'm a person every or three surgeon at
368
00:24:00.319 --> 00:24:03.640
the hospital I've met in some way, shape or form, and I've walked
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up to them in a room and
I was like, hey, doctor Francis,
370
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this is what I do for great
things about or whatever the case is.
371
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But that's not for everybody. So
what works best is really what works
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best for your personality. If you
need a little bit of a warming up
373
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to kind of get it going,
then maybe a phone caller a text.
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And I would also tell you in
busy practices, don't waste your time with
375
00:24:21.440 --> 00:24:25.039
the first introduction being with the medical
doctor or the PA. Go through the
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office staff first, go through the
office manager. Go through the front desk,
377
00:24:29.720 --> 00:24:33.279
bringing a box of candy, a
muffins, panair or bread sandalis bread
378
00:24:33.279 --> 00:24:36.440
coming ready from the country. Do
things like that to make the introduction.
379
00:24:36.759 --> 00:24:38.000
But again, go with your personality. You're like, I don't know how
380
00:24:38.039 --> 00:24:41.720
comfortable some people would be. Hey, I'm coming by your office. You've
381
00:24:41.720 --> 00:24:44.359
never been before. I want ten
minutes of your time for all of you.
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00:24:44.440 --> 00:24:47.480
So it doesn't work for everybody.
There is no right approach. It's
383
00:24:47.519 --> 00:24:51.559
what works best for your personality and
which you need to get there. Mine
384
00:24:51.640 --> 00:24:55.359
has always been I'll show up at
somebody's office and I'll just start talking to
385
00:24:55.440 --> 00:24:56.880
them. That's just that's who I
am. I'll start cracking jokes, being
386
00:24:56.960 --> 00:25:00.960
personable. But that doesn't always work
well. So for me, what worked
387
00:25:00.160 --> 00:25:04.319
was initially was the letter approach.
So getting letters in getting my foot in
388
00:25:04.359 --> 00:25:07.920
the door, followed up by an
email, a phone call with the office
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00:25:07.960 --> 00:25:11.000
manager. I'll call him up,
like, can I speak to the office
390
00:25:11.000 --> 00:25:12.880
manager whoever's in charge for the staff, And I'm going to tell you right
391
00:25:12.920 --> 00:25:18.599
now, nine of medical providers have
no idea where their patients go. That
392
00:25:18.799 --> 00:25:23.680
usually the office staff approach, So
dealing with the office manager, secretary medical
393
00:25:23.720 --> 00:25:26.960
assistance usually the best approach. So
sending the letters a great way to get
394
00:25:27.000 --> 00:25:30.400
it going, and calling them be
like I appreciate your referrals, or I
395
00:25:30.519 --> 00:25:34.119
want to give you guys some donuts
or whatever, the coffee whatever, Can
396
00:25:34.160 --> 00:25:37.240
I drop some coffee off? That's
usually the best way to go it.
397
00:25:37.559 --> 00:25:40.200
And it's never the one thing I
want to say. This isn't a one
398
00:25:40.319 --> 00:25:42.759
time I'm going to show up to
John Smith's office and get a hundred referrals.
399
00:25:44.319 --> 00:25:47.000
This took me years to build to
the point where I am now,
400
00:25:47.400 --> 00:25:51.240
and it's a slow approach. So
starting off slowly with an email, a
401
00:25:51.359 --> 00:25:53.640
text message. I mean, I'm
ultimately can send the facts if you want
402
00:25:53.640 --> 00:25:57.319
to have done that. I still
do that sometimes weird, but building slowly
403
00:25:57.400 --> 00:26:00.000
and just building on that relationship,
so it goes off with it what it
404
00:26:00.079 --> 00:26:06.920
works for your personality. Again,
most mds like they don't. Everything goes
405
00:26:06.960 --> 00:26:11.160
through their office manager. So you
want to suite talk the office manager and
406
00:26:11.200 --> 00:26:15.200
the staff and then get in with
the MD. So I found showing up
407
00:26:15.240 --> 00:26:18.279
in person, schmoozing with the staff, cracking jokes deal with MD work for
408
00:26:18.359 --> 00:26:22.000
me. But that doesn't necessarily mean
that's gonna work for everybody. But that
409
00:26:22.200 --> 00:26:27.319
usually is the best approach. When
you're talking to medical providers and they bring
410
00:26:27.519 --> 00:26:34.119
up the fact that spinal manipulation is
considered has quote unquote low quality evidence,
411
00:26:34.799 --> 00:26:38.599
what is your response and how do
you kind of handle those tough conversations?
412
00:26:40.160 --> 00:26:42.759
Oh that it's either that conversation or
what you do cause a stroke. Those
413
00:26:42.759 --> 00:26:47.160
are my two favorite conversations to have. So my approach is always this,
414
00:26:47.400 --> 00:26:51.480
and it goes back to I don't
want to counterpractic to me, isn't just
415
00:26:51.599 --> 00:26:56.559
manipulation? I do I manipulate all
my patients? Yes? Maybe except for
416
00:26:56.599 --> 00:26:59.720
a few, but I pretty much
manipulated some may sup from all my antients.
417
00:27:00.160 --> 00:27:02.519
But that's not just what I do. And it goes back to evidence
418
00:27:02.559 --> 00:27:06.400
page. So when they mentioned up
the low quality evidence, I mentioned that
419
00:27:06.559 --> 00:27:08.039
that's not all I do. I
also as a physician level service, I'm
420
00:27:08.039 --> 00:27:14.680
also doing therapeutic exercise, your musculary
education, dry needling, low quality evidence.
421
00:27:14.759 --> 00:27:17.319
Yes it might be a low quality, but it does work for people,
422
00:27:17.359 --> 00:27:18.680
and I won't know if it's going
to work for your patient until we
423
00:27:18.799 --> 00:27:22.640
try it. But I also do
the high evidence stuff that I do home
424
00:27:22.720 --> 00:27:27.079
exercise plans and cardiac not cardiac we
had, but building up cardiovascular stuff and
425
00:27:27.200 --> 00:27:33.160
managing all that you really want to
just avoid. Chiropractic is just manipulation and
426
00:27:33.279 --> 00:27:37.079
that's not how I practice. It's
funny because your athpedic surgeon that I work
427
00:27:37.119 --> 00:27:41.119
with, he's adodos are trained in
manipulation. He doesn't manipulate, but he
428
00:27:41.160 --> 00:27:45.000
al sort of sees intrinsic value manipulation, but he also knows that's not That's
429
00:27:45.039 --> 00:27:49.359
one of the puzzle. So your
approaches and how I differentiate myself from the
430
00:27:49.440 --> 00:27:52.880
PT is okay. You can send
to the PT they're gonna do therapeutic exercise.
431
00:27:52.920 --> 00:27:56.200
And I have pts in my office. I love PT but by using
432
00:27:56.359 --> 00:28:02.640
US first, you're now having a
physician level service monitor the patient, examine
433
00:28:02.640 --> 00:28:07.400
the patient, track the patient.
So the PT can just do what PT
434
00:28:07.599 --> 00:28:08.920
does, like you give them a
script. I want these exercise done.
435
00:28:08.960 --> 00:28:11.079
That's all they can do. I
can go one step above it, and
436
00:28:11.079 --> 00:28:15.559
I can diagnose the patient. I
can order imaging, I can order testing,
437
00:28:15.359 --> 00:28:18.400
and then I can still do what
they do, but I can also
438
00:28:18.440 --> 00:28:22.759
do the physicians stuff and it doesn't
necessarily just have to be manipulation or heat
439
00:28:22.839 --> 00:28:26.079
or an acupuncture because I do evidence
base, I do therapeutic exercise, I
440
00:28:26.279 --> 00:28:30.599
do trigger point massage, and I
do airt and I do all the stuff.
441
00:28:30.839 --> 00:28:33.519
And to me, I don't avoid
the question, kind of play it
442
00:28:33.599 --> 00:28:37.160
off as it may be low evidence, but it's worked for people, and
443
00:28:37.160 --> 00:28:38.160
I'm not going to know if it's
worked for your patience. So we try
444
00:28:38.200 --> 00:28:41.119
it. So I try it on
the patient. Doesn't work, then guess
445
00:28:41.160 --> 00:28:41.880
what. I'm not going to do
it. I'm gonna do something else.
446
00:28:42.279 --> 00:28:47.559
And that's what they want to hear. And it's funny because the stroke talks
447
00:28:47.559 --> 00:28:48.480
and other talk. Well, I
don't have to. I don't want to
448
00:28:48.480 --> 00:28:52.519
go into but it's one of those
conversations that you have that's yeah, it
449
00:28:52.599 --> 00:28:56.480
might be a low evidence, but
the evidence is constant, constantly changing.
450
00:28:56.839 --> 00:28:59.240
Most of the medical stuff that you
do is low evidence, but you still
451
00:28:59.240 --> 00:29:00.640
do it because you're trying to see
what works for that patient. This isn't
452
00:29:00.680 --> 00:29:06.480
an exact science. Two out four
alt five discriminations her needing the exact same
453
00:29:06.519 --> 00:29:08.440
way in two different patients. It's
not going to respond to the exact same
454
00:29:08.519 --> 00:29:11.720
treatment in the exact same way.
This is a trial and error thing.
455
00:29:11.759 --> 00:29:15.359
So I'm gonna try some of the
low evidence stuff, sure, but I'm
456
00:29:15.400 --> 00:29:17.920
going to mix it with the high
eveen and stuff to see what works best
457
00:29:17.960 --> 00:29:19.559
for your patient. And that's what
they want to see. They want.
458
00:29:19.920 --> 00:29:22.519
They don't want the cocky Cairo that's
gonna say, well, I'm gonna do
459
00:29:22.599 --> 00:29:26.519
this and this is this is my
cookie cutter treatment plan. This is what's
460
00:29:26.559 --> 00:29:27.720
going to work, because they're gonna
look at you and think, well,
461
00:29:29.039 --> 00:29:32.799
not everything works in the same for
every patient. So you can implement some
462
00:29:32.839 --> 00:29:34.680
of the low evidence stuff. Yes, manipulation may have low evidence stuff,
463
00:29:34.799 --> 00:29:37.079
but it works for some people,
and I'm not gonna know if it's gonna
464
00:29:37.079 --> 00:29:40.759
work for your patient while they try
it. But I get a lot of
465
00:29:40.880 --> 00:29:44.359
the patients referred to me that I
failed PT for a lot of my new
466
00:29:44.440 --> 00:29:48.240
providers, until they realize that I
can do a PT like we can do
467
00:29:48.400 --> 00:29:51.519
it just as well, if not
better, they failed PT. Can you
468
00:29:51.559 --> 00:29:53.000
figure this out? Okay, Well, the high evidence stuff didn't work,
469
00:29:53.039 --> 00:29:56.440
so let's try low ev and stuff. Maybe that's gonna work. So there's
470
00:29:56.480 --> 00:30:00.759
different ways of dealing with that low
evidence a pro which you just have to
471
00:30:00.440 --> 00:30:04.519
spin it to make sense to them. Absolutely, you've kind of mentioned the
472
00:30:04.799 --> 00:30:10.400
emphasis on really making sure you do
some type of reevaluation with your patients.
473
00:30:11.160 --> 00:30:15.559
Are you utilizing any of like the
yellow flag questionnaires? Do you really emphasize
474
00:30:15.559 --> 00:30:21.240
those outcomes measures? And is that
something that you would also send as part
475
00:30:21.279 --> 00:30:25.960
of that reevaluation report or mainly just
give a general briefing there. So I'm
476
00:30:26.000 --> 00:30:27.759
a big fan of functional outcome assessments. I'm going to give a shout of
477
00:30:27.799 --> 00:30:32.119
Greg to Greg Freedman. I've taken
this class. I consider my friend.
478
00:30:32.319 --> 00:30:36.119
He taught me a lot about documentation. But the functional locome assessments to me,
479
00:30:36.599 --> 00:30:37.960
is the gold standard. I hear
saying, I mean not even do
480
00:30:38.240 --> 00:30:42.720
a formal reevaluation on every patient two
two one three, coding like, I
481
00:30:42.799 --> 00:30:47.319
mean I actually do that. My
reevaluation may just be functional locome assessments.
482
00:30:47.960 --> 00:30:52.119
And then when I communicate with the
providers, with the primary care providers who
483
00:30:52.119 --> 00:30:53.599
are referred to me, I'll put
in there, Hey, you know what
484
00:30:55.319 --> 00:31:00.160
initial visit, our FUNCTIONALCOME assessments had
this rating. We notice a forty five
485
00:31:00.240 --> 00:31:03.839
percent decrease after six visits. That's
language I understand when you can put a
486
00:31:03.920 --> 00:31:06.599
number on it. So for me, a FUNCTIONALCOME assessment is much more important
487
00:31:06.960 --> 00:31:11.240
rather than doing something like range emotion
okay, so on visit one shit twenty
488
00:31:11.319 --> 00:31:15.759
degrees and range emotion inflection. But
now she has thirty five providers gonna be
489
00:31:15.759 --> 00:31:18.039
like, that's fifteen degree. It
doesn't seem like a lot. I mean
490
00:31:18.119 --> 00:31:21.480
that's a lot to us, But
the primary I care that. They're like,
491
00:31:21.759 --> 00:31:23.759
what are you talking about? But
now if we talk about functionally we
492
00:31:23.839 --> 00:31:27.359
know it's a forty five percent improvement
in functional rating, They're like, oh,
493
00:31:27.440 --> 00:31:32.839
that's impressive. Like, so I'm
a huge below and functional functionalcome assessments.
494
00:31:33.000 --> 00:31:37.680
And again I may not even do
an a formal reevaluation depending on how
495
00:31:37.759 --> 00:31:41.079
my flow is going. But you
sure can bet that I'm going to do
496
00:31:41.240 --> 00:31:44.759
my best to get a functional alcome
assessment at visit five, six, seven
497
00:31:44.880 --> 00:31:48.240
from the patient, and then I'm
going to compare it. And I tell
498
00:31:48.319 --> 00:31:51.400
my patients I care about your pain, but I really don't care about your
499
00:31:51.440 --> 00:31:53.079
pain when I really care about your
function, like how are you functioning?
500
00:31:53.319 --> 00:31:56.680
I need to know that when I
first saw you could have been over retire
501
00:31:56.720 --> 00:32:00.200
your shoes, and four days later
you're or four visits later you're bending over
502
00:32:00.240 --> 00:32:02.359
time your shoes, putting your shoes
on. No pain or some pain.
503
00:32:02.759 --> 00:32:07.119
I never let pain dictate. And
I have the conversation with my patients earlier,
504
00:32:07.160 --> 00:32:08.599
like I care about your pain,
that's why you're here, but I
505
00:32:08.680 --> 00:32:12.200
really care about it us your function
new pain scale. So I'll be like,
506
00:32:12.240 --> 00:32:14.440
if visit one year, six out
of ten, but you can't do
507
00:32:14.559 --> 00:32:15.960
anything, but now you're a ten
out of ten or an eight out of
508
00:32:15.960 --> 00:32:19.519
ten. But you know what you
played with your grandson. You were able
509
00:32:19.519 --> 00:32:22.799
to play basketball, pay volleyball,
go for a run. To me,
510
00:32:22.960 --> 00:32:25.240
that's a win and that's the way
I'm going to approach that. So functional
511
00:32:25.279 --> 00:32:28.680
walcome assessments for you me are huge. And then when I relate it to
512
00:32:28.799 --> 00:32:32.359
the provider, I talk function more
than I talk pain. I talk about
513
00:32:32.440 --> 00:32:36.559
we were able to get her back
to working out even though she still has
514
00:32:36.640 --> 00:32:39.200
pain, she's functionally more better.
I implement those, whether it's a forty
515
00:32:39.240 --> 00:32:43.519
five percent pcrease in pain like a
number, or whether it's just discussing the
516
00:32:43.559 --> 00:32:45.960
functional improvements I found. That's really
what I try to balance. But functional
517
00:32:46.000 --> 00:32:52.119
income assessments huge in my practice,
is huge. Or asking about ADL's mentioning
518
00:32:52.359 --> 00:32:55.240
case she can go work out at
the gym without pain or whatever the case
519
00:32:55.400 --> 00:33:00.319
is. So you really want to
mention function, I wouldn't necessarily use those
520
00:33:00.599 --> 00:33:05.559
raw numbers, but I would mention
at thirty percent decrease in overall function or
521
00:33:05.640 --> 00:33:09.319
pain levels or whatever the case is. Awesome. Absolutely, So I'm going
522
00:33:09.400 --> 00:33:14.640
to ask one more question and then
But another question we had was have you
523
00:33:14.720 --> 00:33:21.839
ever encountered a situation where you refer
to a PCP and then they tell them
524
00:33:21.880 --> 00:33:25.240
they shouldn't see you anymore, or
that chiropractic is not something that they should
525
00:33:25.279 --> 00:33:30.640
be utilizing and how do you handle
that both with the patient and with the
526
00:33:30.079 --> 00:33:36.799
provider. Oh boy, okay,
So I don't get that much anymore based
527
00:33:36.920 --> 00:33:39.839
on the referrals I make is within
the hospital that I work and they all
528
00:33:39.920 --> 00:33:44.559
know me. But early in practice
I got that that happens, it happens.
529
00:33:44.920 --> 00:33:46.599
There's two approaches here that I kind
of use on this. So it
530
00:33:46.640 --> 00:33:50.000
all depends on why the provider's joining
it. So I'll always make a phone
531
00:33:50.000 --> 00:33:52.759
called by like, hey, doctor
Smith, I refer to this patient.
532
00:33:52.279 --> 00:33:55.440
I understand you told them not to
refer to me, and I have no
533
00:33:55.519 --> 00:33:59.079
problems with that. I just need
to know your logical in it and you
534
00:33:59.119 --> 00:34:00.599
can spin it with did I miss
something? Was there a red flagon?
535
00:34:00.680 --> 00:34:04.440
And catch on them. Just want
to make sure that what's your reasoning.
536
00:34:04.960 --> 00:34:07.079
There's two ansues you're going to get. It's either going to be like,
537
00:34:07.319 --> 00:34:09.719
well, there's some kind of issue
that I feel like you might exacerbate and
538
00:34:10.159 --> 00:34:14.440
or I think there's an issue if
you manipulate. I don't want to be
539
00:34:14.559 --> 00:34:17.119
high velocity on them. I think
there's there's another issue. Or the response
540
00:34:17.159 --> 00:34:21.039
you're going to get as you're a
quack and I don't believe what you do
541
00:34:21.159 --> 00:34:23.320
why, and that's what it is. Depending on the response. Again,
542
00:34:23.480 --> 00:34:27.400
if it's the quack comment, you're
gonna have to chalk it up as a
543
00:34:27.440 --> 00:34:30.440
loss. There's no there's no trying
to change in their mind, there's no
544
00:34:30.719 --> 00:34:36.239
beating in with information. There's no
reason to get aggravated upset. It's not
545
00:34:36.360 --> 00:34:39.280
worth the battle. You're ninety nine
percent of the time it's gonna be wasting
546
00:34:39.360 --> 00:34:43.280
energy and are going to change.
They have that preconceived notion of what you're
547
00:34:43.280 --> 00:34:45.960
doing is dangerous. You're a quack, you're not a doctor, You're you're
548
00:34:45.079 --> 00:34:49.480
terrible. Whatever they believe is what
they believe. You're not going to change
549
00:34:49.519 --> 00:34:52.320
that with one phone conversation, or
you're not going to change that with any
550
00:34:52.400 --> 00:34:57.039
issue with anything like that. If
the response is I think manipulation is going
551
00:34:57.079 --> 00:34:59.480
to be dangerous to the patient,
I think there's an issue with that.
552
00:35:00.159 --> 00:35:02.320
Your typical approach should be listening.
I respect that approach, and I'm not
553
00:35:02.400 --> 00:35:06.159
saying that's not a concern of mine. But what I do is not just
554
00:35:06.320 --> 00:35:07.880
manipulation. I'm gonna do some therapy. A actually is there's stuff we could
555
00:35:07.880 --> 00:35:12.800
do away from manipulation, like getting
them mentality that because we're Cairos, we
556
00:35:12.840 --> 00:35:15.079
don't just manipulate, like, yes, that's a piece of the puzzle,
557
00:35:15.440 --> 00:35:19.519
but we offer so much more.
So it depends on the response you get.
558
00:35:20.119 --> 00:35:24.480
I've heard stories of It's funny because
I had this conversation actually recently.
559
00:35:24.599 --> 00:35:29.519
Quick story. So I was working
at the hospital. Doctor Purs referred to
560
00:35:29.519 --> 00:35:31.400
me a patient he did abdominal surgery
on. He was in a low back
561
00:35:31.440 --> 00:35:35.440
and playing with ridicular complaints and he
was like, do you wanted to trial
562
00:35:35.480 --> 00:35:37.360
a care before we do an MRI
because he put in from MRI. The
563
00:35:37.400 --> 00:35:40.199
insurance company said, well, we
need failed to conservative care before we do
564
00:35:40.320 --> 00:35:44.480
it. And so I did trial
of care and I know it's ridicular.
565
00:35:44.519 --> 00:35:45.800
I was getting worse. I wasn't
doing anything highve lossuit with him. I
566
00:35:45.920 --> 00:35:50.199
was doing some some soft tissue stuff. I was doing some activator, I
567
00:35:50.280 --> 00:35:52.639
was doing a little acupuncture. He
was getting some relief with ridicular. Was
568
00:35:52.639 --> 00:35:54.360
getting worse. So I keeped it
back to doctor Purse, who's a general
569
00:35:54.400 --> 00:35:57.639
surgeon. Like listening to him,
I go, we need to get imaging.
570
00:35:57.840 --> 00:36:00.559
I go, we need to admit
him because it's getting out of control.
571
00:36:00.599 --> 00:36:01.639
And I don't want him waiting any
longer. So it's like, okay,
572
00:36:01.639 --> 00:36:04.599
we'll go ahead and we meet.
We co admitted him, We admited
573
00:36:04.639 --> 00:36:07.519
him to the hospital. He saw
one of the neurosurgeons who's good friends with
574
00:36:07.599 --> 00:36:13.280
doctor Purse, and he ends up
doing a DISKCT to me and decompression the
575
00:36:13.400 --> 00:36:15.360
very next day because it was getting
bad and the ridicular was getting bad.
576
00:36:15.840 --> 00:36:20.800
And as he's walking out of the
hospital, he stopped in my office to
577
00:36:20.840 --> 00:36:22.639
the hospital, he cames like,
hey, then the surgery. I'm like,
578
00:36:22.679 --> 00:36:24.599
I heard whatever, so I didn't
come visit you during surgery or post
579
00:36:24.599 --> 00:36:28.639
stop. I was a lot crazy, whatever the case is. And he's
580
00:36:28.639 --> 00:36:30.760
like, can I come and see
you. I'm like, well, yeah,
581
00:36:30.000 --> 00:36:32.480
I'm not going to manipulate you.
I'm not gonna anything crazy. I'm
582
00:36:32.519 --> 00:36:35.880
gonna he had I think it was
all four, all five or all five
583
00:36:35.880 --> 00:36:37.559
of us one, and I'm like, I can do some accupunctures, manage
584
00:36:37.559 --> 00:36:39.199
some of the post stop pain.
We can do a little ice. We
585
00:36:39.280 --> 00:36:43.000
knew some interferential We're not gonna do
anything too active, too crazy, too
586
00:36:43.079 --> 00:36:45.039
soon, but we can at least
help postopera. We get the pain.
587
00:36:45.159 --> 00:36:47.199
So we follow up to me a
couple of days later, once he got
588
00:36:47.239 --> 00:36:52.000
settled and whatever. And it's funny
because it was all four all five.
589
00:36:52.119 --> 00:36:57.519
I did activator on him, like
mid thorastic, maybe throackle, lumbar junction
590
00:36:57.639 --> 00:37:00.039
and maybe the side joint. And
then I did act unent for postop pain.
591
00:37:00.199 --> 00:37:02.320
And I did a little passive with
him. I did nothing active with
592
00:37:02.400 --> 00:37:07.480
him. And I get a phone
call from the physician's assistant of the surgeon
593
00:37:07.039 --> 00:37:09.639
and she was like, listen,
I don't know who you think you are
594
00:37:09.800 --> 00:37:12.679
and all this stuff. She goes
off on tangent. I'm like, listen,
595
00:37:12.719 --> 00:37:15.159
I go I'm not doing anything.
I'm doing nothing at the surgical site.
596
00:37:15.159 --> 00:37:19.199
I understand what was done. I'm
I'm not high velocity. I'm not
597
00:37:19.360 --> 00:37:22.440
side passing this personal I'm cranking.
I'm not doing anything stupid. I'm managine
598
00:37:22.519 --> 00:37:28.400
postop pain and I'm manipulating like well
above it and well below it to keep
599
00:37:28.519 --> 00:37:31.320
motion going. And I wasn't phased
by that. I deal with all time.
600
00:37:31.320 --> 00:37:35.000
Well, you're a kind of if
you manipulated said manipulation in your documentation,
601
00:37:35.039 --> 00:37:37.960
I'm like, no, no,
I did low velocity, nowhere near.
602
00:37:37.039 --> 00:37:40.239
And my documentation clearly says that and
it's funny, and I just I'm
603
00:37:40.280 --> 00:37:42.920
like, listen, I go,
the patient can see me. If you
604
00:37:42.960 --> 00:37:45.719
don't want the patient seeing me,
I respect that, no problem, and
605
00:37:45.840 --> 00:37:47.679
I go. But you need to
realize I admitted the patient with doctor purs
606
00:37:47.800 --> 00:37:51.400
Like, we co admitted this.
I know what's going on. We're the
607
00:37:51.480 --> 00:37:53.880
reason the surgery had Like where the
reason the surgery happened? Yes, you
608
00:37:53.920 --> 00:37:58.000
did the surgery. And it was
funny because I got off the phone and
609
00:37:58.039 --> 00:38:00.480
I walked my back office and doctor
Purson's back there, like what's going on?
610
00:38:00.559 --> 00:38:01.400
And I told him, Michael,
I'm not upset with it. I
611
00:38:01.920 --> 00:38:06.559
understand, but I'm kind of offended
that they told the patient about to see
612
00:38:06.639 --> 00:38:12.239
me even though I wasn't actually treating
the surgical area, because I'm not stupid,
613
00:38:12.320 --> 00:38:16.079
Like give me some clinical credit.
He got so aggravated and so mad
614
00:38:16.239 --> 00:38:20.199
he literally left as soon as clinical
was over. He's on this patient.
615
00:38:20.199 --> 00:38:22.039
He actually got a patient office.
He went upstairs the surgical before I found
616
00:38:22.039 --> 00:38:25.719
the surgeon and literally he was a
friend of him for twenty years. Told
617
00:38:25.800 --> 00:38:30.960
him, don't ffort with doctor Francis. He's not stupid. You need to
618
00:38:30.960 --> 00:38:35.280
call him and apologize he was doctor
Purst was more aggravated that that happened than
619
00:38:35.320 --> 00:38:39.119
I was. It's part of what
it is and you have to not see
620
00:38:39.119 --> 00:38:42.199
it, and I took none of
a personally. I didn't tell him to
621
00:38:42.239 --> 00:38:44.599
go give him crap and go yell
at him, but he took it upon
622
00:38:44.679 --> 00:38:46.639
himself to go do it, because
clinically, once they know what you can
623
00:38:46.719 --> 00:38:51.719
do clinically, and that clinical you
show that you can, you're not just
624
00:38:51.840 --> 00:38:55.599
manipulating a dangerous partner. It's funny
because three weeks later guests who referred to
625
00:38:55.599 --> 00:39:01.480
me a patient the neurosurgeon. Okay, so it's not you can't get mad
626
00:39:01.519 --> 00:39:05.039
at it. You can't get aggravated
with it, and you can't take it
627
00:39:05.159 --> 00:39:09.559
personally. It's the stigma of our
profession. But by having understanding what you're
628
00:39:09.559 --> 00:39:14.280
doing is clinically relevant, you're smart
about it, You're you're following guidelines,
629
00:39:14.280 --> 00:39:17.159
you're not doing anything stupid. They'll
have their preconceived notions, but then as
630
00:39:17.239 --> 00:39:22.599
you start doing your job, your
reputation follows you and people will go will
631
00:39:22.639 --> 00:39:24.199
fight for you, and then you
don't have to fight that battle. You
632
00:39:24.599 --> 00:39:29.280
I got great hair and I'm barely
forty you don't need that aggravation in your
633
00:39:29.320 --> 00:39:32.519
life. And you just have to
understand that you have to respect their opinions.
634
00:39:32.559 --> 00:39:36.119
And if their opinion is you're a
quack, can't fight it. You're
635
00:39:36.159 --> 00:39:39.000
not gonna you're not gonna win it
now your reputation. Eventually, they'll hear
636
00:39:39.039 --> 00:39:42.079
of what you're doing and they're gonna
want to work with you. And if
637
00:39:42.119 --> 00:39:44.840
they don't, that's their loss and
their patient's loss. If they want to
638
00:39:44.840 --> 00:39:47.159
prescribe them and do whatever, that's
fine. You have to understand that you
639
00:39:47.280 --> 00:39:52.039
can't be combated, you can't get
angry, you can't get upset with it
640
00:39:52.239 --> 00:39:55.159
and take it personally. It just
it is what it is, and you
641
00:39:55.239 --> 00:39:59.639
will. You may lose patience you
refer but reaching out, being professional,
642
00:39:59.760 --> 00:40:04.320
being calm, understand why they said
it, and if it's something that leaves
643
00:40:04.360 --> 00:40:07.519
the door open for communication, use
that to communicate, use it to be
644
00:40:07.599 --> 00:40:09.840
like, I understand your concerned manipulation
because of X, Y, and Z,
645
00:40:10.360 --> 00:40:14.320
but that's not what's just what we
do. I'm going to provide positional
646
00:40:14.400 --> 00:40:16.719
level services. I'm going to monitor
them, undo therapetic exercise. I'm going
647
00:40:16.800 --> 00:40:21.280
to make sure what we do is
evidence based and safe, and that can
648
00:40:21.320 --> 00:40:22.039
go one of two ways. Either
gonna be like, okay, they can
649
00:40:22.079 --> 00:40:24.679
see you again and nine times out
of tendant that's the approach, and that's
650
00:40:24.719 --> 00:40:28.400
a concern. They'll send the patient
right back. If it's because you're a
651
00:40:28.480 --> 00:40:31.639
quack, you're not winning that battle
that day. So just so just understand
652
00:40:31.679 --> 00:40:36.639
that's what risk you might have to
take. But it surprisingly doesn't happen as
653
00:40:36.719 --> 00:40:38.920
much as you think. When you
ask that as extra question, make that
654
00:40:39.000 --> 00:40:44.760
phone call and try to communicate it
usually usually results pretty quickly without losing the
655
00:40:44.800 --> 00:40:49.199
patient. Absolutely, Thank you so
much. So, I think this has
656
00:40:49.239 --> 00:40:53.039
been a great discussion and I think
there's definitely room for possibly a part two
657
00:40:53.159 --> 00:40:57.159
on in the future because there's so
much to unpack it. There's so much
658
00:40:57.239 --> 00:41:10.639
going on here. Yes, I
mean, be sure to tune in for
659
00:41:10.719 --> 00:41:15.119
episode fifty seven, where we'd kick
off a new training title, Creating an
660
00:41:15.159 --> 00:41:22.719
Effective Prehabilitation Program with doctor Davis McAlister. In this two part presentation, we'll
661
00:41:22.800 --> 00:41:28.039
discuss the evidence based components that every
prehab program should have. We'll dive into
662
00:41:28.079 --> 00:41:32.880
the research surrounding ACL injury as well
as discussed the application of force and movement
663
00:41:34.000 --> 00:41:37.639
as it relates to injury prevention.
You won't want to miss it. Episode
664
00:41:37.719 --> 00:41:42.079
fifty seven drops in two weeks.
Now, before we end today's episode,
665
00:41:42.119 --> 00:41:45.800
I have a quick favor to ask. We're working on some exciting new things
666
00:41:45.840 --> 00:41:50.639
at Factor, and while I can't
yet announce everything, what I can say
667
00:41:50.679 --> 00:41:54.719
for certain is that our team is
continually seeking new and innovative ways that we
668
00:41:54.840 --> 00:42:00.639
can serve our global network of healthcare
providers and students. Working with healthcare providers
669
00:42:00.679 --> 00:42:05.280
across the globe for the past decade, I feel like I have a pretty
670
00:42:05.320 --> 00:42:08.000
good grasp on the biggest needs of
our community, but I never want to
671
00:42:08.039 --> 00:42:13.360
make assumptions and miss the mark.
So in the spirit of making sure we're
672
00:42:13.400 --> 00:42:15.760
heading in the right direction, head
to the show notes and click the link
673
00:42:15.840 --> 00:42:21.320
on our Factor survey. It contains
just five simple questions to help us zero
674
00:42:21.440 --> 00:42:24.559
in on exactly what you need most
from our team. It will take less
675
00:42:24.559 --> 00:42:28.800
than a minute to complete, and
I will be ever so grateful to have
676
00:42:28.960 --> 00:42:31.880
your feedback. Now, it doesn't
matter if you've taken a FACTOR course before
677
00:42:32.119 --> 00:42:36.039
or not. It does ask you
that there in the surveys, so please
678
00:42:36.119 --> 00:42:38.480
be honest and let us know if
you've ever taken any of our live courses,
679
00:42:38.920 --> 00:42:43.960
our online courses, or maybe you're
just an avid listener of the podcast
680
00:42:44.039 --> 00:42:46.519
and still kind of figuring this whole
Factor thing out. As a thank you
681
00:42:46.599 --> 00:42:52.559
gift, I'll send you a cultivated
playlist of our best Factor podcast episodes and
682
00:42:52.719 --> 00:42:57.599
provide some content that's custom tailored to
your submissions. So go to the show
683
00:42:57.679 --> 00:43:00.760
notes to click on the Factor survey
link, or visit our linkin bio on
684
00:43:00.840 --> 00:43:06.199
Instagram. I read each and every
one of the responses personally and am very
685
00:43:06.280 --> 00:43:09.400
excited to hear your feedback. That's
all for today. We'll see you next
686
00:43:09.400 --> 00:43:15.440
time. Hey guys, If you
like what you heard today, I encourage
687
00:43:15.440 --> 00:43:22.519
you to visit our website at Factor
hyphenstore dot com that's spelled fak tr hyphenstore
688
00:43:22.800 --> 00:43:27.360
dot com to find out more information
about all that we have to offer.
689
00:43:27.559 --> 00:43:30.440
We have a variety of online offerings
as well as our hands on Factor Rehab
690
00:43:30.519 --> 00:43:35.320
System course scheduled in cities around the
globe. Be sure to also check out
691
00:43:35.320 --> 00:43:38.920
our event calendar and bookmark any of
these upcoming live webinar dates coming up in
692
00:43:38.960 --> 00:43:42.599
the near future so you can join
us live. And of course, the
693
00:43:42.679 --> 00:43:45.920
biggest compliment we can receive is for
you to help us spread the word to
694
00:43:45.000 --> 00:43:49.880
your friends, colleagues and classmates.
You'll find all the important links, as
695
00:43:49.920 --> 00:43:52.920
well as info about our sponsors in
the show notes, so be sure to
696
00:43:52.039 --> 00:43:52.639
check those out,