In my opinion, there are three rules to follow for being a great doctor while running a business. 1) 90% of the diagnosis comes from the patient’s mouth. 2) Use illustrations, videos, and technology as part of your regular exam (I will talk more about that later). 3) Be a great adjuster. With the third rule, when I say “great,” I do not mean good; I mean excellent.
It is important to refine these skills. However, being an evidence-based doctor is very important. I advise any chiropractor to implement exercise therapy in their practice as well as take adjustment courses, especially for extremities, because I know many chiropractors don’t focus on adjusting the extremities.
Be an Excellent Communicator
Patient adherence is defined as the degree to which patients follow the recommendations of their health professionals, and it is a significant outcome of the process of care. In my professional experience, I have found that nonadherence to prevention and disease management activities, such as medications, appointments, screening, exercise, and diet, averages 25% of patients. For certain medical conditions and settings, patient adherence can be as poor as 50% or less.
One factor related to adherence is the provider-patient relationship (DiMatteo, 2004). Essential elements of the clinician-patient relationship include verbal and nonverbal communication; effective questioning and transmission of information; expressions of empathy and concern; and collaborative and participatory decision-making (Zolnierek & DiMatteo, 2009).
A meta-analysis conducted by Zolnierek and DiMatteo (2009) found a 19% higher risk of nonadherence among patients whose physician communicates poorly compared to patients who have good communication with their physician. If you cannot help patients understand their condition and why they need the treatment plan you recommended, they may not see the value of continuing with visits, which may impact your patient retention rate. It is important to know how patients feel as well as their treatment and quality-of-life goals. Then you can provide the appropriate chiropractic care, exercises that can help, and custom orthotics for postural stabilization. In addition, the entire time you are treating them, show your patient the problems that you find in their spine and how you are addressing them.
Include Custom Orthotics in Your Treatment Plan
In my office, everything starts when my assistant points at our fantastic 3D kiosk. The kiosk assesses the arches of the patient’s feet and aids in the production of some of the best quality custom orthotics I have ever seen.
I will be honest that when I was first introduced to the custom orthotics, I was suspicious about the purpose and improvements the patient would see with them. I wanted to make sure I gave the best recommendation to my patients. One day, a friend convinced me to buy a 3D digital foot scanner kiosk. I got a call inviting me to a workshop to learn more about using digital foot scanning and support resources as effectively as possible for improving patient outcomes by maximizing orthotics usage.
I feel that trip was a turning point in the success of my practice. The 3D kiosk assessment uses nice visuals to help patients understand exactly what is going on with their bodies and how their foot alignment affects other areas like the spine and lower back. Furthermore, it helps them understand the value of treatment, helps them support their feet (one of the commonly ignored parts of the body), and helps patients with their pain (foot, back, neck, shoulder, hip, etc.). Not to mention it helped my practice grow by delivering optimal treatment outcomes by helping patients understand the foot-spine connection.
Now I know what you are thinking — how do custom orthotics help with shoulder pain? Putting it in general terms, if your feet are stable, it will affect your entire body, not solely your feet, knees, and hips. As a portion of my examination, I have patients stand in front of the custom orthotics and raise their arm straight in front of them to assess their shoulder strength. Most patients drop their arms and sometimes experience shoulder pain when I press down on their arm. Once they step directly on top of the sample proprioceptive custom orthotics, something magical happens. Their arm gets stronger, and their shoulder pain dissipates. You must see it to believe it. On many occasions, I have tried manual muscle testing (MMT) when I close my eyes and have the patient decide whether to stand on the custom orthotics or not. I can 100% correctly determine if they were standing on the orthotics.
...“you need to do what it takes to be different, to be the best, and to be technologically advanced.”...
Now, let’s talk about the variety of orthotics out there. The reason I love custom orthotics with three-arch support is that they have exceptionally great products for a variety of situations, whether you are a runner, golfer, powerlifter, boxer, work in areas of high moisture, wear dress shoes, like high heels, etc.
In my opinion, three factors separate them from other orthotics: quality of the material, customized support for each of the three arches that form the plantar vault, and they are backed by scientific research.
Go ahead and ask yourself this question: Outside of your hands, what equipment do you currently have that can give you clinically proven measurements, decrease pain, give your patients the best treatment results, increase your retention rate, and grow your practice? Add a modern 3D foot scanner to your office.
Today, if you want to survive as a successful chiropractor, you need to do what it takes to be different, to be the best, and to be technologically advanced. As I said, if patients do not understand, see, and feel their improvements, then they likely will not continue with their care or refer other patients. In my office, all I use is a chiropractic table and the 3D kiosk. Now I see 600 patients a week, with 90% of my patients purchasing and using their custom orthotics as part of ongoing chiropractic treatment.
Dr. Reza Eftekhar is a graduate of the Virginia Military Institute and the University of Bridgeport's Doctor of Chiropractic Program. He is the president and clinical director of the Metropolitan Headache and Spine Center, with offices located in Alexandria, Virginia, and Washington, DC. In addition, Dr. Eftekhar is an adjunct assistant professor of clinical research and leadership for the George Washington University School of Medicine and Health Sciences and serves as chiropractor for the George Washington University Men's Basketball Team. He previously served on the clinical faculty of the University of Maryland School of Medicine. He can be reached at [email protected].
For references please see page 46.
Strategies for Greater Patient and Practice Success References
1. DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004;42:200-209.
2. Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826-834. doi: 10.1097MLR.0b013e31819a5acc
