The Future Adjustment Podcast Episode 5: Evidence-Based Chiropractic

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Podcast Transcription

Daniel: Welcome to the Future Adjustment, Chiropractic Economics podcast series on what’s new and notable in the world of chiropractic. I’m Daniel Sosnoski, editor-in-chief of Chiropractic Economics. And our guest today is Jeffrey Langmaid, DC, who’s the founder of The Evidence Based Chiropractor, a leader in chiropractic communication and research and he’s the author of, Marketing Chiropractic Medical Doctors. He’s also a chiropractor with the Laser Science Institute, based in Tampa, Florida. And he’s here today to talk with us about marketing strategies, referrals, and interdisciplinary collaboration. Dr, Langmaid, you’ve written quite a bit for Chiropractic Economics. And I’ve always enjoyed reading your articles. And to start today, I’d like to ask you about your website, The Evidence Based Chiropractor. What led you to develop this resource for doctors of chiropractic?

Jeffrey: Yeah, thank you. I’m happy to tell you a little bit about it. And I’ll just thank you for having me as a guest. I’ve read Chiropractic Economics since I was in chiropractic school, and maybe even saw it before. And it’s something that I feel it’s a privilege just to have the opportunity to contribute and to talk shop, as far as marketing and research today, is what I’m all about. So, thank you.

Daniel: Hey, you’re welcome.

Jeffrey: And really, The Evidence Based Chiropractor, it really touches on those two items. I always view it as where marketing and research meet. So The Evidence Based Chiropractor is really focused on highlighting chiropractor adjustment, and giving chiropractors, kind of, tools and resources that they can use to better their practice. And the focus of that has typically been, as you kind of eluded to, it’s typically been on, interacting with other healthcare professionals. So, kind of, what we shortly could refer to as MD referrals. But it’s not just about medical doctors, it’s all about all other medical professionals. And really, my goal again is to take that research, put it into an actionable and digestible format, mix it in with a little bit of marketing, and make it a message that chiropractors can be proud to talk about. And a message that will resonate not only with chiropractors reading it, but more importantly, with other healthcare professionals in their communities. So like I started to bridge that gap, and really build their practices.

Daniel: Yeah, I think that’s really needed. It’s just a fact of life that there’s a lot of misinformation, and a lot of myths about marketing and referrals in general. I see it here at the magazine all the time. People think that’s it better to have an ad on the right side of the page or the left side. And there has to be evidence and science behind the science of marketing. And I commend you for, kind of, taking the lead, and bringing some proven knowledge, and know how to clarify what actually works and what’s demonstrably proven.

Jeffrey: Well, thank you. Yeah, I think it’s like, you know, and you bring up a good point really with, you know, moving left to right like all the nuance of marketing is really and it can be important in the top end, right? I mean, when you’re trying to like get that cutting edge, that bleeding edge, and get that extra conversion of .01%, or .1%, those details matter, big time. But for many of us, I can speak for myself, you know, as a chiropractor. You know, it’s like, many of us, and many of the docs out there, are really starting from a point of the ground floor. So that little nuance is like, they just gotta get going, and really have some skills and some tools where it’s not just the latest fad, or it’s not just the….you brought out again, you said the words that I use all the time it’s like, myth and conjecture. Well no, let’s bring it back to reality. Let’s bring it back to whats going on outside of chiropractic, learn from there. And then, the best thing of chiropractic is, you know, we have a product that is unparallel in terms of safety, in terms of afflicacy, in terms of lives impacted. But the onus is on us, to make sure that we’re spreading that message in the best way possible.

Daniel: Yes. Very much so, indeed. You are known as an expert in the area of gaining MD referrals. And we’ll just look at them for the moment, all though, I think we can widen that to be referrals from other types of medical professions. But what are some proven ways for a DC to get on an MD’s radar, and establish a referral relationship?

Jeffrey: There’s three key items that it really really breaks down to. There’s three as I call ’em, pillars of the stool, or legs of the stool when we’re talking about referrals from other healthcare providers. One of those legs is, specifically referring to MDs and primary care physicians is sending case notes. So, you know, there’s some studies done awhile back where, you know, MD to MD let’s say, a primary care doctor sends a patient to an orthopedist. That primary care doctor received back case notes on that patient 89% of the time, or something similar to that. But when that referral was made to a chiropractor, the case notes were sent like 9% of the time [inaudible 00:05:16] between the two was staggering.

And, I would argue, well, I wouldn’t argue, I would say, regardless of whether that patient is referred or walks in, the sending of a case notes on evaluation, reevaluations, and discharge from active care is absolutely imperative, and it’s one leg of the stool that literally takes no additional cost outlay, very little additional effort. And it’s something as a profession we should be doing already. Now, case notes by themselves is one leg of the stool. They don’t result in an avalanche of referrals. But, it is a piece of the puzzle because it’s show casing the social proof that people are coming into your practice, it’s show casing the social proof as the patient goes from eval to reevaluation. That patient’s getting well in your practice, and it also starts to emphasize some comradery as far as the co-management aspect, that really has little to do, it’s a good marketing tool, but it has little to do with sizzle, that’s steak. I mean, that is really where patients meet the road with the patient.

So case notes are something, you know, I always talk about keeping them brief. You know, date of service, patient name, diagnosis, and treatment plan don’t get crazy and send a ten-page note, that kind of defeats the purpose. But keep it simple, keep ’em efficient, and send them at those three intervals. Meaning, evaluation, reevaluation, and discharge. That’s a huge, huge step in the right direction. The other two legs of that stool that I’ll touch on, and that we can dive in if you’d like, is meeting up with those doctors of established MD meetings, as I would call them. So that’s really establishing that rapport, one-on-one finding your value add for them, is very systematic. You don’t have to be charismatic to do it, but, it’s an imperative, kind of I say it’s stepping on the accelerator, or gasoline on the fire when you can talk face to face.

And then the third leg of that is, sending month research updates, which really cements, plants your flag, as the local leader who is giving information, and providing value for those physicians. And as you can probably already start to see, when you have a meeting, when they see case notes, and when they’re getting updates with research, now, you’re starting to create that real, nice territory, that makes your office stand head and shoulders above maybe, some other offices in town.

Daniel: Absolutely. We’ve in Chiropractic Economics, we’ve long exhorted our readers to get into regular communications with MDs if patient is being co-managed by one. When you start the flow of the two way back and forth exchange of case notes and information, the MD is far, many, many, many times more likely to see the DC as a fellow medical professional. And as you said, when only a small percentage of DCs do that, it starts to raise concerns on the MDs part. You know, what’s going on with my patient? Is the chiropractor trying to take them off their medications? You know, about all of those problems.

Jeffrey: Yeah. Could not agree more. I think it’s really, it’s an imperative way. I mean, it’s kind of where the challenge, you know, the challenge is the opportunity. Meaning, I would love it if 99% of chiropractors were sending case notes already. You know, that would be wonderful. But the bottom line is they just aren’t. So when you start doing those little things, even though they might sound simple, and when you start doing those little things, it doesn’t take much. I guess, really, you know, the inspiring message of it, is that to a certain extent, it doesn’t take much to really do, do more. And it doesn’t take much to really start to facilitate that.

And I think a lot of times chiropractors have a little bit of fear. They might have, maybe, had a, you know, they’ve heard a story, or maybe them themselves. They had an interaction that wasn’t all, you know, rose petals, so to speak, and they’re like, you know, not cower in the corner. But they kind of say, “Hey, I’m gonna do my thing, and you can do your things, and we’ll leave it at that.” And I just think, as with anything, it’s a process. Also, having systems, having tools really helps that process along as far as efficiency is concerned. But it never hurts. And it’s always right to keep the patient at the middle of that. And case notes are just a wonderful way to do so.

Daniel: Yeah, I couldn’t agree more. And one technique I have seen work really well in practice in the medical community is a Lunch and Learns. You find a local medical practice that you think might be a, it could be say, orthopedic practice. And you call up the office manager and say, “Hey, I would like to introduce myself to your staff, and I’d like to bring sandwiches. Do you guys like Panera, or do you like Subway sandwiches?” And you take the order for the office, you bring in a basket of snacks. And over their lunch break, you basically introduce yourself. You show them what you do, how you do it, demystify what goes on in your clinic, and you bring in a stack of contact sheet of paper that has your picture, your name, and a list of the things that you treat. And you can leave those with the receptionist, or the doctor’s scheduler. And the next time that they need to refer out for conservative, or manipulation therapy, bingo, you are gonna be top of mind. And you’re gonna be somebody that they think of very favorably. This basic know how. But more docs need to do it if they wanna get that referral machine rolling.

Jeffrey: Yeah. Yeah, those MD meetings are absolutely crucial, to really accelerating that process. I agree. And it is about demystifying, it’s reducing barriers, reducing friction to those referrals, learning about their office, and certainly, educating about your office. I could not agree more. And I’ll kind of add one thing onto the back end of that I found very successful and also, my members found exceptionally successful during that meeting, is really, three questions that we always, always make sure we ask of their office, or of their provider. Which is really, do you take care of, and I’m gonna paraphrase them. But, do you take care of spine complaints? What you seeing more of, and what’s your current treatment protocol? And really, those three questions are using the Socratic method to draw information out of them, so you can find out who makes the most, like how do you fit in with their practice? How can you be the best resource for them?

If they, you know, they might have a brother-in-law that has a different last name, that might be an orthopedist. That’s why I always ask first. Do you currently take care of spine complaints? Because you don’t wanna certainly waste your time at Infantum if they may be, you know, again, have a brother or sister with a different last name that you didn’t know about, that they’re directly referring out to. And then the second component, what are you seeing more of? That’s just asking them to paint the picture. So I live here in Tampa Florida. And, you know, we see, you know, snow birds come down and they start swinging the golf clubs and all the disc injuries, and the low back happens at the same time of year, every year, with the same population. So get them to paint that picture.

But the third one is really the clutch and the clincher because when you ask them, what’s your current treatment of protocol? You know that 99% of the time their probably gonna say, physical therapy, medication, or referral to another MD. Thankfully, as a chiropractors, we have distant advantages to their office, over all three of those, but, you have to ask the question to learn what they are doing before you start positioning how you can help them best. That’s what we found to be absolutely clutch during that meeting. But you hit the nail on the head. You gotta get out there and, kind of, shake some hands, and kiss some babies to a certain extent. And make sure people, that they know you’re around, and what you are about.

Daniel: Right, and that brings us to the third leg of the stool. You know, it seems like chiropractic really got a leg up when the American College of Physicians released their new guidelines for low back pain treatment this year. And I know a lot of people have been really pushing that position paper around because they’re saying, ”Look, even the MDs are saying, you know, don’t start with opioids or surgery. Start with spinal manipulative, as a DC can provide. And do that first. And give it a month before escalating to more extreme measures.” And is there any other research that you found to be particularly compelling, or useful when you’re trying to get the word out?

Jeffrey: Yeah, there’s a couple things. I mean, I think we really focus on the rule of three’s here. We really, focus on safety, efficacy, and cost effectiveness. Efficacy and safety, more than the others. But to touch on what you brought up, which I think is really a ground breaking, paper, so to speak in terms of the intricacy of the papers that have come out by the American College of Physicians, the American Pain Society I believe as most recently the FDA themselves have come out and said, “Not only should patients and providers explore conservative measures such as chiropractic care.” By name, they’re saying now, chiropractic care, before opioids. But they’ve actually now peeled it back to say that, “Chiropractic care should be explored before end sets, and even before any medication script is wrote.” And that’s really, you know, that’s really staggering if you think about where we have been, specifically, let’s say in the last ten years, or so in terms of that.

So as far as the research is concerned, I think the position papers are wonderful because there’s so many other organizations that we would think of as, you know, competitors or perhaps worthy anticipates of, that are stepping up to the plate and calling us out by name as a healthcare profession and providers that they’re patients and members should be exploring and learning about, I think says a lot. And the second component of that is as far as the efficacy and other papers are concerned. The breadth and depth of chiropractic research has just never been better. I mean, you can open up European spine journals. Spinal journal course contained DT, and there is just…there is everything from chiropractic being added to standard medical care, and seeing results that are unbelievably, staggering in terms of the patient getting well, all the way up to, I saw an article that was in Spine, just a couple years back, that chiropractic care for an MRI confirmed, disc herniation, the patients a couple years post we’re doing just as well with chiropractic then if they had a surgical microdiscectomy.

So I mean, it’s the research out there, it’s absolutely, it’s wild in the best way possible. And I think as chiropractors, it’s what I encourage, you know, anybody to keep up-to-date themselves. Or, certainly, you know, check out the organized based chiropractor is I speak all around the country. And often I’ll ask chiropractors, I’ll be presenting the top chiropractic research. And often I’ll ask chiropractor, “How many people in this room have heard of this study?” There might be 300 chiropractors in the room. And I might see three hands go up.That’s not an indictment of the chiropractors. But what I tell them is, “If you guys don’t know about it, how do we expect the PCPs, the orthopedist, and the public to know about it?” So,you know, it’s gotta start with us. But, I think a lot of chiropractors are, kind of getting hip to it. Getting excited about it, and really seeing more and more of it kind of builds that momentum. So I’m excited about the future for sure.

Daniel: For sure. Hey, any of our readers if they would like to follow up with you, or look at any of the resources at your site, The Evidence Based Chiropractor, where do they go online to find you?

Jeffrey: It’s hard not to find me right now. So yeah. Anything with The Evidence Based Chiropractor, theevidencebasedchiropractor.com is the easiest way to check it all out. You can also go to, drjefflangmaid, or just Jeff Langmaid and that will give you to any of my avenues. I’m big right now on Instagram and on YouTube. So those are at, you know, Instagram, Facebook, and YouTube all at The Evidence Based Chiropractor. So there are plenty of ways to connect with me. I encourage anybody that wants to, just check out what we’re doing. Check out our ecosystem. I’m always available Jeff@theevidencebasedchiropractor.com. I love interacting. I’m super active on the Facebook page. So I just would encourage any provider, any chiropractor out there that’s listening, that thinks they’d like to learn more or feel like they resonate with the message. Just check out what we’re doing. There’s tons of free tools, tons of free resources. We’re putting stuff out all the time so that chiropractors have the information, have the knowledge to be able to share what we do with others.

Daniel: Okay. Well, I always love working with you. And I’ll get you back in the magazine soon, so our readers can look at your ideas in more detail. I’d like to thank you so much for spending some time with us today, Dr. Langmaid. This has been extremely informative. And you’ve given us, an evidence based look at the future adjustment. I’m Daniel Sosnoski, and we’ll see you next time. Bye everybody.

The post The Future Adjustment Podcast Episode 5: Evidence-Based Chiropractic appeared first on Chiropractic Economics.

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